PM 17-06-01: Applications Used by AKAAs

WAG 17-06-01

To qualify for the TAP, the AKAA must complete the correct application for the benefit request and send it to the correct office.

The application Form KC 2378MC, Application for All Kids, FamilyCare and Moms & Babies Health Insurance, is used for Family Health Plans only and is sent to the All Kids Unit. Form KC 2379MC may also be accessed via the RealBenefits® system. The cover page of KC 2378MC contains the TAP checklist.

AKAAs that use the RealBenefits® system send Form 2378B, Request for Cash Assistance-Medical Assistance-Food Stamps, to the DHS FCRC when the applicant is requesting medical benefits under Family Health Plans with SNAP benefits or TANF. The TAP checklist, Form KC 2378BC, must be included as a cover sheet on each Form 2378B application submitted.

Both checklists, Form KC 2378MC and Form 2378BC, must include at least the name of the AKAA representative who completed the application and the provider number to receive a TAP.

new textAKAA may submit All Kids and FamilyCare Online Application to the All Kids Unit. When an AKAA submits an online application, the date of the signature must be the same date the application is received electronically. AKAAs use the AKAA FAX cover sheet Form KC 3821W instead of the Form 2378MC checklist when faxing the applicant's signed signature page and proofs needed to complete the online application.