52.02 Application filing4

(a) The application. A single, streamlined application will be used to determine eligibility and to collect information necessary for: Enrollment in a QHP; APTC; CSR; Vermont Premium Reduction; 1 42 CFR § 435.909. 2 42 CFR § 435.907; 45 CFR §§ 155.310(a) and 155.405. 3 42 CFR § 435.906; 45 CFR § 155.310(c). 4 42 CFR § 435.907; 45 CFR § 155.405. Eligibility-and-Enrollment Procedures Part 7 – Page 2 (Sec.52.00, Sub.52.02) Vermont Cost Sharing Reduction; and MAGI-based Medicaid. For Medicaid categories that are not based on MAGI methodologies, the single, streamlined application may be supplemented with a form (or forms) to collect additional information, or an appropriate, alternative application may be used. (b) Filing the application. AHS will: Accept the application from an application filer; and Provide the tools to file an application: (i) Via an internet website; (ii) By telephone through a call center; (iii) By mail; (iv) Through other commonly available electronic means; and (v) In person. (c) Assistance.5 AHS will provide assistance to any individual seeking help with the application or renewal process, in the manner prescribed in § 5.01. (d) Application filers. An application will be accepted from: The applicant; An adult who is in the applicant’s household; An authorized representative; or If the applicant is a minor or incapacitated, someone acting responsibly for the applicant. (e) Missing information6 The applicant’s eligibility for health benefits will not be determined before the applicant provides answers to all required questions on the application. If an incomplete application is received, the applicant will be sent a request for answers to all of the unanswered questions necessary to determine eligibility. The request will include a response due date, 5 42 CFR § 435.908. 6 45 CFR § 155.310(k). Eligibility-and-Enrollment Procedures Part 7 – Page 3 (Sec.53.00, Sub.0) which will be no earlier than 15 days after the date the request is sent to the applicant. If a full response to the request is received on or before the request due date, the eligibility process will be activated for determining: (i) Coverage, based on the date the application was originally received; or (ii) The need to request any corroborative information necessary to determine eligibility. If responses to all unanswered questions necessary for determining eligibility are not received by the response due date, the applicant will be notified that AHS is unable to determine their eligibility for health benefits. The date that the incomplete application was received will not be used in any subsequent eligibility determinations. (f) Limits on information.7 An applicant will be required to provide only the information necessary to make an eligibility determination or for a purpose directly connected to the administration of health-benefits programs. (g) Information collection from non-applicants.8 Information regarding citizenship, status as a national, or immigration status will not be requested for an individual who is not seeking health benefits for themselves. (h) Signature required. An initial application must be signed under penalty of perjury. Electronic, including telephonically-recorded, signatures and handwritten signatures transmitted via any other electronic transmission will be accepted. (i) Accessibility. Any application or supplemental form must be accessible to individuals who are limited English proficient and individuals who have disabilities, consistent with the provisions of § 5.01. Attestation and verification – in general (01/01/2026, GCR 25-055) Basis and scope. The income and eligibility verification requirements set forth in §§ 53.00 through 56.00 are based on §§ 1137, 1902(a)(4), 1902(a)(19), 1902(a)(46)(B), 1902(ee), 1903(r)(3), 1903(x), 1940, and 1943(b)(3) of the Social Security Act, and § 1413 of the ACA. (b) In general. AHS will verify or obtain information as provided in §§ 53.00 through 56.00 before making a determination about an individual’s eligibility for health benefits. Such information will be used in making the eligibility determination. See § 58.00 for details on the eligibility determination process. (c) Attestation.9 Except where the law requires other procedures (such as for citizenship and immigration-status information), attestation of information needed to determine the eligibility of an individual for health benefits will be accepted (either self-attestation by the individual or attestation by an adult who is in the individual’s 7 42 CFR § 435.907(e). 8 45 CFR § 155.310(a)(2). 9 42 CFR § 435.945(a). Eligibility-and-Enrollment Procedures Part 7 – Page 4 (Sec.53.00, Sub.0) household, an authorized representative, or, if the individual is under age 1810 or incapacitated, someone acting responsibly for the individual) without requiring further information (including documentation) from the individual. (d) Use of federal electronic verification service.11 To the extent that information related to determining eligibility for health benefits is available through an electronic service established by HHS, AHS will obtain the information through such service, unless AHS has secured HHS approval of alternative procedures described in (e) below.12 (e) Flexibility in information collection and verification. Subject to approval by HHS, AHS may request and use information from a source or sources alternative to those listed in § 56.01(b), or through a mechanism other than the electronic service described in (d) above, provided that such alternative source or mechanism will reduce the administrative costs and burdens on individuals and the state while maximizing accuracy, minimizing delay, and meeting applicable requirements relating to confidentiality, disclosure, maintenance, or use of information. (f) Notice of intent to obtain and use information.13 Before it requests information for an individual from another agency or program, AHS will inform the individual that it will obtain and use information available to it to verify income, resources (when applicable), and eligibility or for other purposes directly connected to the administration of a health-benefits program or to enrollment in a QHP. (g) Security of electronic information exchanges.14 Information exchanged electronically between AHS and any other agency or program will be sent and received via secure electronic interfaces, as specified in § 4.09. Any such exchange of data will be made pursuant to written agreements with such other agencies or programs, which will provide for appropriate safeguards limiting the use and disclosure of information as required by federal or state law or regulations. (h) Limitation on scope of information requests An individual will not be required to provide information beyond the minimum necessary to support eligibility and enrollment processes. An individual will not be required to provide additional information or documentation unless information 10 In its response to comments on its proposed rule, CMS indicated that “[s]tate law and regulation establish who may file an application for an insurance affordability program on behalf of a child under age 21, and nothing in the Affordable Care Act or these regulations alters State authority or flexibility on this matter.” 77 FR 17,156 (March 23, 2012). In Vermont, the age of majority is 18. 1 VSA § 173. 11 42 CFR § 435.949(b). 12 42 CFR § 435.945(k); 45 CFR § 155.315(h). 13 42 CFR § 435.945(f). 14 42 CFR § 435.945(i). Eligibility-and-Enrollment Procedures Part 7 – Page 5 (Sec.54.00, Sub.54.01) needed by AHS cannot be obtained electronically or the information obtained electronically is not reasonably compatible, as that term is defined in § 57.00(a), with information provided by or on behalf of the individual. (i) Limitation on use of evidence of immigration status. Evidence of immigration status may not be used to determine that an individual is not a Vermont resident. (j) Verification plans. For purposes of Medicaid eligibility, AHS has developed, and maintains, verification plans describing the verification policies and procedures it has adopted to implement the provisions set forth herein. Attestation and verification of citizenship and immigration status (01/01/2026, GCR 25-055)