Methods of Verification
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.
Verification methods include:
Electronic verification (731-1)
Hard copy verification
Client statement, which means that in your professional judgement, based on your knowledge of the individual’s situation and reasonableness of the information provided, you have decided the client’s statement is an acceptable form of verification (731-3)
Collateral contact, which is a contact with a third party who has the knowledge necessary to confirm information the individual has provided (731-5)
Requesting Verification
1. The eligibility agency must use all available resources to determine eligibility for medical programs.
2. 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.
· If client statement is not compatible with electronic interfaces, do not deny or close a program or reduce benefits until you have given the individual a chance to provide verification.
· Do not request verification of items that have been verified and are not subject to change such as birth date or citizenship.
· Do not request verification of items that do not affect the person’s eligibility.
· Do not require a non-applicant to provide a Social Security number or information about their citizenship/non-citizen status to determine eligibility for another household member (221-3).
3. The applicant or recipient must provide acceptable verification when the eligibility agency cannot access the information.
· Help the individual get the verification if the individual needs help.
· If the individual cannot get the verification, the eligibility worker will make necessary contacts on behalf of the individual to verify information. Workers may make a collateral contact by phone or by sending a signed release of information form.
· Document these contacts in the case record.
· If a third party is unwilling or unable to cooperate with an agency request, the worker will try other methods of verification with the individual.
4. 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).
5. 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.
a. For ongoing cases, the individual must request more time by the date the verification are due.
b. Applicants must request more time by the end of the application period.
c. If the post office returns the request for verification notice with no forwarding address, see 811-4.
6. See 703-5 if an applicant provides verification within 30 days of the denial notice.
7. 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.
8. 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).
9. At reviews, verify only those eligibility factors necessary to redetermine continued eligibility.