1805.000.00 VERIFICATION

IM-#125, December 31, 2013

Except where the law requires other procedures, the Family Support Division (FSD) may accept a participant’s statement of information needed to determine the eligibility of an individual for MO HealthNet without requiring further proof from the individual, unless the statement is questionable. Individuals eligible to offer a participant’s statement are the adults in the applicant’s household, an authorized representative, or someone acting for the participant when the participant is a minor or incapacitated.

NOTE: Verification of Social Security Number (SSN), Identity, Citizenship, Immigrant status, and Income are required by law.

1805.005.00  RESIDENCE

IM-#125, December 31, 2013

Section 208.040 RSMo states to be eligible for MO HealthNet, the individual must be a Missouri resident with the intent to remain.

1805.010.00  AGE, DATE OF BIRTH, AND HOUSEHOLD SIZE

IM-#125, December 31, 2013

A participant’s statement of an individual’s age, date of birth, and household size is acceptable verification, unless the FSD has information that is not reasonably compatible with such statement. Refer to section 1805.010.20.15.

1805.010.05 Social Security Number (MO HealthNet)

IM-#125, December 31, 2013

Section 1902 (a) of the Social Security Act requires individuals to apply for and provide a Social Security Number (SSN) as a condition of eligibility for MO HealthNet. This requirement applies only to those persons requesting or receiving MO HealthNet benefits. It does not apply to parents or children included in the household who are not requesting benefits.

Obtain a copy of the SSN card for all individuals requesting benefits at the time of the initial application whenever possible. If a SSN card is not available but the applicant knows the number, accept the applicant's statement.

For persons requesting benefits who do not have a SSN, proof of application for the SSN must be obtained prior to the individual's approval. Do not deny or delay approval pending issuance of a SSN once the application for the SSN has been verified.

1805.010.05.05 Failure to Complete a SSN Application or Furnish a SSN

IM-#125, December 31, 2013

Individuals failing to complete an application for a SSN or failing to provide an existing SSN are not eligible for MO HealthNet. Include their needs and income in the budget when determining eligibility for the remaining members.

When processing applications containing individuals who have not applied for a SSN or who have not provided an existing number, use the following procedures.

  1. At application, provide a Request for Information (IM-31A) form allowing 10 days to apply for a SSN or provide the SSN.

    EXCEPTIONS: For Newborns, refer to Income Maintenance memorandum Missing Social Security Number with Good Cause Report dated September 17, 2012.

  2. For cases in which some household members have complied, while others have not applied by the 30th day following application, use the following procedures.
    1. Approve eligible members of the household that have complied with the SSN requirement.
    2. Notify the household of approval of compliant individuals and denial of the individual/s who failed to comply with the SSN requirements.

      If the non-compliant individual is the only eligible child or if all members of the household do not comply, deny the application by the 30th day and notify the household.

      NOTE: If there is no eligible child in the home, the caretakers do not qualify for MO HealthNet for Families (MHF).

      Individuals denied due to failure to apply for, or disclose an existing SSN must verify they have complied before eligibility is established. Their eligibility begins no earlier than the first day of the prior quarter preceding the date they comply. Determine cooperation on this factor at each review.

1805.010.10 Citizenship and Immigrant Status

IM-#125, December 31, 2013

Section 6036 of the Deficit Reduction Act of 2005 amended section 1903 of the Social Security Act to require states to obtain satisfactory documentation of citizenship and identity prior to approving Medicaid benefits, effective July 1, 2006.

Certain individuals are exempt from having to provide documentation of citizenship and identity. Refer to Section 0110.020.00 for more information.

Refer to Section 0110.020.01 for a complete list of acceptable documents to use as verification.

Section 211 of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) signed February 4, 2009, amended section 1903(x) of the Social Security Act. The law allows an individual declaring to be a citizen or national of the United States who is required to present documentary evidence of citizenship or nationality a reasonable opportunity to present the documentation. A reasonable opportunity is defined as 90 days from the date of approval. Refer to Section 0110.020.02 for more information on reasonable opportunity.

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 changed eligibility for individuals who are not citizens of the United States. MO HealthNet eligibility for immigrants is based on whether the immigrant is qualified or non- qualified, and the immigrant’s date of entry into the United States.

1805.010.10.05  Citizenship

IM-#125, December 31, 2013

Effective July 1, 2006, states must obtain documents establishing citizenship and identity for new applicants and participants for all categories of Medicaid.

The following individuals are exempt from having to provide documentation of citizenship/identity:

Refer to Section 0110.020.00 for a complete list of acceptable documents to use as verification.

1805.010.10.10  Qualified Immigrant

IM-#125, December 31, 2013

A qualified immigrant is one who is:

1805.010.10.15  Qualified Immigrants Entering Prior To 8/22/96

IM-#125, December 31, 2013

All qualified immigrants who were in the U.S. PRIOR to August 22, 1996, and who otherwise meet MO HealthNet eligibility criteria, are eligible.

1805.010.10.20 Qualified Immigrants Entering After 8/22/96

IM-#125, December 31, 2013

For qualified immigrants entering the U.S. ON OR AFTER August 22, 1996, some may be eligible for MO HealthNet immediately, while others are subject to a five-year period of ineligibility.

1805.010.10.20.05 Residence (MAF)

IM-#125, December 31, 2013

Qualified immigrants entering the U.S. on or after August 22, 1996 who are members of the groups listed below and who otherwise meet MO HealthNet eligibility criteria have no waiting period to obtain eligibility.

1805.010.10.20.10 Qualified Immigrants with a Five-Year Period of Ineligibility

IM-#125, December 31, 2013

Qualified immigrants entering the U.S. on or after August 22, 1996 who are not eligible for MO HealthNet for five years following their date of entry are listed below. Once the five-year period of ineligibility has expired, these qualified immigrants who otherwise meet MO HealthNet eligibility criteria will be eligible for MO HealthNet.

1805.010.10.30 Non-Qualified Immigrants

IM-#125, December 31, 2013

Non-qualified immigrants are ineligible for MO HealthNet benefits.

NOTE: Non-qualified immigrants may be eligible for emergency medical care for ineligible immigrants, see Income Maintenance Manual section 1700.000.00 EMERGENCY MO HEALTHNET CARE FOR INELIGIBLE ALIENS (EMCIA).

1805.010.10.35 Documentation and Verification of Citizen or Immigrant Status

IM-#125, December 31, 2013

All non-citizen applicants for MO HealthNet who declare they are qualified immigrants must provide Department of Homeland Security (DHS) documents to establish immigration status.

Give the immigrant a reasonable opportunity to provide the required documentation. If the immigrant does not provide the requested documentation within a reasonable time frame, deny eligibility. If the immigrant does provide the requested documentation within the time frame, verify the documentation with the DHS using the SAVE System.

Exception: The DHS SAVE system does not contain information about victims of severe forms of trafficking. Until further notice, do not contact SAVE concerning these individuals. See Trafficking Victims.

If an applicant presents an expired DHS document or is unable to present any documentation of his or her immigration status, refer the person to the local DHS District Office to obtain evidence of status unless he or she can provide an immigrant registration number.

If the applicant provides an immigrant registration number, use the SAVE System to verify status. If the applicant presents verification he or she has applied to DHS for a replacement document, contact the DHS to verify status by using the SAVE System. Contact the DHS if there is reason to question the authenticity of a document presented or the information on the document is insufficient to determine whether the immigrant status requirement is met.

Acceptable documentation of qualified immigrant status:

Immigration  Status Verification Document (Department of Homeland Security (DHS) U.S. Citizenship and Immigration Services (USCIS) forms unless otherwise noted. Access the Systematic Alien Verification for Entitlements (SAVE) database to verify USCIS documents.)

Lawful Permanent Resident (LPR)

  • Form I-551 (Permanent Resident Card or Alien Registration Receipt Card (Form I-551 also known as a green card)
  • Temporary I-551 stamp in a foreign passport or on Form I-94 for recent arrivals or immigrants who have applied for a replacement I-551

Refugees

  • Form I-94 (Arrival/Departure Record) annotated with stamp showing entry as refugee under 207 of the INA and date of entry to U.S.
  • Form I-766 (Employment Authorization Document) annotated “Valid for Re-entry to the U.S. or Serves as I-512 Advance Parole”
  • Form I-571 (Refugee Travel Document)

NOTE: Refugees usually adjust to Lawful Permanent Resident LPR status after 12 months in the U.S., but are still considered refugees for eligibility purposes. Review the coding on the I-551 for codes RE-6, RE-7, RE-8, or RE-9.

Asylee

  • Form I-94 annotated with stamp showing grant of asylum under 208 of the INA
  • Grant letter from the Asylum Office of the INS
  • Form I-766 annotated “Valid for Re-entry to the U.S. or Serves as I-512 Advance Parole”

Afghan Special Immigrants

Refer to Documentation for Special Immigrants chart

Iraqi Special Immigrants

Refer to Documentation for Special Immigrants chart

Immigrant with Deportation or Removal Withheld

  • Order of an Immigration Judge showing deportation withheld under 243(h) or 241(b)(3) of the INA and date of the grant;
  • Form I-766 annotated “Valid for Re-entry to the U.S. or Serves as I-512 Advance Parole”

Immigrant Granted Parole for at Least One Year

  • Form I-94 annotated with stamp showing grant of parole under 212(d)(5) of the INA and a date showing granting of parole for at least one year

Immigrant Granted Conditional Entry

  • Form I-94 with stamp showing admission under 203(a)(7) of the INA, refugee-conditional entry;
  • Form I-766 annotated “Valid for Re-entry to the U.S. or Serves as I-512 Advance Parole”

Cubans and Haitians

  • Form I-94 annotated parole into the U.S. on or after April 21, 1980 or parole at any time as a “Cuban/Haitian Entrant (status pending)”
  • CH6 code on the I-551;
  • Cuban or Haitian passport with a 212(d)(5) stamp dated after October 10, 1980.
  • DHS Form I-221;  DHS Form I-862; DHS Form I-220A; DHS I-122; DHS Form I-221S; Copy of DHS Form I-589 date stamped by the Executive Office for Immigration Review (EOIR); Copy of DHS Form I-485 date stamped by EOIR; or EOIR-26; I-766 code C08 or C10; I-688B Employment Authorization Document with the provision of law 274a.12(c)(10) or 274a.12(c)(8) ; Other applications for relief that have been date stamped by EOIR; or Other documentation pertaining to an applicant’s removal, exclusion or deportation proceedings.
  • DHS receipt for filing Form I-589 (Application for Asylum and Withhold of Removal)

    NOTE: Persons admitted on B2 visas are not qualified immigrants, or lawfully residing in the U.S. under section 214 of CHIPRA and are not eligible for benefits as a Cuban/Haitian Entrant.

Battered Immigrant

  • Contact Income Maintenance (IM) Program and Policy for Further Instructions.

    EXCEPTION: The battered immigrant will not be a qualified immigrant during any period in which the individual responsible for such battery or cruelty resides in the same household as the individual subjected to such battery or cruelty.

American Indian born in Canada
(Cross-border Native American)

  • Birth or baptismal certificate issued on a reservation;
  • Tribal records;
  • Letter from the Canadian Department of Indian Affairs; or
  • School records

    NOTE: This does not include a spouse or child of such Indian, or a non-citizen whose membership in an Indian tribe or family is created by adoption unless such person is of at least fifty percent (50%) or more Indian by descent

Amerasian Immigrant

  • Form I-551 coded AM6, AM7, or AM8
  • Unexpired temporary I-551 stamp in foreign passport or on Form I-94 with the Code AM1, AM2, or AM3

Trafficking Victim

  • Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR) original certification letter or eligibility letter for children. Verify the letter by calling Trafficking Verification (202) 401-5510 and notify ORR of the benefits for which the individual has applied.
  • Trafficking victims are not required to provide any additional documentation of their identity or immigration status.

U.S. Military Veteran

  • Original or notarized copy of Department of Defense DD Form 214 Separation Document showing at least 2 years of active duty service and honorable discharge. A character of discharge “Under Honorable Conditions” is not an “Honorable” discharge for these purposes.

    NOTE: If the applicant cannot provide the DD-214, send a signed authorization requesting a copy of the DD-214 to the Military Personnel Record Center, 9700 Page, St. Louis, MO 63132.

U.S. Military Active Duty Personnel
(Army, Air Force, Marine Corp, or Coast Guard)

  • Current military ID card (DD Form 2 (Active)) that lists an expiration date of more than one year from the date of issue. If the card will expire within one year, use a copy of his/her military order to document active duty status.
  • A member of a reserve component shall establish active duty status by showing a current DD Form 2 (Reserve){red} and military active duty orders showing such persons is on active duty, but NOT on active duty for training. No other method of verifying this status is currently available.

    NOTE: If the individual is unable to furnish either of the above, active duty may be verified through the nearest RAPD (Real Time Automated Personnel Identification System) located at many military installations or by requesting verification in writing (which can be transmitted by facsimile) from the DEERS Support Office:

    DEERS Support Office
    ATTN: Research and Analysis
    400 Gigling Road
    Seaside, California 93944-6771
    FAX Number: (408)655-8317

Spouse, Unmarried Surviving Spouse ,or Child of a Veteran or Active Duty Armed Forces Military

  • Unexpired Uniformed Services Identification and Privilege Card DD1173 showing
    • the individual is married to a veteran or active duty member,
    • the individual is a non-married surviving spouse
    • a child is dependent on the veteran or active duty member of the Armed Forces for his/her support and is under the age of eighteen (18) or if a full-time student, under age twenty-two (22).

    NOTE: If the Military ID Card is unavailable or further documentation is needed, refer the individual to the Veterans Administration (VA) regional office.

1805.010.15 PREGNANCY

IM-#125, December 31, 2013

A participant’s statement of pregnancy is acceptable verification unless the agency has information that is not reasonably compatible with such statement.

1805.010.20 INCOME

IM-#43, August 25, 2014, IM-#125, December 31, 2013

Modified Adjusted Gross Income (MAGI) is calculated by totaling Adjusted Gross Income plus any foreign earned income excluded from taxes, tax-exempt interest, and tax-exempt Social Security income. The following are exceptions to this rule:

The division must verify all eligibility factors, through available means, including information obtained through electronic data sources, a participant’s statement, or other information the division has obtained. Verification and comments on the case must support, to the greatest extent possible, that all sources of income have been identified, and the budgeted amounts are accurate.

Available resources must be used in the following order prior to requesting verification from the applicant/participant:

NOTE: New Hire Matches can only be used as income verification if the participant has reported the source of income, and the information is reasonably compatible . If the participant has not reported the income source, and an additional electronic data source supports the employment, contact the participant for clarification.

If information is available from the electronic data hub and the participant provided permission to use such information, the agency must obtain the information. If the information is not available from the electronic data hub the Eligibility Specialist must check through other state available electronic methods.

MEDES interfaces with the Department Of Labor and Industrial Relations (DOLIR)/ Division of Employment Security and provides two types of data:

NOTE: This data is also available through the IMES Screen. The process of printing and scanning the IMES screen to the Virtual File Room has not changed. Staff is instructed to continue this procedure until further notice.

1805.010.20.05 Reasonable Compatibility

IM-#43, August 25, 2014, IM-#125, December 31, 2013

Reasonable compatibility as defined in 13 CSR 40-7.010, means the information received by the Family Support Division (FSD) is not in conflict with other information known by the FSD. If the participant provides information and it is reasonably compatible with information obtained through the federal data hub, or one of the above mentioned sources, use the information provided by the participant (no additional verification is required).

Income information is reasonably compatible if the sources of income information show:

Or

If reasonably compatible standards are not met, secondary verification is required. Secondary verification may include the following:

EXAMPLE 1: Charles has applied for MO HealthNet for Families for himself and his two children. Individual self-attestation of income is below the MAGI eligibility level.

Electronic data sources show that Charles’ income is below the MAGI eligibility level:

Determination: Charles is not eligible for coverage but his two children are determined eligible for MO HealthNet non-CHIP coverage. The information received from the electronic data sources and the self-attested information are both below the MO HealthNet non-CHIP eligibility level.

EXAMPLE 2: Betty has applied for MO HealthNet for Families for her three children (all over the age of one).Individual self-attestation of income is above the MAGI eligibility level.

Electronic data sources show that Betty’s income is above the MAGI eligibility:

Determination: The self-attested income and the information from the electronic data sources are all above the MAGI eligibility level, so Betty’s children are ineligible for MO HealthNet non-CHIP coverage. Since reasonably compatible standards are not met, secondary verification is required and the household will be screened for CHIP eligibility.

EXAMPLE 3: Sophie has applied for MO HealthNet for Families for one child.

Individual self-attestation of income is below the MAGI eligibility level. Electronic data sources show that Sophie’s income is above the MAGI eligibility level

Determination: Data is not consistent so the ES must apply the reasonable compatibility standard.

  1. If the difference between the self-attested income and the electronic data source income is less than 10% the data is reasonably compatible. Sophie’s child is eligible for MO HealthNet non-CHIP coverage. If the income had not been reasonably compatible, the ES would move to option 2.
  2. Request an explanation of the discrepancy. If reasonable, for example Sophie recently had her hours cut, determine the child eligible for MO HealthNet non-CHIP. If not reasonable move to option 3.
  3. Request verification from Sophie.

EXAMPLE 4: James is age 18 and applying for MO HealthNet for Families for himself. Individual self-attestation of income is above the MAGI eligibility level. Electronic data sources show that James’ income is below the MAGI eligibility level:

Determination: Self attested income is above the MO HealthNet non-CHIP limit but the electronic data sources are below. The difference between the self attested income and the electronic data source income is more than 10%. Inform James of the discrepancy and ask him to clarify his statement of income before determining him ineligible for MO HealthNet non-CHIP coverage and screening him for MO HealthNet CHIP coverage.

1805.010.20.10 Earned Income

IM-#43, August 25, 2014, IM-#125, December 31, 2013

To determine eligibility, verify earned income. The participant must provide permission to access the federal data hub. If verification cannot be obtained through the federal data hub, and verification is available through other electronic sources, use these sources to verify the earned income.
Income verification received for any Family Support Division (FSD) program within the last six (6) months prior to a MO HealthNet application date or receipt date of an annual review may be used for the MO HealthNet application. When calculating the last six (6) months go by the date the agency received the documentation, not the date the applicant received the pay. This income amount must be reasonably compatible with the client’s statement.
If all above resources are exhausted, verification must be requested from the applicant or active household. It is required to have them provide one of the following:

There may be instances when you are unable to obtain any verification other than the client’s statement. In these instances, consult your office management and determine if you should accept the client statement without a second source of verification. Thoroughly document the basis for the decision in the comments.

1805.010.20.15 Unearned Income

IM-#43, August 25, 2014, IM-#125, December 31, 2013

To determine eligibility, verify unearned income. The participant must provide permission to access the federal data hub. If verification cannot be obtained through the federal data hub, and information is available through other electronic data sources, use these sources to verify the unearned income. Examples of electronic sources include, but not limited to:

If information is unavailable through these sources, you may look at verification received for any Family Support Division (FSD) program within the last six (6) months. Explore reasonable compatibility between the electronic data source and the participant’s statement.

If all above resources are exhausted, verification must be requested from the applicant or active household. It is required to have them provide one of the following:

There may be instances when you are unable to obtain any verification other than the client’s statement. In these instances, consult your office management and determine if you should accept the client statement without a second source of income.

1805.010.20.20 Excluded Income

IM-#43, August 25, 2014

All sources of income must be entered into MEDES including excluded income. Participant statement is acceptable for verification of excluded income, however, if an electronic data source is available, employ reasonable compatibility guidelines.

1805.010.25 ADDING COMMENTS TO EVIDENCE

IM-#43, August 25, 2014, IM-#125, December 31, 2013

Comments must be entered in the Missouri Eligibility Determination and Enrollment System (MEDES) detailing how the income was verified. Comments should be placed on the Application or Integrated Case under Evidence. Click on the green action arrow for the specific evidence you are verifying and select “EDIT”.

Record any information regarding income source, reason ended, or any information pertinent to your calculation of income that requires further explanation. Include percentage for reasonable compatibility (if appropriate). Record any information regarding the income amount and how that was determined.