Medicaid Policy
Medicaid Policy
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Who can apply?
An applicant must apply for assistance and sign the application form on his own behalf unless he is unable to do so because he is a minor or because of incapacity that prevents him from completing the application process. If the applicant asks for help to complete the forms, the local supervisor shall assign someone to assist him. (See 703-1 for signature information.)
A legal guardian of a protected person may apply on behalf of the protected person.
If the applicant is a minor, the applicant’s parent, legal guardian, or representative must sign the forms. If the minor is living independently, the minor may apply on her own behalf. (A representative for a child may be a specified relative or other responsible adult living with the child.)
When DCFS has custody of a child and the child is placed in foster care, the Division of Child and Family Services will complete the application process in their Division.
An adult in the household may apply
If the individual is a minor or incapacitated, someone acting responsible for the applicant may apply.
An applicant may appoint an authorized representative to apply on his behalf.
In general, the person who signs the application should be someone who can answer the questions on the application form, complete an interview as needed, and provide the required verifications.
When a representative applies for the individual
When an applicant cannot complete the application process on her own, she can designate a representative to apply for her. The applicant must sign the application form if possible. If an applicant cannot write, she must make her mark on the forms and have at least one witness to the signature. If the applicant cannot sign because of incapacity, the eligibility worker needs to have someone else sign the application.
When an individual decides to have someone represent him through the application and eligibility process, explain to the individual that we must share case information with the representative. This includes information about the individual’s finances and assets and copies of letters mailed to the representative about the individual’s eligibility.
Sharing protected health information (PHI) with the representative requires that the individual signs a release of information. PHI is information that identifies the physical or mental health condition of an individual, the provision of health care to an individual and payments for the provision of health care to an individual.
Inform the individual that she does not have to give permission to disclose PHI. Do not deny Medicaid eligibility because the individual does not give permission to disclose PHI to an authorized representative.
Follow HIPAA guidelines when sharing PHI. The written permission must describe what PHI can be shared with the representative and for how long. The customer must include the following information when granting permission for us to share PHI with a representative:
Individual's name
Individual's Medicaid identification number
Individual's date of birth; other identifying information such as address if needed
Name of the person or persons to whom the customer authorizes the agency to disclose PHI
The purpose for the disclosure
The effective date of when we can start sharing information
The effective date of when we may no longer share information
Give the customer a copy of the release form. Update the release when it expires or at the eligibility review.
If the individual cannot sign a release form authorizing disclosure of PHI, use the following guidelines to decide what information can be shared.
When a person with legal responsibility for the individual, such as a spouse, parent, caretaker relative, guardian, or authorized representative, applies for the individual, case information can usually be shared with that person as if he or she were the individual.
When a friend, a representative from an organization, or someone who works for a medical provider signs the application, workers may decide that not all of the applicant's personal information should be shared with that individual. In general, disclose only such information as needed to process eligibility.
Regardless of how much case information can be shared with the individual who applies on behalf of an applicant, tell that person what verifications are required, when they must be provided, and the outcome of the eligibility decision. Remember the signer is usually taking responsibility for completing the application process, even if workers are not able to share all information with them. Staff can contact the Program Specialists if they have questions about confidentiality.
An emancipated individual who is not under a legal guardianship may revoke permission to share information with a representative, can change the designated representative, or may choose to no longer have a representative. A legal guardian who signed a release can exercise these same rights as if she were the individual.