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• If an individual attests to income above the Medicaid or S-CHIP applicable income standard and the electronic data indicates income below the applicable income threshold, the individual is determined ineligible with no additional information sought. The individual is screened for eligibility for other insurance affordability programs. • If an individual attests to income below the Medicaid or S-CHIP applicable income standard and the electronic data indicates income above the applicable standard, documentation will be required from the applicant to resolve. In this situation, the worker needs to send a Pending Verifications for Applicants/Recipients (DFR Form 2032) to the client to verify the income before the case is closed/denied. • If the difference between what an individual attests to and the electronic data results in a different category or cost-sharing amount, documentation will be required from the applicant to resolve.

Note: Local Office must investigate and request documentation (send DFR Form 2032) when information retrieved from an electronic data source directly conflicts with member/applicant’s attestation and results in a benefit change.21 Refer to Chapter 3000 for the applicable income and resource standards for everyone. 2035.15.00 PRE-ADMISSION SCREENING IS PENDING (MED 1)

When pre-admission screening (PAS) is pending on an individual who has entered a nursing facility, ICF/IID or CRF/DD, it is to be assumed that the individual will be approved, absent evidence to the contrary. A "yes” should be entered on the drop-down menu for Pre-Admission Screening field on the Facility Details page in the Eligibility system. The date is either the date the screening was initiated, if known, or the date the individual entered the facility.

The DFR will not receive a copy of the Form 450B (Physician Certification for Long Term Care Services) when the level of care determination is made. DFR should arrange a procedure with Medicaid facilities so that the facilities will notify the caseworker if a level of care is denied. When a denial is received by the worker, the information on Facility -Details page must be updated accordingly. 2035.20.00 HOME AND COMMUNITY-BASED SERVICE WAIVERS (MED 1)

Parental income and resources are not considered when determining the Medicaid eligibility of individuals less than 18 years of age who are being considered for Home and Community-Based Services (HCBS). Parents should be asked early in the interview if they want retroactive Medicaid coverage for the child. If retroactive coverage prior to the waiver effective date is requested, the parents must provide verification of their income and resources. Generally, most parents do not