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Effective: July 1, 2009 |
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07.05.15ar4 - Application Not Required (Archive) |
Archived: February 1, 2010 |
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 MA or GAMC.
Application Not Required for Transitional MinnesotaCare.
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 New Applicant Request for Payment of Long-Term Care Services (DHS-4803) 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 client submits a renewal during the renewal month, but after disenrollment. See Processing MinnesotaCare Renewals, Processing MA/GAMC 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 most recent application or renewal is:
r 12 months or older for MA/GAMC, or
r 11 months or older for MinnesotaCare. See Adding a Household Member..
l An individual applies for MHCP using the CAF.
n Do not require a HCAPP.
n Do not delay processing MHCP while waiting for the client to attend the cash or FS interview.
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/GAMC 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 or GAMC is closed. Neither a request from the client nor a new application is required. See Processing MA/GAMC Annual Renewals.
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.
Application Not Required for MA/GAMC
Do not require an application in the following situations:
l The client applies for all MHCP. All MHCP are denied. The client requests MA/GAMC within 45 days of the last completed application.
l The client applies for MinnesotaCare only. MinnesotaCare is denied. The client requests MA/GAMC within 45 days of the last completed application.
l The client’s MA/GAMC is closed. The client requested MA/GAMC before the effective date of the MA/GAMC closure.
l The client’s MinnesotaCare is closed. The client requests MA/GAMC within 45 days of the last completed application or renewal.
Note: In some situations, MA/GAMC 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/GAMC 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 There is a change in the basis of eligibility under a specific MA or GAMC 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 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 A person receiving QMB, SLMB or QI requests MA.
Note: People cannot receive QI and MA concurrently.
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.
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.
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) or MA client 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.
Application Not Required for Transitional MinnesotaCare
There are additional considerations for Transitional MinnesotaCare applicants and former enrollees who are applying or reapplying for health care programs. For more information, see:
l Transitional MinnesotaCare - Application Process.