Application for Benefits

(A) Filing an Application. To apply for MassHealth, a person or their authorized representative must file an application online atwww.mahix.org, complete a paper application, complete a telephone application, or apply in person at a MassHealth Enrollment Center (MEC). (1) Date of Application. (a) The date of application for an online, telephone, or in-person application is the date the application is submitted to the MassHealth agency. (b) The date of application for a paper application that is either mailed or faxed is the date the application is received by the MassHealth agency. (2) Online or Telephone Application Requirements. (a) People, or their authorized representative, if applicable, completing an application for MassHealth online at www.mahix.org or by telephone must be identity proofed pursuant to 130 CMR 502.001(A)(3). Eligibility based on an online or telephone application cannot be determined until the identity is proven or a paper application is submitted. (b) If an applicant submits a paper application or applies in person at a MEC, identity proofing is not required. (3) Identity Proofing Process. A person or their authorized representative, if applicable, completing an online or telephone application will be asked a series of questions to prove their identity. (a) If the individual is successfully identity proofed, the application may be submitted and an eligibility determination will be performed. (b) If the individual is not successfully identity proofed, the individual will be asked to provide one or two forms of acceptable documentation proving their identity. (c) When identity proof is received, an individual can submit an application and the eligibility process begins. The MassHealth agency will determine 1. the coverage type providing the most comprehensive medical benefits for which the applicant is eligible and the application is considered submitted on the date of successful identity proofing; and 2. the need to request any corroborative information necessary to determine eligibility, as provided in 130 CMR 502.001(B) through (D). (d) If identity proof is not received, the MassHealth agency is unable to determine eligibility for medical benefits. (e) To prove their identity, a person can submit the acceptable proofs of identity as described in 130 CMR 504.005(A)(1): Acceptable Proof of U.S. Citizenship and Identity or 130 CMR 504.005(A)(3): Acceptable Proof of Identity. (4) Paper Applications or In-person Applications at the MEC Containing Missing or Inconsistent Information. (a) If a paper application is received at a MEC or a MassHealth outreach site and the applicant did not answer all the required questions or if the application is unsigned, the MassHealth agency is unable to determine the applicant’s eligibility for MassHealth. (b) The MassHealth agency requests responses to all the unanswered questions necessary to determine eligibility. The MassHealth agency must receive such information within 15 days of the date of the request for the information. (c) If responses to all unanswered questions necessary to determine eligibility are received within 15 days of the date of the request referenced in 130 CMR 502.001(A)(4)(b), the eligibility process begins. The MassHealth agency will determine 1. the coverage type providing the most comprehensive medical benefits for which the applicant is eligible, and the application is considered submitted on the date the initial incomplete application was received by the MassHealth agency; or 2. the need to request any corroborative information during the provisional eligibility period necessary to determine eligibility, as provided in 130 CMR 502.001(B) through (D). (d) If responses to all unanswered questions necessary for determining eligibility are not received within the 15-day period referenced in 130 CMR 502.001(A)(4)(b), the MassHealth agency notifies the applicant that it is unable to determine eligibility for medical benefits. The date that the incomplete application was received will not be used in any subsequent eligibility determinations. If the required response is received after the 15-day period, the eligibility process begins and the application is considered submitted on the date the response is received. Although, if the required response is submitted more than one year after the initial incomplete application, a new application must be completed. (e) Inconsistent answers are treated as unanswered. (B) Corroborative Information. The MassHealth agency requests all corroborative information necessary to verify eligibility. The applicant must supply such information within 90 days of the receipt of the Request for Information Notice, as described at 130 CMR 502.003(C). (C) Corroborative Information Received. If all necessary information is received within 90 days of the receipt of the Request for Information Notice, as described at 130 CMR 502.003(C), the MassHealth agency will determine the most comprehensive medical benefits for which the applicant is eligible. (D) Corroborative Information Not Received. If the necessary information is not received within 90 days of the receipt of the Request for Information Notice, as described at 130 CMR 502.003(C), with the exception of the individuals described at 130 CMR 502.001(D)(1) through (4), the MassHealth agency will attempt to redetermine eligibility using electronic data sources, if available, but if such information is not available from these sources, the applicant’s MassHealth benefits will be denied or terminated, as described in 130 CMR 502.003(D)(2). The MassHealth agency will notify the applicant accordingly. (1) If the only necessary information not received within the provisional eligibility period referenced in 130 CMR 502.003(E) is verification of breast or cervical cancer, the individual will not be considered as an individual with breast or cervical cancer and will be determined for the most comprehensive coverage for which the individual qualifies without this factor. (2) If the only necessary information not received within the provisional eligibility period referenced in 130 CMR 502.003(E) is verification of HIV-positive status, the individual will not be considered as an individual with HIV-positive status and will be determined for the most comprehensive coverage for which the individual qualifies without this factor. (3) If the only necessary information not received within the provisional eligibility period referenced in 130 CMR 502.003(E) is verification of disability status, the individual will not be considered a disabled individual and will be determined for the most comprehensive coverage for which the individual qualifies without this factor. (4) If immigration status information is not received within the reasonable opportunity period referenced in 130 CMR 502.003(F) and the immigration status cannot be verified using electronic data sources, the individual’s eligibility will be determined as an “other noncitizen” as described in 130 CMR 504.003(D): Other Noncitizens.