Tier 4

Contact with the applicant or recipient. If the agency is unable to verify non-citizen status via any of the means above, verification shall initially be waived and a Reasonable Opportunity Period (ROP) applied as described below. The individual shall be contacted to provide verification and notified of the Reasonable Opportunity Period (ROP).

Reasonable Opportunity Period (ROP) for Non-Citizens - An application shall not be delayed or denied because the agency was unable to verify non-citizen status. 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 the prior months as well.

The following processes shall be utilized:

Research by the agency – Staff shall review the application, case file and imaged documents to determine if the applicant has previously declared they meet a qualifying non-citizen status.

Contact with the applicant or recipient – If there is not enough information available to determine if the applicant is a qualifying non-citizen, phone contact is required to obtain additional information necessary to confirm whether or not the individual meets a qualifying non-citizen status. Staff shall attempt to obtain document types, immigration ID numbers and other details during this contact. If unable to reach the applicant, the individual is not provided with an ROP and a request for information is generated.

Verify Lawful Presence (VLP) – The Tier 1 and Tier 2 processes are completed as indicated above. If VLP does not provide the information needed to complete a full determination of eligible status, then an ROP is provided for those who declare/attest to an eligible status. If more time is needed to verify status after the initial 3-month period, the ROP will be extended to allow additional time.

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.

If proof of legal non-citizen status 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 legal non-citizen status for an applicant for medical assistance. Since the individual is otherwise a qualifying non-citizen and eligible, assistance is approved on August 7th with notification that verification must be provided by November 7th. Verification is provided within the ROP on September 30th. Eligibility continues without interruption.

If the individual failed to provide verification (and the agency was unable to independently verify) by November 7th, coverage would end effective November 30th (assuming action was taken by timely notice deadline).

Example 2 : The agency is unable to verify legal non-citizen status for an applicant for medical assistance. Since the individual is otherwise a qualifying non-citizen and eligible, assistance is approved on September 29th with notification that verification must be provided by December 29th. The recipient fails to provide verification within the ROP. Coverage ends effective January 31st.

If the individual provides verification by February 28th (the month after the month coverage ends), eligibility may be reinstated without a new application/request for assistance. If verification is provided after February 28th, a new application/request is required.