Current through Bulletin 2024-06, March 15, 2024
(1) The Department adopts and incorporates by
reference
42 CFR
435.945,
435.948,
435.949,
435.952,
and
435.956,
October 1, 2012 ed.
(a) The Department may
seek approval from the Secretary in accordance with
42 CFR
435.945(k) to use
alternative electronic data sources in lieu of using the data available from
the federal data hub.
(b) Medical
assistance applicants and recipients must provide identifying information that
the eligibility agency needs to complete electronic data matches.
(c) The eligibility agency may request
verification from applicants and recipients in accordance with the agency's
verification plan that is necessary to determine eligibility.
(2) Medical assistance applicants
and recipients must verify all eligibility factors requested by the eligibility
agency to establish or to redetermine eligibility when the information cannot
be verified through electronic data matches, or when the electronic data match
information is not reasonably compatible with the client provided information.
(a) The eligibility agency shall provide the
applicant or recipient a written request of the needed verification.
(b) The applicant or recipient has at least
ten calendar days from the date that the eligibility agency gives or sends the
verification request to provide verification.
(c) The due date for returning verification,
forms or information requested by the eligibility agency is the close of
business on the date that the eligibility agency sets as the due date in a
written request.
(d) An applicant
must provide all requested verification before the close of business on the
last day of the application period. If the last day of the application
processing period is a non-business day, the applicant or recipient has until
the close of business on the next business day to return
verification.
(e) The eligibility
agency shall allow the applicant or recipient more time to provide verification
if he requests more time by the due date. The eligibility agency shall set a
new due date based on what the applicant or recipient needs to do to obtain the
verification and whether he shows a good faith effort to obtain the
verification.
(f) If an applicant
or recipient does not provide verification by the due date and does not contact
the eligibility agency to ask for more time to provide verification, the
eligibility agency shall deny the application or review, or end
eligibility.
(g) If a due date
falls on a non-business day, the due date is the close of business on the next
business day.
(3) The
eligibility agency must receive verification of an individual's income, both
unearned and earned. To be eligible under the Medicaid Work Incentive program,
the eligibility agency may require proof such as paycheck stubs showing
deductions of FICA tax, self-employment tax filing documents, or for newly
self-employed individuals who have not filed tax forms yet, a written business
plan and verification of gross receipts and business expenses, to verify that
the income is earned income.
(4) If
an applicant's citizenship and identity do not match through the Social
Security electronic match process and the eligibility agency cannot resolve
this inconsistency, the eligibility agency shall require the applicant to
provide verification of his citizenship and identity in accordance with
42 U.S.C.
1396 a(ee)(1)(B).
(a) The individual must provide verification
to resolve the inconsistency or provide original documentation to verify his
citizenship and identity within 90 days of the request.
(b) The eligibility agency shall continue to
provide medical assistance during the 90-day period if the individual meets all
other eligibility criteria.
(c) If
the individual fails to provide verification, the eligibility agency shall end
eligibility within 30 days after the 90-day period. The eligibility agency may
not extend or repeat the verification period.
(d) An individual who provides false
information to receive medical assistance is subject to investigation of
Medicaid fraud and penalties as outlined in
42 CFR
455.13 through
455.23.
