|
Effective: August 1, 2007 |
|
|
07.05.15ar2 - Application Not Required (Archive) |
Archived: October 1, 2007 |
There are specific situations when a new application is not required. This is based on program, as well as additional factors listed in this section.
For information on when an application is required, see Application Required.
MinnesotaCare (MCRE) Application Not Required.
MA/GAMC Application Not Required.
Do not require a HCAPP in the following situations:
l A person is added to an existing MCRE household. See Adding a Household Member.
l People reapply for MCRE within eleven months of the last completed application or renewal form, regardless of whether or not the applicant was denied, cancelled or failed to pay the initial premium.
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 eleven months have elapsed since he completed his application. Update the previous application.
l People apply for MA/GAMC, are denied or closed, and then request MCRE within eleven months of the application date.
n Determine eligibility based on information in the case record using any form completed by the enrollee, including a CAF.
n County agencies that are not MCRE enrollment sites must send the most recent application and current renewal form, if any, to MCRE Operations.
Note: If there is no renewal form on file, send the most recent application along with current case information.
n The date of application is the date of the most recent application or renewal form.
l People who live together but must be in separate MCRE households apply on the same HCAPP only if it is signed by the second household and it contains sufficient information to determine eligibility for the second household.
MA/GAMC Application Not Required
Do not require an application in the following situations:
l There is a change in the basis of eligibility under a specific MA or GAMC program.
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) , regardless of which application form they completed.
Note: An enrollee who enters a LTCF or begins waivered services must complete the Request for Payment of Long-Term Care Services (DHS-3543) or another type of request if applicable before eligibility for those payments can be determined. See Application Forms for more information.
Example:
Bertha, age 78, lives in the community. She was approved for MA effective May 1. She enters a LTC facility 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 An applicant submits a form designed for a different population.
l People are added to the household. Gather information needed to determine the new member’s eligibility.
Exception: Require an application if the household asks to add new members when the only person on MA is an auto newborn and the household has not completed an application or renewal form within the past 12 months.
l People who are not currently enrolled but are already counted in the household size request coverage. See Adding an MA/GAMC Current Household Member to Coverage.
l People are receiving automatic MA or automatic GAMC and the cash assistance ends. Gather sufficient information to determine if eligibility for MA or GAMC continues under another basis.
Example:
John is receiving GA. He reports he started a job and his income will exceed GA standards.
Action:
Do not require a new application to re-determine eligibility for GAMC.
l People who live together but must be in separate MA or GAMC households apply on the same HCAPP only if it is signed by the second household and it contains sufficient information to determine eligibility for the second household.
l A person receiving QMB, SLMB or QI requests MA.
Note: People cannot receive QI and MA concurrently.
l People meet the criteria in Shared and Transferred Applications.
l MCRE enrollees request MA/GAMC and an application or renewal has been completed within the previous 45 days.
l A former GHO enrollee is re-hospitalized within six months of the date of the most recent application.
Do not require an application when the following people convert from GAMC to MA:
l Pregnant women.
l People with Acquired Immune Deficiency Syndrome (AIDS).
l People approved for GAMC who are determined disabled by Social Security or the State Medical Review Team (SMRT).
l People leaving an Institution for Mental Diseases (IMD).
l People turning age 65.
l People who are initially eligible for GAMC but will become eligible for MA within 45 days of the date of application.
Do not require an application when the following people convert from MA to GAMC:
l A General Assistance (GA) / MA recipient reaches age 21.
l People who are initially eligible for MA but will become eligible for GAMC within 45 days of the date of application.