Section 477-3-005 - APPLICATION005.01APPLICATION SUBMITTAL. An application may be submitted by an applicant, an adult member of the applicant's immediate family, an adult member of the applicant's tax household, an authorized representative, or if the applicant is a minor or incapacitated, someone acting responsibly for the applicant. A medical provider may submit an application on behalf of an individual whom the provider is treating if the individual is unconscious or otherwise unable to apply and does not have an existing power of attorney or court-appointed individual to apply on his or her behalf. An application may be signed in writing, by telephonic acknowledgment, or by electronic signature. An application may be submitted in person, by mail, by telephone, by fax, or by electronic submission. An application may be taken on behalf of a deceased person, including a miscarriage or a stillborn. If there is no one to represent a deceased person, the administrator of the estate may sign the application.005.02APPLICATION DATE. An application is considered valid the date it is received by the Department if it contains the applicant's name, address, and proper signature of the applicant or authorized representative.005.03APPLICATION WITH A DESIGNATED PROVIDER. An applicant or authorized representative may apply for Medicaid with a designated outreach provider or entity which has contracted with the Department to accept Medicaid applications at its location.005.04ALTERATIONS. The application, when completed and signed by the applicant or authorized representative, constitutes the applicant's own statement regarding eligibility. Information may be added to an application up to the decision date.005.05WITHDRAWALS. An applicant may voluntarily withdraw an application verbally or in writing, which will be confirmed by the Department sending a Notice of Action to the applicant or authorized representative documenting this voluntary withdrawal.005.06NEW APPLICATION. A new application is required after 90 days of ineligibility.477 Neb. Admin. Code, ch. 3, § 005
Amended effective 3/13/2018Amended effective 7/29/2020Amended effective 9/17/2024