Current through Register Vol. 63, No. 9, September 1, 2024
In the GA, OSIP, OSIPM, and QMB programs:
(1) All eligibility (see OAR
461-001-0000) factors, including
identity, must be verified at initial application, when there is a change to
any factor, and whenever eligibility for benefits becomes
questionable. See OAR
461-115-0704 for the
requirements to provide verification of citizenship and immigration
status.
(2) Methods of verifying
information include the following:
(a)
Electronic. Information available and provided to the Department from an
electronic source, including but not limited to:
(A) State Wage Information Collection
Agency.
(B) Internal Revenue
Service.
(C) Social Security
Administration.
(D) State
Unemployment Compensation Agency.
(E) State agencies administering programs
under Title 1, 10, 14, or 16 of the Social Security Act.
(F) SNAP agencies.
(G) Other insurance affordability
programs.
(H) The Department of
Treasury.
(I) The Department of
Homeland Security.
(J) Asset
Verification System.
(b)
Self-attestation. Information provided orally or in writing by or on behalf of
an individual.
(c) Documentation.
Documentary evidence provided by or on behalf of an individual, or obtained by
the Department from a third party.
(3) If necessary, information needed to
determine eligibility must be provided by or on behalf of the
individual requesting benefits.
(4)
The Department must allow a reasonable amount of time to provide additional
information, if necessary.
(5)
Financial eligibility.
(a)
Resources.
(A) In the OSIP, OSIPM, and QMB-DW
programs, if the total self-attested value of gross "liquid resources" of the
financial group (see OAR
461-110-0530) is less than $400,
further verification of the value of "liquid resources" is only required if
questionable. For the purposes of this rule, "liquid resources" include cash as
well as other resources that can be converted to cash within 20 business days,
except that the cash surrender value of a life insurance policy is not
considered a liquid resource.
(B)
The Department must request and use information from available electronic
sources, without requiring additional documentation, to verify a resource,
unless:
(i) The information is not available
to the Department electronically.
(ii) The information provided by
self-attestation differs from the information received electronically and the
individual or person acting on the individual's behalf could not provide a
statement which reasonably explains the discrepancy.
(C) The Department must use the Asset
Verification System when a resource or transfer of assets (see
OAR 461-140-0210 to
461-140-0300) evaluation is
necessary to determine eligibility. Consent to use the Asset
Verification System is required and a condition of
eligibility. If resource information is not available, or not
returned, through the Asset Verification System, or differs from self-attested
information, resource documentation may be requested directly from the
individual, subject to the other requirements of this
section.
(b) Income. The
Department verifies income through electronic, self-attestation, and
documentary methods. Except for as provided in paragraph (A) of this
subsection, individuals may self-attest to income that is not subject to
verification by the Federal Data Services Hub (FDSH), such as self-employment
or private pension. Income subject to verification by the FDSH is compared to
self-attested income to determine if further verification is needed.
Self-attestation may otherwise be accepted subject to the provisions in
paragraph (B) of this subsection.
(A)
Supplemental Security Income (SSI) and all Social Security Title II income will
be verified via means separate from the FDSH check described in part (B) of
this subsection. The verified amounts shall be used to determine
eligibility.
(B)
FDSH check. Self-attested income is compared to information obtained through a
match with the FDSH.
(i) Step One. The
self-attested income of each individual in the
financial group
is compared to the values returned by the FDSH for that individual to determine
if it is considered "reasonably compatible," meaning no further verification is
needed. The income is
reasonably compatible if it meets any of
the following:
(I) The FDSH returns a value
greater than $0, but less than the individual's attested amount.
(II) The FDSH returns a value greater than
the attested amount, but within 110% of the individual's attested
amount.
(III) The individual
attests to $0 income, and the FDSH returns $0 or absent value.
(ii) Step Two. If any member of
the financial group has income that is not reasonably
compatible as described in paragraph (i) of this part above, the total
self-attested income of each individual's financial group is
compared to the total income obtained by the FDSH for the financial
group to determine if it is considered reasonably
compatible, meaning no further verification is required. The income is
reasonably compatible if the total income of the individual's
financial group obtained via the FDSH and the total
self-attested income of the financial group are both within
the income threshold for the benefit for which the individual is
evaluated.
(iii) If the total
self-attested income of the financial group results in
financial ineligibility, the Department shall accept the attested information
and deny benefits.
(iv) If
self-attested income is not
reasonably compatible under Step
One or Step Two and does not result in financial ineligibility:
(I) Self-attested income will be used for the
initial eligibility determination and documentary verification
will be requested post-eligibility.
(II) Upon receipt of documentary
verification, the Department will confirm or adjust ongoing
eligibility as appropriate.
(III) If documentary verification cannot be
obtained, the individual must provide a reasonable explanation as to why, which
the Department may accept.
(6) Identity.
(a) Except as provided for in subsections (c)
and (d) of this section, individuals must provide documentation to verify
identity.
(b) The Department must
accept the following as proof of identity, provided such document has a
photograph or other identifying information sufficient to establish identity,
such as name, age, race, height, weight, eye color, or address:
(A) Driver's license issued by a state or
territory.
(B) School
identification card.
(C) U.S.
military card or draft record.
(D)
Identification card issued by the federal, state, or local
government.
(E) Military dependent
identification card.
(F) U.S. Coast
Guard Merchant Mariner card.
(G)
For children under the age 19, a clinic, doctor, hospital, or school record,
including preschool or day care records.
(H) Two other documents containing consistent
information that corroborates an applicant's identity. Such documents can
include employer identification cards; high school, high school equivalency,
and college diplomas; marriage certificates; divorce decrees; and property
deeds or titles.
(c) The
Department may accept the finding of identity from a federal or another state
agency for the purposes of public assistance, law enforcement, internal revenue
or tax bureau, or corrections, if the agency has verified and certified the
identity of the individual.
(d) If
the individual does not have any document specified in subsection (b) of this
section, and identity cannot be verified under subsection (c) of this section,
the Department must accept an affidavit signed, under penalty of perjury, by an
individual other than the applicant who can reasonably attest to the
applicant's identity. Such affidavit must contain the individual's name and
other identifying information described in subsection (b) of this
section.
(7) Social
Security numbers. The Department must verify that the SSN furnished by an
individual was issued to that individual. Acceptable sources of verification
must show a correct Social Security number, including but not limited to:
(a) Social Security Card.
(b) Social Security award letters or other
correspondence or forms bearing the individual's SSN.
(c) Medicare card, if the individual is
receiving Medicare off their own record.
(d) Information provided electronically to
the Department from the Social Security Administration.
(e) Wage stubs or unemployment
records.
(f) IRS forms or
letters.
(8) Pregnancy.
The Department must accept self-attestation of pregnancy unless the Department
has information that is not reasonably compatible with such
attestation.
(9) Residency, age,
date of birth, household size. The Department may accept self-attestation as
verification of residency, age, date of birth, and household size, unless the
statement differs from information available to the Department electronically
or otherwise, in which case the Department may require the individual to
provide documentation.
(10) If the
Department is unable to verify information electronically or from a third
party, the Department will accept, on a case-by-case basis, self-attestation to
verify all eligibility criteria, except citizenship and
immigration status, under the following circumstances:
(a) Documentation does not exist at initial
application or redetermination; or
(b) Documentation is not reasonably available
at initial application or redetermination, such as in the case of homelessness,
domestic violence, or natural disaster.
(11) The Department may not deny, close, or
reduce benefits if verification available to the Department is incompatible or
absent, and the Department did not request additional information from the
individual.
Statutory/Other Authority: 411.070, 411.404, 411.706,
413.085, 414.685, ORS
409.050,
411.060,
411.402,
42
USC 1396W &
42 CFR 435.940-
435.965
Statutes/Other Implemented: ORS 409.010, 409.050, 411.060,
411.070, 411.404, 411.706, 413.085, 414.685, 414.839, 411.402,
42
USC 1396W &
42 CFR 435.940-
435.965
