55.02 Verification of attestation

An individual’s attestations of information needed to determine the following eligibility requirements will be verified by AHS: Social Security number35 The Social Security number furnished by an individual will be verified with SSA to insure the Social Security number was issued to that individual, and to determine whether any other Social Security numbers were issued to that individual. For any individual who provides a Social Security number, AHS will transmit the number and other identifying information to HHS, which will submit it to SSA. To the extent that an individual's Social Security number is not able to be verified through the SSA, or the SSA indicates that the individual is deceased, the procedures specified in § 57.00 will be followed, except that: (i) The individual will be provided with a period of 90 days from the date on which the notice described in § 57.00(c)(2)(i) is received for the individual to provide satisfactory documentary evidence or resolve the inconsistency with the SSA. (ii) The date on which the notice is received means five days after the date on the notice, unless the individual demonstrates that they did not receive the notice within the five-day period. 34 42 CFR § 435.956; 45 CFR §§ 155.315 and 155.320. 35 42 CFR §§ 435.910 and 435.956(d); 45 CFR § 155.315(b). Eligibility-and-Enrollment Procedures Part 7 – Page 16 (Sec.55.00, Sub.55.02) For more information about Social Security numbers and eligibility for health benefits, see § 16.00. (b) Incarceration status.36 When determining an individual’s eligibility for enrollment in a QHP, the individual’s attestation regarding incarceration status will be verified by: Accepting the individual’s attestation; or Relying on any electronic data sources that are available to AHS. If relying on available data sources, as described in (2) above, to the extent that an individual’s attestation is not reasonably compatible with information from the data source or other information provided by the individual or in AHS’s records, AHS will follow the procedures specified in § 57.00. (c) Eligibility for MEC other than through an eligible employer-sponsored plan.37 When determining eligibility for APTC and CSR: AHS will verify whether an individual is eligible for MEC other than through an eligible employer- sponsored plan or Medicaid, using information obtained by transmitting identifying information specified by HHS to HHS. AHS will also verify whether an individual already has been determined eligible for coverage through Medicaid within the state. (d) Enrollment in an eligible employer-sponsored plan and eligibility for qualifying coverage in an eligible employer-sponsored plan38 General requirement. When determining eligibility for APTC and CSR, AHS will verify whether an individual reasonably expects to be enrolled in an eligible employer-sponsored plan or is eligible for qualifying coverage in an eligible employer-sponsored plan for the benefit year for which coverage is requested. Verification procedures39 (i) Except as specified in paragraph (d)(2)(ii) of this subsection, an individual’s attestation regarding the verification specified in paragraph (d)(1) of this subsection will be accepted without further verification. (ii) AHS may select a statistically significant random sample of individuals found eligible for APTC 36 45 CFR § 155.315(e). 37 45 CFR § 155.320(b). 38 45 CFR § 155.320(d). 39 45 CFR § 155.320(d)(4). Eligibility-and-Enrollment Procedures Part 7 – Page 17 (Sec.55.00, Sub.55.02) based on their attestation as described in (d)(2)(i) of this subsection and: Provide notice to the selected individuals indicating that AHS will be contacting any employer identified on the application for the individual and the members of their family to verify whether the individual is enrolled in an eligible employer-sponsored plan or is eligible for qualifying coverage in an eligible employer-sponsored plan for the benefit year for which coverage is requested; Proceed with all elements of eligibility determination using the individual's attestation, and provide eligibility for enrollment in a QHP to the extent that an individual is otherwise qualified; Ensure that APTC and CSR are provided on behalf of an individual who is otherwise qualified for such payments and reductions, if the tax filer for the individual attests that they understand that any APTC paid on their behalf is subject to reconciliation; Make reasonable attempts to contact any employer identified on the application for the individual and the members of their family, to verify whether the individual is enrolled in an eligible employer-sponsored plan or is eligible for qualifying coverage in an eligible employer-sponsored plan for the benefit year for which coverage is requested; If AHS receives any information from an employer relevant to the individual's enrollment in an eligible employer-sponsored plan or eligibility for qualifying coverage in an eligible employer- sponsored plan, AHS will determine the individual's eligibility based on such information and in accordance with the effective dates specified in § 73.06, and if such information changes their eligibility determination, notify the individual of such determination; If, after a period of 90 days from the date on which the notice described in paragraph (d)(2)(ii)(A) above is sent to the individual, AHS is unable to obtain the necessary information from an employer, the individual's eligibility will be determined based on their attestation regarding coverage provided by that employer. In order to carry out the process described in this paragraph (d)(2)(ii), AHS will only disclose an individual's information to an employer to the extent necessary for the employer to identify the employee. (e) Verification related to eligibility for enrollment in a catastrophic plan.40 AHS will verify an individual's attestation that they meet the requirements of § 14.00 (eligibility for enrollment in a catastrophic plan) by: (i) Verifying the individual's attestation of age as follows: Except as provided in paragraph (e)(1)(i)(C) of this subsection, accepting their attestation without further verification; or Examining electronic data sources that are available and which have been approved by HHS for this purpose, based on evidence showing that such data sources are sufficiently current and accurate, and minimize administrative costs and burdens. If information regarding age is not reasonably compatible with other information provided by the 40 45 CFR § 155.315(j). Eligibility-and-Enrollment Procedures Part 7 – Page 18 (Sec.56.00, Sub.56.01) individual or in AHS’s records, examining information in data sources that are available and which have been approved by HHS for this purpose based on evidence showing that such data sources are sufficiently current and accurate. (ii) Verifying that an individual has a certificate of exemption in effect as described in § 14.00(b). To the extent that AHS is unable to verify the information required to determine eligibility for enrollment in a catastrophic plan as described in paragraphs (e)(1)(i) and (ii) of this subsection, the procedures specified in § 57.00, except for § 57.00(c)(4) (eligibility for APTC and CSR), will be followed. Attestation and verification of financial information41 (01/01/2026, GCR 25-055)