Tier 4

Contact with the applicant or recipient. If the agency is unable to verify citizenship and identity via any of the means above, verification shall initially be waived, and a reasonable opportunity period applied as described below. The individual shall be contacted to provide verification and notified of the reasonable opportunity period (ROP).

An application shall not be delayed or denied because the agency was unable to verify citizenship or identity. If otherwise eligible, the application shall be processed and approved granting a reasonable opportunity period (ROP) to the individual to provide the verification. The ROP shall be three (3) calendar months commencing from the date of approval. If prior medical assistance has been requested and the individual is otherwise eligible, coverage shall be approved for these prior months as well.

If proof of citizenship or identity is provided, the ROP ends, and additional information is not necessary.

If the individual fails to provide verification (or the agency is unable to independently verify) by the end of the ROP, coverage shall end allowing for timely notification. If verification is provided within the month after the month coverage ends, eligibility may be reinstated without a new application/request.

The following examples illustrate:

Example 1 : The agency is unable to verify citizenship or identity for an applicant for medical assistance. Since the individual is otherwise eligible, assistance is approved on March 11th with notification that verification must be provided by June 11th. Verification is provided within the ROP on April 23rd. Eligibility continues without interruption.

If the individual failed to provide verification (and the agency was unable to independently verify) by June 11th, coverage would end effective June 30th (assuming action was taken by timely notice deadline).

Example 2 : The agency is unable to verify citizenship or identity for an applicant for medical assistance. Since the individual is otherwise eligible, assistance is approved on February 27th with notification that verification must be provided by May 27th. The recipient fails to provide verification within the ROP. Coverage ends effective June 30th.

If the individual provides verification by July 31st (the month after the month coverage ends), eligibility may be reinstated without a new application/request for assistance. If verification is provided after July 31st, a new application/request is required.

NOTE : An extension of the ROP will be provided if the individual is making a good faith effort to resolve any inconsistencies or obtain necessary documentation, or if the agency needs more time to complete the verification process through the Federal Data Hub or Verification of Lawful Presence (VLP) interfaces. A decision to extend the period must be thoroughly documented and supported in the case file.