Iowa Code r. 441-86.3 - Application process
(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 (249A).
(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 (514I) 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)
Time 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
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