Medicaid Policy                                                                 

 

731 Verification

Effective Date: November 1, 2024

Previous Policy

 

A.Methods of Verification

  1. We are required to verify all factors of eligibility. There are several ways to verify items of eligibility, and in some cases, the information available in the record of a member participating in one program can be used to verify their eligibility for another program. Explore all possible avenues of eligibility and rely on information that is reasonably available.

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.   

  1. Verification methods include:

B.Requesting Verification

  1. The eligibility agency must use all available resources to determine eligibility for medical programs.

  1. Send a written request for verification 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.

  1. The applicant or recipient must provide acceptable verification when the eligibility agency cannot access the information.

  1. Give individuals at least 10 days from the date you mail the written request to provide verification. If the 10th day is a non-business day, the due date is the next business day after the 10th day (107-2).

  1. Individuals may request more time to provide verification. The eligibility agency can also extend the time when extenuating circumstances make it difficult for the individual to respond timely, or if the worker knows the individual needs more time.

  1. See 703-5 if an applicant provides verification within 30 days of the denial notice.

  1. Do not stop benefits when the individual fails to provide verification, if required, for changes that result in a positive change (e.g. lower spenddown or MWI premium), or that don’t make the individual ineligible. However, do not increase benefits unless required verification is received.

  1. Applicants and recipients may be asked to cooperate with and provide requested verification to the Department or the eligibility agency to assist in quality control and payment accuracy reviews (107-7).

  1. At reviews, verify only those eligibility factors necessary to redetermine continued eligibility.