54.05 Inconsistencies and inability to verify information18

In general. Except as provided in § 54.06, with respect to citizenship, lawful presence or satisfactory immigration status which cannot be verified through SSA or DHS, AHS will: Follow the procedures specified in § 57.00 (inconsistencies), except that: (i) The opportunity period described in § 57.00(c)(2)(ii) during which the individual must submit documentation or resolve the inconsistency begins with the date the notice described in § 57.00(c)(2)(i) is received by, rather than sent to, the individual and, for both QHP and Medicaid purposes, extends 90 days from that date. The date on which the notice is received is considered to be five days after the date on the notice, unless the individual demonstrates that they did not receive the notice within the five-day period. (ii) The opportunity period may be extended beyond 90 days for QHP purposes, and for Medicaid purposes for individuals declaring to be in satisfactory immigration status, if the individual is making a good-faith effort to resolve any inconsistencies or AHS needs more time to complete the verification process. If the individual does not have a Social Security number, assist the individual in obtaining a Social Security number;19 Attempt to resolve any inconsistencies, including typographical or other clerical errors, between information provided by the individual and data from an electronic data source, and resubmit corrected information to the electronic data source; Provide the individual with information on how to contact the source of the electronic data so they can 17 42 CFR § 435.956; 45 CFR § 155.315(c). 18 42 CFR § 435.956; 45 CFR 155.315(c)(3). 19 42 CFR § 435.910. Eligibility-and-Enrollment Procedures Part 7 – Page 7 (Sec.54.00, Sub.54.06) attempt to resolve inconsistencies directly with such data source; and Permit the individual to provide other documentation of citizenship or immigration status.20 (b) Eligibility activities during opportunity period.21 During the opportunity period described in paragraphs (a)(1)(i) and (ii) of this subsection, AHS will: Not delay, deny, reduce, or terminate benefits for an individual who is otherwise eligible for health benefits. Begin to furnish Medicaid benefits to otherwise eligible individuals effective on the date of the application containing the declaration of citizenship or immigration status by or on behalf of the individual. If relevant, proceed with respect to QHP enrollment, APTC, and CSR, as provided for in § 57.00(c)(4).22 (c) Failure to complete verification during opportunity period. If, by the end of the opportunity period described in paragraphs (a)(1)(i) and (ii) of this subsection, the individual’s citizenship or immigration status has not been verified in accordance with paragraph (a) of this subsection, AHS will: With regard to the individual’s eligibility for Medicaid, take action within 30 days to terminate eligibility.23 With regard to the individual’s eligibility for enrollment in a QHP, APTC and CSR, proceed in accordance with the provisions of § 57.00(c)(4)(ii).24 (d) Records of verification. AHS will maintain a record of having verified citizenship or immigration status for each individual in a case record or electronic database. 54.06 Individuals not required to document citizenship or national status for Medicaid25 (01/01/2018, GCR 17-048) The following individuals are not required to document citizenship or national status as a condition of receipt of Medicaid benefits: An individual receiving SSI benefits under Title XVI of the Act; 20 42 CFR §§ 435.956(b)(1)(iii), 435.406 and 435.407. 21 42 CFR § 435.956(a)(5); 45 CFR § 155.315(f)(4). 22 45 CFR § 155.315(c)(3). 23 42 CFR § 435.956(b)(3). 24 45 CFR § 155.315(f)(5). 25 42 CFR § 435.406(a)(1)(iii). Eligibility-and-Enrollment Procedures Part 7 – Page 8 (Sec.54.00, Sub.54.07) (b) An individual entitled to or enrolled in any part of Medicare; (c) An individual receiving Social Security disability insurance benefits under § 223 of the Act or monthly benefits under § 202 of the Act, based on the individual’s disability (as defined in § 223(d) of the Act); (d) An individual who is in foster care and who is assisted under Title IV-B of the Act, and an individual who is a recipient of foster-care maintenance or adoption assistance payments under Title IV-E of the Act; and (e) A child born in the United States on or after April 1, 2009, who was deemed eligible for Medicaid as a newborn (§ 9.03(b)).26