Family and Children's Medicaid MA-3210 VERIFICATION REQUIREMENTS FOR APPLICATIONS

II. policy principles

A. Require verification of information only if it is needed to determine eligibility.

A county may ask for verification of information for which the applicant’s statement is acceptable verification. If the Income Maintenance Caseworker requests this information, the individual must be informed that his statement is acceptable verification and the requested information is not required to process the application. Also, inform the individual that as long as the individual provides a statement that can be used as verification, the application cannot be denied.

B. Review all county records for citizenship and identity documentation.

If there is a citizenship and/or identity documentation record in another program, obtain a copy or print the data screen, document where the evidence was obtained, the date it was obtained, and the hierarchy code. Conduct an SOLQ Social Security number inquiry to establish identity. If the SOLQ inquiry returns a “Social Security number verified” statement, identity is established. See MA-3332, US Citizenship Requirements.

C. Verify each element necessary to determine eligibility in the aid program/category.

D. Third party verification is required for certain eligibility factors.

Always obtain verification other than the individual’s statement for the following.

1. Documentation confirming U. S. citizenship and identity. See MA-3332, US Citizenship Requirements.

2. Any element requiring medical verification. This includes, but is not limited to, verification of disability, incapacity, pregnancy, emergency dates for certain aliens and incompetence. It also includes completion of the FL-2, MR-2, and the CAP Plan of Care.

3. Proof a deductible has been met. See MA-3315, Medicaid Deductible.

4. Immigration status, unless in the U.S. without INS documentation. See MA-3330, Alien Requirements.

REISSUED 07/01/10 – CHANGE NO. 08-10

(II.D.)

5. Proof of reserve reduction when resources exceed the allowable limit. See MA-3320, Resources.

6. Proof of countable resources when the individual’s statement of the value exceeds $1,200.00. See MA-3320, Resources.

a. If the individual’s statement of resources is a range, determine the midpoint and accept that value.

b. If the individual’s statement is a range and the midpoint exceeds $1,200.00, pursue third party verification.

7. Proof of rebuttal value of a resource. See MA-2230, Financial Resources.

8. Proof of a legally binding agreement limiting resource availability. See MA-3320, Resources.

9. Proof of enumeration when the assistance unit member has never had a Social Security number or the Social Security number is unknown. See MA-3355, Enumeration Procedures.

10. Proof of earned and unearned income, including deductions, exclusions and operational expenses. See MA-3300, Income.

Exception – Job Bonus: The applicant’s statement of earned income is acceptable verification for establishing a Job Bonus period. Verification of earned income is required for determining eligibility beyond the Job Bonus period. Follow policy in MA-3300, Income, regarding verification.

11. Payment of the NC Health Choice enrollment fee, if applicable. See MA-3255, NC Health Choice.

12. Proof of North Carolina residency. See MA-3335, State Residence.

13. Proof of purchase/change date of an annuity and/or any changes to an existing annuity. Refer to MA-2230, Financial Resources in the Aged, Blind, and Disabled Medicaid Manual.

If the purchase/change date is November 1, 2007, or later the following criteria must be verified:

a. North Carolina’s Medicaid Program is named as a remainder beneficiary in the first position. If there is a community spouse and/or any child under age 21, or a disabled child of any age, when the purchase/change takes place North Carolina’s Medicaid Program may be named in the next position after those individuals. This applies to the a/r and the a/r’s spouse.

REVISED 01/01/12 - CHANGE NO. 02-12

(II. D.)

The amount that the State of North Carolina Medicaid Program can receive as a beneficiary of a Medicaid recipient’s annuities is limited to the amount that Medicaid paid on behalf of the Medicaid recipient.

b. Meets the annuity criteria in MA-2230, Financial Resources.

14. Proof of the homesite equity value. Request proof of the equity of the homesite if, the tax value of the homesite exceeds $525,000.00. Refer to MA-2242, Home Equity Value & Eligibility for Institutional Services.

15. Proof to demonstrate hardship if home equity is over $525,000.00.

16. Proof to substantiate undue hardship if a transfer of assets sanction is applied. Request documentation from the a/r or the a/r’s spouse or their representative to rebut that a sanction for transfer of assets will cause an undue hardship.

17. Any information which the individual does not know and for which he cannot give a reasonable estimate.

E. The individual’s statement is acceptable verification for all other eligibility factors not listed in D.

F. When third party verification is required, the individual must provide identifying information or leads to allow the agency to pursue that verification.

G. The agency may negotiate with the individual to determine who can most readily obtain the required verification.

H. The DSS must obtain the verification for the a/r when:

1. There is a fee involved in obtaining the information, such as birth certificates, or

2. The information is available within the agency, either in other DSS records or via automated queries with agencies outside of DSS, or

3. The individual requests assistance, or

4. The individual is mentally, physically or otherwise incapable of obtaining the information and a representative has not accepted responsibility nor asked for

assistance. Examples may include, but are not limited to, an individual who does not speak English, who cannot read or write, who is homebound or institutionalized, or who is clearly unable to obtain the information without assistance.

REISSUED 01/01/12- CHANGE NO. 02-12

(II.)

I. Except for long term care cases involving community spouse income/resource protection or a transfer of assets, do not require the individual to provide verification of income or resources if he states he no longer has them as of the first month of the certification period for which assistance is requested.

J. Inform the individual/representative of required information using the DMA-5097/DMA-5097S, Request for Information. Use the appropriate verification form to request information from a third party. When requesting citizenship and/or identity documents, note documents that may be acceptable. This is not needed if the county is requesting the documentation on the applicant’s behalf. Documents must be original and/or certified by the issuing agency. In some situations, such as mail-in applications, a copy of the original document may be submitted. Refer to MA-3332, US Citizenship Requirements, and/or MA-3330, Alien Requirements.

K. Make at least two requests for information from the individual or third party. There must be at least 12 calendar days between the requests.

L. Explain to the individual that if more time is needed to provide the required information he can request an extension. If an extension is requested, allow additional time of at least 12 calendar days.