823           VERIFICATION REQUIREMENTS

To receive MAGIModified Adjusted Gross Income Medicaid, an individual must meet eligibility requirements outlined in this manual. An applicant must claim on the application form that the eligibility requirements are met. In addition, the applicant may be required to verify that the household or a member of the household meets certain factors of eligibility.

Verification can be obtained primarily through electronic interfaces. Other sources include documents and contacts with third parties. Verification is used to establish the accuracy of information stated on the application or provided by the applicant.

The household has the primary responsibility for providing documentary evidence to support statements made and to resolve any questionable information.  

The caseworker applies professional expertise and exercises prudent judgment to determine if the proof is sufficient to document the eligibility requirement. A household cannot be found eligible for Medicaid if the applicant refuses to allow the caseworker to verify or document information relevant to the eligibility determination.

When an applicant or recipient submits an application or reports a change, most eligibility requirements will be verified through electronic interfaces. If eligibility cannot be verified electronically and secondary verification is needed, the household may be required to provide proof that they meet eligibility requirements.

823 a.   THE FOLLOWING FACTORS OF ELIGIBILITY REQUIRE PROOF:

• Citizenship status

• Qualified alien status

• Multiple Births

• Countable income (unless reasonably compatible, see section 823-2)

• Pre-tax payroll deductions

• Income tax deductions

• TPLThird Party Liability termination

823 b.  CLIENT STATEMENT IS ACCEPTABLE FOR THE FOLLOWING FACTORS IF NOT QUESTIONABLE:

• Earned Income if client statement is reasonably compatible with electronic information (see section 823-2);

• Self-Employment Income;

• Household Composition;

• Parent/Caretaker relative relationship;

• Pregnancy (unless multiple births are expected);

• Age;

• Race;

• Ethnicity;

• Gender;

• Tax filing or tax dependency status (If the individual doesn't know their tax filing or dependency status, the caseworker is to determine eligibility using non-filer rules.); and

• Crowdfunding.

823 C.   QUESTIONABLE INFORMATION

Questionable information is unclear or inconsistent information that contradicts a previous application, written or verbal statement made by the applicant, or other information received by the agency.

Any information that an caseworker determines to be questionable must be verified when it affects a household's eligibility for Medicaid. Verification of previously verified information cannot be required, unless the caseworker determines the information has become questionable.

When information from another source contradicts statements made by the applicant, the applicant must be provided an opportunity to clarify and verify their circumstances.

823 D.   DOCUMENTATION

Documentation is a record of what elements are verified and why certain decisions are made that relate to a determination of eligibility for Medicaid. The caseworker must place verification in the case file and document verification in the case notes. The caseworker must also document each action taken that is related to an individual’s or household’s application for or receipt of Medicaid. (See Administrative Procedures Manual for documentation standards.)