Medicaid Policy
Medicaid Policy
No Previous Policy
Restrict Access To Match Reports
Income match report information is private. Protect it as explained in Section 111 and 115. Do not allow unauthorized individuals to access or view computer match information or printed match reports. There are even more rules for protecting IRS match reports. IRS data must NOT be identifiable in case records. INSTEAD, note a report of possible unreported income, or income-producing assets or investments.
Take Action On Match Reports
Promptly evaluate all information received from the individual, on behalf of the household, or from electronic data matches to see if the information impacts eligibility for medical assistance.
If the information is reasonably compatible (what the individual tells you is the same as the electronic data) you can take action on the change. Income information is compatible if what the individual tells you and the electronic data tells you are both below the income limit (individual is eligible), the same as the income limit (individual is eligible), or if both are above the income limit (individual is not eligible).
Example 1: Household reports that unemployment benefits have ended and that their household income is now $0. An electronic data match shows that the household is still receiving unemployment benefits of $1000 a month. The income limit for the medical program the children in the household qualify for is $1628. What the individual tells you and the electronic data are both below the income limit. The income information is compatible.
Example 2: Household requests to add a family member to the medical assistance. They report earnings of $1200/month. An electronic data match shows this person earning $1800/month. The income limit for the program is $1628. The information is not compatible because what the individual reports is below the limit and the electronic data is above the limit. There are no other electronic data sources to check. Request an explanation from the household and if needed request documentation.
Example 3: Household reports they are now receiving unemployment benefits of $1700/month. An electronic data match confirms that the household is receiving UC benefits of $1750/month. The income limit for the medical assistance is $1628. The income information is compatible because both amounts are above the income limit. Re-determine eligibility and look for another program the household may be eligible for.
If the information is not compatible check other sources of data to resolve the discrepancy. Do not require the individual to provide documentation unless you cannot verify the information with electronic data or the information is still not compatible.
If you cannot resolve the discrepancy ask the individual/household to explain why the information is different. If needed, request documentation from the individual/household. The household may need to contact another agency to correct a date of birth or make a name change before the data will match. When the household says they have done that try to match the data electronically again.
All requests must describe the issue that must be resolved and explain that a match indicates the person has unreported income and/or unreported assets. The notice must explain what must be verified and the time period or specific monthly amounts needed. It may include information such as the employer's name, the bank branch and account number, the type of pension, the type of assets, etc. To comply with Safeguard rules, the notice MUST NOT name "DWS-Job Service" or "IRS" as the source.
Follow the rules for proper and timely notice. Tell the recipient when the verification is due, and what will happen if the individual fails to comply with the request.
Notify the Household
Do not deny, reduce, or terminate benefits for any household member until you have asked the household to explain/verify information that is incompatible.
Provide proper notice and hearing rights to households that have their benefits denied, reduced or terminated.
Special Federal Income Match Rules
Federal rules require complete actions on all match data for open cases. Once an Income Match report is received (on-line or printed), an application or case review CANNOT be approved before appropriate actions are taken that resolve questions about current eligibility. Send all requests for verification to resolve conflicting information within 30 days of receipt of the match report. The agency must complete action on at least 80% of the cases on the report. (The agency may exceed the 30-day limit for taking action on the match reports on up to 20% of the cases ONLY WHEN you are waiting for responses to requests for verification.)
The Federal Income Match rules define complete action as:
Comparing the match data to the case record: It may prompt a need to verify both current and past eligibility. Decide if further action or verification is needed. Record the SSA or DWS match and the action needed in the case file. To prevent violation of safeguard rules, NEVER identify IRS match data in the case record.
Requesting verification when the income match data differs from the case record: Request verification from either the individual, or the source of income. (You do not need the individual's permission to contact the source.) Make the request in writing. Electronic notices are available to send to the individual.
Completing the action on the income match data: A complete action includes documenting the actions taken and providing written ten-day notice of any change in eligibility or benefits.