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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M02 July 2025 Subchapter Subject Page ending with Page M0220.000 CITIZENSHIP & ALIEN REQUIREMENTS M0220.100 4

(MMIS) and SSA for the documentation of C&I for individuals enrolled in the Medicaid and FAMIS programs. In order for this process to be used to verify citizenship and identity, the individual’s SSN must be verified by SSA (see M0240). For eligibility determinations processed through VaCMS, the Social Security data match takes place when the individual’s information is sent through the Hub. For cases not processed in VaCMS, the SSA data match will take place after the individual has been enrolled in MMIS. 1. MMIS Data Matches SSA If the information in the MMIS matches the information contained in the SSA files, the MMIS will be updated to reflect the verification of C&I. No further action is needed on the part of the eligibility worker, and the enrollee will not be required to provide any additional documentation, if the SSA match code in MMIS shows that SSA verified the individual’s C&I. 2. MMIS Data Does Not Match SSA If the information in the MMIS does not match the information in the SSA files, a discrepancy report will be generated monthly listing the inconsistent information. Eligibility staff is expected to review the report to see if the report lists any enrollees who were rejected because SSA could not verify the enrollee’s citizenship and identity.

a. SSA Cannot Verify C&I

If the SSA data match result does not verify the individual’s C&I, eligibility workers must review the information in the system to determine if a typographical or other clerical error occurred. If it is determined that the discrepancy was the result of an error, steps must be taken to correct the information in the system so that SSA can verify C&I when a new data match with SSA occurs in the future.

If the inconsistency is not the result of a typographical or other clerical error, the individual must be given a reasonable opportunity period of 90 days to either resolve the issue with SSA or provide verification of C&I. The eligibility worker must send a written notification to the enrollee that informs the enrollee of the discrepancy and gives him 90 calendar days from the date of the notice to either resolve the discrepancy with the SSA and to provide written verification of the correction, OR provide acceptable documentation of C&I to the LDSS.

The notice must specify the date of the 90th day, and must state that, if the requested information is not provided by the 90th day, the individual’s Medicaid coverage will be canceled. Include with the notice the “Birth Certificates and Proof of Citizenship for Medicaid” Fact Sheet available on at https://fusion.dss.virginia.gov/bp/BP- Home/Medical-Assistance/References. Acceptable forms of documentation for C&I are also included in Appendix 1 to this subchapter.

b. Individual Does Not Provide Verification in 90 Days

If the individual does not respond to the request and does not provide the information necessary to meet the C&I documentation requirements by the 90th day, coverage may be canceled. Send an advance notice and cancel coverage at the end of the month in which the 90th day occurs. If the individual provides part of the information or is in the process of getting the information, a new reasonable opportunity period shall be provided. The new reasonable opportunity period begins the day after the first period ended. No more than two reasonable opportunity periods should be granted within a certification period since the case cannot be successfully redetermined without the C&I documentation.