101.08.01 MAKING AN ELIGIBILITY DECISION

Eligibility decisions are made using the following: • Verification - Verification is the substantiation, confirmation or authentication of an assertion, a claim or previously submitted information. Verification is obtained using electronic data sources or by information provided by the applicant. The specialist will accept reasonable documentary verification provided by the applicant and will be primarily concerned with how adequately the verification proves the statements on the application form. Only information material to the applicant’s eligibility is subject to verification, through electronic means or otherwise. Verification provided by an applicant or beneficiary must never be discarded, destroyed, ignored or altered. • Documentation - All cases must be thoroughly documented. Documentation is the written record of all information pertaining to the eligibility decision. Case documentation includes the completed application form, the specialist’s verbal and written contacts with the applicant, information requested and received from electronic data sources, the applicant or third-party sources, such as governmental or nongovernmental agencies, businesses and individuals, and notification of the eligibility decision. When an applicant claims no income or resources, the specialist must fully document the facts provided to substantiate these claims. “Applicant states none” is not sufficient documentation. The case narrative must also show why the statement of the applicant or beneficiary is reasonable and acceptable. NOTE: For MAGI applicants who attest on the application form that one or more household members receive income that does not count (such as SSI, TANF, VA benefits, Workers’ Compensation, Child Support), consider this as documentation of income available to support the family. In other words, the household is not a $0 income household but rather a household sustained by income that does not count. If the application form has no mention of receipt of non- countable income and there is no declared income or resources, the case narrative must contain a reasonable explanation of how the household is meeting basic needs. When action is taken to deny the application because the applicant has not provided the information necessary to determine eligibility within the specified timeframe, documentation in the case narrative must show an appropriate request(s) was issued to the applicant. • Evaluation –Information provided by the applicant or obtained through electronic data sources or third-party sources must be assessed prior to making an eligibility decision. When information is not logical, consistent or reasonable, it must be resolved prior to determining eligibility. When there is conflicting information, the reliability of each source of information must be evaluated and the case narrative should specify which source was accepted and why. The final determination of eligibility is made based on the most reliable source available.