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COMBINED MEDICAID 103-4 Veriﬁcations and Documentation

Supersedes: CMA 103-4 (4/1/2023) Reference: 42 CFR 435.403, .406, .522, .910, .913, .920, .940, .945, .948, .949, .952, .953, .956; 42 CFR 457.380; ARM 37.82.101, .401, .402 & .416; 42 USC 1396b; Deﬁcit Reduction Act of 2005 Overview: All Medicaid Programs: Income and expenses reported on income tax forms are considered valid. However, if the client expects their income to change, additional information may be needed. ACA and Family Medically Needy: Self-attestation is accepted for most non-ﬁnancial, and ﬁnancial criteria. We must accept self-attestation from the individual, an adult who is in the client’s household or an authorized representative. Self-attestation is an oral or written client statement of information needed to determine eligibility. ABD Only: Unless otherwise noted, hard copy veriﬁcation is required. Non-ﬁnancial and ﬁnancial criteria must be veriﬁed and/or documented for all ABD Medicaid clients. Certain criteria (e.g., household composition) only require documentation in case notes while other criteria (e.g., age, citizenship) must be veriﬁed. All information and veriﬁcation must be established in the case prior to eligibility being determined. Veriﬁcation must be from a knowledgeable source that does not have an interest in the property being veriﬁed. See ‘Knowledgeable Source’ in the glossary. Do not request information that is not needed to determine Medicaid eligibility. The following items may need to be veriﬁed and/or documented, depending on which Medicaid program is being evaluated. AGE: ACA and Family Medically Needy: If data source indicates an inconsistency, follow PEV inconsistency process.

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Official source

COMBINED MEDICAID 103-4 Veriﬁcations and Documentation

Supersedes: CMA 103-4 (4/1/2023) Reference: 42 CFR 435.403, .406, .522, .910, .913, .920, .940, .945, .948, .949, .952, .953, .956; 42 CFR 457.380; ARM 37.82.101, .401, .402 & .416; 42 USC 1396b; Deﬁcit Reduction Act of 2005 Overview: All Medicaid Programs: Income and expenses reported on income tax forms are considered valid. However, if the client expects their income to change, additional information may be needed. ACA and Family Medically Needy: Self-attestation is accepted for most non-ﬁnancial, and ﬁnancial criteria. We must accept self-attestation from the individual, an adult who is in the client’s household or an authorized representative. Self-attestation is an oral or written client statement of information needed to determine eligibility. ABD Only: Unless otherwise noted, hard copy veriﬁcation is required. Non-ﬁnancial and ﬁnancial criteria must be veriﬁed and/or documented for all ABD Medicaid clients. Certain criteria (e.g., household composition) only require documentation in case notes while other criteria (e.g., age, citizenship) must be veriﬁed. All information and veriﬁcation must be established in the case prior to eligibility being determined. Veriﬁcation must be from a knowledgeable source that does not have an interest in the property being veriﬁed. See ‘Knowledgeable Source’ in the glossary. Do not request information that is not needed to determine Medicaid eligibility. The following items may need to be veriﬁed and/or documented, depending on which Medicaid program is being evaluated. AGE: ACA and Family Medically Needy: If data source indicates an inconsistency, follow PEV inconsistency process.