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:[
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[
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:
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
has been received[ at the appropriate office]; or[ .]
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]
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;[
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.
(4)] An[ The]
applicant may be:
(a) Assisted by an individual of
his] choice in the application process;
may be] Accompanied
by this individual in all contacts with the agency.
Deaf and hard of hearing services shall be provided in accordance with 920
KAR 1:070[ 900 KAR 1:070].
Interpreter services shall be provided for persons who do not speak English[ ,
utilizing procedures and forms specified by 920 KAR 1:070][ 900
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
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
the][ Institution] in which the child is
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
(2) An exception to the timeframes
referenced in subsection (1) of this section shall be made if the[
If the] Applicant is
cooperating but is unable to obtain necessary verification for an eligibility
decision to be made; or
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).
The] case record
shall document the cause for the[ time standard] delay.
(4) Failure to process an application
above] time frames referenced in this section[ frame]
shall not be used as the basis for denial.
Voter Registration. (1) An applicant or recipient [ meeting all of the following
criteria] 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:
Be] Age eighteen (18) years
Be] Present in the office at
the time of the interview or when[ if] a change of address
is reported; and
be] registered to vote
or not registered to vote at the applicant’s or recipient’s[ his]
(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.
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].
Forms and information utilized in the voter registration process shall:
(a) Remain confidential; and
(b) Be used only for voter registration purposes.
Only Board of Elections officials may view forms and information utilized
directly in the voter registration process.
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.
7.] Applicability.[ (1)]
The provisions and requirements of this administrative regulation shall:
Children in foster care;
Aged, blind, or disabled individuals; and
Individuals who receive supplemental security income benefits; and
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[
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 email@example.com.