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ACCESS Florida Web Application Guide

October 2011

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ACCESS Web Application Process Flow....................................................................................... 5 ACCESS Florida Splash Page ........................................................................................................ 9 Welcome – What Would You Like to do?.................................................................................... 10 Benefit Choices ............................................................................................................................. 12 Drug Testing Information Acknowledgement and Consent Release ............................................ 14 Relative Caregiver Eligibility Requirements ................................................................................ 15 Medicaid ....................................................................................................................................... 16 Important Information ................................................................................................................... 17 ACCESS Online User Sign-Up .................................................................................................... 19 Applicant Information ................................................................................................................... 20 Address Validation........................................................................................................................ 21 Application Summary ................................................................................................................... 22 Household List .............................................................................................................................. 23 Rights and Responsibilities ........................................................................................................... 25 HIPAA .......................................................................................................................................... 26 Household Relationships .............................................................................................................. 27 Household Information ................................................................................................................. 28 Additional Household Information ............................................................................................... 29 Certification of Identity................................................................................................................. 30 Absent Parent Details .................................................................................................................... 31 Long Term Care Details................................................................................................................ 32 Additional Long Term Details ...................................................................................................... 33 Prior Residence ............................................................................................................................. 34 Noncitizen Details ......................................................................................................................... 35 Sponsor Details ............................................................................................................................. 36 Alias Name / Social Security Number Details .............................................................................. 37 Household Information Details ..................................................................................................... 38 Pregnancy Details ......................................................................................................................... 39 Details regarding pregnancy must be entered on this screen ........................................................ 39 School Details ............................................................................................................................... 40 Disability Details .......................................................................................................................... 41 Disability Pamphlet ....................................................................................................................... 42 Supplemental Security Income (SSI) Details ............................................................................... 44 Case Information ........................................................................................................................... 45 Case Details .................................................................................................................................. 46 Migrant Details ............................................................................................................................. 47 Household Summary ..................................................................................................................... 48

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Asset Information.......................................................................................................................... 51 Liquid Asset Details ...................................................................................................................... 52 Life Insurance Details ................................................................................................................... 53 Vehicle Details .............................................................................................................................. 54 Real Estate/Property Details ......................................................................................................... 55 Business Asset Details .................................................................................................................. 57 Asset Transfer Details ................................................................................................................... 58 Cash Settlement Details ................................................................................................................ 59 Asset Summary ............................................................................................................................. 60 Employment Information .............................................................................................................. 61 Current Employment Income Details ........................................................................................... 62 Past Employment Income Details ................................................................................................. 63 Self Employment Income Details ................................................................................................. 64 Room And Board Income Details ................................................................................................. 65 Employment Summary ................................................................................................................. 66 Other Income Information ............................................................................................................ 67 Qualified Income Trust Details ..................................................................................................... 68 Other Income Details .................................................................................................................... 70 Application for Other Benefits Details ......................................................................................... 71 Other Income Summary ................................................................................................................ 72 Insurance Information ................................................................................................................... 73 Medicare Details ........................................................................................................................... 74 Medicare Premium Details ........................................................................................................... 74 Health Insurance Details ............................................................................................................... 75 Heath Insurance paid for by someone outside of the household .................................................. 75 Expense Information ..................................................................................................................... 76 Housing Expense Details .............................................................................................................. 77 Utility Expense Details ................................................................................................................. 78 Child or Adult Daycare Expense Details ...................................................................................... 79 Room And Board Expense Details ............................................................................................... 80 Support Payment Details............................................................................................................... 81 Past Medical Expense Details ....................................................................................................... 82 Medical Expense Details............................................................................................................... 83 Blind Work Expense Details ......................................................................................................... 84 Expense Summary ........................................................................................................................ 85 Case Summary .............................................................................................................................. 86

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Statement of Understanding .......................................................................................................... 90 Electronic Signature (in household) .............................................................................................. 92 Electronic Signature (outside of household) ................................................................................. 93 Confirmation Page ........................................................................................................................ 94 ACCESS Online Survey ............................................................................................................... 95 Adding Comments after Application Submitted........................................................................... 96

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ACCESS Web Application Process Flow

Important Information

Splash Page

User Sign- up

Complete an unfinished application

Add comments to an application that you submitted

My ACCESS Account and eligibility reviews.

Apply for benefits

My ACCESS Account Login

Continue where previously left off.

Application Comments

User Login

User Login

Applicant Information

Address Validation

Application Summary

Relative Caregiver Program Eligibility Requirements

Medicaid

Drug Testing Information Acknowledgement and Consent Release Requirements

Relative Caregiver Program Eligibility Requirements (court placed)

Benefit Choices

Welcome – What Would you Like to do?

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Case Information

Case Details (Lifeline)

Noncitizenship Details

Household Information Details

Long Term Care Details

Absent Parent Details

Alias Name / SSN Details

Household Information

Certification of Identity

Additional Long Term Care Details

Migrant Details

Household List

HIPAA

Rights & Responsibilities

Household Relationships

Sponsor Details

Pregnancy Details

School Details

Disability Details

Supplemental Security Income (SSI) Details

Additional Household Information

Household Summary

Prior Residence Details

Disability Pamphlet

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Asset Transfer Details

Asset Summary

Additional Real Estate/Property Details

Case Settlement Details

Employment Information

Other Income Information

Current Employment Income Details

Self Employment Income Details

Other Income Details

Room & Board Income Details

Application for Other Benefits Details

Employment Summary

Past Employment Income Details

Other Income Summary

Qualified Income Trust Details

Asset Information Liquid Asset Details

Life Insurance Details

Vehicle Details

Real Estate/Property Details

Business Asset Details

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Case Summary

Expense Information

Health Insurance Details

Housing Expense Details

Utility Expense Details

Child or Adult Daycare Expense Details

Support Payments Details

Room & Board Expense Details

Medicare Details

Expense Summary

Insurance Information Medicare Premium Details

Health Insurance Paid By Someone Outside of Household

Details

Past Medical Expense Details

Medical Expense Details

Blind Work-Related Expense Details

Confirmation Page

Did not e-sign E-Signature (inside HH)

E-Signature (outside HH)

Application Completed

ACCESS Online Survey

Statement of Understanding

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ACCESS Florida Splash Page This is the ACCESS webpage that is the portal to the ACCESS Customer facing systems.

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Welcome – What Would You Like to do? The customer chooses which process they wish to complete. The customer has the following options:

• Click on “Apply for benefits” and the “Continue” button to begin the application process.

• Click on “Complete a recertification review” and the “Continue” button to begin the recertification process.

• Click on “Complete an unfinished application or recertification review” and the “Continue” button to complete an application or review that has already been started. (The customer must have the application number and password.)

Information on the bottom half of the page tells the customer information they may need to complete the web application.

The customer can choose the language in which they wish to complete the application.

If the customer clicks on this button, information displays which explains the screen

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• Click on “Add comments to an application that has been submitted using an Electronic- Signature” to add comments to an application which has been submitted, but has not had processing started by the caseworker. (The customer must have the application number and password.) “Report a change to my case” this will drive them to the ACCESS FLORIDA change report system.

• “My ACCESS Account” will allow the customer to check the status of case and to view benefit information.

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Benefit Choices

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The customer must select whom they wish to apply for and for which benefits they wish to apply.

• Food Stamps • Cash Assistance • Medicaid • HCBS / Waivers (Home and Community Based Services) • Hospice • Medicare Savings Program • Simplified Eligibility for Pregnant Women

Click on the icon next to each program for more detailed information about the program.

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Drug Testing Information Acknowledgement and Consent Release

This screen displays for customers who choose only Cash Assistance - Cash assistance for myself and my family

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Relative Caregiver Eligibility Requirements This screen is displayed when one of the following situations is indicated under Cash Assistance:

• Cash assistance for a child the court’s placed with me • Cash assistance for a child that is not mine but is related to me.

This box displays to inform the caretaker relative of the option of Relative Caregiver assistance when the child has not been placed through the court.

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Medicaid The Medicaid screen displays if Medicaid is the only benefit the customer has choosen. It informs them of the option to apply for Medicaid for the children only and links to the Florida Healthy Kids application webpage.

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Important Information

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This screen informs the customer of the following:

• Application processing time standards for each program • Answers provided during the application process determine if the household

meets expedited food stamp criteria • How to check the status of an application by using My Account • Information regarding noncitizens and SSN • Information regarding Fraud • Information regarding computer matching

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ACCESS Online User Sign-Up It is very important that the customer remember their password.

• The customer should write down the application number. • Explain that this will allow them to stop at any point and complete the application

later. Once the customer has reached this screen, they have the ability to “SAVE & QUIT” the application, and return at a later time. The following message displays when the “SAVE & QUIT” option is selected:

It is important to write down the ACCESS Online Number and password. They must have their Application Number and Password to return.

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Applicant Information The Applicant Information screen is the first screen in the “Application” It captures information about the name and address for the head of household. This screen displays the Navigation Menu and the Progress Bar as a reference for the applicant. If the applicant answers “YES” to receiving mail at a different address, the additional address mailing fields must be completed to ensure correct delivery of mail.

Progress Bar – This feature tells the customer how far along they are in the application process

Navigation Menu – This feature shows the customer which screens are completed during the application process. It also allows them to navigate back to a specific screen

0% Complete

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Address Validation The address entered on the Application Information screen is validated based on information from the United States Postal Service for accuracy

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Application Summary At the end of each section of the application you will see a summary screen. This allows the customer to review their entries up to this point and return to specific screens to make any changes or corrections.

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Household List This screen is used to capture information about the household members.

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When the customer clicks “NO”, the message “Please add all members in the household even if you are not applying for them” is displayed. The customer can then click “CONTINUE” to move to the next screen

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Rights and Responsibilities The customer must click “yes” for the Rights and Responsibilities.

The customer must use the scroll bar to read the entire Rights and Responsibilities

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HIPAA The customer must click “YES” for HIPAA.

The customer must use the scroll bar to read the entire HIPAA Statement

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Household Relationships The customer must choose the relationship of all members of the household

This question is displayed if the applicant indicated on the Benefit Choices screen that they are applying for food assistance.

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Household Information Information for the household is captured on this screen. Based on the entries made on this screen, detail screens are displayed.

The questions on this screen are dynamic, based on the type of assistance requested and the demographics of the individuals in the case.

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Additional Household Information

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Certification of Identity The screen is displayed when the application contains children under age 16. It allows the applicant to certify to the identity of those children

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Absent Parent Details This screen will display when the individual is a child and both parents are not listed in the application. Information regarding the Absent Parent is entered on this screen. There may be multiple Absent Parent detail screens

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Long Term Care Details

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Additional Long Term Details

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Prior Residence

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Noncitizen Details

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Sponsor Details

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Alias Name / Social Security Number Details If an individual has an Alias name or Social Security Number, the information is entered on this screen. The drop down boxes provide the options for Alias Name Type and Social Security Number Type.

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Household Information Details

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Pregnancy Details Details regarding pregnancy must be entered on this screen

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School Details Detailed information regarding school attendance is entered on this screen. Graduation date is mandatory if “High School, Equivalent” is selected for School Type.

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Disability Details

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Disability Pamphlet

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Disability Pamphlet (cont)

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Supplemental Security Income (SSI) Details

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Case Information Additional information regarding the household is captured on this screen.

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Case Details This screen captures additional information when the applicant states on the prior screen that they are interested in the discounted phone service (lifeline).

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Migrant Details The Migrant Details screen is displayed if the applicant is applying for Food Assistance benefits and indicates there is a migrant in the household. It is used to determine eligibility for expedite services.

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Household Summary

The Household Summary screen allows the customer to see the information entered in this section of the application The customer may correct any information that was entered incorrectly by clicking on the Change button. This will return them to the detail screen to correct previous entries.

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Household Summary (cont)

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Household Summary (cont)

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Asset Information Based on the entries made on the Asset Information screen, the following detail screens will be displayed:

• Liquid Asset Details • Life Insurance Details • Vehicle Details • Real Estate Property Detail • Business Asset Details • Asset Transfer Details • Cash Settlement Details

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Liquid Asset Details Detailed information regarding liquid assets is entered on this screen. The drop down boxes provide options for Type of Asset.

Multiple assets can be entered if this entry is “YES”

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Life Insurance Details Detailed information regarding Life Insurance is entered on this screen. The drop down boxes provide options for Type of insurance. Multiple life insurance policies can be entered.

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Vehicle Details Detailed information regarding vehicles is entered on this screen. The drop down boxes provide options for how the vehicle is used. Multiple vehicles can be entered.

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Real Estate/Property Details Detailed information regarding Real Estate/Property is entered on this screen. The drop down boxes provide options for Type of Property.

Multiple properties can be listed if this entry is “YES”

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Additional Real Estate/Property Details

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Business Asset Details Detailed information regarding Business Assets is entered on this screen. The drop down boxes provide options for Type of Asset.

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Asset Transfer Details Detailed information regarding asset transfer is entered on this screen. The drop down box provides options for what asset was transferred

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Cash Settlement Details

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Asset Summary The Asset Summary screen allows the customer to see the asset information entered. The customer may change information by clicking on Change, which returns customer to the appropriate screen.

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Employment Information Based on the entries made on the Household Employment screen, the following detail screens will be displayed:

• Current Employment Income Details • Past Employment Income Details • Self Employment Income Details • Room and Board Income Details

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Current Employment Income Details Detailed information regarding current employment is entered on this screen. The drop down box provides options for How Often Paid. Space is provided for the customer to enter comments regarding employment. The customer may enter up to 500 characters in the comments section.

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Past Employment Income Details Detailed information regarding past employment is entered on this screen. The drop down box provides options for How Often Paid. Space is provided for the customer to enter comments regarding employment. The customer may enter up to 500 characters in the comments section.

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Self Employment Income Details Detailed information regarding self employment income and expenses is entered on this screen. Multiple drop down boxes provides options for Type of Income and Type of Expense.

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Room And Board Income Details

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Employment Summary The Employment Summary screen allows the customer to see employment information entered. The customer may change information by clicking on Change, which returns customer to the appropriate screen.

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Other Income Information

Based on the entries made on the Other Income Information screen, the following detail screens will be displayed:

• Other Income Details • Application for Other

Benefits Details

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Qualified Income Trust Details

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Qualified Income Trust Details (cont)

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Other Income Details Detailed information regarding Other income is entered on this screen. The drop down boxes provide options for Type of Income and How Often Received.

Multiple Other Income amounts can be entered if this entry is “YES”

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Application for Other Benefits Details

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Other Income Summary The Other Income Summary screen allows the customer to see the non-employment income information entered. The customer may change information by clicking on “Change” which returns customer to the appropriate screen.

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Insurance Information Based on the entries made on Insurance Information screen, the following screens will be displayed:

• Medicare Details Medicare Premium Details

• Health Insurance Details Health Insurance Paid by Someone Outside the Household

Details

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Medicare Details Medicare Premium Details

If an entry of “YES” is in these fields the Medicare Premium Details screen will be displayed.

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Health Insurance Details Heath Insurance paid for by someone outside of the household

If entry in “Who pays for this policy” is “OTHER” this screen will be displayed. Details regarding that individual must be provided.

Details regarding Health Insurance must be entered. Drop down boxes provide options for Type and Coverage.

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Expense Information Based on the entries made on Expense Information screen, the following screens will be displayed:

• Housing Expense Details • Utility Expense Details • Child or Adult Daycare Expense Details • Support Payments Details • Room & Board Expense Details

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Housing Expense Details Detailed information regarding Housing expense is entered on this screen. The drop down box provides options for Type of housing expense.

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Utility Expense Details

Detailed information regarding Utility expense is entered on this screen. The drop down box provides options for Type of utility expense. An entry of “YES” allows entry of multiple utility expenses. Another Utility Expense Details screen will be displayed.

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Child or Adult Daycare Expense Details

Multiple expense amounts can be entered if this entry is “YES”

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Room And Board Expense Details Detailed information regarding Room and Board expenses is entered on this screen. The drop down box provides options for “Number of meals per day”.

Multiple expense amounts can be entered if this entry is “YES”

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Support Payment Details Detailed information regarding Support payment expense is entered on this screen. The drop down boxes provide options for “Is this court ordered”, “Has court obligation been met” and “Relationship of dependent”.

Multiple expense amounts can be entered if this entry is “YES”

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Past Medical Expense Details

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Medical Expense Details

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Blind Work Expense Details

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Expense Summary The Expense Summary screen allows the customer to see the expense information entered. The customer may change information by clicking on “Change” which returns customer to the appropriate screen.

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Case Summary

A summary of all information entered will be displayed. The customer may make changes to any entry at this point. The customer must scroll down to see all entries.

Application Summary

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Household Summary

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Asset Summary

Employment Summary

Other Income Summary

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Expense Summary

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Statement of Understanding

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Statement of Understanding (cont)

The customer must check the box stating they have reviewed and understand the Statement of Understanding.

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Electronic Signature (in household) The customer may apply for benefits by clicking “SIGN NOW” or not submit an application by clicking “SAVE & QUIT”. If “SIGN NOW” is selected, a Confirmation Page will be received.

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Electronic Signature (outside of household)

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Confirmation Page The application has been completed and successfully submitted.

The e-mail confirmation serves as a receipt for the customer to let them know their application has been received.

This new section informs the customer if they are potentially eligible for expedited services and what to expect next in the process.

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ACCESS Online Survey

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Adding Comments after Application Submitted A customer may add comments to the application after it has been submitted. The customer must access the system and select “Add comments to an application that has been submitted using an Electronic Signature”

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The customer must use the ACCESS Online Number and password to access the case. The comments can then be entered and saved. If the customer does not want to add or save the comments they can select Exit.

The message below will be received if the customer selects Exit.

ACCESS Web Application Process FlowACCESS Florida Splash PageWelcome – What Would You Like to do?Benefit ChoicesDrug Testing Information Acknowledgement and Consent ReleaseRelative Caregiver Eligibility RequirementsMedicaidImportant InformationACCESS Online User Sign-UpApplicant InformationAddress ValidationApplication SummaryHousehold ListRights and ResponsibilitiesHIPAAHousehold RelationshipsHousehold InformationAdditional Household InformationCertification of IdentityAbsent Parent DetailsLong Term Care DetailsAdditional Long Term DetailsPrior ResidenceNoncitizen DetailsSponsor DetailsAlias Name / Social Security Number DetailsHousehold Information DetailsPregnancy DetailsDetails regarding pregnancy must be entered on this screenSchool DetailsDisability DetailsDisability PamphletSupplemental Security Income (SSI) DetailsCase InformationCase DetailsMigrant DetailsHousehold SummaryAsset InformationLiquid Asset DetailsLife Insurance DetailsVehicle DetailsReal Estate/Property DetailsBusiness Asset DetailsAsset Transfer DetailsCash Settlement DetailsAsset SummaryEmployment InformationCurrent Employment Income DetailsPast Employment Income DetailsSelf Employment Income DetailsRoom And Board Income DetailsEmployment SummaryOther Income InformationQualified Income Trust DetailsOther Income DetailsApplication for Other Benefits DetailsOther Income SummaryInsurance InformationMedicare DetailsMedicare Premium DetailsHealth Insurance DetailsHeath Insurance paid for by someone outside of the householdExpense InformationHousing Expense DetailsUtility Expense DetailsChild or Adult Daycare Expense DetailsRoom And Board Expense DetailsSupport Payment DetailsPast Medical Expense DetailsMedical Expense DetailsBlind Work Expense DetailsExpense SummaryCase SummaryStatement of UnderstandingElectronic Signature (in household)Electronic Signature (outside of household)Confirmation PageACCESS Online SurveyAdding Comments after Application Submitted