5000-4        VERIFICATION AND DOCUMENTATION

To receive Medicaid, an individual or household must meet many eligibility requirements.  An applicant must claim on the application form and in an interview with a fee agent or caseworker 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 through documents, EIS Eligibility Information System or on-line system information, contacts with third parties, or home visits, and can be used to establish the accuracy of information stated on the application or provided by the applicant.

5000-4 A.   VERIFICATION REQUIREMENTS

The following require documentary or third party verification:

• Citizenship and identity for individuals who are U.S. United States citizens;

• Alien status, for individuals who are not U.S. United States citizens;
   

• Age;
   

• Caretaker relationship;
   

• Cooperation with Child Support Services Division or a claim of good cause for not cooperating;

• Deprivation;
   

• Development of income;
   

• Gross non-exempt income of all members of the household;
   

• Pregnancy with expected date of birth;
   

• Questionable information;
   

• Changes that may affect the household’s eligibility for Medical Assistance; and
   

• Disability determination.

In addition, the following must be verified to be included in the calculation of the household’s eligibility:  

• Work-related expenses (self-employment costs of doing business and child care expenses);
   

• Child support payments; and
   

• Deemed parent and stepparent deeming deductions (child support or dependent allowance).

The applicant has the primary responsibility for providing documentary evidence to support statements made, and to resolve any questionable information.  The caseworker must place verification in the case file and document the case notes.

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 or Denali KidCare if the applicant refuses to allow the caseworker to verify or document information relevant to the eligibility determination.

5000-4 B.   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.  For example, information would be considered questionable if a household’s expenses continually exceed their monthly income.

Any information that a caseworker determines to be questionable must be verified when it affects a household's eligibility for Medicaid or Denali KidCare.  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.

5000-4 C.   DOCUMENTATION

Documentation is a record of what elements are verified and how, and why certain decisions are made that relate to a determination of eligibility for Medicaid.  The caseworker must 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.)