109.01 Filing an Application SR 13-06, 10/13 (MAM-A)

The official Filing Date for applications is the date when the application is completed and received by the District Office (DO), if the completed application is received by the DO during business hours on a day that the DO is open for business. If received after hours or on a day when the DO is closed for business, the official filing date of the application is the next day the DO is open for business.

Applications can be submitted:

• online via the NH EASY website;

• in-person at the District Office; or

• via mail.

If required by the program, personal eligibility interviews are in person at the District Office or, if approved by the District Office Supervisor, by telephone.

Exception: Applications made using DFA Form 800P, Application for Children’s Medicaid (CM) and Medical Coverage for Pregnant Women (MCPW), or DFA Form 800MA, Application for Health Coverage & Help Paying Costs, may be submitted by mail, and no interview is required.

A completed application must, at minimum, contain the applicant’s:

• name;

• address; and

• signature, or the signature of an authorized representative acting on behalf of the applicant.

Individuals have the right to file an application on the same day they contact the District Office.

Exceptions:

• When a resident of an institution applies for assistance prior to leaving the institution, the filing date of the application is the date the applicant is released from the institution.

• For individuals applying for medical assistance at New Hampshire Hospital or any federally qualified health clinic or other agency or outreach site authorized to assist individuals with filing an application, the time frames begin from the date the application is filed at the facility.

Support Staff Process

Direct individuals to the NH EASY website or the DHHS website to apply for assistance, or provide the individual with DFA Form 800, Application for Assistance, upon request. If the paper DFA Form 800 is provided:

• Assist the applicant in completing the form, if requested.

• When the individual returns the application, review to ensure the application is complete as described above, and then date stamp the application.

• Complete the "Agency Use Only" section on the back of the first page (the Coversheet) of the DFA Form 800, indicating the date the application was received.

• Review the application for eligibility for expedited Food Stamp benefits. All individuals potentially eligible for expedited Food Stamp benefits are interviewed on the same day that the application is filed. If the applicant cannot be interviewed on the date of application, schedule a personal or phone interview for the next business day or when it is otherwise convenient for the applicant.

• For all other individuals, schedule the individual for an eligibility interview by completing Client Registration (CR) in New HEIGHTS and using the "Schedule Individuals" screen. Do not initiate or print Form 800H, also known as the HAF, at the conclusion of CR. Write a note on DFA Form 797, Eligibility Narrative, to notify the FSS that CR has been completed.

• Give the DFA Form 800 Coversheet plus New HEIGHTS-generated letter CS0002, Schedule Initial Interview, DFA Form 800A, DFA Program and Services Guide, and all other applicable forms to the individual.

• Create an electronic case file for the individual.

Filing of an Application Received in the Wrong DO

If an application is mailed to the wrong District Office (DO), date stamp it and forward it to the appropriate DO on the same day that it was received, unless it meets the criteria for expedited Food Stamp benefits. If information on the application indicates the household is eligible for expedited benefits, process the Food Stamp portion of the application immediately.

If an individual contacts the wrong DO, give the individual the address and telephone number of the correct DO, and offer the individual the opportunity to complete an application that same day.

If the individual hand-delivers an application to the wrong DO, schedule an appointment for the correct DO and forward the application to that office. Give the individual the address and telephone number of the correct DO, with the CS0002 indicating the time of the individual’s appointment in the correct office.

Special Procedures for Applications Filed by Mail

Once a mailed DFA Form 800 is received in the DO, support staff review all the information on the application and complete the "agency staff only" boxes on the application. Most applicants will then be scheduled for the next available interview appointment. However, the following applications are not immediately scheduled for an interview:

• applications containing information indicating potential eligibility for Expedited Food Stamp benefits. These applications are given to the Supervisor for review once the support staff determines potential eligibility. If the Supervisor confirms the potential eligibility, support staff calls the applicant to schedule an interview for the next business day, or another day convenient to the applicant. If the applicant cannot be reached by phone, an interview is scheduled no sooner than 5 business days from the date of application; and

• applications containing information indicating no potential eligibility for any DFA assistance program or service requested. These applications are given to the Supervisor for review as well. If the Supervisor confirms that there is no potential eligibility for all assistance requested on DFA Form 800, the DFA worker may deny all assistance requested without an interview.

Special Procedures for DFA Form 800MA, Application for Health Coverage & Help Paying Costs

If DFA Form 800MA is mailed or faxed to the individual’s local District Office as opposed to CMU, support staff must review the application to determine if the individual who is applying for health coverage is currently receiving any DFA benefits. Support staff must:

• scan DFA Form 800MA into New HEIGHTS for processing by CMU for applications containing individuals:

- who are not currently receiving any DFA benefits; or

- who are currently only receiving DFA benefits that are normally processed by CMU, such as CM, MCPW, or other MAGI-related Medicaid programs that are effective January 1, 2014; or

• retain the applications in-house to be processed at the local District Office, for individuals who are currently receiving DFA benefits, such as Food Stamps or Cash benefits.

Once DFA From 800MA is received at the appropriate location for processing, Support staff must:

• review DFA Form 800MA to ensure the application contains, at minimum, the applicant’s name, address, and signature; and

• create an electronic case file for the individual.

No interview is required to process DFA Form 800MA.