Medicaid Verifications

The following situations must be verified from the source.

Citizenship/immigration status/identity must be verified for all COAs. Refer to Section 2215 - Citizenship/Immigration/Identity for acceptable forms of verification. Verification of immigration status is not required if eligibility is determined using Emergency Medical Assistance (EMA) procedures.

If a pregnant woman is claiming multiple births, the number of fetuses is not required to be medically verified to increase the size of the budget group unless questionable. If questionable, document in case notes why verification is required. If verification is not returned, the pregnant woman would count as a BG of 2.

Resources must be verified for Family Medicaid Medically Needy if the total value of the resources is at or above 75% of the resource limit. Refer to Section 2301 - Family Medicaid Resources Overview .

Medical bills used to meet Medically Needy Spenddown.

Any questionable situation or information must be verified. Verification must be requested for any information provided by the applicant/recipient that conflicts with information known to the agency, or that is otherwise questionable. Document the reason that the information is conflicting and/or questionable.

For ABD Medicaid verification requirements, see the sections pertaining to the specific COA and the Income and Resource Chapters.

The applicant/recipient’s statement is acceptable as verification for all other Family Medicaid and Q-Track eligibility situations.

Verify information, if required, to determine eligibility as follows:

Utilize Data sources prior to requesting any verification that cannot be located through the data sources.

Determine if verification is available from agency sources prior to requesting verification from the AU.

Requests for verification may be made verbally but must also be made in writing. The request for verification is provided to the applicant/recipient and, if applicable, the AREP.

Verbally or orally inform the applicant/recipient of any contacts that will be made with the verification source by the agency.

Allow sufficient time for the applicant/recipient to obtain verification.

Allow additional time to provide verification if requested by the applicant/recipient and the request is made within the SOP.

If incomplete verification is returned, send another checklist specifying what is required; establish a new reasonable deadline for returning requested verification.

Consider verification received for one program to be received for all programs.

Accept the applicant/recipient’s oral or written statement as verification when allowed by policy.

Do not require verification if the applicant/recipient’s oral or written statement establishes ineligibility (e.g. c/s of self-employment exceeds all applicable income limits, then no additional verification is required).

All Medical Assistance cases (except QMB and P4HB COAs) that close for failing to return verification will be reinstated if all the verification is returned within 90 days of closure ; an application will not be required. Refer to Section 2706 - Medicaid Renewals .