10-144-332 Me. Code R. § 5-4

Current through 2024-51, December 18, 2024

Section 144-332-5-4 - APPLICATION PROCESS

A. An application is the request for medical coverage made by signing and dating an approved application form. The individual or anyone acting on the individual's behalf may sign the application form. The applicant may choose to have another person help them complete the form.

The date of application is the date the signed application form is received in or by any OFI regional office, My Maine Connection, or the State Based Marketplace. My Maine Connection or the State Based Marketplace will forward the application to OFI. Applications must be processed within 45 days of their receipt by the Department. If the applicant is not sent a notice of the eligibility decision within 45 days, temporary coverage will be authorized. (See Part 2 § 12.3.)

All signed applications will be acknowledged in writing. A written eligibility decision will be sent to the applicant.

An application is valid for authorizing coverage starting the month the application is received.

B. When an individual applies for medical coverage, this is considered to be an application for Medicaid and CHIP.

C. Verification of information needed to determine eligibility must be requested initially from the individual. If information is requested from other sources (with the exception of public records) the individual must be informed. If the individual does not give consent for other sources to provide the Department with the requested information, denial or termination must occur. (See Part 2 § 12.1.)

When a decision cannot be made due to inconclusive or conflicting information, the individual will be notified what questions remain and what needs to be resolved. If the Department cannot determine that eligibility exists after contacting the individual or collateral contacts, assistance will be denied or terminated.

10-144 C.M.R. ch. 332, § 5-4