Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 001 - GENERAL; HEALTH BENEFITS ELIGIBILITY AND ENROLLMENT › Chapter 007 - PART SEVEN: ELIGIBILITY-AND-ENROLLMENT PROCEDURES › Section 13 001 007 - PART SEVEN: ELIGIBILITY-AND-ENROLLMENT PROCEDURES

Current through June, 2024
Part Seven
sets forth the application processing
				  and enrollment requirements for health benefits, including verification of
				  eligibility factors, determination of premium assistance amounts, billing and
				  collection of Medicaid premiums, and periodic renewals of eligibility.
51.00 AUTOMATIC ENTITLEMENT TO MEDICAID
				FOLLOWING A DETERMINATION OF ELIGIBILITY UNDER OTHER PROGRAMS [1]
(01/15/2017, GCR 16-100)
A separate application for Medicaid is not required from an
				  individual who receives SSI or AABD.
52.00 APPLICATION [2]
(01/01/2018, GCR 17-048)
52.01. In General.
(01/15/2017, GCR 16-100).
An individual will be afforded the opportunity to apply for
				  health benefits at any time, without delay. [3]
52.02. Application Filing [4].
(01/01/2018, GCR 17-048).
(a)
The
				application.
A single, streamlined application will be used
				to determine eligibility and to collect information necessary for:
(1) Enrollment in a QHP;
(2) APTC;
(3) CSR;
(4) Vermont Premium Reduction;
(5) Vermont Cost Sharing Reduction;
				and
(6) MAGI-based Medicaid. For
				Medicaid categories that are not based on MAGI methodologies, the single,
				streamlined application may be supplemented with a form (or forms) to collect
				additional information, or an appropriate, alternative application may be
				used.
(b)
Filing the application.
AHS will:
(1) Accept the application from an
				application filer; and
(2) Provide
				the tools to file an application:
(i) Via an
				internet website;
(ii) By telephone
				through a call center;
(iii) By
				mail;
(iv) Through other commonly
				available electronic means; and
(v)
				In person.
(c)
Assistance.
[5]AHS will provide
				assistance to any individual seeking help with the application or renewal
				process, in the manner prescribed in §
											5.01.
(d)
Application
				filers.
An application will be accepted from:
(1) The applicant;
(2) An adult who is in the applicant's
				household;
(3) An authorized
				representative; or
(4) If the
				applicant is a minor or incapacitated, someone acting responsibly for the
				applicant.
(e)
Missing information
[6]
(1) The applicant's eligibility for health
				benefits will not be determined before the applicant provides answers to all
				required questions on the application.
(2) If an incomplete application is received,
				the applicant will be sent a request for answers to all of the unanswered
				questions necessary to determine eligibility. The request will include a
				response due date, which will be no earlier than 15 days after the date the
				request is sent to the applicant.
(3) If a full response to the request is
				received on or before the request due date, the eligibility process will be
				activated for determining:
(i) Coverage, based
				on the date the application was originally received; or
(ii) The need to request any corroborative
				information necessary to determine eligibility.
(4) If responses to all unanswered questions
				necessary for determining eligibility are not received by the response due
				date, the applicant will be notified that AHS is unable to determine their
				eligibility for health benefits. The date that the incomplete application was
				received will not be used in any subsequent eligibility
				determinations.
(f)
Limits on information.
[7] An applicant
				will be required to provide only the information necessary to make an
				eligibility determination or for a purpose directly connected to the
				administration of health-benefits programs.
(g)
Information collection
				from non-applicants.
[8] Information regarding citizenship,
				status as a national, or immigration status will not be requested for an
				individual who is not seeking health benefits for themselves.
(h)
Signature
				required.
An initial application must be signed under
				penalty of perjury. Electronic, including telephonically-recorded, signatures
				and handwritten signatures transmitted via any other electronic transmission
				will be accepted.
(i)
Accessibility.
Any application or
				supplemental form must be accessible to individuals who are limited English
				proficient and individuals who have disabilities, consistent with the
				provisions of §
											5.01.