Page 10
10
the financial institution.
Example: The lookback is Jan. 15, 2020, through Jan. 15, 2025. The caseworker runs AVS and no results are returned within 7 days. The caseworker will then request the bank statements from the a/b via the DHB-5097 Request for Information. The client states they cannot provide the statements and asks for assistance obtaining the verifications. A caseworker can then utilize the DSS-3431 Request for Financial Information to request from the institution a financial document or balance verification for at least January 2025, December 2024, January 2020 and January (or any available month) from 2021, 2022, 2023 and 2024.
These financial documents can be used to verify consistency in balances. If these exact months are not available, but the information provided is reasonably close, accept the information. The local agency may request more information but not to the point that it discourages the a/b.
(4) Review the highest and lowest balances for all accounts for the entire lookback period. The highest and lowest balances can be used to verify average balance. An extremely high balance may require further documentation from the a/b.
(5) Look for deposits that do not appear regular and recurring. Irregular deposits may indicate other sources of income and/or assets. Pensions and SSA are regular and recurring deposits.
(6) Note the date accounts may have been closed during the lookback period and the amount of the closing withdrawal(s). This can be used to identify accounts closed during the lookback period and possibly the source of other deposits reissued.
b. If needed, obtain evidence to indicate a pattern of giving regarding regular donations/gifts to charities, religious organizations, or family members. A pattern of giving can indicate intent other than to qualify for Medicaid.
For example, the a/b regularly gives each family member $1,000 at Christmas and birthdays. c. Do not deny if the a/b cooperated but it is determined information is not available. Accept the a/b’s statement or use the information provided to determine eligibility.
6. Once information has been provided, refer to Section C. Reviewing Verifications.
7. If the a/b does not provide the information needed to complete the evaluation, refer to VI. B. below.
C. Reviewing Verifications