OBSOLETE POLICY CHIP MANUAL |
Effective: August 1, 2011
Verifying and requesting verification are the acts of confirming the truth or validity of a statement. Applicants and enrollees are required to provide requested verifications to the eligibility agency to determine eligibility for medical assistance. Applicants and enrollees are also required to cooperate with and provide requested verifications to the Department and the eligibility agency to assist in quality control and payment accuracy reviews. See 102-5.
There are several ways to verify items of eligibility and in some cases, the information available in the record or a client participating in one program can be used to verify their eligibility for another program. Workers must explore all possible avenues of eligibility and rely on information that is reasonably available.
Use computer matches and collateral contacts whenever possible. eFIND can provide information on several type of income.
Do not request hard copy verification of items that are not needed for eligibility or that have previously been verified. (See section 705-2 #3 for CHIP verifications that require hard copy or imaged documentation.)
All factors of eligibility must be verified.
Verification methods include using client statement; by computer interface match; by requesting hard copy verification; by collateral contact; or any other verification which the case worker determines is acceptable.
U.S. Citizenship, identity and alien or immigration status of individuals who are not citizens of the United States but are seeking CHIP coverage, along with household income must be verified by interface match or hard copy. See Table IV for acceptable sources.
Verify household income with available computer interface match systems, such as eFIND, first. If income cannot be verified through a computer match, request hard copy verification, or do a collateral contact with the employer or the entity providing the income to the client.
A collateral contact with an employer must document the wage information, frequency of payment, the person contacted, the employer’s or business’s name, the phone number and the date of contact. Request information about health insurance and premiums the client may be paying.
A collateral contact with some other entity or person who is providing income to the client must document similar information about the source, amount and frequency.
For all other factors of eligibility, use the client's statement unless you have a valid reason to question the accuracy of the individual’s statement, or if you have information that contradicts their statement. Request hard copy verification of any questionable items.
Provide a written request for verifications that are needed. Make the request as complete as possible. Do not request verification of items that are available to the eligibility agency through other reliable means such as eFIND, and that do not require independent verification. (See 110-1 for computer match information that must be independently verified.)
Give clients 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 client until the next business day following the 10th day to provide verification. Section 102-2 defines when verifications are due.
At review, verify only those eligibility factors necessary to redetermine continued eligibility.
Except at review, do not stop benefits when the client fails to provide verification for changes that result in an increase in benefits (e.g. lower CHIP plan). However, do not increase benefits unless the verification is received.
Section 102-2 defines when verifications are due. Clients may request more time to provide verifications. The eligibility agency can also extend the time when extenuating circumstances have made it difficult for the client to respond timely.
The client must request more time by the date that the verifications were due.
Applicants must request more time by the end of the application period.
If the Post Office returns the request for verifications notice with no forwarding address, see Section 803-2.