Effective Date: March 1, 2022

Previous Policy

1. To apply for CHIP, individuals must complete, sign, and date a medical application or the Single Streamlined Application used to apply for all Insurance Affordability programs. Applicants have several options to complete and file an application (701).

· Paper application : A paper application must be completed, signed, dated and filed at a DWS local office, the Federally Facilitated Marketplace (FFM), or an outreach location by delivering it in person, mailing it, or faxing it.

· Telephone applications : Applicants may ask to apply by telephone. When applying by phone, the agency will take the eligibility information over the phone. The applicant will have the option to complete the application over the phone in one of two ways:

o Telephonic signature: The telephonic signature will be documented and stored by the agency. A confirmation receipt documenting the telephonic application will be sent to the applicant via the communication method they have selected, or

o A copy of the completed telephonic application form can be mailed to the applicant. The applicant must sign and return the signature page in person, by mail or fax no later than the last day of the application processing period.

· Online Applications : Applicants may complete an online application through the state agency or complete the Single Streamlined Application through the FFM. When applying online, applicants may complete the online signature. The agency accepts an online signature as a legal signature of the individual applying for CHIP. The applicant can print a copy of the application, the rights and responsibilities, and other important information provided for their own records.

· FFM Account Transfers : Individuals assessed eligible for Medicaid or CHIP by the FFM will have their account transferred to the state agency for a final determination.

· Review Form : If an individual or household is currently open for public assistance, a review form may be used as an application for another type of assistance, or for a new household member. The individual must indicate on the form what type of assistance is being requested, who the household wants to cover, and the date of the request. The review form with the request must be received:

o Electronically online;

o In Person, at a DWS employment center;

o Over the phone with a telephonic signature that will be documented and stored by the agency;

o By Mail; or

o By Fax

If the individual has not previously signed a medical assistance application and completed appropriate assignment of rights and third-party liability information, the agency will send this information to the applicant to complete, sign and return. If the review closed for failure to complete the review process, the review form can be used to re-apply if received by the eligibility agency within 90 days after the closure. See section 704 .

· Verbal Request : An applicant who has a pending application for other types of assistance may make a verbal request to add CHIP to the application.

a. The applicant must make the verbal request while the application for other assistance is still pending and within 30 days of the application date of the pending application. If the 30 th day is a non-business day, the applicant has until the first business day following the 30 th day to make the verbal request. The date the applicant makes the request to add CHIP is the date of application for medical assistance.

b. If the agency has approved or denied the application for other assistance, or if it is more than 30 days after the application date, the applicant must submit a new application.

2. An unsigned application is not complete and the agency cannot determine eligibility until it receives the signature. The applicant must physically, electronically or telephonically sign no later than the last day of the application processing period or the agency will deny the application. (See section 701 -1 on filing an application and section 701-2 on how the agency sets the application date.)

3. If an application is not complete, the agency will contact the applicant and offer ways for the applicant to complete the application. The application must be completed by the end of the application processing period, or the application will be denied.