Section 210-RICR-40-00-2.4 - Completing and Submitting the ApplicationA. In general, the process of completing and submitting an application proceeds in accordance with the following: 1. Account Creation - To initiate the application process, a person must create a login and establish an account in the eligibility system. This can be done through the self-service portal by the person alone or with the help of an eligibility specialist or certified assister. a. Identity proofing. The applicant must provide personally identifiable information for the purpose of creating an on-line account as a form of identify proofing during the process of applying for Medicaid. Verification of this information is automated. Documentation proving identity may be required if the automated verification process is unsuccessful. Acceptable forms of identity proof include a driver's license, school registration, voter registration card, etc. Documents may be submitted via mail, fax, on-line upload, or to a DHS Office.b. Account matches. Once identity is verified, account matches are conducted to determine whether the applicant or members of the applicant's household have other accounts or are currently receiving benefits.2. Account Duration - An application account is open for a period of ninety (90) days. Applications may be started at any time. Once started, progress can be saved at any point and the application returned to at a later time. Incomplete applications not submitted within ninety (90) days are automatically deleted in the eligibility system.3. Application Materials - The application materials a person seeking Medicaid coverage must have on hand may vary depending on the application processing flow: a. MAGI-based eligibility. As indicated in §2.6.2 of this Part, applicants who are under sixty-five (65) are generally evaluated first for eligibility in one of the Medicaid Affordable Care Coverage (MACC) groups before being considered for the IHCC groups. The MACC group, MAGI-based application process is explained in greater detail in Medicaid Code of Administrative Rules, Application Process. This eligibility process generally requires applicants to provide information used when filing federal tax forms and/or documents commonly used for identification and income verification purposes.b. SSI-based eligibility. The IHCC application process builds on the MAGI review unless a person is 65 or older. In all cases, self-attestation of income and resources begins the process. To the full extent feasible, electronic data matches are used to verify financial information. Documentation of certain information may be required, however. In addition, when using a paper application, access to certain types of materials may be necessary. (1) Materials that may be of assistance in completing the application include, but are not limited to: (AA) Federal tax filing status(BB) Social Security Numbers(DD) Passport or other immigration numbers(FF) Information about any health coverage available to you or your family, including any information you have about the health insurance your current employer offers even if you are not covered by your employer's insurance plan, Medicare and other forms of coverage(GG) W-2 forms with salary and wage information if you work for an employer(HH) 1099 forms, if you are self-employed.(2) Common types of documentation that may be needed to verify income and resources include the wage and earning and tax forms noted above and: (AA) Copies of checks or receipts for unearned or irregular income(CC) Annuity/retirement fund statements for insurance companies(EE) Stock ownership statements(FF) Copies of life insurance policies(GG) Statements from insurance companies or companies providing annuities(HH) Copies of burial purchase agreements.(3) Common documents that may be required with respect to self-employment income include: (AA) Tax forms such as 1040 Schedule ES (Form 1040), Schedule C or comparable State form or federal return with the "Self-Employment Tax" line completed.(BB) Business records if the applicant has not been self-employed long enough to file taxes, including financial statements, gross receipts and expenses, quarterly reports, certified statement form licensed accountant.(CC) For royalties, honoraria, and stipends, the nature and amount of payments, any Social Security of Medicare withholding, dates of payments and frequency of payments, and/or tax forms above or 1099 MISC and the name of the issuer.(4) Common documents that are required related to health status or disability include: (AA) Authorization to obtain medical and/or health care records, the names and addresses of the treating physicians and other providers, health care bills incurred or paid during the three month retroactive eligibility period, or that remain unpaid from any previous period.4. Application Filing Date - The filing date of an application is the date used to determine when eligibility begins if it is approved. The filing date is not necessarily the date an application is complete, but is typically the date a signed completed application form is submitted through the self-service portal on-line or date-stamped as received by the agency or electronic means if uploaded, mailed, faxed, or scanned or delivered in-person. The filing date may be protected if the application is not complete due to outstanding verifications or required reforms. The timeline the agency must meet for making an eligibility determination does not begin until the date an application is complete, as indicated below, however.5. Application Completeness - An application must be complete before a determination of eligibility can be made. An application is considered complete when all information requested, including any ancillary required forms and authorizations, are date-marked as received by the State. As the timelines for making a determination of eligibility specified in subsection (8) below begin on the date the application is complete, applicants are informed and offered the opportunity to provide any additional documentation or explanations necessary to proceed to the determination of eligibility in a timely manner. Such information is provided to applicants immediately through an electronic notification from the IES when applying on-line either through the consumer self-service portal or with the assistance of an agency representative. In cases in which an agency eligibility specialist or assister is entering information into an applicant's account or scanning a paper application, information about necessary documentation is generated immediately in the on-line account and must be made available as soon as feasible.6. Voluntary Withdrawal - An applicant may request that an application for Medicaid health coverage be withdrawn at any time either through their secure on-line account or by submitting the request in writing via the U.S. mail or fax to the EOHHS or DHS agency representative. The Medicaid agency sends a notice to the applicant verifying the time and date of the voluntary withdrawal and indicating that the applicant may reapply at any time.7. Self-Attestation of Application Information - All questions on the application must be answered in a truthful and accurate manner. Every applicant must attest to the truthfulness and accuracy by signing a paper application in ink or by providing an electronic signature on-line under penalty of perjury. The IES verifies the information electronically to the fullest extent feasible and must verify applicant attestations in accordance with the procedures set forth in the Medicaid Code of Administrative Rules, Application Process and Verification.8. Privacy of Application Information - Application information must only be used to determine eligibility and the types of coverage a person is qualified to receive. Accordingly, the EOHHS, the agencies under its umbrella, and all other entities serving as its agents in the Medicaid eligibility process maintain the privacy and confidentiality of all application information and in the manner required by applicable federal and state laws and regulations.9. Eligibility Determination Timelines - Federal and State law set specific timeliness for making determinations of Medicaid eligibility. The timelines vary in length depending on whether a clinical eligibility determination is required that necessitates a review of information from second parties (e.g., health practitioner or provider) and/or third parties (e.g., insurers). In accordance with R.I. Gen. Laws §40-8.6(b)(2) ( Public Law 16-150), the timeline for determining eligibility begins on the date a completed application, including any required forms and/or authorizations are received by the EOHHS, or its authorized eligibility agents, and ends on the date a notice is sent to the applicant explaining the agency's decision. The EOHHS is responsible for processing applications within these time limits for IHCC group members who have not been deemed or determined eligible on the basis of participation in another federal program (e.g., SSI, DCYF Foster Child, etc.). The timelines are as follows: MACC and IHCC Eligibility Determination Timelines |
Coverage Group | Determination Timeline |
MACC Groups | 30 Days |
Community Medicaid - Elders 65 and over | 30 Days |
Community Medicaid - Adults with Disabilities | 90 Days |
Sherlock Plan | If determination of disability has been made - 30 days If determination of disability or level of care is required - 90 days |
Medically Needy - Persons with Disabilities | 90 Days |
Medically Needy - No Disability | 30 Days |
LTSS | 90 Days |
210 R.I. Code R. 210-RICR-40-00-2.4