109 APPLICATION PROCESS (MAM-A) |
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To complete the application process, the applicant must do all of the following:
. complete an application:
. participate in an eligibility interview if required by the program of assistance requested; and
. provide all required verification within timeframes.
Individuals have the right to:
. apply for assistance;
. file an application on the same day the District Office has been contacted; and
. have an eligibility decision made on their application for assistance.
Individuals can apply for assistance in 4 ways:
. Individuals can apply for assistance by visiting the following websites and completing an application online: www.nheasy.nh.gov or, for Medical Assistance only, www.HealthCare.gov;
. Individuals can print an application from http://www.dhhs.nh.gov/dfa/apply.htm or http://www.dhhs.nh.gov/dfa/forms.htm and mail or fax the completed application to the District Office;
. Individuals can apply over the phone by calling 1-800-852-3345, extension 9700; or
. Individuals can contact a District Office and request an application per the instructions below.
Requesting an Application from a District Office
An individual may request an application by contacting any District Office.
. DFA Form 800, Application for Assistance, is provided to anyone requesting an application.
If the individual contacts the District Office by telephone, fax, or mail, direct the individual to the NH EASY website so that the individual can immediately complete the online application, or notify the individual of the availability of the application on the Department's website, where the DFA Form 800 can be printed off immediately for the individual's use. If the individual does not have access to a computer or the Internet, mail DFA Form 800 to the individual on the same day the request is received.
. DFA Form 800 Insert, Medical Assistance for Children, Pregnant Women, and Parent/Caretaker Relative, is provided to anyone interested in applying for Medical Assistance, along with DFA Form 800.
This insert supplements DFA Form 800 to allow individuals to provide eligibility information that is not already collected on DFA Form 800, but is required for the MAGI-related Medical Assistance (MA) categories and the Federal Facilitated Marketplace (FFM). Information collected on DFA Form 800 Insert will be electronically transferred to the FFM for those individuals who do not qualify for MA. Individuals who do not wish to apply for MA, or do not qualify for MA under a MAGI-related category, are not required to complete DFA Form 800 Insert.
This form must be completed in conjunction with DFA Form 800 to apply for MA under the MAGI-related categories. The applicant's signature on DFA Form 800 indicates that the information obtained on DFA Form 800 Insert is also true and correct to the applicant's best knowledge. If this form is returned without a corresponding DFA Form 800, the individual is not considered to be an applicant for any DFA programs.
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. DFA Form 800MA, Application for Health Coverage & Help Paying Costs, is provided to clients who only want to apply for *MA and other ACA related health coverage options.
Households may also apply for MA * and other ACA related health coverage options by going to https://nheasy.nh.gov/ or www.HealthCare.gov and completing an application online.
No eligibility interview is required for individuals who apply for MA only and are eligible for MA under a MAGI-related category. Individuals who apply for MA and do not qualify as a MAGI-related group may have to participate in an eligibility interview as needed.
Prior to giving or mailing DFA Form 800MA to the applicant, advise the individual of the availability of other DFA programs. If the individual chooses to use DFA Form 800MA, offer the opportunity for a personal interview and provide the applicant with a clear explanation of the application process and verification requirements associated with DFA Form 800MA.
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If the client wishes to apply for additional programs of assistance, such as Food Stamp benefits, cash, or childcare assistance*, DFA Form 800 must be completed and an interview or attendance at the NHEP orientation may be required.
Completing an Application
A completed application must, at minimum, contain the applicant's name, address, and signature.
Application Filing Date
The official Filing Date for applications is the date when the application is completed as described above and received by the District Office. For more information on the application filing date, see Section 109.01, Filing an Application.
Eligibility Interview
Most applicants for non-MAGI medical assistance groups are required to also participate in a detailed interactive Application Entry (AE) eligibility interview with a Family Services Specialist (FSS). MAGI medical assistance applicants are not required to participate in an interview.
Required Verification
All applicants must provide verification, if required by the program, such as proof of:
. eligibility factors and circumstances;
. information related to benefit allotment amount; and
. information the individual provided on the application or to the FSS during the interview.
References: He-W 601.01(n) & (p), He-W 601.03(a), He-W 602.03, RSA 167:8,I, 42 CFR 435.907, 42 CFR 435.911, 42 CFR 435.1200(e), 45 CFR 206:10(a)(1) & (b)(1)-(3)