Page 3

NOTE: If the data source indicates an inconsistency or if the information currently provided contradicts information previously reported, verification (e.g., divorce decree) is needed. IDENTITY: Proof of identity is required for all Medicaid clients. Identify is verified electronically. If electronic interface is unable to provide verification, then a hard copy is requested. If hard copy is required, it must be an original or certified copy of the document. INCOME: ACA: Verify self-attested income using PEV. PEV is used for initial month of application and for subsequent eligibility. If the data sources indicate an inconsistency, follow the Electronic Verification for Medicaid Business Process. Family Medically Needy: Use self-attestation for initial month of eligibility. PEV is used for subsequent eligibility. If data sources indicate an inconsistency, follow PEV inconsistency process. ABD: Pay stubs, employer statements, MISTICS, SEARCHS, BENDEX (or other system inquiry screens), SOLQ, tax records. Income must be verified at application and anytime an income change is reported. Actual income must be verified when determining retroactive Medicaid eligibility. LIVING WITH A SPECIFIED RELATIVE: ACA and Family Medically Needy: If information in the data sources indicates an inconsistency, follow PEV inconsistency process. If hard copy verification is necessary, the following can be used: Birth certificate, adoption papers, baptismal certificate, marriage license, divorce decree, death certificate. If the specified relative is not the natural/adoptive parent, they must be related within the fifth degree of kinship. ABD: not required MEDICARE ELIGIBILITY, ENROLLMENT & MEDICARE NUMBER: ACA and Family Medically Needy: If information from data source indicates an inconsistency, follow PEV inconsistency process. ABD: If information from the data source indicates an inconsistency, hard copy verification is required. Interface queries, or other documents from Medicare can document eligibility, enrollment, and Medicare claim numbers.