806-1         THE APPLICATION

806-1 A.     ACCEPTABLE APPLICATIONS

The Application for Services (GEN 50C) is the initial application form that is used to apply for any public assistance program, except the Heating Assistance Program (HAP). The GEN 50C may be submitted in person, by fax, via email, pr through the mail. 

Individuals can also apply for Medicaid online through the FFMFederally Facilitated Marketplace or the SSPSelf Service Portal, or over the phone by calling the Virtual Call Center (VCC).

If an older version of the Application for Services or a Native Family Assistance Program (NFAP) application form is received that does not include the information needed to determine MAGI Medicaid eligibility, additional information will need to be requested from the household.

Note:

The MED 4Medicaid Application for Adults and Children with Long Term Care Needs should be used to apply for Medicaid benefits for an applicant needing Long Term Care Services and Supports. However, if the individual is found to be ineligible for LTCLong Term Care, a MAGIModified Adjusted Gross Income Medicaid determination can be made without requiring a GEN 50CApplication for Services to be completed. 

The caseworker must request the additional information needed for a MAGIModified Adjusted Gross Income Medicaid Determination. 

The following specialized application form is also available for non-MAGIModified Adjusted Gross Income Medicaid programs and is used when appropriate:

•  The Application for Medicaid and Title IV-E Foster Care (GEN 33) for a child in state custody is used by the Office of Children's Services to apply for children in state custody, Title IV-E foster care and adoption assistance agreements, and state-only adoption assistance agreements.

806-1 B.   AN APPLICATION iS REQUIRED

1.  Upon the individual's first application for Medicaid, except if the individual is already a recipient of another DPADivision of Public Assistance assistance program and we have enough information to determine Medicaid eligibility. Do not add Medicaid without an application if the individual is only receiving Senior Benefits, Heating Assistance, or General Relief Assistance.

2.  Upon application from a denied, withdrawn, or closed status, unless the denial or closure was the result of an administrative error.

3.  Any time the ETEligibility Technician believes the individual’s circumstances have changed sufficiently to justify conducting a special redetermination of eligibility, including when an office conducts a special review project for all or part of its caseload.

806-1 C.   AN APPLICATION IS NOT REQUIRED

1.  To reopen a closed case as a result of an individual's timely request for a fair hearing, or to open or reopen a case as the result of a fair hearing decision.

2.  To reopen a case that had been closed incorrectly.

3.  To redetermine eligibility after the initial application is denied for failing to provide verification and the household provides the verification within 30 days from the application filing date.

4.  When there is a change in payee, in care of addressee, or mailing address.

5.  When the individual is already a Medicaid recipient in another eligibility category.

Example:

An individual on Child Under 19 category Medicaid is removed from the MAGIModified Adjusted Gross Income Medicaid case because the individual turned 19. If the 19 year old meets all the financial and non-financial criteria of the Medicaid program that individual may be moved to the Under 21 Medicaid eligibility category without a new application.

6.  When an applicant is being added to an ongoing Medicaid case. All additional forms and documentation needed for that individual (i.e., verification of citizenship, etc.) must be obtained before eligibility can be determined.  

7.  When an individual is already part of an active public assistance case and the existing case file already includes the information needed to make a prospective Medicaid determination. The ETEligibility Technician must carefully document the source of information used to make the eligibility determination. TPLThird Party Liability or any other missing information should be requested separately.

8.  When a family moves from MAGIModified Adjusted Gross Income Medicaid to Transitional Medicaid or from Transitional Medicaid to MAGIModified Adjusted Gross Income Medicaid.

9.  When an applicant originally applied for TEFRADisabled Child at Home but at the time of application was only found eligible for MAGIModified Adjusted Gross Income Medicaid. The recipient is not required to file a new application at the time the recipient does move to TEFRADisabled Child at Home.

10.  When a household is ineligible for the first month but eligible for the second month. See section 806-2 (A).

11.  If the FFMFederally Facilitated Marketplace determines that a household may be eligible for Medicaid, the application information will be sent to DPADivision of Public Assistance through a secure electronic interface and DPADivision of Public Assistance will notify the household that a Medicaid application has been received. DPADivision of Public Assistance will not request a new application or any information that has already been provided by the FFMFederally Facilitated Marketplace.

12.  If the Medicaid case cannot be renewed and closes with timely notice of adverse action, the household has 90 days to submit the requested information. If the household is eligible, the case is reopened. A new application is not required and there is no break in service.

806-1 D.   IDENTIFIABLE APPLICATION

An identifiable application is an acceptable application form containing the applicant’s name, address, and signature (or witnessed mark) of the individual seeking assistance or of the individual's authorized representative. Each DPADivision of Public Assistance office must accept and date the identifiable application when it is presented.

See MAGI MS 806 for application signature requirements.

An individual who contacts a DPADivision of Public Assistance office and who shows interest in the program or a desire to apply shall be advised of his or her right to submit an identifiable application on the date of the contact in order to establish the benefit start date. The individual may file an identifiable application on an acceptable application form as described at section 806-1 (A).

806-1 E.   WHO CAN SIGN AN APPLICATION?

Any person has a right to submit an application for Medicaid and to sign the application form, either for themselves or on behalf of another person. Even though anyone can submit and sign an application for themselves or another person, there are preferences to who should sign the application as the signer must certify, under penalty of perjury, the truth of the information contained in the application.

•  An adult household member

•  A minor parent

•  An authorized representative

•  An individual who has legal authority to act on the applicant’s behalf (i.e., Office of Public Advocacy, legal guardian)

•  An individual with appropriate power of attorney.

•  A responsible person, if the individual filing the application is incapable of applying and of appointing an authorized representative in writing.

•  If a child is living with more than one parent/caretaker relative, either of the relatives may be an eligible signer of the MAGIModified Adjusted Gross Income Medicaid application.

•  A child, or the child's guardian may sign a Medicaid application when the child does not have a parent/caretaker relative and the ETEligibility Technician determines it is appropriate.

The appropriate individual to sign a Medicaid application for a child is a parent/caretaker relative of the dependent child, the authorized representative of a parent/caretaker relative, or, if the parent/caretaker relative is incompetent or incapacitated, a responsible individual acting on behalf of the parent/caretaker relative.

See MAGI MS 806 for application signature requirements.

Note:

Boarding Schools may apply for Medicaid benefits on behalf of a child if they provide a signed statement from the child's parent(s) or caretaker relative allowing them to complete and submit the Medicaid application.

Hospitals may apply for Medicaid benefits on behalf of a child if the child has been hospitalized for more than 30 days. If the child has not been hospitalized for more than 30 days, the application should be completed by the child's parent(s) or caretaker relative.

Please review the note in MAGI MS 815-1 for additional information regarding institutional deeming rules.

806-1 F.   AUTHORIZED REPRESENTATIVE

A responsible adult, 18 years or older, may be designated by the applicant in writing as authorized representative. If the applicant is illiterate, his/her mark must be witnessed by two individuals who must each sign their names and date the document. No special form is required.

Authorized representatives may sign the application and act on behalf of a household. A household member should prepare or review the application, if possible, even though the authorized representative will be filing the application, and/or, for non-MAGIModified Adjusted Gross Income programs, attend the interview.

806-1 G.   COMPLETING THE APPLICATION FORM

In addition to making an identifiable application and having it signed by an appropriate individual, all questions on the application form must be answered.

If the individual requests help in completing the application form, the ETEligibility Technician will offer assistance.

If the application form is not completed, the ETEligibility Technician will allow the household an opportunity to complete the form. In this case, written notification will be sent to the household listing the items that need to be completed. See section 806-2 (C).

Note:

Use PPJPrudent Person Judgment when the application is not complete. For example, if an applicant did not fill in their birthdate, but DPADivision of Public Assistance has the birthdate already, or is able to get it with a phone call, there is no need to send written notification. If the applicant only signed the application, but did not complete any questions, written notification should be sent, requesting the applicant to complete the application.