*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: November 1, 2012 |
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07.05.15 - Application Not Required |
Archived: June 1, 2016 (Previous Versions) |
There are specific situations when a new application is not required. This section discusses the requirements for all programs and those that apply to specific programs only.
For information on when an application is required, see Application Required.
Application Not Required for All Minnesota Health Care Programs (MHCP).
Application Not Required for MinnesotaCare.
Application Not Required for Medical Assistance (MA).
Application Not Required for All MHCP
Do not require an application in the following situations:
l An applicant submits an application designed for a different health care population.
Note: Although a new application may not be required, an applicant who submits an application designed for a different health care population may be required to complete additional forms. For example, an applicant requesting MA payment of long-term care services may be required to complete the MHCP Request for Payment of Long-Term Care Services (DHS-3543) before eligibility for payment of those services can be determined.
See Applications for Health Care Programs to determine if an additional form is required.
Exception: Clients may not use a Minnesota Family Planning Application (MFPP) (DHS-4740) to apply for any program except MFPP.
l The enrollee submits a renewal during the renewal month, but after disenrollment. See Processing MinnesotaCare Renewals, Processing MA Annual Renewals, and Six-Month Renewals.
l People who live together but must be in separate households apply on the same application, both sign the application and it contains sufficient information to determine eligibility for the second household.
l An individual is removed from an existing MHCP household, requests MHCP for himself or herself, and has signed the most recent application or renewal. See Removing a Household Member and Application Required for more information.
l People who are not currently enrolled but are already counted in the household size request coverage. See Adding a Household Member.
l Individuals are added to an existing MHCP household. See Adding a Household Member.
Exception: Require an application if the household asks to add new members when the only person open is an auto newborn and the most recent application or renewal is:
r 12 months or older for MA, or
r 11 months or older for MinnesotaCare. See Adding a Household Member.
l An individual applies for MHCP using the Combined Application Form (CAF).
n Do not require a Health Care Application (HCAPP).
n Do not delay processing MHCP while waiting for the client to attend the cash or Food Support interview or to provide verifications needed only for the cash or Food Support determination.
n Contact the applicant by phone or in writing if additional information is required.
l Individuals meet the criteria in Shared and Transferred Applications.
Application Not Required for MinnesotaCare
Do not require an application in the following situations:
l The client applies for all MHCP. All MHCP are denied. The client requests MinnesotaCare less than 11 months from the last completed application or renewal form.
l The client applies for MinnesotaCare only. MinnesotaCare is denied. The client requests MinnesotaCare less than 11 months from the last completed application or renewal form.
l The client’s MA is closed. The client requests MinnesotaCare less than 11 months from the last completed application or renewal form.
Note: In some situations, MinnesotaCare eligibility must be determined when MA is closed. Neither a request from the client nor a new application is required. See Processing MA Annual Renewals.
Do not require children under 21 who resided in foster care or a juvenile residential correctional facility on their 18th birthday and have been released from care to complete an application even if the original application is more than 11 months old. Upon termination from MA for reasons other than residency, determine eligibility for MinnesotaCare or transfer the application to the appropriate agency for a MinnesotaCare determination. Refer to MinnesotaCare for Certain Children Exiting Foster Care or a Juvenile Residential Correctional Facility for more information.
l The client’s MinnesotaCare is closed. The client requests MinnesotaCare less than 11 months from the last completed application or renewal form.
Note: If more than one month has elapsed since the last application or renewal, contact the applicant to update the application.
Example:
Georgia applies for MCRE on January 3 and is enrolled effective February 1. Her coverage terminates effective June 1. She calls in November to reapply.
Action:
Do not require a new HCAPP because it has been less than eleven months since she completed her application. Update the application because more than one month has elapsed since coverage ended.
Example:
Stuart applies for MCRE on April 10, and is pended awaiting payment on April 25. No payment was received as of September 1. He calls in October requesting coverage.
Action:
Do not require a new HCAPP because less than 11 months have elapsed since he completed his application. Update the previous application.
l An auto newborn enrolled in MA requests MinnesotaCare prior to the month of their first birthday.
l A client who was previously enrolled in MinnesotaCare for Volunteer Firefighters and Ambulance Attendants reapplies for the program and is volunteering for the same organization as when the client was previously enrolled. Require the individual to submit a new application if the previously completed application is 11 months or older.
Application Not Required for MA
Do not require an application in the following situations:
l The client applies for all MHCP. All MHCP are denied. The client requests MA within 45 days of the last completed application.
l The client applies for MinnesotaCare only. MinnesotaCare is denied. The client requests MA within 45 days of the last completed application.
l The client’s MA is closed. The client requested MA before the effective date of the MA closure.
l The client’s MinnesotaCare is closed. The client requests MA within 45 days of the last completed application or renewal.
Note: In some situations, MA eligibility must be determined when MinnesotaCare is closed. Neither a request from the client nor a new application is required. See Applications after Nonpayment of MinnesotaCare Premium.
l Determine MA eligibility without a new application if MinnesotaCare is closed for non-payment of premiums and the client meets the requirements in Applications after Nonpayment of MinnesotaCare Premium.
l An auto newborn enrolled in MinnesotaCare requests MA prior to the month of their first birthday.
l There is a change in the basis of eligibility under a specific MA program.
Example:
Louisa receives MA with a parent/caretaker basis. Clayton is her only child. Clayton recently turned 18 and is not a full-time student.
Action:
Do not require a new application to determine if Louisa continues to be MA eligible under another basis.
Example:
Susan receives MA as a parent/caretaker. She reports she is pregnant.
Action:
Do not require an application to change the basis of eligibility to pregnant woman.
l A person on MA enters or leaves a Long-Term Care Facility (LTCF).
Note: An enrollee who enters an LTCF or requests services through a home and community-based waiver program must complete the Request for Payment of Long-Term Care Services (DHS-3543) before eligibility for those payments can be determined. See Applications for Health Care Programs for more information.
Example:
Bertha, age 78, lives in the community. She was approved for MA effective May 1. She enters an LTCF in October.
Action:
Do not require an application. Send Bertha a DHS-3543 to gather the additional information. Request the form be returned in 10 days.
l People are receiving automatic MA and the cash assistance ends. Gather sufficient information to determine if eligibility for MA continues under another basis.
l A person receiving QMB, SLMB or QI requests MA.
Note: People cannot receive QI and MA concurrently.
l An MA enrollee requests QMB or SLMB.
l MCRE enrollees request MA and an application or renewal has been completed within the previous 45 days.
l A client’s MinnesotaCare closes for non-payment of premiums and the client:
n Receives the MinnesotaCare Programs Option letter, and
n Returns the MinnesotaCare Programs Option letter on or before the due date.
See Applications after Nonpayment of MinnesotaCare Premium for more information.
l An incarcerated individual, or the individual’s authorized representative, submits a Request to Reopen Medical Assistance (MA) (DHS-5038) within 45 calendar days prior to the anticipated date of release, but no later than 10 calendar days following the date of release. See MHCP and Incarcerated Individuals.