808-7         REASONABLE OPPORTUNITY PERIOD

If an individual claims that he or she is a U.S.United States citizen or qualified alien who has met the 5 year waiting period and the individual’s status cannot be verified through an electronic interface, the household must submit proof. If the household does not have proof of their citizenship or qualified alien status the ETEligibility Technician must provide a reasonable opportunity period of 90 days for the household to provide proof of their citizenship or qualified alien status.

808-7 A.    PROVIDING ASSISTANCE TO APPLICANTS

During the reasonable opportunity period, if needed, the ETEligibility Technician must assist the household. The ETEligibility Technician can assist with the following ways:

• Help the individual get a social security number;

• Try to resolve any inconsistencies, including errors, between information provided by the individual and data from an electronic source. The ETEligibility Technician must resubmit corrected information to the electronic data source.

• Give the individual information on how to contact the source of the electronic data so they can attempt to resolve the conflict(s) directly.

• Let the individual provide other acceptable documentation of citizenship or qualified alien status.

808-7 B.    MEDICAID ELIGIBILITY DURING THE REASONABLE OPPORTUNITY PERIOD

Medicaid eligibility for individuals who claim to be U.S.United States citizens or qualified aliens may not be delayed or denied during the reasonable opportunity period if the individual meets all other eligibility factors. Medicaid benefits must be provided as soon as all other eligibility factors are confirmed. If otherwise eligible, Medicaid benefits begin the first day of the month of application.

If, by the end of the 90-day reasonable opportunity period, the required verification has not been received and the ETEligibility Technician has not been able to verify U.S.United States citizenship or qualified alien status in any other way, the individual, including individuals on Children Under 19 and Pregnant Women and Postpartum Medicaid, must have their Medicaid eligibility terminated with timely notice of adverse action.

An individual may have more than one reasonable opportunity period. A new application is needed for each 90 day period. If an individual receives more than one reasonable opportunity period in order to provide adequate proof of U.S.United States citizenship or qualified alien status, a fraud referral may be appropriate.

A fraud referral would be appropriate if it appears the individual is not just experiencing difficulty in providing the necessary proof, but is instead seeking to receive Medicaid benefits to which the individual is not entitled. See section 803 for the policy on fraud and fraud referrals.

Note:

Children under the age of 19 are not eligible for a 12-month continuous eligibility period if their citizenship or qualified alien status is not verified. See section 808-6.

Women under the Pregnant Women Medicaid category are not eligible through the end of the pregnancy and post-partum period if their citizenship or qualified alien status is not verified. See section 816-1.