HAR §17-1711.1-20. Purpose

This subchapter describes the application process to determine eligibility for participation in a medical assistance UNOFFICIAL 1711.1-10 program. [Eff 09/30/13] (Auth: HRS §346-14; 42 C.F.R. §§435.906, 435.907) (Imp: HRS §346-14, 42 C.F.R. §§435.906, 435.907) §17-1711.1-21 Filing an application for medical assistance. (a) The application process shall begin when a completed application for medical assistance is received by the department or designee and ends with the department’s issuing an eligibility determination to the applicant. (b) The application shall be used for all insurance affordability programs and may be submitted according to the applicant’s preference by one of the following methods: (1) Via the department’s designated internet web site(s); (2) By telephone; (3) Via the United States Postal Service; (4) In person; and (5) Through other commonly available electronic means. (c) The date an application is received by the department or designee shall be considered the date for a determination of medical assistance. (d) An individual applying for assistance on a basis other than Modified Adjusted Gross Income (MAGI) methodology may be required to provide additional information, as determined by the department, in order to complete an eligibility determination. (e) The department may request a non-applicant’s SSN provided that: (1) The provision of the SSN is voluntary; (2) The SSN is used only to determine an applicant’s eligibility for Medicaid or other insurance affordability program or for a purpose directly connected to the administration of the State plan; and (3) At the time the SSN is requested, the agency notifies and ensures the applicant, or person acting on the applicant’s behalf, understands that the provision of the non- UNOFFICIAL 1711.1-11 applicant’s SSN is voluntary and how the information regarding the SSN will be used. (f) The application shall be signed under penalty of perjury by the applicant, adult included in the household for an applicant who is a minor, authorized representative, or an individual acting on behalf of an incompetent or incapacitated applicant in accordance with this chapter. [Eff 09/30/13] (Auth: HRS §§346-l4, 346-29, 346-53; 42 C.F.R. §435.907) (Imp: HRS §346-29; 42 C.F.R. §435.907) §17-1711.1-22 Application withdrawn or discontinued. (a) An individual may withdraw or discontinue an application in writing, verbally by telephone, in person or through other commonly available electronic means. (b) Requests for application withdrawal shall be documented in the individual’s record and a confirmation notice of withdrawal sent in accordance with chapter 17-1713.1. (c) The department may discontinue an application for medical assistance prior to an eligibility determination for any of the following reasons: (1) Death of the applicant, and: (A) Information provided at the point of application is insufficient to determine eligibility; or (B) No other individual is designated or able to continue the application process on behalf of the deceased; (2) Applicant whereabouts is unknown. (d) In the event an application is discontinued, an appropriate notice shall be sent to confirm the department’s action under the provisions of chapter 17-1713.1. (e) An individual whose application was denied or discontinued and reapplies within ninety days from the date of denial or discontinuation shall be able to: (1) Submit updated or supplemental information UNOFFICIAL 1711.1-12 on the original application form as applicable with a new date of application entered; and (2) The updated application shall be processed in the same manner as a new application. [Eff 09/30/13] (Auth: HRS §§346-14, 346- 29; 42 C.F.R. §§435.907, 435.911, 435.912) (Imp: HRS §346-29; 42 C.F.R. §§435.907, 435.911, 435.912)