Current through Bulletin 2024-06, March 15, 2024
(1) The
Department shall comply with the requirements in
42
CFR 435.907, concerning the application for
medical assistance.
(a) The applicant or
authorized representative must complete and sign the application under penalty
of perjury. If an applicant cannot write, the applicant must mark on the
application form and have at least one witness to the signature.
(i) An electronic signature is legal in
accordance with Section
46-4-201.
(ii) An electronic signature must be
retrievable as evidence of the individual's case record.
(b) A representative may apply on behalf of
an individual. A representative may be a legal guardian, a person holding a
power of attorney, a representative payee or other responsible person acting on
behalf of the individual. In this case, the eligibility agency may send
notices, requests and forms to both the individual and the individual's
representative, or to just the individual's representative. The eligibility
agency may assign someone to act as the authorized representative when the
individual requires help to apply and cannot appoint a
representative.
(c) If the Division
of Child and Family Services (DCFS) has custody of a child and the child is
placed in foster care, DCFS must complete the application. DCFS determines
eligibility for the child pursuant to a written agreement with the Department.
DCFS also determines eligibility for children placed under a subsidized
adoption agreement. The Department does not require an application for Title
IV-E eligible children.
(2) The application date for medical
assistance is the date the eligibility agency receives the application during
normal business hours on a week day that does not include Saturday, Sunday, or
a state holiday except as described in Subsection (2):
(a) When the individual applies through the
federally facilitated marketplace (FFM) and the application is transferred from
the FFM for a Medicaid eligibility determination, the date of application is
the date the individual applies through the FFM;
(b) If the application is delivered to the
eligibility agency after the close of business, the date of application is the
next business day;
(c) If the
applicant delivers the application to an outreach location during normal
business hours, the date of application is that business day when outreach
staff is available to receive the application. If the applicant delivers the
application to an outreach location on a non-business day or after normal
business hours, the date of application is the last business day that a staff
person from the eligibility agency is available at the outreach location to
receive or pick up the application;
(d) When the eligibility agency receives
application data transmitted from the Social Security Administration (SSA)
pursuant to the requirements of
42
U.S.C. Sec. 1320b-14(c), the
eligibility agency shall use the date that the individual submits the
application for the low-income subsidy to the SSA as the application date for
Medicare cost -sharing programs. The application processing period for the
transmitted data begins on the date the eligibility agency receives the
transmitted data. The transmitted data meets the signature requirements for
applications for Medicare cost -sharing programs;
(e) If an application is filed through the
"myCase" system, the date of application is the date the application is
submitted to the eligibility agency online.
(3) The eligibility agency shall accept a
signed application that an applicant sends by facsimile as a valid
application.
(4) If an applicant
submits an unsigned or incomplete application form to the eligibility agency,
the eligibility agency shall notify the applicant to sign and complete the
application no later than the last day of the application processing period.
The eligibility agency shall send a signature page to the applicant and give
the applicant at least 10 days to sign and return the signature page. When the
application is incomplete, the eligibility agency shall notify the applicant of
the need to complete the application and offer ways to complete the
application.
(a) The date of application for
an incomplete or unsigned application form is the date the eligibility agency
receives the application if the agency receives a signed signature page and
completed application within the application processing period.
(b) If the eligibility agency does not
receive a signed signature page and completed application form within the
application processing period, the application is void and the eligibility
agency shall send a denial notice to the applicant.
(c) If the eligibility agency receives a
signed signature page and completed application within 30 calendar days after
the notice of denial date, the date of receipt is the new application date and
the Subsection (2) applies.
(d) If
the eligibility agency receives a signed signature page and completed
application more than 30 calendar days after it sends the denial notice, the
applicant must reapply by completing and submitting a new application form. The
new application date is determined in accordance with this rule.
(5) The eligibility agency treats
the following situations as a new application without requiring a new
application form. The application date is the day the eligibility agency
receives the request or verification from the recipient. The effective date of
eligibility for these situations depends on the rules for the specific program.
(a) A household with an open medical
assistance case must ask to add a new household member by contacting the
eligibility agency.
(b) The
eligibility agency shall end medical assistance when the recipient fails to
return requested verification, and the recipient must provide requested
verification to the eligibility agency before the end of the calendar month
that follows the closure date. The eligibility agency waives the requirement
for the open enrollment period during that calendar month for programs subject
to open enrollment.
(c) The
eligibility agency shall end a medical assistance program due to an incomplete
review, and the recipient must respond to the review request within the three
calendar months that follow the closure date.
(d) Except for Targeted Adult Medicaid and
Utah's Premium Partnership for Health Insurance (UPP) that are subject to open
enrollment periods, the eligibility agency shall deny an application when the
applicant fails to provide requested verification, but provides requested
verification within 30 calendar days of the denial notice date. The new
application date is the date the eligibility agency receives requested
verification and the retroactive period is based on that date. The eligibility
agency does not act if it receives verification more than 30 calendar days
after it denies the application. The recipient must complete a new application
to reapply for medical assistance.
(e) For Targeted Adult Medicaid and UPP
applicants, the eligibility agency shall deny an application when the applicant
fails to provide requested verification, but provides requested verification
within 30 calendar days of the denial notice date and the eligibility agency
has not stopped the open enrollment period. If the eligibility agency has
stopped enrollment, the applicant must wait for an open enrollment period to
reapply.
(6) For an
individual who applies for and is found ineligible for Medicaid from October 1,
2013, through December 31, 2013, the eligibility agency shall redetermine
eligibility under the policies that become effective January 1, 2014, using the
modified adjusted gross income (MAGI)-based methodology without requiring a new
application.
(a) Medicaid eligibility may
begin no earlier than January 1, 2014, for an individual who becomes eligible
using the MAGI-based methodology.
(b) For applications received on or after
January 1, 2014, the eligibility agency shall apply the MAGI-based methodology
first to determine Medicaid eligibility.
(c) The eligibility agency shall determine
eligibility for other Medicaid programs that do not use MAGI-based methodology
if the individual meets the categorical requirements of these programs, which
may include a medically needy eligibility group for individuals found
ineligible using the MAGI-based methodology.
(7) If a medical assistance case closes for
one or more calendar months, the recipient must complete a new application form
to reapply, except as defined in Subsection
R414-308-6(7).
(8) An individual determined eligible for a
presumptive eligibility period must file an application for medical assistance
with the eligibility agency in accordance with the requirements of Sections
1920, 1920A, and 1920B of the Social Security Act.
(9) The eligibility agency shall process
low-income subsidy application data transmitted from SSA in accordance with
42
U.S.C. Sec. 1320b-14(c) as
an application for Medicare cost -sharing programs. The eligibility agency
shall take appropriate steps to gather the required information and
verification from the applicant to determine the applicant's eligibility.
(a) Data transmitted from SSA is not an
application for Medicaid.
(b) An
individual who wants to apply for Medicaid when contacted for information to
process the application for Medicare cost -sharing programs must complete and
sign a Department-approved application form for medical assistance. The date of
application for Medicaid is the date the eligibility agency receives the
application for Medicaid.