Eligibility Online Manual

M301A Factors Requiring Verification

Purpose: This section will describe the eligibility factors that require verification.


Current Policy Effective Date: April 1, 2021

Date Last Reviewed: April 1, 2021

Previous Policy: May 1, 2017

POL M301A: FACTORS REQUIRING VERIFICATION

1. Citizenship And Identity Must Be Verified Within 90 Days

Medicaid applicants who declare U.S. Citizenship and identity, have 90 days to provide verification. Refer to Medicaid Table 5 for evidence of citizenship and identity except for the following programs that do not have this verification requirement:

          • Emergency Services.

          • Basic Foster Care.

          • Institutional Foster Care.

2. Citizenship And Identity Verification Not Required

Verification of citizenship and identity has already been documented by the Social Security Administration; for that reason, verification is not required for the following Individuals:

          • Entitled to Supplemental Security Income (SSI).

          • Entitled to Social Security Disability.

          • Entitled to or enrolled in Medicare.

Verification of citizenship and identity is not required for a newborn of a Medicaid eligible mother.

Verification of citizenship and identity is not required when documentation has already been provided for a previous application.

3. Date Of Birth Must Be Verified

Any electronic source or document that verifies citizenship and lists the applicant's date of birth can be used to verify date of birth. Refer to Medicaid Table 5 for evidence of citizenship.

4. Social Security Number Must Be Verified

SSN can be verified via the following electronic sources:

  • SDX

  • SOLQ-I

  • H03

  • SVES

A Social Security card can be used as hard copy verification of SSN.

5. Eligibility Must Not Be Delayed

Eligibility determination must not be delayed while verification for other programs is pending.

6. Age Must Be Verified

Age must be verified using primary or second level documents for the Aged, Blind or Disabled Programs. Refer to Medicaid Table 5B.

7. Income Must Be Verified

Income must be verified using primary or secondary evidence sources. Refer to Medicaid Table 5B.

A report of zero income does not require verification.

Verification of income is not required for the Medicare Savings Programs when an application is received from the Social Security Administration.

8. Income Deductions Must Be Verified

Tax deductible adjustments to income for MAGI programs must be verified at application and renewal or when the deduction is added to the case.

Client can request the deduction not be included in the calculation if they cannot provide verification.

Deductions that do not make a difference in eligibility do not need to be entered into WES or verified.

9. Resources Must Be Verified

Resources must be verified for the Aged, Blind or Disabled (except for the Employed Individuals with Disabilities (EID) program), Medicare Savings, and Tuberculosis Assistance Programs, using primary or secondary evidence sources. Refer Medicaid Table 5B.

Verification of resources is not required for the Medicare Savings Programs when an application is received from the Social Security Administration.

Reference:

Defining Requirement: 42 CFR 435.940

42 CFR 435.945

42 CFR 435.948

42 CFR 435.952

42 CFR 435.953

42 CFR 435.955

42 CFR 435.960


Clarifying Information:

1. Verification is defined as the act of proving a fact to be true by obtaining documentation.

2. Client's who were issued on Medicaid prior to 01/01/2014 can have DOB, SSN, Citizenship and Identity changed to Collateral Contact in WES as these items were verified by DFS on the original application.


Worker Responsibilities:

Verifying Eligibility Factors

1. Refer to Section M301B for information on how to verify eligibility factors.