1400 Application Process, Case Disposition, and Written notice of Case Action

 

1410 Application Process

 

1411 Application Process, Case Disposition, and Written notice of Case Action - Submittal of a signed paper application or an on-line application shall be considered a request for assistance.

 

Based on the provisions of 4000, an application shall include all persons who are required to be in the assistance plan. A new application is not required to add additional household members to existing programs.

 

Intake may be limited to providing the application form unless the applicant makes an additional request. If there is an intake interview, it must provide the applicant an opportunity to state his request and explain his situation and enable the agency to provide the applicant with needed information or to refer him to other staff members or other agencies for the help requested.

 

The application form together with the eligibility worker's records (if any), the necessary forms (budgets, notices of action, narratives, etc.), and any required verification must substantiate eligibility or ineligibility.

 

At the time of application processing, each month shall be viewed separately in determining eligibility or ineligibility. For example, if an application is filed in July but processed in August, ineligibility in August shall not effect the eligibility determination for the month of July.


1411.1 How to Apply - Applicable to All Programs - Appendix- Application Forms and Materials - can be requested from the Clearinghouse or any Outstationed Worker site. An application can be filed in person, by mail, by fax, or electronically online.  The following application forms are in use:

 

•KC1500 – E&D Medical Application

 

•KC1100 – Family Medical Application

 

•KC1105 – E&D Supplement to KC1000

 

When an application is requested, the agency shall help the household identify their medical needs and assure that the individual receives the appropriate application.  The individual shall be encouraged to file the application the same day – in person, by fax, or electronically online. (See 1411.2 below for the application date of an online application). An application shall be mailed to the household the same day the request is received.

 

If the applicant household is homeless and they have no physical street address to list, the application shall be so noted and accepted by the agency.

 

 For ongoing recipients who have completed an application form and who subsequently request additional assistance and for situations in which an additional program is added to a pending application based on a client's request, the following provisions shall apply:

 

1.  If the new program is requested within the month following the month of application or in the first month of the new review period, a new application, signature, or interview is not required. The date of application for the new program shall be the date the additional request is first received – either orally or in writing, by the agency.

  

2.  Reserved

  

3.  If a request is made for a new medical program on an open medical assistance case, additional information may be requested, but a new application is not required.

  

4.  Reserved

 

5.  No new application is required if the agency initiates the new program, such as, adding QMB coverage to an open Medically Needy (MN) case.


1411.2 Application Date - The date of receipt of a signed paper application in the KanCare Clearinghouse or Outstationed Worker site is considered the application date for establishing initial eligibility.

 

All signed applications shall be date-stamped the date received at the KanCare Clearinghouse or the Outstationed Worker site.



For information regarding a faxed or copied application form, see 1212.2.



NOTE: Date-stamping of an application by non-agency personnel does not constitute a date of receipt for application purposes.

 

1.  Online applications – The following rules apply in determining the application date for an online application:

 

a.  Reserved

 

b.  The date the online application (which is electronically signed by the applicant or legal representative) submitted through KDHE-DHCF shall be considered the application date if submitted on a business day. If the application is submitted on a weekend or holiday, the application date is the next following business day.

 

If the application is submitted by an individual with no legal relationship to the applicant, the application date is the date the “Medical Representative Authorization” or “Signature Page” form is received. If neither of these two (2) forms is received within 30 days of the date the online application was received, the application is void.  A weekend is defined as Saturday and Sunday. Staff shall make a notation of the date discrepancy (after 5:00 PM on a business day, weekend, or holiday) in the case file.

 

2.  Applications with no program request – The application date for a paper application received with no indication of the program(s) being requested is the date the application is received in the KanCare Clearinghouse or Outstation Worker site. Immediate contact with the applicant must be made to determine which programs are being requested.

 


The programs requested shall be registered using the date of receipt as the application date for those programs only. Any subsequent request for other programs by the applicant shall be registered with an application date based on the date of request.

 

3. Unsigned applications – Paper applications that are received either through the mail or left at the KanCare Clearinghouse or Out-stationed Worker site that are not signed by the applicant or legal representative are to be returned to the applicant for signature. The entire application shall be returned to allow the applicant to review his/her answers prior to certifying under penalty of perjury that all answers are correct and complete to the best of their knowledge. A cover letter must be attached to the application explaining the need to sign the application and to return it to the appropriate office for processing.


1411.3 Who May File - An application for assistance shall be made by the individual in need or by another person able to act in the individual's behalf. See 2110. If the applicant or his representative signs by mark, the names and addresses of two witnesses are required. Obtaining the signatures of all persons in the family group who are requesting assistance and able to act in their own behalf per 2110 is encouraged, but cannot be required.

 

1.  Filing on Behalf of a Deceased Person - For medical, an application may be made on behalf of a deceased person by any responsible person. Application must be made in the month of death or within the three following months.
 

2. Filing for Institutionalized Individuals (Not applicable to the MediKan Reintegration Program) - When possible, all necessary information and signed forms will be obtained by institutional personnel. Parents, spouses, guardians/conservators and others who may apply on behalf of the individual per 2110 must always be given the opportunity to apply on behalf of an institutionalized person not able to act in his own behalf. If institutional personnel are unable to obtain an application from the patient or any of the above individuals, the administrator of a licensed facility may apply on behalf of the patient. For minor children, if the length of stay will not exceed 30 days so that parental income and assets are considered, hospital staff are not allowed to complete the application process.

 

General hospitals are generally not regarded as a licensed facility for this purpose unless approved.  However, KDHE policy may approve exceptions on a case by case basis.

 


Complete applications will be forwarded to the Clearinghouse for processing.  All information pertinent to eligibility and known by institutional staff will be communicated to the Clearinghouse. When the institution acts as an employer to the patient, institutional personnel will be responsible for reporting all earnings to the Clearinghouse.

 

3. Filing for Individuals Requesting Tuberculosis Coverage - For persons KDHE determines to be in need of treatment for TB (per 2692)  who  are not eligible for regular medical coverage, Appendix- Application Forms and Materials, the ES-3100.3 is normally used for application.

The form must include an authorization for care from KDHE as well as an effective date for care.


4. Filing for Individuals Qualifying for the MediKan Reintegration Program - Discharged staff have the responsibility for initiating a discharge plan for persons being discharged from Medicaid approved psychiatric hospitals, the Larned State Security Program, and the Larned Correctional Mental Health Facility (Central Unit). For MediKan Reintegration program purposes, an approved discharge or release plan shall include:

 

 

All documents are found on KanCare Eligibility Policy: External forms.

 

In addition, the plan will also include the anticipated date of discharge, documentation that the individual has been referred to Social Security to make application for SSI or SSDI benefits, the individual's address and living arrangement following discharge, and an ongoing treatment plan.

 

The assigned worker shall have at least five working days advance notice to carry out the eligibility functions. (See 2314.) Upon receipt of the approved discharge plan, the worker will need to ascertain the current eligibility status of the individual.

 

5. Filing for Individuals Being Released from State Correctional Institutions - Discharge staff at the 9 State Correctional Facilities may begin the application process for potentially eligible inmates a maximum of 90 days prior to their release. The correctional facilities are El Dorado (Central, North, and Toronto Unit), Ellsworth, Hutchinson (Central, East, and South Units), Lansing (Central and East Units), Larned (Central and West Units), Norton, Topeka, Wichita Work Release Facility, and Winfield.



In such instances, the inmate can sign the application as of the date of completion and the application can be filed with the Clearinghouse where the facility is located. The application must be part of the approved discharge plan for the inmate. Designated Clearinghouse staff shall be responsible for coordinating submission and processing of these applications. Discharge planning staff at each correctional facility are responsible for initiating a release plan which incorporates a completed and signed application for benefits, if appropriate, as well as all supporting documentation for the application. If application is made for medical assistance benefits, the guidelines provided for MediKan Reintegration cases in item (4) above are applicable. This includes completion of the ES-3903 and completion of necessary forms and referrals as well as all medical records obtained by the facility regarding the person's disability.



The application shall be registered in KEES at the time of receipt. However, the application is not valid until the release date. As such, the application registration date shall be changed to reflect the release date at the time of release and application processing time frames (including expedited benefits) will be based on that date.



The agency shall make an eligibility determination and issue benefits within 30 days following the date of the applicant's release from the institution. If, for any reason, the agency is not notified on a timely basis of the applicant's release date, the agency shall determine benefits based on the date of release.


Assistance shall be determined based on the living arrangement the person is residing in upon release.  Assistance for the individual shall be prorated for the first month of assistance based on the date of application/discharge.

6. Filing for Individuals through the Health Insurance Marketplace – Individuals may apply for medical assistance through the Health Insurance Marketplace. The Marketplace application allows any adult member of the tax household to apply for any and all other members of the tax household. Should the agency receive an application via account transfer from the Marketplace, it shall be accepted and processed even if the individual filing the application does not meet the requirements of 2110 and subsections.

 

1411.4 Withdrawing the Application - The household may voluntarily withdraw its application at any time. The agency shall document in the case file the reason for withdrawal, if any was stated by the household, and that contact was made with the household to confirm the withdrawal. The household shall be advised of its right to reapply at any time subsequent to withdrawal.

 

1411.5  Reserved

 

1411.6 Registration of Applications – Applications for all programs that are not entitled to expedited benefits, must be registered within two business days of the date of application (see 1411.2).  Applications that are entitled to expedited benefits must be registered within one business day of the date of application. For example a non-expedited online application is submitted on a Saturday. The application date is Monday, and the application must be registered by close of business on Wednesday. Or a non-expedited online application is received submitted on the Wednesday before Thanksgiving. The application date is the following Monday and the application must be registered by close of business on Wednesday. For expedited, the same policy applies except the agency has only one day to register the application. So, an expedited application submitted online on a Saturday must be registered by close of business on Monday. Or an expedited paper application is received on a Friday and it must be registered by close of business on Monday.



Applications received without a benefit program request must be registered within two business days of the date the agency determines the programs for which the client is applying. Applications that are entitled to expedited benefits must be registered within one business day of the date the agency determines the programs for which the client is applying. See 1411.2.