109 APPLICATION PROCESS SR 98-36, 08/98 (FAM-A)

Any individual has the right to apply for assistance and to have an eligibility decision made on the application. Application is made on Form 800, Application.

Exception: Application for medical coverage as a poverty level pregnant woman (PLP) or for KidsCare PLUS is made on Form 800P, Application for Medical Assistance for Low Income Pregnant Women and Children, provided the client does not want to apply for other Division of Family Assistance (DFA) case programs. If the client wishes to apply for additional case programs, Application Form 800 is used to apply for all programs being requested.

An individual may request an application by contacting any District Office.

·   Give Form 800, Application, to anyone requesting it.

·   Give Form 800P, Application for Medical Assistance for Low Income Pregnant Women and Children, to clients who want to apply only for PLP or KidsCare PLUS. Prior to giving or mailing Form 800P to the client, advise the client of the availability of other DFA case programs. If the client chooses to use Form 800P, offer the client the opportunity for a personal interview, and provide the client with a clear explanation of the application process and verification requirements associated with Form 800P.

·   If the individual contacts the District Office by telephone or mail and does not want to come to the office to file an application on the same day, mail Form 800 or Form 800P to the individual on the same day the request is received.

Households may apply for Medical Assistance for Poverty Level Pregnant Women or for KidsCare PLUS at the District Office, at participating local health facilities, contract agency clinics funded by the Department of Public Health Services, and other participating agencies or organizations. Participating providers will furnish and accept Form 800P, Application for Medical Assistance for Low Income Pregnant Women and Children, on site.