Page 13

UPDATED: JUNE 2010

468

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

NOTE: If the applicant’s representative signs the application, the LDSS must obtain a separate authorization from the applicant or a copy of legal guardianship. The applicant can identify the role of this person to: apply for and/or renew Medicaid, discuss his/her Medicaid application or case, and/or get copies of notices and agency correspondence. This authorization continues until it is revoked by the recipient; a reauthorization is not required at renewal. However, if the applicant is incompetent or incapacitated, a copy of the legal guardianship papers is not required, nor is a separate document authorizing the representative. In these situations, the LDSS is authorized to discuss the application/case and send notices and related correspondence to the responsible individual in addition to the applicant.

The date of application is the date that a signed “State-prescribed” application form, or a State-approved equivalent form or process is received by the LDSS. The application date for individuals who apply at outreach sites or facilitated enrollers is the date on which the application is started. For children under age 19 and pregnant women applying through the presumptive eligibility process, the application date is the date of the screening.

NOTE: An application is considered to be filed with the LDSS when an applicant submits a signed and dated application that includes his/her name and address. The LDSS may need more information to make a Medicaid eligibility determination, but the application date is protected.

A district cannot refuse an individual the right to apply. The applicant may be accompanied and assisted in the application process, if s/he wishes, by a person of his/her choice. The applicant may receive application assistance by an LDSS staff member, an FE, or designated staff at outreach sites such as family planning providers, providers who determine presumptive eligibility and hospitals with out-stationed workers. If requested, application assistance must be provided by the LDSS in person either as a walk-in or by appointment, over the telephone or in writing. Local departments of social services must work with the applicant or his/her representative to obtain any information missing from the application, including necessary documentation.

(See OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL FACILITATED ENROLLERS)

Effective April 1, 2010, an in-person application interview with the applicant or his/her representative must not be required. Applicants for presumptive eligibility (PE) and family planning benefit program (FPBP) must be screened in person when they present at a facility for covered services by a PE provider. (MRG)