5/6/16 Documentation Policy Technical Assistance Training 1 Documentation A/R’s Responsibilities Worker’s Responsibilities Factors of Eligibility that MUST be verified/documented Factors of Eligibility that do not need to be verified/documented 2 Verification Evidence used to establish or confirm the accuracy of information obtained during the eligibility determination process Validation Information that is validated or confirmed by another agency 3 1
5/6/16 Verification May Be in the Form of: Documents Written statements Oral communication 4 Documentation Entering into the case record the verification which is obtained during the eligibility process 5 Documentation May Be in the Form of: Originals, photocopies of documents, facsimiles, scanned or other copies Written statements by the examiner Statements by other individuals 6 2
5/6/16 Source of Verification Primary: A/R and members of their household Secondary/Collateral: Relatives or other persons & agencies 7 A/R Responsible for: Providing informational documents that are readily available to verify eligibility Providing information that will help the worker obtain verification not readily available 8 Eligibility Worker Responsible for: Checking to see if the active case record or closed case record contains information not subject to change Checking WMS/MMIS (Clearance Report) for demographic information: – Date of Birth – SSN 9 3
5/6/16 Eligibility Worker (cont’d) If the evaluation of the Clearance Report shows an active, closed or denied case, certain demographic data associated with that CIN is considered to be verified even if entered by another district, unless there is reason to believe otherwise 10 Eligibility Worker (cont’d) Providing the A/R with a written list or form – Documents Needed When You Apply for Health Insurance (DOH-4220B) Noting the required date of return for required documents Make calls or write to sources to obtain verification that the A/R cannot acquire 11 Documentation/Verification Only factors of eligibility must be requested Always use each form of verification for as many aspects of eligibility as possible 12 4
5/6/16 Incomplete Application If information is missing on an application LDSSs have 2 choices: – Call applicant and notate findings on application OR – Photocopy incomplete pages of the application and mail them to the applicant to be completed and returned • Documents Needed When You Apply for Health Insurance (DOH-4220B) indicating a return date, and DOH-4418 13 Application Referrals from NY State of Health An Access NY Health Care application (DOH-4220) and, for SSI-Related, Supplement A (DOH-4495A) must be completed, signed and returned with appropriate documentation within 15 working days If returned without complete documentation, a request for missing documentation should be sent 14 Express Lane Eligibility Applications Documentation is not required for Express Lane Eligibility (ELE) cases – 12 OHIP/ADM-2 – Except for Immigration documents Information given on CHPlus renewal and CHPlus Screening Worksheet is sufficient ELE cases must not be pended for additional information 15 5
5/6/16 Social Security Number A/Rs are required to tell the LDSS what their SSN is, but are not required to show proof of the SSN initially – Children will be denied/discontinued if parent/caretaker relative does not provide or apply for a SSN for them 16 Social Security Number (cont’d) Individuals exempt from SSN rules: – Pregnant women – Children up to the age of one who are born to a mother in receipt of Medicaid (Deemed Newborns) – Undocumented aliens/temporary non immigrants 17 Social Security Number (cont’d) Documentation is necessary only if the SSN cannot be verified or validated through the SSA – SSN card – Correspondence from SSA Applicants will have 10 days to resolve a SSN that does not validate 18 6
5/6/16 SSN Validation - No History on Clearance LDSS enters SSN Code 1 SSA Not Validated Validated SSN Code SSN Code 8 other than 8 A/R has 10 days No further to provide action verification of required SSN Process is repeated 19 SSN Validation - History on Clearance SSN Code A B Request verification of SSN D 9 7 SSN validated – no further 8 action required 20 Social Security Number (cont’d) If A/R does not have an SSN they must apply for one – Application must not be denied or delayed pending issuance of SSN – A/R has 4 months from SSN application to provide SSN – An individual who declares U.S. citizenship or nationality under penalty of perjury at time of application is not required to document their citizenship, identity, or date of birth 21 7
5/6/16 Citizenship & Identity Requirements All United States citizens applying for and renewing Medicaid coverage are required to provide “satisfactory documentary evidence” of their identity and U.S. citizenship – Applies to natural born citizens and individuals who acquire citizenship through naturalization 22 Citizenship & Identity Requirements (cont’d) Presentation of documentary evidence of citizenship and identity is a one-time activity 23 Federal Exemptions for Citizenship & Identity Documentation A/Rs eligible for or enrolled in Medicare; Receiving Supplemental Security Income (SSI); Receiving Social Security Disability Income (SSDI); Children under Title IV-B (on the basis of being a child in foster care); or Adoption/foster care assistance under Title IV-E 24 8
5/6/16 Citizenship & Identity Documentation Deemed Newborns – Born to mothers who were on Medicaid at the time of their birth – Considered to have provided satisfactory documentation of citizenship and identity by virtue of being born in the United States when renewed on their first birthday – Will not be required to further document citizenship or identity at any subsequent Medicaid eligibility redetermination 25 Citizenship & Identity Documentation (cont’d) Deemed Newborns (cont’d) – Documentation must be kept in case record • Newborn’s automated Medicaid enrollment form • Copy of the mother’s Medicaid coverage history screen at the time of birth • Correspondence from managed care plans or hospital – District worker must make note in case record 26 A/Rs Not Required to Prove Citizenship/Immigration Status Immigrants applying for Medicaid for the treatment of an emergency medical condition Pregnant women Verification of identity is still required 27 9
5/6/16 CHIPRA Citizenship Verification Process A Medicaid A/R declaring U.S. citizenship is not required to provide documentation of identity, citizenship and date of birth initially at application They must attest to their U.S. citizenship and provide an SSN that will go through a validation process with SSA If their SSN is validated by SSA their information will again be matched with SSA Data to validate identity, U.S. citizenship and date of birth 28 CHIPRA Citizenship Verification Process (cont’d) Once an A/R’s SSN is validated by the SSA with an SSN validation code of 7 or 8, and the citizenship code in screen 3 is a “C” the A/R’s information will go through the SSA Citizenship Data Match 29 CHIPRA Citizenship Verification Process (cont’d) If verified by SSA a Birth Verification Indicator (BVI) will be system generated with a code of a “1” in WMS (screen 3) – No further action is required and no additional documentation of identity, U.S. citizenship or date of birth is required 30 10
5/6/16 CHIPRA Citizenship Verification Process (cont’d) If there are “inconsistencies” a BVI of B, C, or D will be system generated in screen 3 – If the BVI generates a B (B=“Bad Match”), the LDSS must resolve the inconsistency 31 CHIPRA Citizenship Verification Process (cont’d) If the SSN code is an 8, and changes are made to the demographic data (Name, Sex, DOB), SSN code must be changed to a 1 – BVI of B or 5 will automatically be reset to blank and the information will go through the SSN and citizenship validation process with the new information 32 CHIPRA Citizenship Verification Process (cont’d) If an inconsistency is not resolved, the LDSS must request citizenship and identity documentation from the applicant – Send “Request to Provide Additional Documentation – Citizenship/Identity Match 90- Day Notice” – Must also include a copy of the appropriate “Request for Verification of Birth” form and a copy of the DOH-4418 33 11
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