10.09.24.04-1

.04-1 Specific Application Requirements for MAGI Exempt Coverage Groups.

A. All of the requirements of Regulation .04 of this chapter shall apply with the exceptions stated in this chapter.

B. Application Filing and Signature Requirements.

(1) An individual who wishes to apply for Medical Assistance shall submit a signed application to the Department or its designee in the jurisdiction where his residence is located.

(2) A deemed newborn is eligible for receiving Medical Assistance if at the time of birth the childís mother was covered in another state as a child under CHIP or under a 1115 waiver.

(3) An individual who has filed an application may voluntarily withdraw that application; but the withdrawal may not affect the requirements for the penalty period associated with the transfer of a resource specified under Regulation .08I of this chapter.

C. Period Under Consideration. Current eligibility shall have a period of consideration of a 6-month period beginning with the month of application for Medical Assistance, except as specified in Regulation .04H(3) of this chapter.

D. Processing Applications. When a written or electronic application is filed, a decision shall be made promptly but not later than:

(1) 45 days from the date of application in the case of determination of aged and blind individuals; or

(2) 60 days from the date of application in the case of determination of disability.

E. Extension of Time Standards.

(1) The time standards specified in Regulation .04I(1) of this chapter shall be extended to allow the applicant sufficient time to complete provision of information when the examining physician delays or fails to take a required action.

(2) Reactivation of an Application Following a Decision of Ineligibility for Reasons Other than Nonfinancial Factors, Excess Resources, or Excess Income.

(a) A request for current eligibility following the rejection of an application for reasons other than nonfinancial factors, excess resources, or excess income shall be considered a reactivation of the appropriate earlier application.

(b) The reactivation period shall:

(i) Apply to the earliest rejected application for which the period under consideration has not expired; and

(ii) Include the retroactive period associated with the current period.

(c) The applicant may establish eligibility for the current period, the retroactive period, or both, at any time during the reactivation period.

(3) Disposition of Application Following a Decision of Ineligibility. If an applicant is determined ineligible for the current period under consideration due to a nonfinancial factor or excess resources, the application shall be disposed of and the application date may not be retained. If the applicant reapplies, the process and the period under consideration shall be established under Regulation .04I(9) of this chapter.

F. Interview.

(1) A face-to-face interview may be conducted at the request of the applicant or the Department or its designee.

(2) If it is determined that a face-to-face interview is necessary, the interview may be conducted with an individual other than the applicant in the following situations:

(a) When the Department or its designee determines that the applicant cannot participate in the interview because of unusual circumstances such as severely incapacitating disabilities, the interview shall be conducted with an authorized representative or individual acting responsibly on behalf of the applicant; or

(b) When the applicant is an unmarried child younger than 18 years old and is not living with a parent or other caretaker relative, the interview shall be conducted with one or more of the following individuals who is 18 years old or older:

(i) The parent or other knowledgeable relative of the child;

(ii) The nonrelated individual with whom the child is living; or

(iii) Another designated responsible individual who is knowledgeable about the child's circumstances.

G. Required Application for Income Benefits.

(1) Eligibility may not be established until applicants, and recipients furnish proof that they have applied for and taken all other necessary steps to obtain and accept all income benefits to which there may be entitlement, except as specified in §N(3) of this regulation.

(2) Income benefits include, but are not limited to:

(a) Social Security;

(b) Unemployment Compensation;

(c) Railroad Retirement;

(d) Veteransí Administration;

(e) Civil Service annuities;

(f) Federal, state, or local government and private pensions; and

(g) Workersí Compensation.

(3) Applicants and recipients determined by the Department or its designee to be unable to perform the required activity because of the applicantís or recipientís physical or mental condition and for whom there is no other individuals to perform the activity are not required to apply for income benefits.

(4) Determination of initial eligibility may not be delayed pending the results of the application filed for income benefits.

(5) At the time of redetermination or reapplication, eligibility will be determined on the basis of the applicantís or recipientís documented reasonable and continuous efforts to establish entitlement to income benefits.

H. An applicant who is 65 years old or older, or blind or disabled, is not eligible until the applicant furnishes proof that the applicant has applied for or is receiving Part A Medicare. Eligibility determination may not be delayed pending the results of the application filed for Part A Medicare. Periodic reviews of eligibility are necessary for those blind or disabled individuals initially determined ineligible for Medicare because of the required waiting period.

I. Social Security Number.

(1) Eligibility may not be established until the applicant or recipient furnishes or applies for a Social Security number for each member of an assistance unit and any individual whose income and resources are considered in determining the financial eligibility of an assistance unit.

(2) An individual may not be added to an assistance unit until an application is completed for a Social Security number.

J. Retroactive Eligibility for Cash Assistance Applicants or Recipients. A Public Assistance applicant or recipient who desires Medical Assistance coverage for a past period shall apply for retroactive coverage. The date of application for retroactive coverage shall be established as follows:

(1) The Medical Assistance application date shall be the:

(a) Same as that of the Public Assistance application date if the Medical Assistance application is filed within 3 months of the date of the Public Assistance application; or

(b) Date the Medical Assistance application is filed if the filing date is more than 3 months after the date of the Public Assistance application.

(2) Retroactive eligibility shall be determined in accordance with the requirements of Regulation .10C of this chapter.

K. The Department or its designee shall conduct a wage-screening inquiry to determine wages, benefits, and claimant history for an Aged Blind Disabled applicants or recipients that:

(1) Resides in a long term care facility; or

(2) Is chronically ill and non-ambulatory.

L. An applicant shall sign consent forms as needed authorizing the Department or its designee to verify from sources such as an employer, banks, and public or private agencies, information needed to establish eligibility.

M. Obtaining Financial Records from Fiduciary Institutions Doing Business in the State as of October 1, 2017.

(1) The Department or its designee shall inform the applicant or authorized representative in a written or electronic document of the required information and verifications needed to determine financial eligibility for Medical Assistance and the time limit for submitting the required records.

(2) The applicant or authorized representative shall provide all of the required information and verifications needed to determine financial eligibility for Medical Assistance within the time period specified in the notice from the Department or its designee.

(3) The Department or its designee shall request financial records necessary to determine the applicantís eligibility for Medical Assistance on behalf of the applicant when:

(a) The applicant or authorized representative is actively attempting to obtain financial documentation to establish eligibility but has been unable to provide the required financial information through no fault of his own from a certain fiduciary institution conducting business in the State;

(b) The applicant or authorized representative provides documentation to show their efforts to obtain the information; and

(c) The applicant or authorized representative provides a signed consent form designated by the Department or its designee to obtain the records.

(4) If the conditions set forth in §M(3) of this regulation are not met, the applicant or authorized representative remains responsible to provide the information.

(5) Reimbursement Schedule. The Department or its designee shall reimburse a fiduciary institution for providing copies of financial records in accordance with the Banks and Banking regulations found in 12 CFR §219.3, including the Reimbursement Schedule at Appendix A.