109 APPLICATION PROCESS SR 99-26, 06/99 (FAM-A)

Any individual has the right to apply for assistance and to have an eligibility decision made on the application. Individuals have the right to file an application on the same day they contact the District Office. Advise individuals that they may file the application before an interview is conducted.

Application at the District Office for all programs is made on Form 800H, HEIGHTS Application Form, generated at the conclusion of the Client Registration (CR) process. Form 800H contains an official Request for Assistance (RFA) and the official Filing Date of the application.

Exceptions:

• An individual may request and receive paper Form 800, Application, by contacting any District Office. 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 a Form 800 on the same day the request is received.

• Application for medical coverage for the following groups may be made on Form 800P, Application for New Hampshire Healthy Kids Medical Insurance or Medical Coverage for Pregnant Women provided the client does not want to apply for other Division of Family Assistance (DFA) programs.

- MCPW: Medical Coverage for Pregnant Women;

- HKG-185: Healthy Kids-Gold medical coverage for children aged 0-19 with family income no higher than 185% of federal poverty income guidelines,

- HKG-300: Healthy Kids-Gold medical coverage for infants up to age 1 with family income greater than 185%, but no higher than 300%, of federal poverty income guidelines, and

- HKS: Healthy Kids-Silver medical insurance coverage (Department subsidized) for children aged 1-19 with family income greater than 185% but no higher than 300% of federal poverty income guidelines.

 No face to face interview is required. If the client wishes to apply for additional programs of assistance, Forms 800 or 800H are used to apply for all programs being requested, including MCPW, HKG-185, HKG-300, and HKS.

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

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

·   Give Form 800P to clients who want to apply only for MCPW, HKG-185, HKG-300, or HKS. Prior to giving or mailing Form 800P to the client, advise the client of the availability of other DFA 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 MCPW, HKG-185, HKG-300, and HKS at the District Office, participating local health facilities, contract agency clinics funded by the Department of Public Health Services, and other authorized agencies or organizations. Authorized providers will furnish and accept Form 800P on site.