1322.4 Special Verification Provisions - The following special provisions apply to the Medical Assistance programs. See also 7123(2) (Reasonable Compatibility), 7123(3) (Budgeting Method) and 7241 (Deductions for MDN, QMB, LMB, QWD, and Working Healthy).
1. Tiered Verification - The medical assistance programs will use a four-tiered approach to verifying information needed to determine eligibility. This method means the agency will try to verify reported information as much as possible before contacting the consumer for the information. The verification process will proceed in order from Tier 1 through Tier 4. It is acceptable to return to a prior Tier to verify information when a new self-attestation is received or when an administrative error is made. For example, when a Reasonable Compatibility test has already been completed in Tier 2, staff may return to Tier 2 to repeat the RC test when the consumer has clarified information or provides new information.
a. Tier 1 - Reported information is verified through the use of a payer source interface (Federal Hub, Social Security, Unemployment Compensation, KPERS). Since this data comes directly from the source of the reported information, it is considered verified. Note: If there is a difference between the reported SSA or SSI amount and the amount verified through the Federal HUB, the Social Security interface (EATSS) may be accessed to resolve the discrepancy. Reported unearned income not verifiable through a payer source interface shall be verified as indicated in 1321 and subsections.
Also included as a payor source for purposes of this section are pay stubs, or other comparable documentation voluntarily provided by the employee or employer at the time of application or request for assistance, which are sufficient to determine the countable amount of earned income without request for further verification. To be considered sufficient, the information provided must meet one of the following:
i. All pay stubs received in the 30 days immediately preceding the date of application or request for assistance;
ii. pay stubs which allow calculation via year-to-date totals of gross earnings received in the 30 days immediately preceding the date of application or request for assistance;
iii. A written statement from the employer attesting to the employee’s gross earnings received in the 30 days immediately preceding the date of application or request for assistance, including the date(s) and frequency of payment; or
iv. Any other document or documents from either the employee or employer which verifies the total amount of gross earnings received by the employee in the 30 days immediately preceding the date of application or request for assistance.
If the information voluntarily provided is sufficient to verify earned income, no further verification is required. The information voluntarily provided shall be used to determine the amount of earnings. If insufficient to verify the earned income, the information voluntarily provided is not considered a payor source.
Note: If sufficient information as described above is not voluntarily provided at the time of application or request for assistance, eligibility staff shall not request pay stubs or additional information as part of the Tier 1 process. Verification shall proceed through the remaining Tiers 2 through 4, in order.
b. Tier 2 -Reported information is verified through the use of a secondary non-payer source interface (i.e., The Work Number (TALX), Kansas Department of Labor (KDOL), the Asset Verification Solution (AVS)). This data does not come directly from the source of the reported information but may be used for verification. Use of Tier 2 interfaces to verify earned income for Working Healthy (WKH) and Long Term Care (LTC) is not appropriate. See (c) and (d) below.
Note: See 1322.4(2) for more information about using the AVS as a verification source.
c. Tier 3 -Manual research by the eligibility worker is required. This may include review of the Medical and Non-Medical case files, reconciling information received from Tier 2 interfaces, checking other available program information, and making collateral contacts. Any decision to verify reported information at this level must be thoroughly documented.
In addition, the manual research shall progress through the following steps in the order listed:
i. The Work Number - When The Work Number data is not successful in establishing reasonable compatibility for reported or no reported earned income in Tier 2, the interface data is used as outlined in 7123.2. If Work Number data is not available, proceed to researching the medical case file.
ii. Medical Case File - The medical case file shall be searched for hard copy verification of the reported information. If no hard copy information is found in the medical case file, proceed to the DCF images.
iii. Department for Children and Families (DCF) Images - A manual search of the DCF case records shall be completed for usable images to satisfy verification requirements if a consumer was part of a DCF case for a relevant time period. If verification cannot be obtained from DCF images, proceed to collateral contact.
iv. Collateral Contact – Collateral contact shall be made to verify the reported information, when deemed appropriate. If verification cannot be made via collateral contact, proceed to Tier 4 level verification.
d. Tier 4 - As a last resort when the reported information cannot be verified through any other means, contact with the consumer is required. Normally a formal request for information will be sent to the consumer to provide verification. However, in some instances, a phone contact with the consumer may be sufficient.
2. Resource Verification - There are no payer interface sources for verification of resources.
a. At application, all resources for resource-tested medical assistance programs shall be verified as described in 1322.1(9) and 1322.3(3).
b. When processing an application or Pre-Populated Review, the Asset Verification Solution (AVS) shall be used to verify bank account information as described in 1322.3(3) and 9333. When determining the amount of a CSRA, bank account information may be verified by either use of the AVS or through the tier 3 and 4 process described in 1322.4(1)(c) and (d).
c. When processing a request to add a person to an active program or add a non-active program with or without a new application, the pre-populated review resource verification provisions of 9333(2)(b) apply, including use of the Asset Verification Solution (AVS).
d. A change in resource reported via a passive review response shall be completed using the normal change reporting process as indicated in 9121.1. Also see 9310.2(3).
e. Self-attestation of the value and status of resources may be accepted without further verification when the countable value of all resources exceeds the applicable resource limit for the medical assistance program. The thoughtful and deliberate use of prudent person (see 1310) should be employed in making this determination. See Policy Memo 2018-10-01, re: SSI Termination and Verification of Resources for additional guidance.
3. Expense Verification - Since there are no interface sources for verification of medical expenses (i.e., health insurance premiums, medical bills) or household expenses used to determine the excess shelter expense for spousal impoverishment income allocation [8144.2(1)(b) and 8244.2(2)], those expenses shall be verified as described in 1322.2(2).
4. Prior Medical Period Verification - For all medical assistance programs except long term care (LTC), verification of income and resources in a prior medical assistance period shall proceed as follows:
a. No Change Reported - If an individual requesting prior medical assistance reports that there has been no change in income or resources in the prior months from the application month, income and resources verified in the current period are considered verified in the prior period as well and will be budgeted for each of those months.
b. Change Reported - If the individual reports that there has been a change in income and/or resources in the prior period, verification of actual income and/or resources for each of the prior months must be obtained as indicated above. The verified actual income and/or resource amounts will be budgeted for each month of the prior period.
NOTE: The applicant must answer ‘yes’ or ‘no’ to the prior medical questions. These answers cannot be assumed. If responses are not provided, the prior medical determination cannot be completed.
5. Verification of Pre-tax Income and Federal Deductions – When total reported income or federal deductions is over $300.00 per month, verification of deductions will be required for them to be used in the income determination. If proof is not received, processing may be completed without them, and the applicant advised by notice that the amount was not used. Eligibility may not be denied due to failure to provide proof of deductions.
Verification of pre-tax income and/or federal deductions will follow the tiered approach of earned income in 1322.4 (1) above. Information on hand, such as the case file and TALX records must be used if available prior to requesting the information from the consumer. Pay stubs must be no older than three months prior to the month of the application to be used. Collateral contact with the employer may also be used but is not required. If there is no available information on file, the information must be requested from the consumer as noted below:
a. Pre-tax income deductions – Pay stubs from the last 30 days or a statement from the employer
b. Federal/IRS deductions – Corresponding tax form or most recent tax return
Note: If based on the consumer’s self-attestation of both wages and deductions, the income will exceed guidelines for all programs, it is not necessary to request proof of the deductions.