Obsolete 0322 - 107-1 Completion of an Application

Effective Date: June 1, 2016 - February 28, 2022

To apply for medical assistance, individuals must complete, sign, and date a Medicaid application or the Single Streamlined Application used to apply for all Insurance Affordability programs. The applicant has several choices of how to complete and file an application. (See 703-1 on What is an Application?)

The Medicaid agency will accept applications in the following ways.

Paper Application: Applicants may pick up a paper application at the eligibility agency's local offices, from the Federally Facilitated Marketplace, print one from the agency's website or ask that one be mailed to them. A paper application must be completed, signed, dated and filed at a DWS local office, the Federally Facilitated Marketplace, or an outreach location by delivering it in person, mailing it, or faxing it.
Telephone Applications: Applicants may ask to apply by telephone. (See 703-1) When applying by phone, the agency will take the eligibility information over the phone then send a copy of the application form to the applicant. The applicant must sign and return the signature page to the appropriate office 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 must complete the online signature. The agency accepts an online signature as a legal signature of the individual applying for Medicaid. 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 delivered to a local agency office. If the individual has not previously signed a Medicaid 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. (See Section 721-1 for updating TPL at reviews.) If the case closed for failure to complete the review process a review form can be used to reapply if received within 3 months of the closure.
Nursing Home/Long-Term Care Addendum: When a recipient enters a nursing home or is referred for home and community based services waiver, the client may be asked to complete a nursing home addendum. New applicants for such services may also need to complete the addendum. Long-term care has different eligibility requirements and additional information is needed to complete an eligibility decision.

An unsigned application is not complete and the agency cannot determine eligibility until it receives the signature. The applicant must return the signed signature page no later than the last day of the application processing period or the agency will deny the application. (See Sec. 703 on filing an application and Sec. 703-2 on how the agency sets the application date.)

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 agency will deny the application.