California Code of Regulations
Title 10 - Investment
Chapter 12 - California Health Benefit Exchange
Article 5 - Application, Eligibility, and Enrollment Process for the Individual Exchange
Section 6478 - Verification Process Related to Eligibility Requirements for Enrollment in a QHP Through the Exchange

(1) For any individual who provides their SSN to the Exchange, the Exchange shall transmit the SSN and other identifying information to HHS, which will submit it to the SSA.

(2) If the Exchange is unable to verify an individual's SSN through the SSA, or the SSA indicates that the individual is deceased, the Exchange shall follow the procedures specified in Section 6492, except that the Exchange shall provide the individual with a period of 95 days from the date of the notice described in Section 6492(a)(2)(A) for the applicant to provide satisfactory documentary evidence or resolve the inconsistency with the SSA. If the Exchange determines on a case-by-case basis that the individual has demonstrated that they did not receive the notice within five days from the date of the notice, the individual shall have 90 days from the date on which they received the notice to provide satisfactory documentary evidence to the Exchange or resolve the inconsistency with the SSA.

(1) For an applicant who attests to citizenship and has a SSN, the Exchange shall transmit the applicant's SSN and other identifying information to HHS, which will submit it to the SSA.

(2) For an applicant who has documentation that can be verified through the DHS and who attests to lawful presence, or who attests to citizenship and for whom the Exchange cannot substantiate a claim of citizenship through the SSA, the Exchange shall transmit information from the applicant's documentation and other identifying information to HHS, which will submit necessary information to the DHS for verification.

(3) For an applicant who attests to citizenship, status as a national, or lawful presence, and for whom the Exchange cannot verify such attestation through the SSA or the DHS, the Exchange shall follow the inconsistencies procedures specified in Section 6492, except that the Exchange shall provide the applicant with a period of 95 days from the date of the notice described in Section 6492(a)(2)(A) for the applicant to provide satisfactory documentary evidence or resolve the inconsistency with the SSA or the DHS, as applicable. If the Exchange determines on a case-by-case basis that the individual has demonstrated that they did not receive the notice within five days from the date of the notice, the individual shall have 90 days from the date on which they received the notice to provide satisfactory documentary evidence to the Exchange or resolve the inconsistency with the SSA or the DHS, as applicable.

(1) Except as provided in subdivisions (d)(2) and (3) of this section, the Exchange shall accept an applicant's attestation that the applicant meets the residency standards of Section 6472(e) without further verification.

(2) If information provided by an applicant regarding residency is not reasonably compatible with other information provided by the individual or in the records of the Exchange, the Exchange shall examine information in HHS-approved data sources that are available to the Exchange.

(3) If the information in data sources specified in subdivision (d)(2) of this section is not reasonably compatible with the information provided by the applicant, the Exchange shall follow the procedures specified in Section 6492. Evidence of immigration status may not be used to determine that an applicant is not a resident of the Exchange service area.

(1) The Exchange shall verify an applicant's attestation that the applicant meets the requirements of 6472(d) by:

(2) If an applicant's attestation is not reasonably compatible with information from HHS-approved data sources described in subdivision (e)(1)(A) of this section or other information provided by the applicant or in the records of the Exchange, the Exchange shall follow the inconsistencies procedures specified in Section 6492.

(1) The Exchange shall verify an applicant's attestation that the applicant meets the requirements of 6472(f) by:

(2) If the Exchange is unable to verify the information required to determine eligibility for enrollment through the Exchange in a QHP that is a catastrophic plan as described in subdivision (f)(1) of this section, the Exchange shall follow the procedures specified in Section 6492, except for Section 6492(a)(4).