(a) The department
will not act on a request for Medicaid eligibility or coverage until the
department receives an identifiable application. An identifiable application
must be made on a form provided by the department for the purpose of applying
for Medicaid. That application form must
(1)
include
(A) a legible name and address;
and
(B) a signature or witness mark
of the applicant or the applicant's authorized representative appointed under
7
AAC 100.006(a);
(2) be submitted by
(A) the applicant;
(B) an authorized representative appointed
under 7 AAC 100.006(a);
or
(C) an individual acting
responsibly in the place of the applicant in accordance with
7
AAC 100.006(b); and
(3) be received by
(A) a district office of the division
handling public assistance matters in the department;
(B) a fee agent or other department designee;
or
(C) if the child is in the
department's protective custody, the office of the department handling matters
for children in the department's protective custody.
(b) Before the department will
determine eligibility for Medicaid, the application form must be signed by
(1) the applicant;
(2) the caretaker relative, if the
application is for a dependent child under an eligibility category in
7
AAC 100.102(a) or (c);
(3) both parents, if
(A) the application is for a dependent child
under an eligibility category in
7
AAC 100.102(a) or (c) who is residing
with both parents in the same home; and
(B) the financial needs, resources, and
income for both parents are used to determine eligibility for the dependent
child;
(4) an individual
who has legal authority to act on the applicant's behalf;
(5) the authorized representative appointed
under 7 AAC 100.006(a);
or
(6) an individual acting
responsibly in the place of the applicant under
7
AAC 100.006(b).
Each type of Medicaid applicant form provided by the
department, as referred to in 7 AAC 100.004, is available at any Division of
Public Assistance office of the Department of Health and Social
Services.
