Appendix D: Procedures for Sending COMPASS Letters (Attachments D1 to D4)

The COMPASS application is considered a valid application without the signed “signature page”. However, applicants are required to provide the signed signature page and all required documentation prior to the determination of eligibility. The only exception is that E-Signature applications do not require the receipt of a signed signature page.

Attachments to this appendix include the four form letters to applicants informing them of the requirement to provide the necessary information for an eligibility determination or the interview time. The proposed use for each letter is as follows:

The CAO will mail this letter and applicable enclosures to applicants that specify they do not have a printer and have selected programs for which a face-to-face interview is required. Applicable enclosures include a copy of the complete COMPASS application and two signature pages.

The CAO will mail this letter to applicants for health care benefits who have not submitted the signed signature page or the required documentation within ten days of the receipt of the COMPASS application.

The CAO will mail this letter and applicable enclosures to applicants for health care benefits that specify they do not have a printer. Applicable enclosures include a copy of the complete COMPASS application and two signature pages.

The CAO will mail this letter and applicable enclosures to applicants that specify they do not have a printer and have selected programs for which a face-to-face interview is required. Applicable enclosures include a copy of the complete COMPASS application and two signature pages. This specific letter is designed for applicants for health care benefits that require a face-to-face interview.

Attachment D1 (Interview Required)

(CAO Letterhead)

(Date)

(Applicant’s Name)
(Street Address)
(City, State, ZIP Code)

Dear (name)

We have received your COMPASS application for benefits for the following individuals:

(List individual family (household) members)

Enclosed is a copy of the complete application and two “signature pages” that were submitted. Please review the application and return the signed “signature page” and the requested documentation, as listed on this page, to our office at the time of your interview. Your interview is scheduled for _______________________ AT ________________.

If you have any questions, please contact me at (CAO telephone number).

Sincerely,

(CAO caseworker’s signature)

(cao caseworker’s name)

Enclosures

Attachment D2 (Medical Assistance No Interview)

(CAO Letterhead)

(Date)

(Applicant’s Name)
(Street Address)
(City, State, ZIP Code)

Dear (name)

We have received your COMPASS application for health care benefits for the following individuals:

(List individual family (household) members)

We have not received your application “signature page” or any of the required information. This documentation is needed for a determination of Medical Assistance eligibility. Once we receive the information (the signed “signature page” and the required documentation) you will be notified regarding eligibility for Medical Assistance for each household member listed above.

If you have any questions, please contact me at (CAO telephone number).

Sincerely,

(CAO caseworker’s signature)

(CAO caseworker’s name)

Attachment D3 (Medical Assistance No Interview)

(CAO Letterhead)

(Date)

(Applicant’s Name)
(Street Address)
(City, State, ZIP Code)

Dear (name)

We have received your COMPASS application for health care benefits for the following individuals:

(List individual family (household) members)

Enclosed is a copy of the complete application and two “signature pages” that were submitted. Please review the application and return the signed “signature page” and the requested documentation, as listed on this page, to our office within 10 days. This documentation is needed for a determination of Medical Assistance eligibility. Once we receive the information (the signed “signature page” and the required documentation) you will be notified regarding eligibility for Medical Assistance for each household member listed above.

If you have any questions, please contact me at (CAO telephone number).

Sincerely,

(CAO caseworker’s signature)

(CAO caseworker’s name)

Enclosures

Attachment D4 (Interview Required)

(CAO Letterhead)

(Date)

(Applicant’s Name)
(Street Address)
(City, State, ZIP Code)

Dear (name)

We have received your COMPASS application for benefits for the following individuals:

(List individual family (household) members)

We have not received your application “signature page” or any of the required information. This documentation is needed for a determination of eligibility. Please review the application and return the signed “signature page” and the requested documentation, as listed on this page, to our office at the time of your interview. Your interview is scheduled for _______________________ at ________________.

If you have any questions, please contact me at (CAO telephone number).

Sincerely,

(CAO caseworker’s signature)

(CAO caseworker’s name)

Updated February 14, 2012, Replacing June 27, 2008