9.9 Mandatory Verification Items

Do not request income verification from health care applicants and members unless the information cannot be obtained through an electronic data source, or information from the data source is not reasonably compatible with what the applicant or member has reported (see section 9.12 Reasonable Compatibility).

9.9.1 Social Security Number

Social security numbers (SSNs) need to be furnished for household members requesting BadgerCare Plus unless they are exempt from the SSN requirement (see 6.1). SSNs are not required from non-applicants, including outside of the home tax dependents and co-filers.

An applicantA request for BadgerCare Plus coverage. The request must be on the Department's or Federally-facilitated Marketplace’s application, registration form or account transfer (from Federally-facilitated Marketplace) and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. is not required to provide a document or Social Security card. He or she only needs to provide a number, which is verified through the CARESThis system supports the Income Maintenance operations for DHS and DCF. CARES is used to determine eligibility, issue benefits, track premium payments, and manage support for BadgerCare Plus, EBD Medicaid, W-2, Child Care, and Work Programs. SSN validation process.

If the SSN validation process returns a mismatch record, the member must provide the Social Security card or another official government document with the SSN displayed. If an applicant does not yet have an SSN he or she must be willing to apply for one.

Assist the member in applying for an SSN for any group member who doesn’t have one (IMM, Ch. I, Part C).

Do not deny benefits pending issuance of an SSN if you have any documentation that an SSN applicationA request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. was made. At the next renewal, check to see if an SSN has been issued.

The member should be informed if the SSN validation process indicates another individual is using the same SSN. The member should contact the Social Security Administration and request they conduct an investigation. The IM worker can not provide the member with any information that would identify the individual who is using the member's SSN.

If the Social Security Administration finds that the SSN has been used fraudulently it may:

Recommend further action be taken.

and/or

Provide the member with the information on the fraudulent action so that the member may pursue action through the legal system.

Verify the SSN only once.

9.9.1.1 Newborns

A parent of a newborn may begin an SSN application on the newborn’s behalf while still in the hospital.

Do not require an SSN to be furnished or applied for on behalf of a newborn determined continuously eligible (8.2) for BC +. Accept the mother’s statement about the existence and residence of the newborn.

9.9.1.2 BC + Emergency Services

Do not require or verify SSNs of members who receive BadgerCare Plus Emergency Services only (Chapter 39).

9.9.1.3 BadgerCare Plus Prenatal Program

Women applying for the BadgerCare Plus PP do not need to apply for or provide an SSN. See 41.1 BadgerCare Plus Prenatal.

9.9.2 Immigrant Status

A member who indicates he or she is not a citizen must provide an official government document that lists his or her immigrant registration number. Verification of the individual’s immigration status is done through the Systematic Alien Verification for Entitlement (SAVE) system. Women applying for BadgerCare Plus Prenatal Program (Chapter 41) and persons applying for Emergency Services (Chapter 39) who do not provide proof of immigration status can still qualify for those benefits.

An immigrant that presents documentation of his or her immigrant status and meets all other eligibility criteria is eligible while any secondary verification of immigrant status is taking place.

Do not re-verify immigrant status unless the member reports a change in citizenship or immigrant status.

9.9.3 Pregnancy

Verification of pregnancy is only required until December 31, 2013. Beginning January 1, 2014, verification is no longer required for pregnancy unless the worker has information that contradicts the applicant or member’s statement.

Through December 31, 2013, if a woman wants to be considered pregnant for the BadgerCare Plus pregnant women group or the BadgerCare Plus Prenatal Program (Chapter 39) eligibility determination, documentation from a health care professional attesting to the pregnancy is required. Fetus count and the expected pregnancy end date are not mandatory verification items.

When pregnancy must be verified, acceptable verification sources for pregnancy are:

Physician's statement.
Physician assistant's statement.
Licensed nurse practitioner's statement.
A written statement from a registered nurse (RN) working:

1. In a Healthy Birth Identification of Pregnancy Project (EDP).
2. In a Publicly funded family planning project.
3. As a Certified Nurse Midwife.

A valid BadgerCare Plus Temporary Enrollment card.

Note: After January 2014, if pregnancy must be verified, the IM worker will no longer be able to use a BadgerCare Plus Temporary Enrollment card as a source of verification, as pregnancy will not be verified for Temporary Enrollment for Pregnant Women.

9.9.4 Medical Expenses

Medical expenses used to meet a deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan. must be verified. The expense amount, any third party liability amount and date of service must all be verified.

9.9.5 Power of Attorney and Guardianship

Verify power of attorney and any guardianship type as specified by the court. Ask for any documentation regarding durable power of attorney or court-ordered guardianship.

9.9.6 Access to Employer-Sponsored Health Insurance

Verification of access to health insurance is required at the following times, unless the individual has already verified health insurance access within the last 12 months with the same employer:

BadgerCare Plus Application and Renewal.
Person Add - if adult (age 18 or over) is employed and part of the BadgerCare Plus test group .
When an adult (age 18 or over) in the BadgerCare Plus test group gets a new job.
When a change is processed causing total household income to exceed the following FPL thresholds:
- Infants less than 1 year old, 300% of the FPL,

- Children ages 1 through 5 (up to age 6), 185% of the FPL,
- Children ages 6 to 18, 150% of the FPL,
- Parents and caretakers, 133% of the FPL, and
- Parents and caretakers with access to a Wisconsin state employee’s health insurance plan, 150 % of the FPL

Note: Because of changes in income limits, the reporting requirements listed above for parents and caretakers are only effective until March 31, 2014.

Note: Verification of access to insurance when parents’ and caretakers’ household income exceeds 133% is applied beginning July 1, 2012, when one of the following occurs:

A new application or program request is submitted,
New employment is reported,
The next review/renewal is completed, or
A parent or caretaker with employment is added to the assistance group.

9.9.6.1 Employer Verification of Health Insurance (EVHI) Database

It is not the client’s responsibility to verify access to employer-sponsored health insurance. For the majority of BadgerCare Plus applicants and members the EVHI database will be used to verify insurance access. Information gathered from employers is stored in the database. The verification will be returned based on the employer details entered on the employment page. It will be critical for Income Maintenance workers to enter the correct FEIN number and all other employment details for each employment sequence so that all employers are correctly identified in the EVHI database.

If the employment details are not complete enough to verify access, the applicant will be sent a letter from the State requesting more information and the case will pend.

Example 1: Mary’s employer has verified that permanent full-time employees have access to health insurance, however temporary employees do not. Mary did not indicate whether she is a permanent or temporary employee. Since that information is necessary to verify access to health insurance using the database, she will be sent a letter requesting the information.

If the employer has not provided information about the health insurance they offer to their employees, the BadgerCare Plus eligibility will pend and a request will be sent from the State to the employer requesting that the information be provided.

BadgerCare Plus eligibility can pend up to the end of the 30 day application processing period. At that point, regardless of whether the employer has responded or not, eligibility must be confirmed. If the employer has not responded assume there is not access to employer sponsored health insurance.

BadgerCare Plus will not be terminated or denied due to an employer failure to respond to a request for verification of health insurance access. If BadgerCare Plus eligibility begins and an employer later responds to the verification request indicating that health insurance access is available to the employee, BadgerCare Plus eligibility will be terminated with adequate notice of adverse action . There will be no overpayment liability for the applicant.

9.9.6.2 Other Forms of Health Insurance Access Verification

Other types of verification can be used to document access to employer sponsored health insurance. If a BadgerCare Plus applicant or member needs medical services, agencies may use other contacts with employers in these situations to speed the verification process. Other forms of verification include:

EVF-H form
Employer statement
Collateral Contact with the employer

9.9.7 Tribal Membership

Tribal members are exempt from paying BadgerCare Plus premiums and may be exempt for certain benefit co-payments. Effective January 1, 2014, tribal members eligible for BadgerCare Plus will also be exempt from co-pays.

To receive these exemptions, verification of tribal membership or descent from a tribal member is required. Verification may be done with a:

Tribal Enrollment Card
Written verification or a document issued by the tribe indicating tribal affiliation
Certificate of degree of Indian blood issue by BIA
Tribal census document
Medical record card or similar documentation that specifies an individual is an Indian that is issued by an Indian Health Care provider.

9.9.8 Pre-Tax Deductions

Individuals whose eligibility is determined using MAGI rules can claim pre-tax deductions in order to determine their MAGI taxable income. In order to claim a pre-tax deduction, verification of the amount is required. Verification sources such as pay stubs or other documentation from the individual’s employer can serve as acceptable documentation. See 16.3.2 for list of pre-tax deductions.

9.9.9 MAGI Tax Deductions

Individuals whose eligibility is determined using MAGIModified Adjusted Gross Income. MAGI rules are used to determine BadgerCare Plus eligibility for new applicants beginning in 2014 and for existing members as of March 31, 2014, or their next regularly scheduled renewal, whichever is later. MAGI rules are based on tax relationships and family relationships, and they consider taxable income and whether children and tax dependents are required to file. rules can claim certain tax deductions from the IRS 1040 Form, regardless of whether or not the individual files taxes. Individuals who claim such deductions must provide proof that the expense is or was incurred. See 16.3.3 for a list of tax deductions.

Forms of verification for MAGI tax deductions could include:

Receipts,
Bank statements,
Check stubs, or
Previous years’ tax forms.

This page last updated in Release Number: 15-01

Release Date: 05/15/2015

Effective Date: 05/15/2015