Verification
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Verification


Revised July 21, 2014



Purpose: This chapter describes what information must be verified, other factors that may be verified if necessary, and criteria for evaluating documents that are received.

WAC 388-490-0005The department requires proof before authorizing benefits for cash and Basic Food.

Additional Information

*** As a result of implementation of the Affordable Care Act (ACA), this clarifying page may no longer be effective for medical coverage applications received on or after 10/01/2013. Please see the ACA Transition Plan for more information. Clients under 65 years of age who need to apply for medical coverage on or after 10/01/2013 should be referred to Washington Healthplanfinder. Applications for medical coverage for households where all members are 65 years of age and older should be referred to Washington Connection. ***

 

 

Verification Chart - Cash and Basic
Verification Chart - Medical
Verification Chart - Acceptable Forms

WAC 388-490-0005

WAC 388-490-0005

Effective October 1, 2013

WAC 388-490-0005 The department requires proof before authorizing benefits for cash and Basic Food.

This rule applies to cash and Basic Food. 

  1. When you first apply for benefits, the department may require you to provide proof of things that help us decide if you are eligible for benefits. This is also called "verification". The types of things that need to be proven are different for each program.

  2. After that, we will ask you to give us proof when:

    1. You report a change;

    2. We find out that your circumstances have changed; or

    3. The information we have is questionable, confusing or outdated.

  3. Whenever we ask for proof, we will give you a notice as described in WAC 388-458-0020.

  4. You must give us the proof within the time limits described in:

    1. WAC 388-406-0030 if you are applying for benefits; and

    2. WAC 388-458-0020 if you currently receive benefits.

  5. We will accept any proof that you can easily get when it reasonably supports your statement or circumstances. The proof you give to us must:

    1. Clearly relate to what you are trying to prove;

    2. Be from a reliable source; and

    3. Be accurate, complete, and consistent.

  6. We cannot make you give us a specific type or form of proof.

  7. If the only type of proof that you can get costs money, we will pay for it.

  8. If the proof that you give to us is questionable or confusing, we may:

    1. Ask you to give us more proof, which may include providing a collateral statement. A "collateral statement" is from someone outside of your residence who knows your situation;

    2. Schedule a visit to come to your home and verify your circumstances; or

    3. Send an investigator from the Division of Fraud Investigations (DFI) to make an unannounced visit to your home to verify your circumstances.

  9. By signing the application, eligibility review, or change of circumstances form, you give us permission to contact other people, agencies, or institutions.

  10. If you do not give us all of the proof that we have asked for, and we have not granted you an extension to give us the rest of the information we need as described in WAC 388-406-0030, we will determine if you are eligible based on the information that we already have. If we cannot determine that you are eligible based on this information, we will deny or stop your benefits.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

1.     Address Confidentiality Program:

See CONFIDENTIALITY for instructions on verification if the client is a participant in the Address Confidentiality Program (ACP).

  1.  Verification of Income Deductions for Basic Food:

We only require verification of a household's income deductions for Basic Food when the information is questionable.  This includes verification at initial application, recertification, or Mid Certification Review (MCR). A client's statement is acceptable for income deductions unless there is something to suggest that the claimed expense is incorrect.

We must still make use of readily available information such as child support paid by the household through SEMS or Chlid Care Subsidy Programs copayments through WCAP. 


EXAMPLE

Client verifies income of $850 monthly and claims rent of $800 and that they pay for utilities.  Although we do not have to verify the household’s eligibility for the standard utility allowance, the rent in light of the household income and other expenses is questionable.  You would need to resolve how the household is meeting their monthly expenses with their income.


NOTE: Although we do not have to verify income deductions that are within reason, we must still verify their monthly income.

NOTE: Refer to the ACES User Manual for instructions on using verification valid value “OT” for income deductions that are not questionable when you do not have another form of verification.   Remember to document that the expense was not questionable in remarks.

3. Living Above Means (LAM)

a. What is LAM?

A positive LAM determination suggests that a household has some way of paying for their living expenses through nonstandard or unexplained ways. A household is considered LAM when the AU’s countable income for Basic Food (BF) is less than the allowable rent/mortgage costs. These amounts can be found on the FSFI/eligibility screen in ACES/3G.
For purposes of LAM, countable income follows WAC 388-450-0162 except that we do not subtract the shelter (rent/mortgage/utility) deductions under WAC 388-450-0185 (5) because the LAM countable income will be compared to the rent/mortgage. Utility deductions (such as SUA) are not taken into account in any part of the LAM calculations.

b. What should we do when a household is LAM?

i. Application/Eligibility Review (ER): When a household is LAM, we must obtain information about how the household is paying for expenses and meeting needs. This applies to both the BF and TANF AUs (excluding TANF AU’s that do not have an accompanying BF AU), even though the determination of LAM is based on countable income for BF.
Set the indicator(s) for BF and TANF in ACES/3G to “Yes” to show that the household is LAM. Even when the household explains/verifies how it meets needs, leave the indicator as Yes so the information can be reviewed at the next ER.

ii. Mid-Certification Review (MCR): MCR processing does not require us to confirm/re-verify LAM. If the household was already LAM and had no changes related to how they were meeting needs, then the situation does not have to be re-explained or re-verified. If during the MCR process, the household is discovered to have become LAM due to reduced income, verify the income change before considering the MCR complete because the situation is questionable.

iii. Active Cases/Changes: Active cases should not be pended (such as setting a tickler to check a case later) for LAM or verification of LAM if there is no MCR or ER due.
If an active household reports a change which causes their situation to become LAM, we do not need to verify meeting needs specifically. Note – there still may be cause to verify changes or other questionable circumstances during changes.

c. When does LAM require explanation or verification?

In general, if the household situation changed less than two weeks ago and put the household within the LAM definition, then the household should not be required to explain how it will pay for needs. If the household has been paying for their needs without sufficient income/resources for at least two weeks, then the household should be asked to explain LAM. Note – the two week measure is a suggestion, and it may be appropriate to not require an explanation unless more than a month has passed since the circumstances that caused a LAM determination.
We should only require verification if the explanation is not clear, not reasonable or suggests there is other income that may be countable. If the client fails to turn in requested verification, deny the AU for failure to provide verification. If the client turns in verification that appears sufficient for eligibility determination but still seems questionable, the eligibility worker may decide to make a fraud (FRED) referral.

d. What if the case is not LAM?

Per WAC 388-490-0005 (2) (c) and (8) (a), anything that is questionable and may affect benefits needs to be explained and/or verified, even if the household is not LAM. Be sure to mark the indicator(s) in ACES/3G as “No” for LAM.


EXAMPLE

Client Jenifer verifies gross earned income of $850 monthly and claims rent of $800 and pays electric heat.  After the earned income deduction of $170 and standard deduction of $152, the countable income is $528. Since the countable income of $528 is less than the rent of $800, the client is LAM.  You question how Jenifer has been able to pay rent, and she states that her mom has been paying $300 towards Jenifer’s rent for a few months. You need to verify the rent being paid by the mom, to find out how to correctly classify it, such as direct payment to landlord, loan, gift and how long her mom’s help will continue.


EXAMPLE

Client Jenifer verifies gross earned income of $850 monthly and claims rent of $500 and pays electric heat.  After the earned income deduction of $170 and standard deduction of $152, the countable income is $528. Since the countable income of $528 is more than the rent of $500, the client is not LAM.  Reminder: the utility deduction is not considered in the LAM determination.


EXAMPLE

Client Jenifer verifies gross earned income of $850 monthly and claims rent of $500 and pays electric heat.  Jenifer also pays $65 per month for child care.  After the earned income deduction of $170, the standard deduction of $152 and the $65 deduction for child care, the countable income is $463. Since the countable income of $463 is less than the rent of $500, the client is LAM. You question how the client has been able to pay rent and other expenses. Jenifer states that she has been dwindling down her checking account which still consists of $2600 of an Earned Income Tax Credit from her Federal Tax Refund received 2 months ago.  You notice in Spider that Jenifer did work more last year than she is now, so the bank account (resource) does not need to be verified.


EXAMPLE

Client Bob has MCR due for BF.  He turns in the form by mail and indicates there are no changes in income or expenses (since his application 5 months ago).  The case was already marked as LAM during the last application process.  Bob’s AU data shows gross earned income of $850 monthly and claims rent of $800 and pays electric heat.  After the earned income deduction of $170 and standard deduction of $152, the countable income is $528.  Since the countable income of $528 is less than the rent of $800, the client is LAM; however, you do not need to delay processing of this MCR for explanation of LAM because there was no change at MCR to the previous LAM situation.


EXAMPLE

Client Holly sends a letter of termination from her employer stating that her last pay was one week ago. There is no MCR or ER due, so this change will follow the change of circumstances rules.  Since the stop work was verified, the income should be removed.  Though the client may now be considered LAM, no explanation or verification regarding the new LAM determination should be requested. LAM will be reviewed at the next ER.


4.    Verification at recertification for Basic Food:

For Basic Food, only certain factors must be verified at recertification. In addition, there are some factors we cannot require clients to verify at recertification.

We must verify:

Don’t require verification of:

·        A change of income if the source has changed or the amount has changed by more than $50;

·       Questionable expenses;

·        Any information that is incomplete, inaccurate, or outdated.

  • Income if the source hasn’t changed and the amount has changed $50 or less;
  • Income deductions that aren’t questionable; or

·       Income-in-Kind


NOTE: We must always verify information needed to determine eligibility if it appears incomplete, inaccurate, or outdated. This is true even if the client reports the eligibility factor as unchanged at recertification.

EXAMPLE

Client is in the CSO on March 14th for recertification. They report rent has changed from $475 to $500 monthly. You determine that this is reasonable considering the household’s income and prior rent and do not request verification. 


EXAMPLE

Client applies for assistance on December 15th and states that she just began a new job on December 10th. Her employer states that he anticipates that she will be working 20 hours per week and will make $9.00 per hour. She is certified for December through February.  

In February, you should request verification of both her current hours of work and her pay rate since anticipated income for new hires often changes after the employer has a chance to evaluate their work performance.


5. Verification of citizenship and identity for Medicaid programs:

Citizenship and identity are two separate requirements and acceptable forms of verification are listed in the citizenship and identity documents section.  


Who must verify citizenship and identity

Medicaid (Title XIX) and CHIP (Title XXI) applicants and recipients who declare they are U.S citizens or U.S Nationals are required to verify their citizenship and identity if the department is unable to verify through a Social Security Administration (SSA) citizenship/identity interface. 

If SSA does not return a successful match the applicant/recipient is given a reasonable opportunity to provide verification or work with the Citizenship Central Unit (CCU) to obtain the required verification.

The following programs are required to verify citizenship and identity and will be sent through the SSA interface, if they do not meet one of the exemptions:

  • Cash programs: TANF (F01) and Aged, Blind or Disabled (G02).
  • Medical programs: F02, F03, F04, F06, F07, F10, F99, G03, G95, G99, P02, P05, P06, P99, K01, K95, K99, S02, S08, S30, S95, S99, L02, L21, L22, L95, and L99.


NOTE:

Clients of public assistance may be eligible to receive a WA state "Identicard" at the cost of production (RCW 46.20.117) from the Department of Licensing.  To assist clients with applying for a reduced priced ID card, please complete DSHS Form 16-029


Who is exempt from verifying citizenship

The following Medicaid applicants /recipients are exempt from the citizenship and identity verification requirements:

  • People who receive Supplemental Security Income (SSI) or who have received SSI in the past.
  • People who receive Social Security Disability based on their own disability.
  • People who are not U.S. citizens or U.S. Nationals, regardless of immigration status.
  • Children in Foster Care.
  • Newborn children, born to a mother on Medicaid, and automatically eligible for Medicaid (these newborns are verified for citizenship and identity for life).

Social Security Administration (SSA) Citizenship/Identity Interface

At application and renewal of a non-exempt Medicaid program, the names and SSN’s of all clients (including legal and undocumented aliens) will be sent through the SSA citizenship/identity interface if the following exists:

  • Federally verified SSN;
  • Not an exempt client;
  • Not already verified for citizenship and identity with:

Citizenship Valid Value

Identity Valid Value

T1, T2, EW or FV

V, E or F

 




Clients who match with the SSA interface for citizenship/identity will automatically be updated by ACES with “FV” valid value for citizenship and “F” valid value for identity.  See CSO procedures below for legal or undocumented aliens that federally verify with the SSA citizenship/identity interface.

For clients who do not match with the SSA citizenship/identity interface ACES will issue a 455 (Citizenship –unable to verify Via SSA cross match) alert to the CCU for further contact and action with the client. 


NOTE: Do not delete these alerts when processing eligibility for the clients or the CCU will not receive an alert to work with the client in obtaining citizenship or identity.

CSO Procedures

Review the electronic case record (ECR) for acceptable citizenship and identity verification and update ACES with approved citizenship and identity codes available in the ECR or received at time of application (See citizenship and identity flowchart ).


NOTE: Do Not look up Washington births in DOH Web for citizenship and identity requirements.  We do not want to pay for the look up when we can verify with the SSA interface.



For each non-exempt applicant or recipient declaring they are a citizen without citizenship and/or identity verification available at time of application or in the ECR, code their DEM2 screen in ACES with CS in the citizenship verification field and P in the identity verification field.

For legal or undocumented aliens that federally verify through the SSA interface as a citizen, review their ECR for current verification of immigration status.

If it is determined the interface is in error and the federally verified codes need changed call or email:

Citizenship Central Unit (CCU)

Health Care Authority's Citizenship Central Unit (CCU) will obtain citizenship and/or identity documentation for applicants and recipients that are unsuccessfully matched with the SSA interface and are unable to provide proof.

CCU will track the reasonable opportunity for applicants/recipients and if the client fails to cooperate in getting acceptable verification or the CCU is unable to get the verification within a reasonable opportunity timeframe they will send a DMS tickler to the appropriate Customer Service Center to terminate Medicaid with advanced and adequate notice.


NOTE:  For Children and Pregnant women who have failed to verify through SSA interface or fail to cooperate in the verification process, the CCU will request their citizenship status be updated to undocumented (U) until they verify their citizenship or alien status.  This will allow them to receive the state funded programs.



Any questions contact your HCA Regional Representative.


ACES PROCEDURES: See Citizenship and Identity Coding


6.    Verification of citizenship or alien status for Basic Food, ABD and state funded medical programs.

For these programs, we only require verification of citizenship or alien status if:

·         The client declares they are not a citizen, or

·         The client declares they are a citizen but there is a valid reason to question their status.


EXAMPLE

A client of Hispanic descent declares that he is a U.S. citizen. We accept his statement at face value.


EXAMPLE

A client declares that he is a U.S. citizen but produces a Social Security card that states “Valid for work only with BCIS/INS authorization”. We ask for verification of his citizenship.


EXAMPLE

A client from Somalia declares that he is a non-citizen. We ask for verification of his specific immigration status.


    7.     Verification requirements for department programs:

The linked charts display the eligibility factors that must be verified at initial application for each program and the factors that have different verification requirements at recertification. Accept a client's declaration of age, identity, citizenship, and SSN. Ask for verification to be provided whenever the information is questionable.

Most eligibility factors cannot be automatically re-verified after initial certification. They can only be re-verified if:

a.      A program the client receives benefits from specifically requires the factor to be re-verified; or

b.      There is a change in that specific factor or the information is incomplete, inaccurate, inconsistent, or outdated.

For more information, see:

Verification Requirements Chart – Cash Assistance and Basic Food

Verification Requirements Chart – Medical Assistance

             Acceptable Forms of Verification Chart

 

     8.   Department forms for verifying information:

There are some DSHS forms that may also be used to obtain verification. These forms verify several eligibility factors and may be more convenient for the client to use rather than obtaining several sources of verification. Do not require the client to use these forms.


9.    DFI home visits to reservations:

DFI has an agreement with several tribes that investigators will contact the tribe before making any unannounced home visits on the reservation.

10.  Verification to include when splitting case records:

See CASE RECORDS for verification that needs to be included in the record when splitting, separating, or combining case records.


WORKER RESPONSIBILITIES

  1. At initial application, obtain mandatory verification of each eligibility factor for the program(s) the client has requested.  For cash or medical, you may also want to verify the client's resources if the estimated value of countable resources is equal to or greater than 3/4 of the resource limit.  For example, the TANF resource limit for applicants is $1000.  You may want to request verification of the resources if the client states the value of the countable resources totals $750 or more to make sure that the client's resources are below the limit.

NOTE:

When documentation of a client's citizenship is received for Medicaid eligibility, based on the type of document provided, update the ACES DEM2 screen with the corresponding verification Tier level.


  1. At eligibility review or recertification, look in the case record before asking the client to provide the verification.  If the client has previously provided verification of an eligibility factor, do not require the client to provide the verification again unless the program requires the factor to be re-verified, there is a change in that specific factor, or the information is incomplete, inaccurate, or inconsistent or outdated.

NOTE: Ensure that the Electronic Case Record (ECR) has a readable copy of the proof of identity required for each program.

  1. When you need verification, use alternative methods, such as telephone calls, as the primary method to verify client circumstances. Request paper verification only when there are no other methods readily available

  2. When requesting paper verification, ask for documents that the client can easily get.  If it will take the client more than three business days to get the verification, offer to help the client get it.


EXAMPLE

Lost immigration documents can be replaced through a Freedom of Information Act (FOIA) request to the BCIS/INS but this may take months. You may need to rely on a “collateral statement” in the meantime.


5.      The client may only have documents that are old or expired. Do not assume that the information in an old or expired document is not valid but seek more current verification. This is particularly important in the case of immigration documents, since immigration status does not necessarily expire when the document expires.

6.      If you know or have reason to suspect that the client is a victim of domestic violence or if you have reason to suspect that the client is a victim of domestic violence:

a.       Have the client write a statement that explains what proof or way of getting proof would put the client or the children at risk of harm, if any.

b.      Help the client get proof that will not put them at risk.

c.       For a victim of domestic violence who is also an immigrant, consider referring her to an immigration attorney or to the Northwest Immigrant Rights Project. A “collateral statement” from an immigration attorney may be sufficient to document status in such cases.

d.      Many women who are victims of domestic violence change back to their maiden names after dissolution of their marriage. For a victim of domestic violence who is also an immigrant, BCIS/INS will not issue new documents to reflect this change. To verify status, make a copy of both the immigrant document and the dissolution decree describing the name change.


EXAMPLE

A woman and her two children apply for assistance. They are living at the local domestic violence shelter and the father of the children lives in the family home. Do not call the family home to verify any information. Do not require the victim to return to the home to get any verification.


7.      If the client has a disability that would make it difficult or impossible to get certain information, offer to get the information for the client.

8.      See NSA for additional procedures if the client has been designated as needing Necessary Supplemental Accommodation (NSA).

9.      If the verification will cost money (such as birth, death, or marriage certificates, medical information, copies of bank statements, etc.) authorize advance payment.

For vital statistics records:

a.       For Medicaid, out of State citizenship verification from Vital Statistics or identity verification from Department of Licensing will be requested through the Citizenship Central Unit if the client does federally verify with SSA interface.  See Citizenship and Identity verification for Medicaid in clarifying information of this section.

b.      For other purposes, complete the appropriate state's form to request the Vital Statistic Record. You can download the form, find out the current charge for the record, and find the correct address for the payment at http://www.vitalcheck.com.


NOTE: When using this site, do not use the on-line purchasing option to obtain the record.

c.       Complete an A19-1A, State of Washington Invoice Voucher, for the request.

·         Use the appropriate state name for the vendor name.

·         For the address, use your CSO name, mail stop, and zip code 10000.

·         For Vendor Number, use VOD1.

·         For Invoice Number, use VITALS.

d.      Send vital statistics A-19’s as a separate batch. To avoid several small batches, local offices may want to hold the requests until there are several that need to be processed. Due to the time constraints for receiving vital statistics records, input the batch of A-19’s at least once a week.

e.       When the A-19 batch is sent, send an email to Rridula Rohila (rohilm@dshs.wa.gov) or Christina Milam (Milamc@dshs.wa.gov) at the office of Accounting Services.

f.       When the checks are returned to your office, send the check and the state’s form to the appropriate state’s address.

g.      Maintain a log with the following information:

·         Date the A-19 was input;

·         Date the checks were received from OAS;

·         The warrant number and date;

·         Date the request was sent to the our-of-state agency; and

·         Date the Vital Statistics Record was received.

10.  When requiring additional verification from the client, document on the remarks screen in ACES why additional verification was needed.  Some reasons to request additional verification are:

a.       The information you have received is questionable.  Consider the information questionable when it:

                                            i.            Contradicts or conflicts with other statements made by the client;

                                          ii.            Is received from a third-party source that contradicts or conflicts with other statements made by the client; or

                                        iii.            Causes you to question the accuracy of the information provided by the client.

b.      The client does not know information that could affect eligibility.  (For example, the client knows that they pay the electric bill and the gas is included in the rent, but they do not know if the heat is electric or gas); or

c.       You need precise information in order to determine eligibility, e.g., a client's resources are close to the resource limit.

11.  Criteria for evaluating verification:

a.       Use the following criteria to evaluate documents and verbal/written statements used for verification:

                                                        i.            Does it verify the eligibility factor?  (For example, a child's birth certificate verifies age, citizenship, and parentage.  It does not establish that the child is living with the client.)

                                                      ii.            Is the document/statement the most reliable available evidence?

                                                    iii.            Was the document/statement prepared near the time the event took place? (Note that for Medicaid citizenship verification, some Tier verification must be historical in that it must be created at a defined time in the past).

                                                    iv.            Is the document/statement signed and dated?

                                                      v.            Has the time period the document/statement covers expired?

                                                    vi.            Who prepared the document/statement? Is that person reliable? Does that person have a personal interest in the outcome? For Medicaid purposes, a person signing a Citizenship affidavit for an applicant must also prove that he or she (the person signing the affidavit) is a US citizen.

                                                  vii.            Is there a phone number to contact the person who prepared the document/statements?

                                                viii.            For what purpose was the document/statement prepared?

                                                    ix.            Does the document/statement deny knowledge of a fact although the statement maker was clearly in a position to know the facts?

                                                      x.            Was there a legal process involved in establishing the document/statement?  Was an oath administered?  Was an affidavit taken? Were witnesses present?

                                                    xi.            Are there any inconsistencies in the document/statement itself?

                                                  xii.            Is the document/statement consistent with other information?

                                                xiii.            Is the document/statement based upon first-hand knowledge rather than opinion, inference, or hearsay?

                                                xiv.            Has the document been in the possession of a person with reason to change it?  Does it appear the document is altered?  For instance, is a different typeset or handwriting style used on only a portion of the document?  Has anything been erased or covered with correction fluid (White-Out®)?

                                                  xv.            Is there any other reason to question the validity of the document?

b.      After evaluating a document on the above criteria, determine if you have enough information to establish eligibility.  If not, document the reason and request further verification.

c.       When there are conflicts in documents or verbal/written statements:

                                                        i.            Obtain in writing a clarifying statement from the client or other person that reasonably explains or resolves the conflict.

                                                      ii.            Obtain verification items, or refer the case to FRED to obtain verification items needed to support the explanation or resolution of the conflict.  See FRAUD for details on FRED referrals.

                                                    iii.            When verification items cannot be obtained to support the explanation or resolution, make a decision based on available information.  If the available information is not sufficient to determine eligibility, deny or terminate assistance.  Document the action taken.

12.  What to document for each case:

a.       What verification you requested;

b.      Why you requested verification/additional verification;

c.       What verification you received;

d.      When you received the verification;

e.       Who prepared the verification document/statement;

f.       What action you took, if any, to help the client get the verification;

g.      Whether the client has a disability that would make it hard or impossible to get the verification, and/or whether the client is a victim of domestic violence and failed to get the verification due to the domestic violence;

h.      Whether the client has been designated as NSA, and if so, whether you followed the NSA Accommodation Plan;

i.        What decision or action you took; and

j.        Any other information you consider pertinent to the situation.


ACES PROCEDURES

See Interview -Verification
Modification Date: July 21, 2014