Medicaid Policy
Medicaid Policy
The eligibility agency must establish the date of application to determine when medical assistance coverage can begin. Retroactive coverage to help with past medical bills is based on the date of application, as well as the date the individual met the eligibility criteria (705-1).
Establish the date of application as follows.
Paper Applications
The date of application is the date the eligibility agency receives a completed, signed paper application by the close of business on a business day (703-1).
When an applicant leaves a paper application at an eligibility agency office, other than an outreach location, after business hours, the date of application is the next business day.
Applications for Medicare Cost-Sharing programs sent electronically from Social Security
The date of application for an electronic application transmitted from Social Security is the date the application was received by Social Security.
The 30-day processing period begins on the date DWS receives the data from Social Security (320-1).
Applications received through the Marketplace
The date of application for an application transmitted from the Marketplace is the date the application was received by the Marketplace.
The 30-day processing period begins on the date DWS receives the electronic case from the Marketplace.
Applications sent via FAX
When the eligibility agency receives an application sent by FAX on a business day by the close of business, the date of application is that day.
When the eligibility agency receives an application sent by FAX after the close of business, on a state holiday, or weekend, the date of application is the next business day.
Applications received online through the "myCase" system
The application date for an application received online through the "myCase" system is the date the application is filed online.
Applications received at Outreach Locations
When the agency receives an application at an outreach office location at a time the outreach office is staffed, the application date is the date the application is received by the outreach worker.
When the agency receives an application at an outreach office location when the office is closed, the application date is the last business day that a DWS staff person was available at the outreach office to accept or collect applications.
Verbal Request. If an applicant for other types of assistance makes a verbal request to add medical assistance to a pending application within 30 days of the application date of that pending application, the date of application for medical assistance is the date of the verbal request (703-1).
Ineligible in Application Month. If an applicant is ineligible for medical assistance in the application month, the agency may use the same application form to determine eligibility for the following month. In this case, the new application date is the first day of such following month (711).
Unsigned or Incomplete Applications
If the eligibility agency receives an unsigned application, the applicant must provide a signed signature page within the application-processing period (703-5) to retain the original application date (703-1). The agency will notify the applicant of this requirement.
An applicant who files an application online must complete the online signature. If the applicant fails to complete the online signature, the eligibility agency will send a signature page to the applicant. The applicant must sign and return the signature page within the application-processing period (703-5) to retain the application date of the online application.
If the eligibility agency receives the signature page within 30 days after sending the denial notice for lack of a signature, the date the agency receives the signature page is the new application date. If the agency receives the signature page more than 30 days after denying the application, the applicant will have to reapply.
If an application is incomplete, the eligibility agency contacts the applicant and offers ways for the applicant to complete the application. The application must be completed by the end of the application-processing period, or the agency will deny the application. If the applicant completes the application in the 30 days after the agency denies the application for being incomplete, the new application date is the date the application is completed. A new application-processing period begins on the new application date.
Phone Application. When a worker completes an application over the phone with an applicant, the date of application is the date the worker takes the application over the phone. The applicant must return a signed signature page within the application-processing period (703-5) to retain the original application date (703-1 and 703-5). The eligibility agency follows the provisions of #I.3, if it receives the signed signature page after the agency has denied the application.
Adding Someone to an Open Case
Determine the application date as follows when a household with an open medical assistance case asks for medical assistance for a new household member or one who is not currently receiving medical assistance. Use the same rules if the member asks to change to Medicaid from CHIP or UPP.
When the household already receives medical assistance for some household members, the application date is the date the household requests medical assistance by the close of business on a business day. If the request is mailed to the office, the date of application is the date the eligibility agency receives the written request. If the individual needs assistance for past medical bills, the agency determines the retroactive period based on this date of application (705-1).
Applications received when an application is already pending
If a new application is received while an application is already pending, the application date does not change.
The agency reviews the second (or third, etc) application for any new information.
If new information is discovered or needs to be addressed, it becomes a part of the already existing application process. (See 703-4 and 703-5)
Applications received after medical benefits are issued
Review the new application for changes and new information.
If new information is discovered, and no new household members are requesting medical assistance, consider the new application to be a change report and take appropriate action. (815)
Application dates for cases closed or denied in the previous month (703-1)
For reviews, the date the individual makes contact with the eligibility agency for the intent of completing the review is the new application date. Allow application time frames.
For change reports the date the individual provides all requested verification is the new application date. Allow application time frames.
For denied applications, the date the individual provides all requested verification is a new application date. Allow application time frames.
Requests for Assessment of Assets
In the case of long-term care programs, married individuals may request an Assessment of Assets without applying for Medicaid. The agency will send a notice telling the individual the results of the Assessment of Assets without making an eligibility decision. If the individual contacts the worker within 30 days after date on the Assessment notice and says he or she wants to apply, we will use the date the Assessment was requested as the application date.