State of Wisconsin Department of Health Services

Release 26-02 April 15, 2026

View History

20.1 Verification

Proof of certain information is required to determine eligibility for Medicaid. Mandatory (see Section 20.3 Mandatory Verification Items) and questionable (see Section 20.4 Questionable Items) items must be verified at application, renewal, person addition or deletion, or when there is a change in circumstance that affects eligibility or benefit level. One time only verification items do not need to be re-verified. For changes in circumstance and timely renewals, current benefits are maintained until a redetermination of benefits is completed. 

Verification means to establish the accuracy of verbal or written statements made by or about an individual's circumstances. Case files or case comments must include documentation for any information required to be verified to determine eligibility or benefit levels. 

20.1.1 Verification Definition

Verification is part of determining eligibility. To verify means to establish the accuracy of verbal or written statements made by or about an individual's or group’s circumstances.

If the memberA recipient of Medicaid; formerly referred to as a "client." is applying for other programs of assistance see the verification chapters of those program handbooks.

20.1.2 Documentation

Documentation includes storing received information in the case record. 

Documentation also includes adding case comments. For collateral contact or any other information that cannot be stored in the case record, case comments must describe the nature and source of information if follow up is needed. Documentation must explain current eligibility, ineligibility, benefit level, and coverage group changes. 

All documentation must be in sufficient detail to permit a reviewer to determine the reasonableness and accuracy of the determination. 

20.1.3 Verification Receipt Date

The verification receipt date is the day verification is submitted to the appropriate IMincome maintenance agency or the next business day if verification is submitted after the agency's regularly scheduled business hours.

IM agencies must stamp the receipt date on each piece of verification submitted.

20.1.4 General Rules

1. Over-verification, including requiring excessive pieces of evidence for any one item or requesting verification that is not needed to determine eligibility, is prohibited. Once the accuracy of a written or verbal statement has been established, additional verification can’t be required. For example, once U.S. citizenship is verified, a member or applicant never has to verify it again (see Section 7.2 Verifying U.S. Citizenship).
2. If information has already been verified, the applicant or member does not need to verify it again except in the following situations:
   1. There is reason to believe the information is fraudulent or differs from more recent information. If fraud is suspected, the IM agency will determine if a referral for fraud or for front-end verification should be made (see Section 20.6 Front End Verification).
   2. The member reported a change to information that is subject to mandatory verification rules or is questionable.
   3. At renewal, if information is subject to mandatory verification rules or is questionable.
3. One particular type of verification can’t be exclusively required when various types are adequate and available.
4. Verification may be submitted in person, by mail, fax, e-mail, or electronically through ACCESS or the MyACCESS mobile app. Verification is not required to be presented in person.
5. Applicants and members must not be subject to different verification requirements solely based on race, color, national origin, age, disability, sex, religion, or migrant status when people in similar circumstances would not otherwise have the same verification requirements. 

   Example 1

   Marie reports on her application that she is a U.S. citizen. She also reports that the primary language spoken in her home is a language other than English, and it is her preferred language. Marie’s preferred language has no impact on the verification policy for U.S. citizenship. Verification of U.S. citizenship is attempted using the same methods used for all applicants that report U.S. citizenship, which is explained in Section 7.2 Verifying U.S. Citizenship.

6. The applicant or member can’t be required to sign a release form (either blanket or specialized) when the member provides required verification.
7. Verification of information that is not used to determine eligibility cannot be required.
8. During verification, the applicant or member can’t be harassed or have their privacy, personal dignity, or constitutional rights violated.

The applicant or member has primary responsibility for providing verification and resolving questionable information. However, the IM worker must use all available data exchanges to verify information rather than requiring the applicant to provide it, unless the information from the data source is not reasonably compatible with what the applicant or member has reported (see Section 20.3.8.1 Reasonable Compatibility for Income for Health Care and Section 20.3.5.2 Reasonable Compatibility for Assets).

IM agencies must assist the applicant or member in obtaining verification if they request help or have difficulty in obtaining it.

The best information available is used to process the application or change within the time limit when both of the following conditions exist:

1. The applicant or member does not have the power to produce verification.
2. Information is not obtainable timely even with the IM worker's assistance.

Applicants meeting the health care program eligibility criteria based on best available information are eligible for benefits. Even after the application or change is processed using best available information, the IM agency is required to continue in their attempts to obtain verification. When the verification is received, benefits are redetermined based on the new information.

---

The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030