(A)
Filing an Application. To apply for MassHealth, an
individual or their authorized representative must file an application online
at www.MAHealthConnector.org,
complete a paper application, complete a telephone application, or apply in
person at a MassHealth Enrollment Center (MEC).
(1)
Date of
Application.
(a) The date of
application for an online, telephonic, or in-person application is the date the
application is submitted to the MassHealth agency.
(b) The date of application for a paper
application that is either mailed or faxed is the date the application is
received by the MassHealth agency.
(2)
Online or Telephone
Application Requirements.
(a)
Individuals, or their authorized representative, if applicable, completing an
application for MassHealth online at
www.MAHealthConnector.org or by
telephone must be identity proofed pursuant to
130
CMR 502.001(A)(3).
Eligibility based on an online or telephonic application cannot be determined
until the identity is proven or a paper application is submitted.
(b) If an applicant submits a paper
application or applies in person at a MassHealth Enrollment Center, identity
proofing is not required.
(3)
Identity Proofing
Process. An individual or their authorized representative, if
applicable, completing an online or telephonic application will be asked a
series of questions to prove their identity.
(a) If the individual is successfully
identity proofed, the application may be submitted and an eligibility
determination will be performed.
(b) If the individual is not successfully
identity proofed, the individual will be asked to provide one or two forms of
acceptable documentation proving their identity.
(c) When identity proof is received, an
individual can submit an application and the eligibility process commences. The
MassHealth agency will determine
1. the
coverage type providing the most comprehensive medical benefits for which the
applicant is eligible and the application is considered submitted on the date
of successful identity proofing; and
2. the need to request any corroborative
information necessary to determine eligibility, as provided in
130
CMR 502.001(B) through
(D).
(d) If identity proof is not received, the
MassHealth agency is unable to determine eligibility for medical
benefits.
(e) To prove their
identity, an individual can submit the acceptable proofs of identity as
described in
130
CMR 504.005(A)(1):
Acceptable Proof of U.S. Citizenship and Identity or
130
CMR 504.005(A)(3):
Acceptable Proof of Identity.
(4)
Paper Applications or
In-person Applications at the MEC Containing Missing or Inconsistent
Information.
(a) If a paper
application is received at a MassHealth Enrollment Center or a MassHealth
outreach site and the applicant did not answer all required questions on the
application or if the application is unsigned, the MassHealth agency is unable
to determine the applicant's eligibility for MassHealth.
(b) The MassHealth agency requests responses
to all of the unanswered questions necessary to determine eligibility. The
MassHealth agency must receive such information within 15 days of the date of
the request for the information.
(c) If responses to all unanswered questions
necessary to determine eligibility are received within 15 days of the date of
the request referenced in
130
CMR 502.001(A)(4)(b), the
eligibility process commences. The MassHealth agency will determine
1. the coverage type providing the most
comprehensive medical benefits for which the applicant is eligible, and the
application is considered submitted on the date the initial incomplete
application was received by the MassHealth agency; or
2. the need to request any corroborative
information during the provisional eligibility period necessary to determine
eligibility, as provided in
130
CMR 502.001(B) through
(D).
(d) If responses to all unanswered questions
necessary for determining eligibility are not received within the 15-day period
referenced in
130
CMR 502.001(A)(4)(b), the
MassHealth agency notifies the applicant that it is unable to determine
eligibility for medical benefits. The date that the incomplete application was
received will not be used in any subsequent eligibility determinations. If the
required response is received after the 15-day period, the eligibility process
commences and the application is considered submitted on the date the response
is received. Notwithstanding the foregoing, if the required response is
submitted more than one year after the initial incomplete application, a new
application must be completed.
(e)
Inconsistent answers are treated as unanswered.
(B)
Corroborative
Information. The MassHealth agency requests all corroborative
information necessary to verify eligibility. The applicant must supply such
information within 90 days of the receipt of the Request for Information
Notice, as described at
130
CMR 502.003(C).
(C)
Corroborative Information
Received. If all necessary information is received within 90 days
of the receipt of the Request for Information Notice, as described at
130
CMR 502.003(C), the
MassHealth agency will determine the most comprehensive medical benefits for
which the applicant is eligible.
(D)
Corroborative Information Not
Received. If the necessary information is not received within 90
days of the receipt of the Request for Information Notice, as described at
130
CMR 502.003(C), with the
exception of the individuals described at
130
CMR 502.001(D)(1) through
(4), the MassHealth agency will attempt to
redetermine eligibility using electronic data sources, if available, but if
such information is not available from these sources, the applicant's
MassHealth benefits will be denied or terminated, as described in
130
CMR 502.003(D)(2). The
MassHealth agency will notify the applicant accordingly.
(1) If the only necessary information not
received within the provisional eligibility period referenced in
130
CMR 502.003(E) is
verification of breast or cervical cancer, the individual will not be
considered as an individual with breast or cervical cancer and will be
determined for the most comprehensive coverage for which the individual
qualifies without this factor.
(2)
If the only necessary information not received within the provisional
eligibility period referenced in
130
CMR 502.003(E) is
verification of HIV-positive status, the individual will not be considered as
an individual with HIV-positive status and will be determined for the most
comprehensive coverage for which the individual qualifies without this
factor.
(3) If the only necessary
information not received within the provisional eligibility period referenced
in 130 CMR
502.003(E) is verification
of disability status, the individual will not be considered a disabled
individual and will be determined for the most comprehensive coverage for which
the individual qualifies without this factor.
(4) If immigration status information is not
received within the reasonable opportunity period referenced in
130
CMR 502.003(F) and the
immigration status cannot be verified using electronic data sources, the
individual's eligibility will be determined as an "other noncitizen" as
described in
130
CMR 504.003(D):
Other Noncitizens.
