2051 Verification | Medicaid

Eligibility determinations must be based, to the maximum extent possible, on self-attestation of income that is verified by information from electronic data sources. When information from electronic data sources is consistent with an individual’s attestation of income, the income is considered verified.

Self-attestation may be accepted from the following:

If verification is received by another program (e.g. SNAP or TANF), the verification should be used for Medical Assistance as well.

If there is a mismatch of information between what is provided to the agency by an A/R and the available electronic data sources, the EW must determine which source is most reliable or if the A/R needs to provide additional verification.

Client statement is accepted as verification for all criteria of Family Medicaid except for the following:

Client statement is accepted as verification for all Q-Track criteria in ABD Medicaid, except for citizenship/immigration status/identity, or when circumstances are questionable.

The eligibility worker must document that the client’s statement was accepted or the reason why the information was questionable, and the method chosen to verify the information. Annotation of client statement in the verification field is acceptable documentation that client statement is accepted as verification.

The following situations must be verified from the source.

The applicant/recipient’s statement is acceptable as verification for all other Family Medicaid and Q-Track eligibility situations.

Verify information, if required, to determine eligibility as follows:

Third party verification includes the following:

The AU has the primary responsibility for providing verification to support statements or to resolve questionable information. The AU should be given sufficient time to verify information. When the value of a vehicle is obtained through blue book/NADA etc. and the listed value puts the AU over the resource limit, the AU must be given the opportunity to produce evidence of the value of the vehicle from someone who would have the expertise to make that determination such as a dealership.

The agency is responsible for assisting applicants/recipients in obtaining verification when the applicant/recipient requests assistance. Refer to Section 2020 - Americans with Disability Act (ADA) and Section 504.

The agency must accept reasonable verification.

When possible, documents are used as the primary source of verification. Documents provide written evidence of the AU’s statements. Documents or photocopies of documents are filed in the case record and/or scanned into the Document Imaging System (DIS) as proof of the AU’s circumstances. All documents scanned into DIS will be tagged, at a minimum, with the Client ID(s) of the individual(s) the document(s) pertain(s) to, the ID(s) of the case(s) impacted, and with the appropriate document “type” (e.g. pay stubs as Proof of Income).

A collateral contact is an oral or written confirmation of the AU’s circumstances by a non-AU member. The collateral contact may be made in person, over the telephone, or in writing.

A collateral contact alone is not sufficient for verification of income. Documentary evidence such as a signed statement or Form 809 must be received, with the collateral contact made to validate.

If a written statement is provided by the collateral contact, the statement must be signed by the individual who wrote the statement. The statement should be dated but, if not dated, DFCS must date stamp or record on the statement the date it is received. The telephone number and/or address or way to contact the collateral contact must be furnished. This information may be provided as a part of the written collateral statement or recorded in the case file.

If a collateral statement is unacceptable to the agency because it is not completed correctly or lacks the required information and the AU is cooperating with providing information, then the agency must offer assistance to the AU. The agency may ask the AU to provide another collateral contact or contact the collateral contact directly.

The agency may substitute a home visit or select an alternative form of verification if circumstances warrant.

The agency must make sure that the AU understands what information is needed from the collateral contact. The request for verification form should specify what information is needed and the preferred format.

When taking a collateral statement on the telephone or in person, document in the case file the name, address, or telephone number of the contact, the date of the contact and the collateral contact’s statements regarding the AU.

The agency may select a collateral contact if the AU fails to designate one or designates one who is unacceptable to the agency. Examples of acceptable collateral contacts include employers, landlords, neighbors, social service agencies, etc.

When speaking with a collateral contact, the agency must disclose only the information that is absolutely necessary to obtain the information being sought. Avoid disclosing the following information:

Refer to Section 2001 - Computer Matches Overview, Section 2002 - Income and Eligibility Verification System (IEVS) and Section 2004 - Clearinghouse. These sections provide policy regarding verification of case information by computer matching.

If appropriate, prearranged home visits may be used as verification. DFCS employees may use home visits if any of the following situations occur:

Case files must be documented in accordance with the standard documentation requirements. Case notes, the Document Imaging System (DIS) and Gateway together are considered the case file. A written recording of the information and statements provided by the AU is considered verification. This is the AU’s statement of its circumstances. The agency may also request that the AU make a separate, written statement to verify and/or clarify a specific point of eligibility.