20.3 Mandatory Verification Items

20.3.1 Mandatory Verification Items Introduction

Verify the following mandatory items:

SSN (see Section 20.3.2 Social Security Number).
Alien Status (see Section 7.3 Immigrants).
Disability and Incapacitation (see Section 5.2 Determination of Disability).
Assets for the Elderly , Blind, and Disabled (see Section 16.1 Assets Introduction).
Divestment, for EBD long-term care (see Section 17.1 Divestment Introduction).
Medical expenses, for deductibles only (see Section 24.7 Meeting the Deductible).
Medical/remedial expenses for noncovered services for an institutionalized person (see Section 27.7.7.2 Disallowed Expenses).
Documentation for Power of Attorney and Guardianship (see Section 20.3.7 Power of Attorney and Guardianship).
Migrant workers eligibility in another state (see Section 31.2 Simplified Application), if applicable.
Physician certification (verbally or in writing) that the person is likely to return to the home or apartment within six months for institutionalized persons maintaining a home or property (see Section 15.7.1 Maintaining Home or Apartment) and is entitled to a home maintenance allowance.
Income.
Citizenship and Identity (see Section 7.2 Documenting Citizenship and Identity).

Accept self declaration for all other items, unless you document them as questionable.

20.3.2 Social Security Number

An applicant does not need to provide a document or social security card. He or she only needs to provide a number, which is verified through the data exchange with Social Security.

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

Verify the SSN only once.

20.3.3 Immigration Status

A member who indicates he or she is not a citizen must provide an official government document that lists his or her immigration registration number. Verify the individual’s immigration status by using the Systematic Alien Verification for Entitlement (SAVE) system. Women applying for BCPP (see the BadgerCare Plus Handbook) and persons applying for EMA who do not provide proof of immigration status can still qualify for those benefits.

An immigrant that presents documentation of his or her immigration status and meets all other eligibility criteria is presumptively eligible. Begin benefits and determine, through SAVE, that he or she is in a satisfactory immigration status.

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

20.3.4 Disability

Disability and blindness determinations are made by the DDB in the DHS . Items that can be used to verify disability status include, but are not limited to:

Proof of SSI or other SS Disability payment,
SOLQ-I,
Award letter or verbal statement from SSA , or
Proof of MADA approval, including presumptive disability

20.3.5 Assets

Verification of countable assets is mandatory.

Example 1: An EBD Medicaid member’s burial plot is not counted in determining his or her Medicaid eligibility. Do not require verification of its value in determining the group’s Medicaid eligibility.

If reported assets exceed the asset limit, do not pursue verification.

Do not verify cash on hand.

Verify assets using the Asset Verification System (AVS) integrated within CARES Worker Web. If current asset information is not available through AVS, the applicant/member is required to verify their assets through other sources (for example, bank statements). Assist the applicant/member in obtaining verification if he or she has difficulty in obtaining it.

20.3.5.1 Divestment

Verify if a member or spouse has divested assets when determining eligibility for institutional Medicaid and community waivers (see Section 17.1 Divestment Introduction).

20.3.6 Medical or Remedial Expenses

Medical or remedial expenses used to meet a deductible or calculate patient liability, cost share, or premium amounts must be verified. The expense amount, any third party liability amount, and date of service must all be verified. If verification is not provided, do not include the expense to determine when a deductible has been met or in the liability, cost share, or premium calculation. Do not deny or terminate eligibility for failure to provide the requested verification.

20.3.7 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. For applications and other relevant applicant information, refer to Power of Attorney as "Power of Attorney for Finances."

The IM agency must determine the guardianship type specified by the court. Only the person designated as "guardian of the estate," "guardian of the person and estate," or "guardian in general" may attest to the accuracy of the information on the application form and sign it. Do not require a "conservator" or "guardian of the person" to sign the application form.

If verification is not provided, do not grant the claimed power of attorney or guardian access to case notices or follow any direction provided by that person unless he or she is an authorized representative. Do not deny or terminate eligibility for failure to provide the requested verification.

20.3.8 Income

Verify all sources of nonexempt income for EBD Medicaid applicants and members. Verify income using the automated data exchanges, when current (the month for which eligibility is being determined) information is available on a specific data exchange. If current income information is not available through a data exchange, the applicant/member is required to supply verification/documentation of their earned and unearned income.

In certain cases, data exchange resources do not exist or are unavailable to IM workers for eligibility determinations. For example, data exchanges are not available for persons who do not supply their SSN or where the income reported is not part of an existing data exchange. Under these circumstances, income must be verified by the member through other sources (i.e., checkstubs, award letters, etc.).

The following are examples of persons for whom a data exchange will never exist and, therefore, income verification is required at eligibility determination:

Ineligible persons who do not provide an SSN and whose income would be counted in the eligibility determination (Fiscal Test Group member);
Non-citizens without an SSN applying for emergency services. Persons whose employers do not report wages to the Department of Workforce Development (DWD) in Wisconsin, such as Wisconsin residents who work out of state and persons who work for the federal government.
Persons with income from sources that are never available to IM workers through a data exchange, such as self-employment, pensions, retirement income, etc.

The applicant/member is responsible for providing verification of income that is not available through data exchange. For example, data exchanges are not available for persons who do not supply their SSN or where the income reported is not part of an existing data exchange. Under these circumstances, income must be verified by the applicant/member through other sources (i.e. check stubs, award letters, etc.).

Assist the applicant/member in obtaining verification if he or she has difficulty in obtaining it.

Do not deny eligibility if reasonable attempts to verify the income have been made. Use the best information available to process the application or change timely when the following two conditions exist:

The applicant/member does not have the power to produce verification, and
Information is not obtainable timely even with your assistance. In this situation, continue to attempt to obtain the verification. Once the verification is received, benefits may need to be adjusted based on the verified information.

This page last updated in Release Number: 18-02

Release Date: 08/010/2018

Effective Date: 06/23/2018