Ch. 51, § 4. Application Process, Applicant Rights and Responsibilities

(a) Application Process. (i) An applicant shall submit an application in the manner and form prescribed by the Department. The application shall be completed, dated, and signed by the applicant or by any person who is assisting the applicant. (ii) The Department shall act upon an application within forty-five (45) days from the date the application was submitted. (iii) The Department shall notify the applicant in writing of its application determination along with the reasons and regulations supporting its decision. (iv) If the application is denied or not acted upon by the Department within forty-five (45) days, the applicant may request an administrative hearing in accordance with Medicaid Rules Chapter 4. (b) Applicant Rights. (i) An applicant shall be allowed the opportunity to apply for CHIP without delay. (ii) An applicant may be accompanied, assisted, or represented by an individual or individuals of their choice during the application process. (iii) An applicant may request assistance from the Department in completing the application or obtaining required verification. (iv) The Department shall inform applicants of the following information: (A) The eligibility requirements; (B) Available CHIP services; and (C) The rights and responsibilities of applicants and clients. (v) Applications and other personal identifying information are confidential and shall not be disclosed, except as allowed by state and federal law. (vi) An applicant shall not be excluded, denied benefits, or otherwise discriminated against on the grounds of race, color, sex, religion, political belief, national origin, age, or disability. (c) Applicant Responsibilities. (i) Applicants shall cooperate in the process of determining eligibility by providing all information and documentation requested by the Department, (ii) Applicants shall assign to the Department any right to medical support and to payment for medical care from a third party to the extent that CHIP has paid for medical services. (iii) Applicants who fail to cooperate or provide the information requested by the Department shall be denied eligibility. (d) Eligibility Period and Redeterminations. (i) CHIP eligibility begins the first day of the month in which the application was submitted. (ii) Enrolled clients are deemed to be continuously eligible for twelve (12) months from the effective date of eligibility, or for twelve (12) months from the last redermination unless the covered child turns age nineteen (19), enters a public institution, moves out of state, becomes eligible for Medicaid, or requests to be disenrolled. (A) An enrolled client who is pregnant is eligible during the pregnancy and through a twelve (12) month postpartum period beginning on the last day of the pregnancy, even when the client turns age nineteen (19) during this period. (iii) The Department shall re-determine a client's eligibility every twelve (12) months, except for pregnant clients whose eligibility will be re-determined following the client's twelve (12) month postpartum period.