441—86.3 (514I) Application process.
	 86.3(1) Who may apply. Each person wishing to do so shall have the opportunity to apply without delay. When the request is made in person, the requester shall immediately be given an application form. When a request is made that the application form be mailed, it shall be sent in the next outgoing mail.
	  a.   	 Child lives with parents. When the child lives with the child’s parents, including stepparents and adoptive parents, the parent shall file the application on behalf of the child unless the parent is unable to do so.
If the parent is unable to act on the child’s behalf because the parent is incompetent or physically disabled, another person may file the application on behalf of the child. The responsible person shall be a family member, friend or other person who has knowledge of the family’s financial affairs and circumstances and a personal interest in the child’s welfare or a legal representative such as a conservator, guardian, executor or someone with power of attorney. The responsible person shall sign the application form and assume the responsibilities of the incompetent or disabled parent in regard to the application process and ongoing eligibility determinations.
	  b.   	 Child lives with someone other than a parent. When the child lives with someone other than a parent (e.g., another relative, friend, guardian), the person who has assumed responsibility for the care of the child may apply on the child’s behalf. This person shall sign the application form and assume responsibility for providing all information necessary to establish initial and ongoing eligibility for the child.
	  c.   	 Child lives independently or is married. When a child under the age of 19 lives in an independent living situation or is married, the child may apply on the child’s own behalf, in which case, the child shall be responsible for providing all information necessary to establish initial and ongoing eligibility. If the child is married, both the child and the spouse shall sign the application form.
	 86.3(2) Application form. An application for the HAWK-I program shall be submitted on Comm. 156, HAWK-I Application, or on Form 470-4016, HAWK-I Electronic Application Summary and Signature, unless the family applies for the Medicaid program first.
	  a.   	 When an application has been filed for the Medicaid program in accordance with the provisions of rule 441—76.1(249A) and Medicaid eligibility does not exist in accordance with the provisions of rule 441—75.1(249A), or the family must meet a spenddown in accordance with the provisions of 441—subrule 75.1(35) before the child can attain eligibility, the Medicaid application shall be used to establish eligibility for the HAWK-I program in lieu of the HAWK-I Application, Comm. 156, or Form 470-4016, HAWK-I Electronic Application Summary and Signature.
	  b.   	 Applications may be obtained by telephoning the toll-free telephone number of the third-party administrator or by accessing the Web site at www.hawk-i.org.
	 86.3(3) Place of filing. An application for the HAWK-I program shall be filed with the third-party administrator responsible for making the eligibility determination. Any local or area office of the department of human services, disproportionate share hospital, federally qualified health center, other facilities in which outstationing activities are provided, school nurse, Head Start, maternal and child health center, WIC office, or other entity may accept the application. However, all applications shall be forwarded to the third-party administrator.
	 86.3(4) Date and method of filing. The application is considered filed on the date an identifiable application is received by the third-party administrator or the department. An identifiable application is an application containing a legible name, address, and signature.
	  a.   	 Medicaid applications referred to the HAWK-I program. When the family has applied for Medicaid first and the department local office makes a referral to the third-party administrator, the date the Medicaid application was originally filed with the department shall be the filing date.
	  b.   	 Electronic applications. When an application is submitted electronically to the third-party administrator, the application is considered filed on the date the third-party administrator receives Form 470-4016, HAWK-I Electronic Application Summary and Signature, containing a legible signature.
	 86.3(5) Right to withdraw application. After an application has been filed, the applicant may withdraw the application at any time prior to the eligibility determination. Requests for voluntary withdrawal of the application shall be documented, and the applicant shall be sent a notice of decision confirming the request.
	 86.3(6) Application not required.
	  a.   	 An application shall not be required when a child becomes ineligible for Medicaid and the local office of the department makes a referral to the HAWK-I program.
	 (1) 	 A referral to the HAWK-I program pursuant to subrule 86.4(3) or 86.4(4) shall be accepted in lieu of an application.
	 (2) 	 The original Medicaid application or the last review form that is on file in the local office of the department, whichever is more current, shall suffice to meet the signature requirements.
	  b.   	 A new application shall not be required when an eligible child is added to an existing HAWK-I eligible group.
	 86.3(7) Information and verification procedure. The decision with respect to eligibility shall be based primarily on information furnished by the applicant or enrollee. The third-party administrator shall notify the applicant or enrollee in writing of additional information or verification that is required to establish eligibility. The third-party administrator shall provide this notice to the applicant or enrollee personally or by mail or facsimile. Failure of the applicant or enrollee to supply the information or verification or refusal by the applicant or enrollee to authorize the third-party administrator to secure the information shall serve as a basis for rejection of the application or cancellation of coverage. The applicant or enrollee shall have ten working days to supply the information or verification requested by the third-party administrator. The third-party administrator may extend the deadline for a reasonable period of time when the applicant or enrollee is making every effort but is unable to secure the required information or verification from a third party.
	 86.3(8) Time limit for decision. The third-party administrator shall make a decision regarding the applicant’s eligibility to participate in the HAWK-I program within ten working days from the date of receiving the completed application and all necessary information and verification unless the application cannot be processed within the period for a reason that is beyond the control of the third-party administrator. Exception: When the application is referred for a Medicaid eligibility determination and Medicaid eligibility is denied, the third-party administrator shall determine HAWK-I eligibility no later than ten working days from the date of the notice of Medicaid denial unless additional verification is needed.
	 86.3(9) Applicant cooperation. An applicant must cooperate with the third-party administrator in the application process, which may include providing verification or signing documents. Failure to cooperate with the application process shall serve as basis for a denial of the application.
	 86.3(10) Waiting lists. When the department has established that all of the funds appropriated for this program are obligated, the third-party administrator shall deny all subsequent applications for HAWK-I coverage unless Medicaid eligibility exists.
	  a.   	 The third-party administrator shall mail a notice of decision. The notice shall state that:
	 (1) 	 The applicant meets the eligibility requirements but that no funds are available and that the applicant will be placed on a waiting list, or
	 (2) 	 The person does not meet eligibility requirements. In which case, the applicant shall not be put on a waiting list.
	  b.   	 Prior to an applicant’s being denied or placed on the waiting list, the third-party administrator shall refer the application to the Medicaid program for an eligibility determination. If Medicaid eligibility exists, the department shall approve the child for Medicaid coverage in accordance with 441—86.4(514I).
	  c.   	 The third-party administrator shall enter applicants on the waiting list on the basis of the date an identifiable application form specified in subrule 86.3(2) is date-stamped by the third-party administrator. An identifiable application is an application containing a legible name, address, and signature.
	 (1) 	 In the event that more than one application is received on the same day, the third-party administrator shall enter applicants on the waiting list on the basis of the day of the month of the oldest child’s birthday, the lowest number being first on the list.
	 (2) 	 The third-party administrator shall decide any subsequent ties by the month of birth of the oldest child, January being month one and the lowest number.
	  d.   	 If funds become available, the third-party administrator shall select applicants from the waiting list based on the order in which their names appear on the list and shall notify them of their selection.
	  e.   	 After being notified of the availability of funding, the applicant shall have 15 working days to confirm the applicant’s continued interest in applying for the program and to provide any information necessary to establish eligibility. If the applicant does not confirm continued interest in applying for the program and does not provide any additional information necessary to establish eligibility within 15 working days, the third-party administrator shall delete the applicant’s name from the waiting list and shall contact the next applicant on the waiting list.
	 86.3(11) Falsification of information. A person is guilty of falsification of information if that person, with the intent to gain HAWK-I coverage for which that person is not eligible, knowingly makes or causes to be made a false statement or representation or knowingly fails to report to the third-party administrator or the department any change in circumstances affecting that person’s eligibility for HAWK-I coverage in accordance with rule 441—86.2(514I) and rule 441—86.10(514I).
In cases of founded falsification of information, the department may proceed with disenrollment in accordance with rule 441—86.7(514I) and require repayment in accordance with 441—Chapter 11 for the amount that was paid to a health plan by the department.
	 86.3(12) Applications pended due to unavailability of a plan. When there is no participating health plan in the applicant’s county of residence, the application shall be held until a plan is available. The application shall be processed when a plan becomes available and coverage shall be effective the first day of the month the plan becomes available.