520           ELIGIBILITY REQUIREMENTS THAT FOLLOW APAAdult Public Assistance POLICY

520 A.      APPLICATION PROCESS

In order for the Division of Public Assistance (DPA) to determine a household's eligibility, the household must:

• Submit an application that meets the identifiable application requirements in one of the following ways:  

1. by mail;
2. in person;
3. online;
4. by fax;
5. by phone; or
6. by email.

Note:

A Medicaid application submitted through the FFMFederally Facilitated Marketplace or SSPSelf Service Portal can be used for any category of Medicaid. For ADLTCAged, Disabled, and Long Term Care Medicaid categories, the caseworker will need additional information from the household, such as resources, before they can determine eligibility.

An FFMFederally Facilitated Marketplace or SSPSelf Service Portal application can only be used to apply for Medicaid, not APAAdult Public Assistance.

Participate in an interview with DPADivision of Public Assistance caseworker or DPADivision of Public Assistance contracted fee agent; and Provide documentation and verification, including required forms, needed to determine program eligibility.

All households may file an application the same day they contact DPADivision of Public Assistance to establish a protected filing date.  DPADivision of Public Assistance will help all households with the application and renewal process.

A Native Family Assistance Program (NFAP) application form is an acceptable application and renewal form.

Medicaid also uses the MED 4 application form for an individual applying for or receiving institutional or HCBHome and Community-Based waiver services.  The application must be completed, and necessary forms signed by the applicant, a relative or a guardian acting on his or her behalf.  If the applicant is married and living with his or her spouse or entering a nursing home, collect income and resource information of the spouse in order to determine if the community spouse should receive an income maintenance allowance from the institutional or HCBHome and Community-Based waiver spouse.

Fee agents help households who live in communities that do not have a local DPADivision of Public Assistance office apply for public assistance.  The fee agent can help the household apply online or use DPADivision of Public Assistance applications and other forms provided by DPADivision of Public Assistance.  Households are not required to go to a fee agent and may apply directly through DPADivision of Public Assistance.

The receipt of an identifiable application by DPADivision of Public Assistance establishes the application filing date.  An identifiable application must contain the applicant's name, address, and signature.

When the applicant asks to apply for another program prior to a timely Medicaid eligibility determination, use the original filing date and benefit start date for all programs. If the request occurs more than 45 days after a MAGI Medicaid application was received or more than 90 days after an ADLTCAged, Disabled, and Long Term Care Medicaid application was received, a new application is required for another program.

Note:

Online applications include an electronic signature.

Paper applications can be signed by e-signature, digital signature, or a handwritten signature created on an electronic device (finger/stylus to screen) starting October 1, 2024.

Telephonic signatures must be recorded by a caseworker through the VCCVirtual Call Center.

When households apply for multiple programs, DPADivision of Public Assistance must make a Medicaid determination based on the information in the application.  DPADivision of Public Assistance must not delay the Medicaid determination if more information is needed for other programs.

Children in SSISupplemental Security Income-related categories (for examples, SSISupplemental Security Income, TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248, HCBHome and Community-Based waiver services, Special LTCLong Term Care Standard, etc.) are reviewed annually.

When a new or review application is received for other DPA programs, prior to the established date for the Medicaid renewal, the new or review application should not be used to establish a new certification period for Medicaid benefits. It should be reviewed for reports of change.  

An interview is not required at renewal. See section 522(D).

                   520 B.      WHEN AN APPLICATION IS REQUIRED:
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1. Upon the individual's first application for Medicaid.
2. Upon application from a denied, withdrawn, or closed status, unless the denial or closure was the result of an administrative error.
3. Any time the caseworker believes the individual's circumstances have changed sufficiently to justify conducting a special redetermination of eligibility, including when an office conducts a special review project for all or part of its caseload.

520 C.      PROOF OF UNITED STATES CITIZENSHIP AND QUALIFIED ALIEN STATUS

Refer to APA Manual Section 421 for policy on U.S.United States citizenship and eligible alien status.

See this section for U.S.United States citizenship verification procedures and identity verification procedures.

Citizenship and qualified alien status must be verified for most individuals.  Verification of satisfactory immigration status is not required for an individual applying for Emergency Treatment for Aliens (See section 576).  In addition, some U.S.United States citizens are exempt from the requirement to provide proof.  See section 520-B(1) below.

Once a person’s U.S.United States citizenship is documented and recorded, it is not necessary to get proof again unless that person’s citizenship becomes questionable.

Proof of U.S.United States United citizenship or qualified alien status is only needed for the individuals who will receive Medicaid benefits, not for individuals applying for or renewing Medicaid on behalf of someone else. 

If a mandatory household member is found ineligible for Medicaid for lack of verification of citizenship and identify, or immigration status, that individual's needs and income continue to be included in the financial eligibility determination for the household.

Reminder:

If an individual claims he or she is an U.S.United States citizen or qualified alien and the proof of status cannot be promptly verified through a computer match or others acceptable documentation, the individual must be given a reasonable opportunity period (90 days) to provide acceptable proof of their citizenship or qualified alien status.  See Section 520(C).  

1.    WHEN PROOF OF U.S. CITIZENSHIP IS NOT REQUIRED

The following U.S.United States citizens are exempt from the requirement to provide proof:

1. A current Supplemental Security Income (SSI) recipient
    
2. An individual entitled to or enrolled in any part of Medicare
    
3. An individual receiving Social Security Disability Insurance (SSDI) benefits
    
4. Children in state foster care or Title IV-E adoption assistance
    
5. Children receiving Newborn Medicaid coverage

Qualified aliens receiving these benefits are still required to provide proof of their qualified alien status.

Note:

In some circumstances non-citizens may receive SSDISocial Security Disability Insurance, SSISupplemental Security Income or Medicare. Therefore, receipt of these programs does not exempt the individual from verifying their alien status.

2. ELECTRONIC AND INTERFACE VERIFICATION FOR U.S. CITIZENSHIP

Data Matches and Interfaces

Verification of an individual's citizenship is first pursued through an electronic interface.

A)  Federal Data Services HUB

In most cases, proof of citizenship will be immediately available in ARIESAlaska's Resource for Integrated Eligibility Services through a data match with the federal data services hub.  

B)  State Verification Exchange System (SVES) with the Social Security Administration (SSA)

If proof is not available through the federal data services hub in ARIESAlaska's Resource for Integrated Eligibility Services, it is possible that acceptable proof may be available through other data matches in EISEligibility Information System, but only if the individual is already known to EISEligibility Information System. For individuals whose Medicaid eligibility is being determined in EISEligibility Information System, proof of citizenship or qualified alien status must be sought through electronic data interfaces in EISEligibility Information System.

Proof of citizenship will be available within a few days through a SVESState Verification Exchange System data match with SSASocial Security Administration.  If the SVESState Verification Exchange System response does not verify citizenship, the caseworker must confirm that the correct name and SSNSocial Security Number was used for the data match.  If not, the caseworker must make the corrections in either ARIESAlaska's Resource for Integrated Eligibility Services or EISEligibility Information System and request a new data match.

The SVESState Verification Exchange System interface in EISEligibility Information System may be used to verify a person's SSNSocial Security Number, U.S.United States citizenship and identity.  The ETEligibility Technician may accomplish this by submitting a SVESState Verification Exchange System inquiry for one or more persons on the INME/SVIR or SSDOSSN / Date of Birth / Sex screens.

3.  PROOF OF U.S.United States CITIZENSHIP

If proof through an electronic data match or interface is not promptly available, verification of the individual's citizenship or qualified alien status may be obtained through documentary proof.

When accepting documentary proof, a photocopy, fax, scanned, or other copy of a document must be accepted to the same extent as an original document, unless there is good reason to question the document or the information on the document.  Although some documents contain a statement, DO NOT COPY, DPADivision of Public Assistance staff may copy and file these documents in the case file for official purpose of establishing Medicaid eligibility.

4.  DOCUMENTARY PROOF OF U.S.United States CITIZENSHIP

The following documents are considered acceptable evidence of citizenship for other DPADivision of Public Assistance programs requiring proof of identity, these documents are acceptable evidence for both citizenship and identity.

1. A U.S.United States Passport, including a U.S.United States Passport Card issued by the Department of State, even if expired, as long as such Passport or Card was issued without limitation
    
2. A Certificate of Naturalization
    
3. A Certificate of U.S.United States Citizenship
    
4. A valid State-issued driver's license if the state issuing the license requires proof of U.S.United States citizenship, or obtains and verifies a social security number from the applicant who is a citizen before issuing such license.  All of these enhanced drivers licenses have a picture of the U.S.United States flag on the front of the license.
    
5. Documentary evidence issued by a federally recognized Indian Tribe, such as a Tribal enrollment card or Certificate of Degree of Indian Blood, which:

• Identifies the Federally recognized Indian Tribe that issued the document; and
   
• Identifies the individual by name; and
   
• Confirms the individual's membership, enrollment, or affiliation with the Tribe.
   

5. PROOF OF U.S.United States CITIZENSHIP OBTAINED USING A LISTED DOCUMENT AND PROOF OF IDENTITY

Only if citizenship cannot be obtained through an electronic interface and the individual does not provide a document listed in section 520 B(4), a document from the following list and proof of identity from section 520 B(6) may be used for U.S.United States citizenship verification.

1. A U.S.United States public birth certificate showing birth in one of the 50 States, the District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam, the Virgin Islands of the U.S.United States (on or after January 17, 1917), American Samoa, Swain's Island, and the Northern Mariana Island (after November 4, 1986).  This document may be obtained from a data match or online access with the Health Analytics & Vital Records (HAVRHealth Analytics & Vital Records).  When birth information is verified through the online HAVRHealth Analytics & Vital Records Health access look up, a screen print of the information must be marked 'For DPADivision of Public Assistance Use Only' and must be placed in case file.  These screen prints must not be copied for other uses.
    
2. A certification of Report of Birth issued to U.S.United States citizens who were born outside the U.S.United States
    
3. A Report of Birth Abroad of a U.S.United States Citizen.
    
4. A U.S.United States Citizen I.D. Card.
    
5. A Northern Marianas Identification Card issued to a collectively naturalized citizen, who was born in the Northern Marianas Islands before November 4, 1986.
    
6. An American Indian Card issued by the Department of Homeland Security with the classification code "KIC." These are issued to identify a member of the Texas Band of Kickapoos.
    
7. A final adoption decree showing the child's name and U.S.United States place of birth, or if an adoption is not final, a statement from a state-approved adoption agency that shows the child's name and U.S.United States place of birth.
    
8. Evidence of U.S.United States Civil Service employment before June 1, 1976.
    
9. U.S.United States Military Record showing a U.S.United States place of birth.
    
10. A data match with the Systematic Alien Verification for Entitlements (SAVE) Program or any other process established by the Department of Homeland Security to verify that an individual is a naturalized citizen.
     
11. Documentation that a child meets the requirements of section 101 of the Child Citizenship Act of 2000.
     
12. Extract of a hospital record on hospital letterhead established at the time of the person's birth that was created 5 years before the initial Medicaid application date and indicates the U.S.United States place of birth, excluding souvenir 'birth certificates.' For children under 16 years old, the document must have been created near the time of birth of 5 years before the date of Medicaid application.
     
13. Life, health, or other insurance record that indicates a U.S.United States place of birth.  The record must have been created 5 years before the initial Medicaid application date.
     
14. Official religious record recorded with the religious organization within 3 months of birth showing that the birth occurred in the U.S.United States
     
15. School records, including preschool, Head Start and day-care, showing the child's name and U.S.United States place of birth and the names and places of birth of the applicant's parents.
     
16. Once of the following documents that show a U.S.United States place of birth and was created at least 5 years before the application Medicaid.  For children under 16. the document must have been created near the time of birth or 5 years before the date of application:

• Seneca Indian tribal census
   
• Bureau of Indian Affairs tribal census records of the Navajo Indians
   
• U.S.United States State Vital Statistics official notification of birth registration
   
• A delayed U.S.United States public birth record that is recorded more than 5 years after the person's birth
   
• Statement signed by the physician or midwife who was in attendance at the time of birth
   
• The Roll of Alaska Natives maintained by the Bureau of Indian Affairs

17. Institutional admission papers from a nursing facility, skilled care facility or other institution created at least 5 years before the initial Medicaid application date that indicates U.S.United States place of birth.
     
18. Clinic, doctor, or hospital records, excluding immunization records created at least 5 years before the initial Medicaid application date that indicates the U.S.United States place of birth.  For children under 16, the document must have been created near the time of birth or 5 years before the date of application.
     
19. If an applicant does not have one of the document listed above, he or she may submit two written affidavits signed under penalty of perjury by 2 other individuals who can reasonably attest to the applicant's citizenship, and that contains the applicant's name, date of birth, and place of U.S.United States birth.  The individuals attesting to the applicants U.S.United States citizenship must be knowledgeable regarding the citizenship claim, and if known, why the applicant's claim to citizenship does not exist or cannot be easily obtained.  The individual's must also provide proof of their own citizenship and identity.  At least one of the attesting individuals must not be related to the applicant.  A written affidavit must also be provided by the applicant explaining why proof does not exist or cannot be obtained.  The affidavits do not have to be notarized.
     

6.  PROOF OF IDENTITY ONLY

1. A driver's license issued by a state or territory with a photograph or other identifying information.  Refer to section 520-B(4) when reviewing a driver's license from Michigan, New York, Vermont, or Washington, as the driver's license, if meeting requirements, may verify citizenship.
2. School identification card with a photograph.
3. U.S.United States military card or draft record.
4. Identification card issued by the federal, state, or local government with the same information included on the drivers' licenses.
5. Military dependent's identification card.
6. Certificate of Degree of Indian Blood, or other American Indian/Alaska Native Tribal Document that does not meet the requirements outlined in section 520(B)4.
7. U.S.United States Coast Guard Merchant Mariner card.
8. Finding of identity from a federal or state governmental agency.  The agency may accept as proof of identity a finding fom a federal agency or another state agency, including, but not limited to a public assistance, law enforcement, internal revenue or tax bureau, or corrections agency, if the agency has verified and certified the identity of the individual.
9. For children under age 16, a clinic, doctor, hospital, or school record.  School records may include nursery or day-care records and report cards that are verified by the nursery or day-care.

10. Identity affidavit signed under penalty of perjury by a residential care facility director or administrator on behalf of an institutionalized disabled individual in the facility.  It is not required to be notarized.

7.  PROOF OF QUALIFIED ALIEN STATUS

If verification of alien status is not available from electronic sources, an individual must provide proof of his or her alien status.

The following documents are acceptable for determining alien status and whether the alien is subject to the five-year waiting period.  Certain USCISU.S. Citizenship and Immigration Services documents can be viewed online at https.www.uscis.gov/forms/all-forms.

Note:

If an applicant presents a receipt indicating that he or she has applied to USCISU.S. Citizenship and Immigration Services for a replacement document for one of the documents identified above, contact the USCISU.S. Citizenship and Immigration Services to verify status by filing a G-845 with the local USCISU.S. Citizenship and Immigration Services district office and attach a copy of the receipt.

8. SYSTEMATIC ALIEN VERIFICATION FOR ENTITLEMENTS (SAVE) PROGRAM

The Systematic Alien Verification for Entitlements (SAVESystematic Alien Verification for Entitlements) is a program run by the U.S.United States Citizenship and Immigration Services which provides both an online system and a paper-based process to verify the immigration status of aliens.

The Verification Information System (VIS) is the online verification system.  The paper-based process makes use of the G-845, Document Verification Request.

The documents provided by each alien as verification of immigration status must be authenticated by using the SAVESystematic Alien Verification for Entitlements program.  The VISVerification Information System system will identify whether or not the alien has been lawfully admitted into the U.S.United States However, it may not provide enough information to determine whether or not the individual is a "qualified alien." The date of entry indicated on the VISVerification Information System database may not accurately reflect the date an immigrant physically arrived in the U.S.United States Secondary verification may be needed if no records are found or if there are discrepancies between the alien's documents and VISVerification Information System.

Written consent from the household is required to contact USCISU.S. Citizenship and Immigration Services to obtain documentation or information to verify the alien's status.

If the alien does not want the caseworker to contact USCISU.S. Citizenship and Immigration Services, the household can withdraw its application or participate without that member.

Written consent is not required to contact USCISU.S. Citizenship and Immigration Services to verify the validity of documentation provided by the alien or use the SAVESystematic Alien Verification for Entitlements Program inquiry process.

Verification of each alien's status through the SAVESystematic Alien Verification for Entitlements program is required whenever an application is processed for a household containing one or more alien members, and whenever an alien is added to a household.  All such contacts must be clearly documented in the case record.

See Administrative Procedures Manual Section 105-14 for instructions on how to use the SAVESystematic Alien Verification for Entitlements program.

520 D.      DEVELOPMENT OF INCOME

Refer to APA Manual Section 420 for policy on development of income requirements.

Exception #1:  

Pursuit of SSISupplemental Security Income benefits is not a requirement for Medicaid and APA Manual Section 420-2 does not apply to a Medicaid-only case.  However, an individual must still meet APAAdult Public Assistance/SSISupplemental Security Income criteria for blindness, disability, or age.  See APAAdult Public Assistance Manual Sections 424 - 425.

Note:

Pursuit of UIBUnemployment Insurance Benefit, Early Retirement, and Retirement is required if the individual is eligible. Eligibility for UIBUnemployment Insurance Benefit is dependent on the ability to look for and accept employment.  See MAGI MS 813 D or exemptions to apply for UIBUnemployment Insurance Benefit.

520 E.      DISABILITY DETERMINATIONS

The case file should contain a copy of the recipient’s long-term care medical authorization, approval for HCBHome and Community-Based waiver services from the DSDSDivision of Senior and Disabilities Services, and the SSISupplemental Security Income or SSASocial Security Administration approval, whichever are applicable.  If the person is disabled, it is very important to record the SSASocial Security Administration date of disability onset, as this date may determine the start date for retroactive Medicaid eligibility.

Refer to APA Manual Section 425 and Administrative Procedures Manual Section 115-9 for policy and procedures on disability determinations.  

Exception:  

SGASubstantial Gainful Activity is not a factor for Working Disabled Medicaid Buy-In.  See Section 534.  

Note:

A disability decision made by the Social Security Administration (SSASocial Security Administration) always trumps a decision made by Disability Determination Service (DDSDisability Determination Service).  Once SSASocial Security Administration determines that an individual does not meet the disability requirements, it supersedes any state only disability determination that found the individual disabled.  If we have an open APAAdult Public Assistance/MEMedicaid case based on a determination of disability made by DDSDisability Determination Service and SSASocial Security Administration then determines that there is no disability, we would close down the APAAdult Public Assistance/MEMedicaid case based on the SSASocial Security Administration denial.

520 F.      VERIFICATION AND DOCUMENTATION

Refer to APA Manual Sections 400-4 & 410-4  for policy on verification, and APA Manual Section 400-5 for policy on documentation.

520 G.      CHANGES

Refer to APA Manual Section 480-3 for policy on changes.

520 H.      NOTICES

Refer to MAGI MS 802 for policy on notices.

520 I.      LOSS OF CONTACT

Refer to APA Manual Section 480-6 for policy on loss of contact.

520 J.      AGE

Refer to APA Manual Section 424 for policy on qualifying age.

Exceptions:

• SSISupplemental Security Income Child Cases.  A blind or disabled child receiving a SSISupplemental Security Income payment and related Medicaid must be under age of 18.  These children are not included in any other Medicaid categories.

• Disabled Child at Home (TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248).  To be eligible for the TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility category, an individual must be under the age of 19.

520 K.      ABLE ACCOUNTS

Refer to APA Manual Section 433-4 for policy on ABLEAchieving a Better Life Experience Act accounts.

520 L.     CROWDFUNDING aCCOUNTS

Crowdfunding is the practice of obtaining needed funding by soliciting contributions from a large number of people, typically from the online community, e.g. go fund me.  If the client sets up the account themselves and has access to it, it is countable income in the month received and a countable resource the following month.

If the client is a recipient of funds from a crowdfunding account, it is countable income in the month received, except any funds directly paid to vendors on behalf of the client.

520 M.      INELIGIBLE SPOUSE RETIREMENT FUND

Retirement funds belonging to an ineligible community spouse is excluded as a resource per APA MS 460-4A.  APA MS 431-2G provides a list of possible retirement funds that an ineligible spouse may have.