Iowa Admin. Code r. 441-86.3 - Application process

Current through Register Vol. 44, No. 12, December 15, 2021

(1) Who may apply. Each person wishing to do so shall have the opportunity to apply for the hawki program in accordance with rule 441-76.1 (249A).
(2) Applications. An application for the hawki program shall be filed in accordance with rule 441-76.1 (249 A).
(3) Place of filing. An application for the hawki program may be filed with the department through an Internet website, by telephone, through other electronic means, or through an exchange, disproportionate share hospital, federally qualified health center, or other facility in which outstationing activities are provided.
(4) Date and method of filing. The application is considered filed when received in accordance with rule 441- 76.1(249A).
(5) Right to withdraw application. After an application has been filed, the applicant may withdraw the application at any time prior to the eligibility determination. Requests for voluntary withdrawal of the application shall be documented, and the applicant shall be sent a notice of decision confirming the request.
(6) Application not required.
a. An application shall not be required when a child becomes ineligible for Medicaid.
b. A new application shall not be required when an eligible child is added to an existing hawki eligible group.
c. A new application shall not be required when a child moves between supplemental dental-only coverage as specified in rule 441-86.20(5141) and full medical and dental coverage.
(7) Information and verification procedure. The decision with respect to eligibility shall be based primarily on information furnished by the applicant, enrollee, or person acting on behalf of the applicant or enrollee and verified through electronic data matches whenever possible.
a. The applicant, enrollee, or person acting on behalf of the applicant or enrollee shall be notified in writing of additional information or verification that is required to establish eligibility. The notice may be provided personally, by U.S. mail, by email, or by facsimile.
b. Failure to supply the information or verification or refusal to authorize the department to secure the information shall serve as a basis for rejection of the application or cancellation of coverage. If the requested information or authorization is received within 14 calendar days of the notice of decision on an application or within 14 calendar days of the effective date of cancellation for enrollees, the information or authorization shall be acted upon as though it had been provided timely. If the fourteenth calendar day falls on a weekend or state holiday, the applicant or enrollee shall have until the next business day to provide the information.
c. The applicant, enrollee, or person acting on behalf of the applicant or enrollee shall have 10 working days to supply the information or verification requested. The due date may be extended for a reasonable period when the applicant, enrollee, or person acting on behalf of the applicant or enrollee is making every effort but is unable to secure the required information or verification from a third party.
(8) lime limit for decision. Decisions regarding the applicant's eligibility to participate in the hawki program shall be made within 45 working days from the date of receiving the completed application and all necessary information and verification unless the application cannot be processed for reasons beyond the control of the department. Day one of the 45-day period starts the first working day following the date of receipt of a completed application and all necessary information and verification.
(9) Applicant cooperation. An applicant must cooperate with the department in the application process, which may include providing verification or signing documents. Failure to cooperate with the application process shall serve as basis for a denial of the application.
(10) Waiting lists. When the department has established that all of the funds appropriated for this program are obligated, all subsequent applications for hawki coverage shall be denied unless Medicaid eligibility exists.
a. The department shall mail a notice of decision to the applicant that states:
(1) The applicant meets the eligibility requirements but that no funds are available and that the applicant will be placed on a waiting list, or
(2) The applicant does not meet eligibility requirements, in which case the applicant shall not be put on a waiting list.
b. Prior to an applicant's being denied or placed on the waiting list, it must be established that the child is not eligible for Medicaid.
c. Applicants shall be placed on the waiting list on the basis of the date an identifiable application form specified in rule 441-76.1 (249A) is received.
(1) In the event that more than one application is received on the same day, applicants shall be placed on the waiting list on the basis of the day of the month of the oldest child's birthday, the lowest number being first on the list.
(2) Any subsequent ties shall be determined by the month of birth of the oldest child, January being month one and the lowest number.
d. If funds become available, applicants shall be selected from the waiting list based on the order in which their names appear on the list and shall be notified of their selection.
e. After being notified of the availability of funding, the applicant shall have 15 working days to confirm the applicant's continued interest in applying for the program and to provide any information necessary to establish eligibility. If the applicant does not confirm continued interest in applying for the program and does not provide any additional information necessary to establish eligibility within 15 working days, the applicant's name shall be deleted from the waiting list and the next applicant on the waiting list shall be contacted.

Notes

Iowa Admin. Code r. 441-86.3
ARC 8580B, IAB 3/10/10, effective 3/1/10; ARC 9083B, IAB 9/22/10, effective 9/1/10; ARC 0552C, IAB 1/9/2013, effective 4/1/2013; ARC 0837C, IAB 7/24/2013, effective 10/1/2013 Amended by IAB November 20, 2019/Volume XLII, Number 11, effective 12/25/2019 Amended by IAB August 12, 2020/Volume XLIII, Number 4, effective 12/1/2020

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