CABINET FOR HEALTH AND FAMILY SERVICES

Department for Medicaid Services

Division of Policy and Operations

(As Amended at ARRS, February 10, 2014)

 

      907 KAR 20:015. Medicaid right to apply and reapply for individuals whose Medicaid eligibility is not based on a modified adjusted gross income eligibility standard or who are not former foster care individuals.

 

      RELATES TO: KRS 205.520

      STATUTORY AUTHORITY: KRS 116.048, 194A.030(2), 194A.050(1), 205.502(3), 42 C.F.R. 435.906, 435.907, 435.909, 435.911, 435.912, 42 U.S.C. 1396a, b, d, w-3, 1973gg-10[, EO 2004-726]

      NECESSITY, FUNCTION, AND CONFORMITY:[EO 2004-726, effective July 9, 2004, reorganized the Cabinet for Health Services and placed the Department for Medicaid Services and the Medicaid Program under the Cabinet for Health and Family Services.] The Cabinet for Health and Family Services has responsibility to administer the Medicaid Program. KRS 205.520(3) empowers the cabinet, by administrative regulation, to comply with any requirement that may be imposed or opportunity presented by federal law to qualify for federal Medicaid funds[for the provision of medical assistance to Kentucky's indigent citizenry]. KRS 116.048 designates the cabinet to have responsibility for the administration of public assistance programs as a voter registration agency in accordance with 42 U.S.C. 1973gg-10. This administrative regulation establishes the[sets forth] provisions relating to the procedure by which an application for Medicaid coverage is filed, except for individuals for whom a modified adjusted gross income is the Medicaid eligibility income standard or for former foster care individuals between the ages of nineteen (19) and twenty-six (26) years who aged out of foster care while receiving Medicaid coverage, and[. KRS 116.048 designates the cabinet to have responsibility for the administration of public assistance programs as a voter registration agency in accordance with 42 U.S.C. 1973gg-10.][Therefore,][This administrative regulation] establishes the provisions and procedures[sets forth policy and procedure] necessary to provide an eligible Medicaid recipient the opportunity to register, or to decline from registering, to vote.

 

      Section 1. Right to Apply or Reapply. (1) Each individual wishing to do so shall have the opportunity to apply or reapply for Medicaid through the Department for Community Based Services[Social Insurance (DSI)].

      (2)[An individual eligible for TANF, mandatory state supplements, optional state supplements, or SSI benefits][Aid to Families with Dependent Children (AFDC), State Supplementation or Supplemental Security Income (SSI)][through the Social Security Administration shall be eligible for Medicaid without a separate application.

      (3)](a) An individual applying on the basis of age, blindness, or disability shall not be eligible as a medically needy individual, under 907 KAR 20:005[907 KAR 1:011], if the individual’s[his] income and resources are within SSI limits.

      (b) Denial of assistance by the Social Security Administration for SSI for technical reasons shall also be considered a denial for Medicaid benefits.

 

      Section 2. Application Process. (1) An application shall be considered to have been made:

      (a) When the:

      1. [When the] Individual or individual’s authorized[his] representative has signed, under penalty of perjury, the application[form] prescribed by the Department for Community Based Services[DSI] or the Social Security Administration, for SSI benefits;[,] and

      2. [The] Application has been received[at the appropriate office]; or[.]

      (b)[(2)][An application shall also be considered to be made] Based on the date of contact with the Department for Community Based Services[DSI] or the Social Security Administration for SSI benefits, by a person with a physical or mental impairment who needs special accommodation due to the[his] impairment.

      (2)[(3)] If an[the] applicant is unable to come to the office to apply, the applicant[:

      (a)] shall be advised that the applicant may:

      (a) Apply via telephone;[or]

      (b)[he][May] Designate an authorized representative to apply for the applicant using MAP-14, Authorized Representative;[him] or

      (c) Request a home visit to complete the application process.

      (3)[(4)] An[The] applicant may be:

      (a) Assisted by an individual of the applicant’s[his] choice in the application process; and

      (b) [may be] Accompanied by this individual in all contacts with the agency.

      (4)[(5)] Deaf and hard of hearing services shall be provided in accordance with 920 KAR 1:070[900 KAR 1:070].

      (5)[(6)] Interpreter services shall be provided for persons who do not speak English[, utilizing procedures and forms specified by 920 KAR 1:070][900 KAR 1:070].

 

      Section 3. Who May Sign an Application. (1) An application for Medicaid shall be signed by the individual requesting assistance, the relative with whom the child lives if the applicant is a child, or an authorized representative[, or an interested party acting on behalf of the applicant].

      (2) An application for Medicaid for a child[children] in foster care or for a private child caring facility[institution][institutions] shall be signed by the:

      (a) Representative of the agency to which the child is committed; or

      (b) Representative of the facility[the][Institution] in which the child is placed.

 

      Section 4. [Where Applications are Filed and Processed. (1) An][The][application:

      (a)1. May be filed at any Department for Community Based Services][DSI][office; and

      2. Shall be processed in the county of residence except that any application for SSI benefits and Medicaid shall be filed in the service area office of the Social Security Administration.

      (2) If an individual is applying for nursing facility or psychiatric facility services, the Department for Community Based Services][DSI][office in the county where the facility is located shall take and process the application.

      (3) If an individual is applying in a county other than the county of residence and is hospitalized, the Department for Community Based Services][DSI][office in the county of:

      (a) Hospitalization shall take the application and transfer the pending application to the county of residence; and

      (b)][, and the DSI office in the county of][Residence shall process the application using the original application date.

      (4)(a) If an individual is applying in a county other than the county of residence and is not hospitalized, the Department for Community Based Services][DSI][office in the receiving county shall:

      1. Partially complete the application;

      2.][,][Transfer the application to the county of residence on the same day the application is taken; and

      3.][, and][Explain to the applicant that the application shall be processed in the county of residence.

      (b) The Department for Community Based Services][DSI]

[office in the county of residence shall:

      1. Schedule a face-to-face interview; and

      2. Process the application using the original application date.

      (5)(a) If a Kentucky resident is temporarily out of state, a letter from the applicant, an interested party, or an out-of-state agency shall be accepted as the initiation of the application process when:

      1. An emergency arises from accident or sudden illness;

      2.][,][Care and services are needed immediately;][,][and

      3. The individual's health would be endangered if the individual][he][undertook to return to the state.

      (b) Upon notification of the emergency, the official application form shall be forwarded to the initiating party.

 

      Section 5.] Action on Applications. (1)(a) A decision shall be made on each Medicaid application within forty-five (45) days, except[that] for an application[applications] requiring a disability determination.

      (b) An application requiring a disability determination shall be made within[,] sixty (60) days[shall be allowed].

      (2) An exception to the timeframes referenced in subsection (1) of this section shall be made if the[Time frame exceptions]:

      (a)[If the] Applicant is cooperating but is unable to obtain necessary verification for an eligibility decision to be made; or

      (b)[If the] Delay is beyond the control of staff (such as failure or delay on the part of the applicant or examining physician or because of some administrative or other emergency that could not be controlled by staff).

      (3) A[The] case record shall document the cause for the[time standard] delay.

      (4) Failure to process an application within the[above] time frames referenced in this section[frame] shall not be used as the basis for denial.

 

      Section 5.[6.] Voter Registration. (1) An applicant or recipient [meeting all of the following criteria] shall be provided the opportunity at the local Department for Community Based Services[Social Insurance] office to complete an application to register to vote or update the applicant’s or recipient’s[his] current voter registration if the applicant or recipient is:

      (a)[Be] Age eighteen (18) years or over;

      (b)[Be] Present in the office at the time of the interview or when[if] a change of address is reported; and

      (c) Not[be] registered to vote or not registered to vote at the applicant’s or recipient’s[his] current address.

      (2) PAFS-706, Voter Registration Rights and Declination, shall be utilized to document an applicant or recipient's choice to:

      (a) Register to vote;

      (b) Not register to vote; or

      (c) Indicate that the applicant or recipient is currently registered to vote.

      (3) The following individuals shall not be permitted to register to vote by the process established in this administrative regulation:

      (a) An individual not included in the Medicaid application;

      (b) A Medicaid payee only;

      (c) An authorized representative of a Medicaid recipient; or

      (d) An individual acting as a responsible party.

      (4)[(3)] An individual providing voter registration services who seeks to unlawfully influence an applicant's political preference or party registration as prohibited by KRS 116.048(4) shall be subject to a penalty or penalties pursuant to KRS 116.995[may][could][be fined or imprisoned, not to exceed five (5) years, or both].

      (5)[(4)] Forms and information utilized in the voter registration process shall:

      (a) Remain confidential; and

      (b) Be used only for voter registration purposes.

      (6)[(5)] Only Board of Elections officials may view forms and information utilized directly in the voter registration process.

      (7)[(6)](a) Completion of the voter registration form is [only] an application to apply to register to vote.

      (b) The State Board of Elections shall:

      1. Approve or deny the application to register to vote; and

      b. Send a confirmation or denial notice to the applicant.

 

      Section 6.[7.] Applicability.[(1)] The provisions and requirements of this administrative regulation shall:

      (1)[(a)] Apply to:

      (a)[1.] Children in foster care;

      (b)[2.] Aged, blind, or disabled individuals; and

      (c)[3.] Individuals who receive supplemental security income benefits; and

      (2)[(b)] Not apply to individuals[:

      1.] whose Medicaid eligibility is determined:

      (a) Using the modified adjusted gross income standard pursuant to 907 KAR 20:100; or

      (b) Pursuant to 907 KAR 20:075[2. Between the ages of nineteen (19) and twenty-six (26) years who formerly were in foster care and were receiving Medicaid benefits at the time that they aged out of foster care.

      (2) An individual whose Medicaid eligibility is determined using a modified adjusted gross income as the eligibility standard shall be an individual who is:

      (a) A child under the age of nineteen (19) years, excluding children in foster care;

      (b) A caretaker relative with income up to 133 percent of the federal poverty level;

      (c) A pregnant woman, with income up to 185 percent of the federal poverty level, including the postpartum period up to sixty (60) days after delivery;

      (d) An adult under age sixty-five (65) with income up to 133 percent of the federal poverty level who:

      1. Does not have a dependent child under the age of nineteen (19) years; and

      2. Is not otherwise eligible for Medicaid benefits; or

      (e) A targeted low income child with income up to 150 percent of the federal poverty level][Materials Incorporated by Reference. (1) Forms necessary for application for benefits under the Medicaid Program are incorporated effective April 1, 1995. These forms include the PA-1, revised October 1992; PA-1A, revised March 1991; PA-1C, revised October 1991; PA-1P, revised April 1992; PA-1UP, revised May 1991; and the KIM-100, revised March 1994.

      (2) These forms may be reviewed at the Department for Medicaid Services, 275 East Main Street, Frankfort, Kentucky 40621. Office hours are 8 a.m. to 4:30 p.m. Copies may be obtained upon payment of an appropriate fee which shall not exceed approximate cost].

 

      Section 7. Incorporation by Reference. (1) The following material is incorporated by reference:

      (a) “Authorized Representative”, MAP 14, 1/09; and

      (b) PAFS-706, “Voter Registration Rights and Declination”, 8/10.

      (2) This material may be inspected, copied, or obtained, subject to applicable copyright law at the Department for Medicaid Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m.

 

LAWRENCE KISSNER, Commissioner

AUDREY TAYSE HAYNES, Secretary

      APPROVED BY AGENCY: January 13, 2014

      FILED WITH LRC: January 14, 2014 at 1 p.m.

      CONTACT PERSON: Tricia Orme, Office of Legal Services, 275 East Main Street 5 W-B, Frankfort, Kentucky 40601, phone (502) 564-7905, fax (502) 564-7573, email tricia.orme@ky.gov.