SECTION 2 APPLICATIONS
03.01.101. APPLICATION FOR HEALTH CARE ASSISTANCE
03.01.103. APPLICATION TIME LIMITS
03.01.104. ELIGIBILITY EFFECTIVE DATES
03.01.106. RETROACTIVE MEDICAL ASSISTANCE ELIGIBILITY
03.01.107. – 03.01.199 (RESERVED)
03.01.100. PARTICIPANT RIGHTS.
The participant has rights protected by federal and state laws and Department rules. The Department must inform participants of their rights during the application process and eligibility reviews as listed in Subsections 100.01 through 100.04. (4-11-06)
01. Right to Apply. Any person has the right to apply for Health Care Assistance programs. Applications must be in writing on forms provided by the Department. (4-11-06)
02. Right to Hearing. Any participant can request a hearing to contest a Department decision in accordance with IDAPA 16.05.03, “Contested Case Proceedings and Declaratory Rulings”. (4-11-06)
03. Right to Request Reinstatement of Benefits. Any participant has the right to request reinstatement of benefits until a hearing decision is made if the requests for the hearing and for the reinstatement are made within 10 (ten) days of the mailing of the notice of action. (4-11-06)
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Procedure for Continuation of Benefits pending hearing:
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04. Civil Rights. Participants have civil rights under the U.S. and Idaho Constitutions, the Social Security Act, Title IV of the Civil Rights Act of 1964, the Rehabilitation Act of 1973, and all other relevant parts of Federal and State laws. (7-1-98)
03.01.101. APPLICATION FOR HEALTH CARE ASSISTANCE.
The application form must be complete and signed by the participant or authorized representative. By signing the application form, the participant or authorized representative agrees, under penalty of perjury, that statements made on the application are truthful. (7-1-04)T
NOTE: A new AFA is not required if the applicant is eligible within 45 days of the original application date.
A face-to-face interview is not required when an application is filed. (7-01-04)
When applicants apply for Health Care Assistance, they are
required to participate in Healthy Connections (HC). The Healthy Connections
program is administered by the Division of Medicaid. The program helps Medicaid
participants set up a primary care provider, which is also referred to as a
“medical home.” Most primary care providers in Idaho require Medicaid
participants to enroll in Healthy Connections. Having a medical home is
important for maximizing health care benefits.
Healthy Connections Information:
-Flyer HW0237
-Enrollment Form HW0238
-Brochure HW0234
(7-1-04)
03.01.102. COLLATERAL CONTACTS.
A participant's signature on the application is consent for the Department to contact collateral sources for verification of eligibility requirements. (11-1-99)
If a participant provides additional verifications
required by another program, use this information to determine eligibility.
If there is no other program involvement, use interfaces to verify the
information on the application.
1. Verify immigration status of legal non-residents applying for
benefits
2. Verify applicant’s Social Security Number (SSN) or proof of
application for an SSN
3. Verify wages through the Department of Labor
4. Verify vehicles through the Department of Transportation
5. Review ICSES for child support payments
6. Review Vital Statistics to verify ages, if necessary
7. Verify self employment income using current taxes or a profit and
loss statement.
If the information on the application differs from the verification source, or
is questionable, contact the participant for clarification.
Contact employers, landlords and other collaterals ONLY when the participant
cannot provide information needed to resolve the discrepancy. (7-1-04)
03.01.103. APPLICATION TIME LIMITS.
Each application must be processed within forty-five (45) days, unless prevented by events beyond the Department's control. (7-1-97)
NOTE: A new AFA is not required if the applicant is eligible within 45 days of the original application date.
Applications for Title XIX and CHIP A
Act on an application as soon as you have the information
necessary to determine eligibility.
The application date is the date the AFA is received and date stamped in the
Field Office; or if the application is mailed, it is the date of the postmark.
If a household contacts the wrong Field Office, give the household the address
and phone number of the correct Field Office. Register the application and
forward the AFA and the envelope if received by mail, to the correct Field
Office the same day. The AFA must contain the applicant’s name, address,
signature and date of application. Applications received from out-stationed
eligibility workers should be date stamped by the out-stationed worker the day
the application is received. These applications should be received by the Field
Office within 3 days of the application date.
Specialized Health Care Application (SHCA)
CHIP B and Children’s Access Card applicants can use a special form to request
services during the open enrollment period. In most circumstances, the
applicant will mail the form directly to the Consolidated Unit (CU) responsible
for the processing of CHIP B and Children’s Access Card applications. If a SHCA
is received by a Field Office, the worker will fax the application to the
Consolidated Unit at 800-528-5980. The worker will forward the application,
envelope and any information received with the application to the CU within 2
business days. (7-1-04)
Title XIX Medicaid, CHIP A and CHIP B coverage begins the first day of the application month. Children’s Access Card coverage begins the first day of the month the private insurance coverage begins. Individuals may choose Bridge Coverage as described in section 105 of this rule. (7-1-04)T
Health Care Assistance coverage begins the first day of the application month. (7-1-04)
Individuals choosing the Children’s Access Card may enroll in CHIP A or CHIP B until their private insurance coverage begins. (7-1-04)T
Applicants choosing the Children’s Access Card may also choose to
have CHIP coverage until their private insurance begins. This is called Bridge
Coverage.
When the CHIP Consolidated Unit is notified that the private insurance is
effective, the worker closes the CHIP Bridge benefit segment and opens the
Children’s Access Card program. (7-1-04)
03.01.106. RETROACTIVE MEDICAL ASSISTANCE ELIGIBILITY.
Title XIX Medicaid and CHIP A can begin up to three (3) calendar months before the application month if the participant is eligible for Title XIX Medicaid or CHIP A during the prior period. Coverage is provided if services that can be paid by Medicaid were received in the prior period. CHIP B and Children’s Access Card participants are not eligible for retroactive medical assistance unless they meet all of the eligibility criteria for Title XIX Medicaid or CHIP A in the prior period. (7-1-04)T
Retroactive Medical must be addressed on every application, even
when the family is not eligible in the application month. Determine eligibility
for each month requested. Approve and issue retroactive medical for any month
the family is eligible. Retroactive medical may assist the family in becoming
eligible for TM. Retroactive medical months count toward the TM requirement of
receiving Medicaid for three of the last six months.
CHIP B and Children’s Access Card participants are not eligible for retroactive
medical unless they were eligible for Title XIX or CHIP A during one or all of
the prior three
months.
(7-1-04)