*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: June 1, 2012 |
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07.20 - Processing Applications |
Archived: June 1, 2016 (Previous Versions) |
All of the health care programs require that applications be processed as soon as possible, and within a certain number of days from the date of application.
What Does It Mean to Process an Application?
What is a Complete Application?
Application Processing Step 1 - Determine Client's Choice.
Application Processing Step 2 - Review for Completeness.
Application Processing Step 3 - Interview (Optional).
Application Processing Step 4 - Determine Eligibility.
What Does It Mean to Process an Application?
Processing the application means gathering and reviewing all necessary information and determining eligibility.
l For MinnesotaCare purposes, an application is considered processed even if the eligibility determination results in a pending status. The system will automatically deny the application and send a notice if the client does not return missing information.
l For MA an application is considered completely processed when eligibility is approved or denied.
Applications must be processed within the Processing Period for each program.
What is a Complete Application?
A complete application has:
l all questions answered that are needed to determine eligibility.
Note: Do not require applicants to answer questions that are not applicable to determining their eligibility. For example, do not require children to answer questions about assets because children do not have an asset limit.
l all required information and verifications received.
Exception: Participants in the Safe at Home (SAH) Address Confidentiality Program are not required to provide their actual address. They have a card showing their participation in the program and the address to use. See Data Privacy or the Minnesota Secretary of State’s Web site for further information.
l all required signatures and dates on the application or signature page. See Application Signature.
Application Processing Step 1 - Determine Client's Choice
Informed choice allows health care applicants using the Health Care Programs Application (HCAPP) (DHS-3417) or ApplyMN to choose to apply for all health care programs or for MinnesotaCare only. The Combined Application Form (CAF) and pre-01/09 versions of the HCAPP do not ask applicants if they are applying for a specific program. Determine which health care programs the client is applying for if they use one of these forms and process accordingly.
l For information on processing requests for health care on the current HCAPP, see Informed Choice.
l For information on processing a CAF or a pre-01/09 version of the HCAPP, see Where to Apply.
l For information on whether the receiving agency must make the eligibility determination or whether the application must be transferred, see Shared or Transferred Applications.
Application Processing Step 2 - Review for Completeness
Review the application for completeness as soon as possible.
l ApplyMN applications requesting MinnesotaCare as the only health care program, in combination with a request for another program [cash assistance, Supplemental Nutrition Program (SNAP), Child Care Assistance Program (CCAP) or emergency help] may result in the ApplyMN application simultaneously routing to two or three different processing agencies (MinnesotaCare Operations office, a county or tribe). This may require coordination between agencies to minimize duplicate requests for information.
1. Review MAXIS, MEC² and MMIS screens and case notes to determine if the other agency received the needed information.
2. If it is clear the other agency received the needed information, contact the other agency by SIR mail to request a copy of the information for your case file. Document all actions taken in case notes
3. If the other agency has not received the information, request the information from the applicant. Update MAXIS, MEC² or MMIS as appropriate. Document all actions taken in case notes
l Contact the client by phone or mail to request missing items, information on the application that needs clarification and mandatory verifications that have not been provided.
Allow at least 10 days for the applicant to respond to the request for more information.
n Do not deny the application for failure to return the required information before the end of the processing period.
Give the applicant 10-day notice of the proposed denial at the end of a processing period.
n If the applicant returns the missing information or verification, continue on to Step 3.
l Check MMIS to see the status of each household member to determine if any members of the household are active on another health care program.
Coordinate coverage if an applicant is already open on one program and requests a different program. See Eligibility Begin Date for more information on coordinating coverage.
Reminder: For MinnesotaCare applications, send Information for people Who Have Served in the United States Military (DHS-3726) if an applicant indicates on the application that someone in the household has been in the United States military.
Application Processing Step 3 - Interview (Optional)
Do not require an interview for health care program eligibility.
l Schedule an interview as soon as possible if the client requests one.
n Schedule interviews for pregnant women requesting an interview within five days from the receipt of the application.
n Schedule interviews for people with a medical emergency in time to meet the emergent need.
n Review the application with the client during the interview.
n Because of the complexity of Long-term Care (LTC) and Elderly Waiver (EW) eligibility, counties may strongly encourage an in-person meeting, but it cannot be required.
n The interview can be scheduled with the client's county of residence or county of financial responsibility of the client, or the county of residence of the authorized representative.
l If an interview is not requested, go directly to Step 4.
Application Processing Step 4 - Determine Eligibility
Determine eligibility for all people requesting coverage following these steps.
1. For MinnesotaCare applications:
Determine if the client previously was eligible for or applied for MA. If the client was denied or closed from MA based solely on failure to provide asset verification, see MA Asset Verification Denial/Closure to determine if MinnesotaCare eligibility is affected.
2. Enter case information on the appropriate system.
l MinnesotaCare: MMIS.
n Check to see if each person has a Person Master Index (PMI) Number. Ensure that a PMI number is assigned for each person who does not have one.
n Assign a provider number and a case number.
n MMIS will show the case status as Pending Representative Review (PRR) until the worker determines eligibility.
l MA: MAXIS and MMIS.
3. Determine if each person applying is approved, denied or pending.
l If the application is complete, approve or deny eligibility within the processing period. Send an approval or denial notice.
See Notices for more information.
Note: MCRE refers to approval as pending awaiting payment.
l If the application is not complete and more information or verifications are needed to determine eligibility, send a pending notice to the client.
See Pending Applications for more information on policy regarding pending applications.
l If the processing period ends and the application continues to be incomplete, deny eligibility. Send a denial notice for failure to follow through with the application process.
Note: MCRE cases will be auto-denied by MMIS.