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Effective: July 1, 2009 |
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07.05.05ar6 - Applications for Health Care Programs (Archive) |
Archived: April 1, 2010 |
There are several applications that can be used to apply for health care depending on the client's situation and the program for which he or she is applying. The applications gather eligibility information about the client.
General Application Requirements.
Health Care Application (HCAPP).
Combined Application Form (CAF).
Minnesota Family Planning Program (MFPP) Application.
Long-Term Care (LTC) Requests and Applications.
Request to Reopen MA for Incarcerated Individuals.
General Application Requirements
Accept any of the DHS approved applications as detailed in this section.
l Do not require a specific application when another meets the conditions for use.
Exception: Do not use a Minnesota Family Planning Program (MFPP) (DHS-4740) application to determine eligibility for any program other than MFPP.
l Accept unsigned applications to set the date of application. Obtain the application signature as part of the application process.
l Do not require forms or verifications not required as a condition of eligibility regardless of what application is used.
l Provide the DHS-3182, which describes Minnesota's health care programs, with each application. Do not include any other forms with the HCAPP.
Example:
County A has developed a form that includes specific information about the agency’s hours of operation, other resources available in the county, instructions on how and when to reach the worker to report changes, etc. The form also includes some of the client rights and responsibilities that are incorporated on the application.
Action:
County A may send this form to applicants at the time of approval. Do not include the form with the HCAPP or require the applicant to sign and return it.
Health Care Application (HCAPP)
The HCAPP (DHS-3417) allows people to apply for any or all of the Minnesota Health Care Programs (MHCP) on one form. Questions on the HCAPP may apply to all health care programs, only to one or two programs, or to specific populations.
The HCAPP has several functions:
l Collect eligibility information.
l Provide the client with their rights and responsibilities. Clients should detach these pages and retain them for their records.
Note: Clients who request MA payment of long-term care (LTC) services, including home and community-based waiver services, using the HCAPP or a Combined Application Form (CAF) must also complete the New Applicant Request for Payment of Long-Term Care Services (DHS-4803) before eligibility for payment of those services can be determined.
Advise clients that the Minnesota Health Care Programs Application (HCAPP) is also available on the DHS web site at www.dhs.state.mn.us/healthcare.
Combined Application Form (CAF)
The following clients should use the CAF (DHS-5223) to apply:
l Clients applying for cash and Food Support (FS), or other emergency programs, with or without MHCP.
n An interview is required for cash and FS, but is not required for health care.
n Do not wait for the cash and FS interview or the completion of the MDHS Worker Interview Form (DHS-5223A) to determine health care eligibility. Request the information needed to determine health care eligibility.
l Clients who are uncertain for what programs they are applying.
Note: Clients who request MA payment of long-term care (LTC) services, including home and community-based waiver services, using the HCAPP or a Combined Application Form (CAF) must also complete the New Applicant Request for Payment of Long-Term Care Services (DHS-4803) before eligibility for payment of those services can be determined.
Clients who apply for health care coverage only should complete the HCAPP (DHS-3417). However, process the application if they use the CAF to request health care only. Request the information needed to determine health care eligibility. See Processing Applications.
Use the Minnesota Medical Assistance Breast and Cervical Cancer Coverage Group (MA-BC) Application/Renewal (DHS-3525) for women who are screened and found to need treatment through the Sage Screening Program.
Use the Minnesota Family Planning Program (MFPP) Application (DHS-4740) for clients applying for MFPP coverage. Do not use the MFPP application to determine other health care program eligibility. See Minnesota Family Planning Program for information.
Eligibility for MA payment of LTC services, including waiver services, cannot be determined until a request for payment of those services has been received using an acceptable request or application form.
Acceptable requests from applicants include:
l The Minnesota Health Care Programs Application for Payment of Long-Term Care Services (DHS-3531).
Note: Accept the Minnesota Health Care Programs Application for Payment of Long-Term Care Services for all applicants even if they are not requesting MA payment of LTC services. Do not require completion of the HCAPP. Request missing or incomplete information and proofs required to determine eligibility.
l The HCAPP (DHS-3417).
Note: Clients who request MA payment of long-term care (LTC) services, including home and community-based waiver services, using the HCAPP or a Combined Application Form (CAF) must also complete the New Applicant Request for Payment of Long-Term Care Services (DHS-4803) before eligibility for payment of those services can be determined.
l The New Applicant Request for Payment of Long-Term Care Services (DHS-4803).
Clients who request payment of LTC services at the time of application must complete a DHS-4803 if they applied using the HCAPP or a CAF. The DHS-4803 is required for eligibility for payment of LTC services because the required questions are not found on these applications.
MHCP enrollees must complete the MHCP Request for Payment of Long-Term Care Services (DHS-3543) to request payment of these services. Require this form when an enrollee:
l Has moved into a long-term care facility or is requesting services through the home and community-based waiver programs (CADI, CAC, DD, TBI and EW).
l Has a break in LTC services and is again requesting MA payment of LTC services, but is not required to complete a new application.
l Allow 10 days for the enrollee to return the DHS-3543.
Do not close MA if the enrollee does not return the form. However, the enrollee is ineligible for payment of LTC services until the form is returned and eligibility for LTC services is determined.
Determine eligibility for MA payment of LTC services even if the DHS-3543 is returned after 10 days if the person has been continuously eligible for MA since becoming a resident in a LTCF. Services through a home and community-based waiver program cannot begin before the DHS-3543 is returned and the enrollee is determined to be eligible for MA payment of LTC services.
The Minnesota Health Care Programs Renewal (DHS-3418), Renewal for People Receiving Long-Term Care Services (DHS-2128), and Combined Six-Month Report (DHS-5576) may be processed as an application if received during the renewal month. If received after the renewal month see Application Required and Application Not Required to determine if a new application is required or if a previous application or renewal can be updated.
Use a HCAPP along with the Title IV-E Foster Care Supplement to the Health Care Programs Application (DHS-3478) to determine eligibility for Title IV-E for children in placement to eliminate multiple forms.
l If the child is IV-E eligible, MA is automatic without a separate application or eligibility determination.
l If the child is not IV-E eligible, MA is not automatic. An application (HCAPP) must be filed on behalf of the child to determine MA or MCRE eligibility.
GAMC applicants must complete the Required Questions for General Assistance Medical Care (DHS-3423) in addition to an application.
Incarcerated people may apply for MA with a shortened process using the Request to Reopen Medical Assistance (MA) (DHS-5038) if their MA closed due to incarceration and they were incarcerated for 12 months or less. See MHCP and Incarcerated Individuals for more information.
Applicants and enrollees may need to complete additional forms to complete the application process. Additional forms are based on program requirements, household composition and other conditions.
Other forms may include:
l Health Insurance Information Form (HIIF) (DHS-1922B).
n The information gathered on this form is also included as questions on the HCAPP.
n Do not require the HIIF if the applicant supplies the information on the HCAPP or by other means, such as providing the information by phone or submitting copies of insurance cards.
l Medical support referral forms. These include:
n Important Information on Child and Medical Support Services (DHS-3163C).
n Medical Support Referral Form (DHS-3163B).
n Good Cause Form (DHS-2338).
l Medical Services Questionnaire (MSQ) (DHS-2237).
n Agencies may use MSQs to gather information about current or pending Third Party Liability (TPL) .
n Do not submit the MSQ to Benefit Recovery Section (BRS) . For MA and GAMC, record the information on the MAXIS ACCI screen.
l Managed care enrollment information.
n Managed care forms are used for eligible applicants who are required or volunteer to enroll in managed care.
n See the Prepaid MHCP Manual for a list of items to include in managed care education and enrollment packets.