CHIP Policy

705 Verification

Effective Date: January 1, 2018

Previous Policy

Previous Policy (705-1 was incorporated into 705 as of January 1, 2018)

A. Verification

The eligibility agency must use all available resources to determine eligibility for medical programs.  The applicant or recipient is responsible for obtaining acceptable verification when the eligibility agency cannot access the information.  Help the individual to get the verification if the individual needs help.

If the individual cannot obtain appropriate verification, the eligibility worker will make necessary contact on behalf of the individual to verify information.  Document these contacts in the case record.  If a third party is unwilling or unable to cooperate with an agency request, the worker will investigate other methods of verification with the individual.

1. The eligibility agency is required to verify items of eligibility through electronic interfaces before requesting that an individual provide documentation.  The agency must use an individual’s SSN, or other identifying information if an SSN is not available, for the electronic match. The agency cannot require an individual to provide verification when the information is available through electronic interfaces.

2. The eligibility agency may accept client statement for many items of eligibility.  Some eligibility factors require a form of verification other than client statement, including citizenship and immigration status.

3. The agency can only ask an individual to provide documentation if:

• • verification is not available electronically;

• • the client statement is not reasonably compatible with electronic matches; or

• • the client statement is not reasonably compatible with the case history.

4. Income information from electronic matches is reasonably compatible with client statement if both are either above or at or below the income limit or threshold. If income information is not compatible the agency must request information from the individual, including:

• • A statement that explains the discrepancy; or

• • Other information from the individual that is not available electronically.

5. If the individual has expenses and not enough income to cover them, the individual must verify how they are meeting their expenses.

6. If information is not compatible, the eligibility agency cannot deny or close a program or reduce benefits until it has given the individual an opportunity to provide verification.

7. Applicants and recipients are required to cooperate with and provide requested verifications to the Department of Health and Human Services and the Department of Workforce Services to assist in quality control and payment accuracy reviews (102-2).

B. How to Verify Information

1. There are several ways to verify items of eligibility, and in some cases, the information available in the record of a individual participating in one program can be used to verify their eligibility for another program.

• • • This includes being able to use income verification sources that were obtained or verified within the last six months as part of an eligibility determination for the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF) programs.

• • • •  This income data should be used when more current data sources are not available(Table VI), and the member indicates it is reflective.

Example: July paycheck stubs were submitted as part of a SNAP application two months ago. Wage data is currently only available for the 2nd quarter and work number is not available. If the member indicates that those paychecks are reflective, they may be used to create a best estimate of income for Medicaid determination as they are more current than other available data sources.

2. Explore all possible avenues of eligibility and rely on information that is reasonably available.

1. 1. Use computer matches and collateral contacts whenever possible to verify items of eligibility.

1. 2. Client statement can serve as verification for most eligibility factors.

• • • Provide a written request for verifications that are needed to make an eligibility decision.  Do not request verification of items available to the eligibility agency through electronic interfaces that do not require independent verification.  Do not request verification of items that are not subject to change and which have been verified before.

• • • Give individuals at least 10 days from the date you mail the written request to provide verifications. If the 10th day is a non-business day, give the individual until the business day following the 10th day to provide verifications (102-3).

• • • Help individuals get verifications when requested by making collateral contacts or sending signed release of information forms to entities that have the needed verifications.

3. Individuals may request more time to provide verifications. The eligibility agency can also extend the due date when circumstances have made it difficult for the individual to respond timely or if the worker knows more time will be needed.

1. 1. The individual must request more time by the date that the verifications were due.

1. 2. Applicants must request more time by the end of the application period.

1. 3. If the post office returns the request for verification notice with no forwarding address (803-2).