MA PROVISIONS FOR THE APPLICATION PROCESS
FOR THE MEDICALLY NEEDY
§ 125.84. Procedures.
(a) Origin of an application. The following shall apply to the initiation of an application:
(1) The application process will begin when a person indicates to the County Office by any action that he wants his MA eligibility determined.
(2) An application may be made prior to the need for service or at the time the need for service arises.
(3) An application will not be accepted on behalf of a person who has died, in accordance with § 123.82 (relating to definitions).
(4) An application for MA may be made in person, by letter or by telephone.
(5) If because of illness, infirmity or a physical or mental handicap a person is unable to apply for himself, a relative, a friend or official of the institution or agency providing the service may apply on behalf of the applicant.
(6) If the applicant has a guardian or other legal representative, that person shall be expected to apply on behalf of the applicant if he is available to do so.
(7) Regardless of the way an application for MA is made, the county office will follow it up promptly with appropriate action to decide whether or not the applicant is eligible.
(b) Place of application. The place of application shall conform with the following:
(1) Normally, application is made to the county office in the county of residence. However, if the care is being furnished in another county, application may be made in that county.
(2) If the person is not a resident of the county in which application is being made, the completed application forms will be sent to the county of residence, which will complete the determination of eligibility. A person who is institutionalized for other than inpatient hospital care will be considered a resident of the county in which the institution is located.
(3) If a resident is out of this Commonwealth and a request is received, the necessary forms will be sent for completion to the institution providing the care and, upon their return, eligibility will be determined and disposition made.
(c) Personal interview required. A personal interview with an applicant is required. The required interview will be held within 60 days from the date the application, Form PA 743 is received in the County Assistance Office. Pending the interview, MA may be authorized for no more than 60 days on the basis of the information in the application, as set forth in § 127.84 (Reserved). At the time of the personal interview, a Form PA-743R will be completed by the County Assistance Office worker and signed by the applicant. If information gained at the personal interview for Page 1, Form PA-743R, differs from the information on Page 1, Form PA 743 taken at application, the clerical unit must submit the new information to the Bureau of Data Processing via Form PA-743RE.
(d) Purposes of the interview. The purposes of the interview are as follows:
(1) Review and evaluate the application form for accuracy and completeness.
(2) Inform the applicant of additional information or substantiating information needed to determine eligibility or category.
(3) Explain to the applicant his rights and responsibilities and obtain the signature of the applicant on the Form PA-743S (Rights and Responsibilities).
(4) Inform the applicant of the medical services available to him.
(5) Discuss with the applicant any other information or regulations that are pertinent to his situation.
(6) Witness the signature of the client.
(7) Complete a Form PA-743R and obtain the signature of the client on it.
(e) Disposing of an application. Applications will be disposed of as follows:
(1) Applications will be promptly acted upon and eligibility will be determined as quickly as possible, preferably within at least 30 days from the date of application appearing on the Form PA 743. If circumstances are such that the County Office is unable to make a decision within the 30 day period, it may extend this period on condition that the applicant is advised, by letter, of the reasons for the delay, the date he may expect a decision, and his right to a fair hearing if he believes the delay is unjustified.
(2) The application process will end, and the application be disposed of, when one of the following has taken place:
(i) The applicant is found to be eligible.
(ii) The applicant is found to be ineligible.
(iii) The applicant withdraws or fails to complete the application.
(3) However, after the applicant has sworn to and signed the affidavit, and service under the program has been received, the application may not be withdrawn. The worker will record the decision and the supporting evidence in the case record.
Notes of Decisions Denial of Application
It was appropriate for the County Assistance Office to turn down applicant’s Medical Assistance application when her husband refused to substantiate information about his income. Stanley v. Department of Public Welfare, 535 A.2d 674 (Pa. Cmwlth. 1987).
Disposition of an Application
A nursing home’s argument that if the application for Medical Assistance eligibility had been acted upon within 30 days rather than 9 months, it easily could have submitted its invoice for payment of services within the 180-day period allowed, was without merit, where subsection (e)(1)’s ‘‘preference’’ for quick determinations does not rise to the level of a legal obligation, and there was no evidence presented that the Department of Public Welfare contributed ‘‘unnecessarily’’ to the delay, apart from the bare observation that the eligibility determination took a long time. Ashton Hall, Inc. v. Department of Public Welfare, 743 A.2d 529 (Pa. Cmwlth. 1999).
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