A new application (paper or electronic) is not required when an application was denied and the individual requests the application to be reconsidered, asks for a new application, and/or submits required verification within 60 days of the denial date. See Section 304.16, Where to Find a Form, and Who Does or Does Not Need One.
Example: Application is received on March 15, 20xx. Application processed and denied with appropriate notice on March 29, 20xx. Request for reconsideration is received within 60 days of denial date but no later than May 27, 20xx.
Reminder: A new application is required if there is anyone new who wants to apply for MA or if the application was denied because the applicant(s) was over the income and/or resource limit unless the applicant(s) subsequently provides verification that they were within the allowed income and/or resource limits at the time of denial.
When an individual requests reconsideration and/or submits required documents within 60 days of the denial date, reconsider the denied application. Process it with the paperwork and information that was submitted with the original application, and any information the individual subsequently provided. Also review information available through electronic data sources. See Section 312.6 Verification and Section 378.6 Automated Sources. If eligible, open the MA benefits effective the date of the original application. If retroactive coverage is requested, the original application date is the date used when establishing the retroactive period.
NOTE: If an individual requesting a reconsideration is ineligible for MA based on information and paperwork provided, the CAO must process the benefit for reconsideration in the system, issue an eligibility notice, and generate a referral to the Federally Facilitated Marketplace (FFM) or Children’s Health Insurance Program (CHIP) as applicable.
The CAO may have the individual complete a new application when it would expedite benefit delivery.
Example: A new application may benefit the individual if there are delays in locating or transferring previously completed documents from district to district or from county to county.
NOTE: A household may file an appeal and/or also have an application reconsidered. Filing an appeal does not preclude reconsidering an application. Reconsidering an application does not preclude an appeal.
Although a new application (paper or electronic) is not required, the CAO must register a non-application in e-CIS when the individual requests reconsideration, asks for MA to be opened, asks for a new application, and/or submits required verification.
Although a new application (paper or electronic) is not required, the CAO must register a non-application in eCIS when the individual requests a reconsideration, asks for MA to be opened, asks for a new application, and/or submits required verification.
NOTE: If the individual provides some but not all of the pending information, the CAO must work with the individual in an effort to get the required information.
Updated October 2, 2018, Replacing June 20, 2018