1805.000.00 VERIFICATION

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

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

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)

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

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

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.

1805.010.10.05  Citizenship

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:

• Individuals receiving SSI,
• Individuals receiving Medicare,
• Individuals receiving Social Security Disability Insurance (SSDI), and
• Individuals receiving Old Age Survivors Disability Insurance (OASDI) benefits based upon their own disability.

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

1805.010.10.10  Qualified Immigrant

A qualified immigrant is one who is:

• A lawful permanent resident under the Immigration and Nationality Act (INA),
• A refugee, (207 of INA)
• An asylee, (208 of INA)
• An immigrant who has had deportation or removal withheld under 243(h) of (INA) or 241(b)(3),
• An immigrant granted parole for at least one year by the INS under 212(d)(5) of INA,
• An immigrant granted conditional entry under 203(a)(7) of immigration law in effect before April 1, 1980,
• An immigrant granted status as a Cuban or Haitian entrant (as defined in section 501(e) of the Refugee Education Assistance Act of 1980),
• A battered immigrant, as defined by P.L. 104-208,
• An American Indian born in Canada, if s/he is at least one-half American Indian blood, or
• An Amerasian Immigrant
• Trafficking Victim, as defined by the Trafficking Victims Act of 2000

1805.010.10.15  Qualified Immigrants Entering Prior To 8/22/96

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

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)

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.

• American Indians born in Canada,
• Amerasian Immigrant
• Asylees under 208 of INA Refugees under 207 of INA,
• Cubans and Haitian entrants defined in Section 501(e) of the Refugee Education Assistance Act of 1980,
• Immigrants for whom deportation or removal has been withheld under either 243(h) or 214(b)(3) of the INA,
• Iraqi and Afghan Special Immigrants
  IM-#34 April 15, 2010,   IM-#52 July 20, 2009,   IM-#112, December 29, 2008
  • Public Laws 110-161, 110-181, 110-329, and 111-08 granted certain Iraqi and Afghan immigrants special immigrant status under section 101(a)(27) of the Immigration and Nationality Act (INA) effective December 26, 2007. Under the special immigrant status, the immigrant is eligible for refugee resettlement assistance, entitlement programs, and other benefits as a refugee. Prior to December 19, 2009, eligibility could not exceed eight months.
  • The Defense Appropriations Act of FY 2010 (Section 8120, P.L. 111-118) provides that effective December 19, 2009, Iraqi and Afghan Special Immigrants are eligible for benefits to the same extent and for the same period as refugees pursuant to Section 207 of the Immigrations and Nationality Act. Provided that other eligibility requirements are met, Iraqi and Afghan Special Immigrants are eligible for benefits indefinitely.
  • The effective date of eligibility for both Iraqi and Afghan Special Immigrants can be no earlier than December 26, 2007, and begins the date the special immigrant status is granted. Iraqi and Afghan special immigrants enter the United States with another immigrant status, for example LPR (Lawful Permanent Resident). Once granted special immigrant status, these immigrants do not have to meet other immigrant qualifications such as residing in the U.S. for five years, during their period of special immigrant status.
• Refugees under 207 of INA,
• Trafficking Victim, as defined by the Trafficking Victims Act of 2000
  • Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR) has been delegated the authority to conduct certifications for victims for trafficking. To receive a certification, a victim of trafficking must be willing to assist with the investigation and prosecution of trafficking cases AND either (1) have made a bona fide application for a T visa OR (2) be an individual whose continued presence the Attorney General is ensuring to effectuate a trafficking prosecution.
  • When a victim of trafficking applies for benefits, record the “entry date” which is considered the certification date. Record the expiration dates of the certification/eligibility letter for children.
  • Redeterminations of eligibility as a victim of trafficking must be completed when the certification/eligibility letter expires.
  • Victims of trafficking may not possess standard identity documents, such as driver's licenses or social security cards. Do not automatically deny the applications but call the Trafficking Verification line at (202) 401-5510 for assistance.

1805.010.10.20.10 Qualified Immigrants with a Five-Year Period of Ineligibility

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.

• Lawful Permanent Resident
• An immigrant granted parole for at least one year by the INS under 212(d)(5) of INA
• An immigrant granted conditional entry under 203(a)(7) of INA in effect before April 1,1980
• A battered immigrant, as defined by P.L. 104-208:
  • an immigrant who has been battered or subjected to extreme cruelty in the U.S. by a spouse or parent; or a member of the spouse of parent's family residing in the same household as the immigrant if the spouse or parent consented to, or acquiesced in, such battery or cruelty;
  • an immigrant whose child has been subjected to same by a spouse or a parent or the immigrant (without the active participation of the alien), or by a member of the spouse or parents family residing in the same household if the spouse or parent consented to, or acquiesced in, such battery or cruelty; or
  • an immigrant child who resides in the same household as a parent who has been battered or subjected to extreme cruelty in the U.S. by that parent s spouse or by a member of the spouse s family residing in the same household as the parent and the spouse consented or acquiesced to such battery or cruelty, but only if there is substantial connection between such battery or cruelty and the need for benefits to be provided.

  EXCEPTION: The five-year ineligibility period DOES NOT APPLY to the immigrants listed above if they are:

  • On active duty in the U.S. Armed Forces;
  • A veteran of the U.S. Armed Forces;
  • The spouse or dependent child of veterans or active duty U. S. Armed Forces personnel (A dependent child is an unmarried child under age 18 or a child claimed as a dependent on the active duty person's veteran's income tax form.) or;
  • The unmarried surviving spouse of a veteran.

  NOTE: Qualified immigrants subject to the five-year period of ineligibility 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)

1805.010.10.30 Non-Qualified Immigrants

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

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:

1805.010.15 PREGNANCY

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

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:

• An amount received as a lump sum is counted as income only in the month received;
• Scholarships, awards, or fellowship grants used for education purposes and not for living expenses are excluded from income; and
• Certain American Indian and Alaska Native income received may not be counted for MO HealthNet:
  • Per capita payments from a tribe that come from natural resources, usage rights, leases, or royalties;
  • Payments from natural resources, farming, ranching, fishing, leases, or royalties from land designated as Indian trust land by the Department of Interior (including reservations and former reservations); and
  • Money from selling things that have cultural significance.

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:

• The Federal Hub;
• The Work Number;
• IMES, IIVE, or Child Support Payment Information;
• Quarterly Wage Matches/New Hire Matches;
• Income verified for any other FSD program within the last six (6) months.

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:

• Quarterly DES Data
• DES History Request

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

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:

• The income amounts are
  • Above the applicable income standard or other relevant income threshold, (ineligible), or
  • At or below the applicable income standard or other relevant income threshold (eligible),

Or

• The difference between the sources of the income information is ten percent (10%) or less and the sources of income are similar.

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

• Other electronic data sources available;
• Other information, including paper documentation; or
• A written statement which reasonably explains the discrepancy

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:

• Eligibility level = 148% FPL
• Self-attested current income = 115% FPL (only reports income from work)
• IMES data = 130% FPL

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:

• Eligibility level = 148% FPL
• Self-attested current income = 160% FPL
• IRS data = 180% FPL
• Quarterly Wage report (past 3 months) = 165% FPL

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

• Eligibility level = 148% FPL
• Self-attested current income = 147% FPL
• IRS data = 156% FPL
• Quarterly Wage report (past 3 months) = 153% FPL

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:

• Eligibility level = 148% FPL
• Self-attested current income = 160% FPL
• IRS data = 140% FPL
• Quarterly Wage report (past 3 months) = 125% FPL

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

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:

• At least 30 days of current pay stubs
• Most recent income tax return
• Signed and dated statement from employer

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

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:

• IMES to verify Unemployment Compensation;IIVE to verify Social Security and/or Supplemental Security Income;
• IIVE to verify Social Security and/or Supplemental Security Income; and
• Child Support Payment Information

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:

• Award letter
• Signed and dated statement from the source of income

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

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

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.