Department of Medical Assistance Services
Governor’s Access Plan
Online Application Process
Virginia Department of Medical Assistance Services
2015
Department of Medical Assistance
Services
Department of Medical Assistance Services
Finding the Online GAP App
• GAP SMI Screeners will have access to the online
application beginning January 12, 2015 by going to
the web address that was provided to the GAP
Screening Entity via an e-mail notification.
• The application is only available through this special
web address and is NOT posted on Coverva.org.
• The application will NOT be accessible though the
DMAS Web Portal.
Department of Medical Assistance Services
Logging In
At the log in screen youwill need to enter the NPI number of the agency and click “Login”
If you are unable to log in please contact the GAP Unit of Cover VA by calling
Department of Medical Assistance Services
Step 0
Next click the pencil icon toedit the green field. Enter the name of the person assisting with the application.
By clicking on the pencil
icon a pop up box will open. You may need to turn off
any popup blockers on your computer.
Department of Medical Assistance Services
Pop Up 0
In the blank fieldsenter the name, phone number, and e-mail address of the person assisting with the application process. Check the box in order to attest that the
applicant is in the room and able to sign the application.
Department of Medical Assistance Services
On the next screen click
“Start this Step” adjacent to Step 1 to begin entering the applicants information.
Department of Medical Assistance Services
Step 1
A pop up box for step 1will open. Enter the
demographic information of the person who is
applying for the GAP program.
The address entered will need to be a place where the applicant can receive mail. This will be where decision notification will be sent.
Department of Medical Assistance Services
Step 1 Continued
Continue completing theinformation in step 1. Check the box if the person has any form of health insurance. Leave the box blank if not.
Check the box if the person is in foster care, pregnant, disabled,
incarcerated, or
hospitalized. Leave blank if the person is not.
Check any of the tax information boxes that apply. Leave blank if they do not apply.
Department of Medical Assistance Services
Step 2
Click on “Start this Step” forStep 2 to generate the pop up box.
Department of Medical Assistance Services
Step 2 Continued
• In step 2 enter theinformation for all
adults living in the home, and any children of the individual under the
age of 19 living in the home with the person applying. • The tax information in Step 2 pertains to the person listed as living in the home with the
applicant.
• Click save and see next slide for entering another
Department of Medical Assistance Services
Adding/Editing/Deleting in Step 2
To add anotherperson living in the home click the green plus sign and a new pop up box will display. To edit information
already added, click the pencil icon located over the information. To delete information already added, click the red X over the information you wish to delete. These icons will have the same function in each area that you see them.
Department of Medical Assistance Services
To begin each of the
remaining steps continue to click on “Start this
Step” and fill in the
information in the pop up window and click Save. Each area will need to be completed in order to submit the application.
Applications cannot be saved and continued at a later time.
Department of Medical Assistance Services
Step 3 – Household Relationships
Step 3 is tax filinginformation for each of the individuals entered during Step 2.
Since the applicant (Clive Sr.) listed Joy as his wife and a tax filer in Step 2, she is auto listed as a tax payer in Step 3.
The children (Hazel and Clive Jr) are auto listed as Household members.
Select the drop down choice on the right that describes the
Department of Medical Assistance Services
Step 4 – Household Income
Step 4 is to enterhousehold income.
Enter the name of the person receiving income, the source of the income (work, disability, etc.), how often it is received, and the amount received. In the example above
the individual receives $1,200.00 monthly.
Click save to add more Household members.
Department of Medical Assistance Services
Step 4 – Adding More Members
To add additional household member income click on the
green plus sign under Step 4.
Household income includes any income from:
– The individual;
– The individual’s spouse; and
Department of Medical Assistance Services
Step 5 – Authorized Representative
• Step 5 allows for the individual applying for
benefits to list an authorized representative.
• This step is optional and should only be
completed for individuals who have an authorized
representative or would like for a spouse or
family member to act on their behalf.
• The person assisting with the application should
not list the agency as the authorized
representative unless the agency has legal
standing as the individuals authorized
Department of Medical Assistance Services
Step 5 – Authorized Representative
Fill in the name,organization, if any, address, and phone
number of the individual’s authorized representative, or a spouse or family
member that the applicant would like to designate as a representative.
Department of Medical Assistance Services
Step 6 – Digital Signature
Step 6 is the digital signature of the individual applying for GAP benefits. Enter the name of the individual and the date.
This signature indicates that to the best of the individual’s knowledge all information entered is true and correct. It is also a release of
information which needs to be read by the applicant. This should not be
entered without the
individual present in the room when the signature
Department of Medical Assistance Services
Confirmation Page
The final page will listwhat documents to send to Cover VA as well as the fax and mail in address. It will also give the date by which the documents must be received by Cover VA.
Print this page and Give to the applicant.
Department of Medical Assistance Services
Verification Documentation
• Cover VA will need documentation to verify income of theindividual applicant and any household income based on tax status. For example:
– If the applicant is claimed on another person’s taxes then that person’s income verification will be necessary; or
– If the applicant is married and files taxes jointly, then the spouse’s income will need to be verified.
• Cover VA will need to verify one month of income. • There is no resource verification.
• Verification of citizenship is only necessary when the applicant indicates that they are not a U.S. Citizen.
• Other documentation may be required in special circumstances.
Please assist the individual in reading ALL confirmation notices.
