109.03 Processing a Filed Application (AAM)

109.03 Processing a Filed Application (AAM)

SR 15-10 Dated 02/15 Previous Policy

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The time frames for processing the application begins on the date the completed DFA Form 800, Application for Assistance , is received, or “filed,” in the District Office. Once DFA Form 800 is filed, schedule all applicants potentially eligible for DFA programs and services for an initial eligibility interview.

Exceptions:

• Applicants using DFA Form 800Q, Assisted Application For Help With Medicare Costs Through the Medicare Savings Program , or applicants using DFA Form 800, Application for Assistance , in which the only program of assistance requested is QMB, SLMB, or SLMB135, do not require an interview.

• The date New HEIGHTS actually receives the LIS application data from the SSA is considered to be the begin date for processing the QMB, SLMB/SLMB135, or QDWI application.

Prior to the initial interview, review DFA Form 800 to determine if potential eligibility exists for the requested programs.

If the Applicant Is Ineligible for All Programs of Assistance Requested

If the applicant is ineligible for all programs of assistance requested, discuss the reason(s) why the individual is ineligible for assistance prior to the initiation of Application Entry (AE) in New HEIGHTS . Explain to the individual that they have a right to a full eligibility interview if they request one. If the individual does not want a full interactive interview:

• refer the individual to a community, state, or federal agency that may be able to assist them;

• deny the application by choosing the status “Denied” and the most appropriate denial code on the “Conclude Interview” screen in Client Registration (CR). Only choose “Withdrawn” as a status if both of the following criteria are met:

- no reason for the client’s withdrawal is known by the FSS or the reason the individual wants to withdraw their application is known, but no denial code adequately represents the person’s withdrawal reason; and

- if the individual chooses to withdraw their application after being notified that all rights to an administrative appeal are forfeited in the withdrawal process. In the rare instance when both these criteria exist, the client must sign the withdrawal section of DFA Form 800 and indicate the specific programs that are being withdrawn, and it must be explained to the individual that the individual can reapply at any time;

• add case comments to indicate why the applicant is not eligible; and

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• add a row to the “DO Traffic” screen in CR and select the value “Apply – CR Denial.”

Potential Eligibility Exists

If potential eligibility exits, begin the eligibility interview by initiating Application Entry (AE) in New HEIGHTS.

While in the interview, complete the necessary New HEIGHTS screens to determine eligibility for the programs requested by the applicant on DFA Form 800. *

At the completion of the interview:

• generate the Form 811H, Eligibility Interview Summary (EIS), which summarizes the information provided during the application process;

• review the Your Rights and Responsibilities pages of the EIS;

• review EACH statement on the EIS Statements of Understanding page;

• have the client initial and sign in appropriate spaces on the EIS Statements of Understanding page;

• sign and date in the spaces provided once the client has signed;

• scan the EIS;

• provide the applicant with a copy of the signed EIS; and

*

• if the applicant:

- has internet access, provide the applicant with DFA Form 800W, Website Forms , which directs the applicant to the DHHS website to review the information associated with the programs of assistance for which the household is applying ; or

- does not have internet access or refuses to sign DFA Form 800W, provide the required program-specific paper forms listed on Form 800W to the client for review.

Prior to ending the interview, review the following with the applicant:

• providing verifications. Review all of the verifications that need to be provided to the District Office. Emphasize that the verifications need to be provided as soon as possible so that a decision about eligibility can be made;

• reporting changes. Discuss DFA Form 215, Reporting Requirements Handout . Explain the types of changes the client needs to report and when, as well as the importance of reporting these changes to the District Office in a timely manner;

• who determines eligibility. If the client is applying for APTD, ANB, MEAD, CFI, HCBC, HC-CSD or Nursing Home Care, explain that DFA determines eligibility based on financial and non-financial criteria, but another division will determine eligibility based on an independent medical decision; and

• the client ’ s right to appeal a decision. Explain to the client that if the client does not agree with DFA ’ s decision, then he or she has the option to file an appeal with the Administrative Appeals Unit or through the District Office. Notify them that clients have a right to bring someone with them to the appeal, like a friend, relative, or lawyer, or they can come alone. DHHS will not pay for any legal services the individual wants, but there is free and reduced cost legal services available in NH.

References : He-W 601.01(n) & (p), He-W 601.03(a), He-W 602.03, RSA 167:8,I