Verification Requirements for Medicaid/MC+ and Cash Assistance Programs – Table of Contents

VERIFICATION REQUIREMENTS FOR MO HEALTHNET AND ADULT CASH ASSISTANCE PROGRAMS

IM-158 December 14, 2017, IM#19 March 19, 2015, IM#91 November 21, 2012, IM-102, August 11, 1999 IM-57, May 29, 1998

This section contains the verification requirements for all MO HealthNet and adult cash assistance programs.

The Eligibility Specialist, as an employee of the Family Support Division, has the responsibility of requesting necessary verification and recording information in the case record that clearly documents all eligibility requirements for a program are met, or that one or more requirements are not met and ineligibility exists.

Individuals applying for or receiving assistance have the responsibility to provide information or access to the information needed for determining eligibility, both initially and on a continuing basis.

NOTE: If the applicant signs a release form for the FSD to have access to the information needed for determining eligibility, but the source will not provide the information requested to the FSD, requires payment for the response, or requires a company specific form, inform the applicant/participant that they must obtain the information from the source directly. It is the applicant/participant’s, authorized representative’s, and/or legal representative’s responsibility to provide the FSD with all information regarding the eligibility unit’s income and circumstances at the time of the initial application and ongoing to determine eligibility. It is the Eligibility Specialist’s responsibility to inform the applicant/participant what information is needed. Ensure the Request for Information (FA-325 or IM-31A) form clearly identifies the documentation that must be provided.

An applicant must be given at least ten days to supply necessary information per request. A MO HealthNet for Aged, Blind, and Disabled (MHABD) application may be rejected after two Request for Information (FA-325 or IM-31A) forms. When the first written request expires a second Request for Information (FA-325) form is automatically generated by FAMIS, allowing an additional 10 days to return requested information. The second FA325, shown as request “Two”, can be viewed or printed from the Document Queue (DOCQUE/FMVM) screen. If FAMIS fails to generate the second request, the Eligibility Specialist should do so, following the User Guide instructions for Editing and Adding Text to the FA325.

NOTE: If an MHABD MO HealthNet application is rejected prior to the actual due date of the application for failure to provide verification or failure to cooperate, and then all of the requested information is received on or prior to the due date of the application, the application should be cancel rejected and processed using the original date without requiring that the applicant submit a new application document.

For active cases, if the participant refuses or fails to provide the necessary information to establish continuing eligibility within ten days, authorize an adverse action to close in FAMIS, or send a Adverse Action Notice (IM-80) form to close.

NOTE: A collateral contact is not required prior to approval of any MO HealthNet application. If information provided by the applicant is questionable, it may be helpful to contact a collateral to clarify the household’s situation. Do not routinely contact a collateral prior to approving MO HealthNet applications.

Questionable Documentation or Other Verification

The agency is not required to accept questionable documentation or other questionable verification. If the applicant/participant, authorized representative, or legal representative provides documentation or other verification that appears to be inaccurate, incomplete, inconsistent, inauthentic, or not true, send a Request for Information form (FA-325 or IM-31A) to the applicant/participant and/or their legal guardian, conservator, or authorized representative requesting the clarifying or additional information needed. Allow ten days for the applicant/participant, legal guardian, conservator, or authorized representative to provide the information needed to determine eligibility.

If the requested information is not received or does not resolve the discrepancy, authorize the rejection or adverse action to close the case for failure to cooperate.

Record comments from the Eligibility Unit Member Role (EUMEMROL/FM3Z) screen or hard copy of case file for cases not in FAMIS. Comments must provide a detailed explanation of the documentation received and the reasons that the documentation or other verification appears to be inaccurate, incomplete, inconsistent, inauthentic, or not true.

NOTE: If the Eligibility Specialist learns of information effecting the eligibility determination, which was not disclosed at the time of the original application and was not a change in circumstances, allow the applicant/participant, authorized representative, or legal representative up to the application due date to provide needed verification. If the necessary information needed to determine eligibility is not received by the due date, authorize the rejection for failure to cooperate. Do not exceed the application processing time frames. See Application Processing section 0105.045.00 DELAYS IN PROCESSING IM APPLICATIONS.

Any case action can be challenged in a hearing so there must be a rational, reasonable explanation for taking action, such as closing or rejecting a case, based on the information provided or not provided. Staff must be able to explain, based on logic and facts, not on conjecture, prejudice, or emotion, why the documentation was questionable and the application was denied.