1322 Verification Provisions - Verification is the use of documentary evidence, collateral contacts, or home visits to establish the accuracy of statements on the application.

 

1322.1 Mandatory Verification That Affects Eligibility for Program Benefits -  The worker shall verify the following information prior to approval for clients initially applying:

 

1.  Gross Nonexempt Income - Gross nonexempt income shall be verified prior to approval. However, where all attempts to verify the income have been unsuccessful because the person or organization providing the income has failed to cooperate with the household and the worker, and all other sources of verification are unavailable, the worker shall determine an amount to be used based on the best available information.  Also refer to 7110 for rules regarding the prospective budgeting of earned income.

 

2.  Non-citizen Status - The worker shall determine from information on the application if individuals identified as non-citizens are eligible non-citizens, as defined in 2140 and subsections.

 

  a. Reserved

 

  b. Documentation of non-citizen status is required for each individual requesting Medical Assistance as described in 2145.2.

 

The agency may not request verification of non-citizen status from the applicant or recipient if that information can be verified through an available resource. The agency shall make every effort to verify non- citizen status through those resources.

 

If the agency is unable to verify non-citizen status, verification shall be waived and a three (3) month reasonable opportunity period for the individual to provide the information shall be applied. If otherwise eligible, the applicant may be approved for assistance. The individual shall be contacted to provide verification and notified of the reasonable opportunity period. See 2146.6.

 

3.  Social Security Numbers - When an applicant who is required to apply for a Social Security number wishes to apply through the Social Security Administration, the individual shall be required to supply verification of application for the required SSN prior to the agency's certification of that individual unless the individual claims good cause. Refer to 2133.

 

NOTE: A copy of the Social Security Card is not required and assistance cannot be denied for failure to provide the Social Security card when a number has been provided.

 

4.  Reserved

 

5.  Identity -

 

a. Reserved

 

b. The identity of each person requesting coverage, who is claiming to be a U.S. citizen must be documented. See 2145.2. This requirement does not apply to the following individuals:

 

• Current or former SSI recipients

• Current or former Medicare beneficiaries

• Current or former recipients of Social Security Disability benefits

• Children in foster care or recipients of foster care maintenance

• Children who are recipients of adoption assistance

• Children born on or after July 1, 2006 to a Medicaid recipient as outlined in KFMAM 2320

 

Identity for persons claiming to be non-citizens is accomplished through documentation provided under the requirements of KEESM 2146. All documents used to verify identity must be retained in the case file indefinitely per KEESM 1711 (9). For persons exempt from the requirement due to SSI or Medicare status, verification of such status is required.

 

The Reasonable Opportunity to Provide Documentation requirements of 2145.4 are also applicable to requests for identity verification.

 

Acceptable documents and the hierarchical protocol for obtaining acceptable documents are described in Non-Citizen Qualification Chart for Medical Purposes and as follows:

 

i. Primary Document - a document that verifies both identity and citizenship (as described in 2145.2) and is further defined in the Non-Citizen Qualification Chart for Medical Purposes. The availability of a Primary Document shall be explored prior to using another identity document. A person born outside of the U.S. who is now a U.S. citizen, but was not a citizen at birth, must submit a Primary Document.

 

ii. Secondary Identity Document - a document that verifies identity only. The statement of the applicant/recipient that a Primary Document is not available is sufficient to seek a Secondary Document. However, if a primary document is not used, two different documents must be used to establish citizenship and identity.

 

iii. Additional Documents for Children Under Age 16 - Where Primary or Secondary documents are not available to verify identity, special documents may be used for children under 16.

 

iv. Declaration of Identity - As a final option, a written declaration may be used to establish identity for children under age 16 or disabled adults if no other documentation is available. If a declaration is used to establish citizenship it cannot be used for identity verification. Form item, P-7, Declaration of Identity – Child  and form Item P-9, Declaration of Identity – Disabled Adult , may be used for this purpose. The KanCare Clearinghouse manager must be approve the declaration. The person making the declaration must :

 

• be a United States citizen

• sign the declaration under penalty of perjury in the presence of a witness, and

• for children, must be the parent, legal guardian, or caretaker relative of the child;

• for disabled adults, must be the director or administrator of a residential care facility where the individual resides.

 

The signature of the parent, legal guardian, or caretaker relative made under penalty of perjury in the presence of a witness. When a declaration is used to establish identity, the original must be retained in the case file indefinitely.

 

Any document which reasonably establishes identity shall be accepted and no requirement for a specific type of document, such as a birth certificate, will be imposed. If no such document is available, a collateral contact shall be made and documented in the case file.

 

        v. Multiple Documents – When none of the above items of identity are available, a client may submit three or more of the following documents as verification of identity:

 

                • employer identification cards

                • high school or college diplomas, including GED

                • marriage certificates

                • divorce decrees

                • property deeds/titles

                                                                                                                                                                                                                                                                                                                                                                               

Multiple documents can only be used for identity if a second or third level of citizenship has been provided.

 

6.  Disability - Disability must be verified for persons requesting medical assistance under a disability program (see 2662) or requesting MediKan (see 2646).

 

7.  Reserved

 

8.  Reserved 

                                                                                                                                                                                                                                                                                                                                                                                                     

9.  Resources -

 

a.  All trust funds and accounts, including IDA's and annuities, are to be verified by providing a copy of the actual trust instrument as well as any supporting information necessary to establish the availability of the trust (e.g., bank ledgers documenting the value of the trust and wills funding the trust). In addition, all real property (excluding the home in which the applicant/recipient resides), stocks, bonds, and non-exempt retirement funds must be verified.

 

b.  Reserved

 

c.  All burial agreements and plans, life insurance, checking accounts, savings accounts, debit card accounts, and other financial instruments must be verified prior to approval. Other resources, such as vehicles and resources involved in transfers of property, may be verified as the circumstances demand.

 

Note: The balance of a Direct Express electronic debit account used for the deposit of federal benefits (Social Security, SSI, VA, Civil Service Annuities) need not be verified if the only monies in the account are from Social Security or SSI benefits, or the value of all countable resources, including the account, are not within $300 of the applicable resource limit.

 

10.  Reserved
                                                                                                                                                                                               

11. Citizenship -

 

a. Documentation of U.S. citizenship is required for each individual requesting medical assistance as described in 2145.2.   

 

The agency may not request verification of citizenship from the applicant or recipient if that information can be verified through an available resource. The agency shall make every effort to verify citizenship through those resources.

 

If the agency is unable to verify citizenship, verification shall be waived and a three (3) month reasonable opportunity period for the individual to provide the information shall be applied. If otherwise eligible, the applicant may be approved for assistance. The individual shall be contacted to provide the information and notified of the reasonable opportunity period. See 2145.4.

 

b.  Reserved

 

12.  Reserved

 

13.  Reserved

 

14.  Reserved

                                                                                                                                                                                                                                                                                                                                                                                      

 

1322.2 Mandatory Verification That Affects the Amount of Program Benefits - The following information shall be verified prior to a determination of the benefit amount for households initially applying. Failure to provide verification of these items is not grounds for denial, rather the application would be processed without allowing a deduction for the claimed expense.

  

1.  Reserved

  

2.  Medical expense allowed in the medical assistance programs.  The amount of any medical expenses shall be verified prior to initial approval.

 

a. Reserved

 

b. All medical expenses used against spenddown, client obligation or patient liability are to be verified including responsibility and amounts of third party payments.

 

Expenses direct billed to the fiscal agent by the medical provider are considered verified but are subject to review by KDHE-DHCF.

 

In addition, non-medical household expenses used to determine the excess shelter deduction for spousal impoverishment income allocation [8144.2(1)(b) and 8244.2(2)] shall be verified.

  

3.  Reserved

  

4.  Reserved

 


 

1322.3 Verification of Questionable Information - The worker shall verify all other factors of eligibility prior to approval only if they are questionable and affect the household's eligibility or benefit level. To be considered questionable, the information on the application must be inconsistent with other information on the application or previous applications or inconsistent with information received by the agency. When determining if information is questionable, the decision shall be based on each household's individual circumstances. Also see 1310 and 1320.
 

1. Household Composition - If questionable, the worker shall verify any factors affecting the composition of a household.

 

2.  Reserved


3.  Resources - Other than as indicated in 1322.1 (9), resources are to be verified prior to approval only if inconsistent with other information on the application, previous applications, or other documented information, and the resource affects the household's eligibility. Inconsistent resource information shall be identified in the case record with sufficient documentation and verification to support the agency's action in the event of appeal or for Quality Assurance review.

4. Reserved

5. Reserved

 

6. Reserved

 

7. Reserved

 

 

1322.4 Special Verification Provisions - The following special provisions apply to the Medical Assistance programs. See also 7123(2) (Reasonable Compatibility) and 7123(3) (Budgeting Method).


  1. Tiered Income Verification - The medical assistance programs will use a four- tiered approach to verifying income 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.

    1. 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.

    2. Tier 2 - Reported information is verified through the use of a secondary non- payer source interface (The Work Number, Kansas Department of Labor). This data does not come directly from the source of the reported information, but may be used for verification.

    3.  Tier 3 - Manual research by the eligibility worker is required. This may include review of the case file, 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:

      1. The Work Number - A manual search of The Work Number interface shall be completed to determine if the information reported by the individual may be verified. If verification is not found on The Work Number, proceed to researching the case file. 
      2. Case File - The medical case file record shall be searched for hard copy verification of the reported information. This includes the images located in the medical and non-medical case.  If no hard copy information is found in the case file, proceed to the collateral contact. 
      3. 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 records, proceed to collateral contact.
      4. Collateral Contact – Collateral contact with the income source 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.

    4. 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 - Since there are no payer or non-payer interface sources for verification of resources, all resources for resource-tested medical assistance programs shall be verified as described in 1322.1(9) and 1322.3(3).

  3. Expense Verification - Since there are no interface sources for verification of medical expenses (ie: 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:

    1. 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.

    2. 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.