Medical Assistance for Employed Persons with Disabilities

2.3.5.1.1 Mandatory Verifications

Mandatory verifications must be verified through an available electronic data source or by paper proof, if electronic data sources are unsuccessful or unavailable. Self-attestation of certain eligibility factors may be accepted if electronic data sources are unsuccessful or unavailable and paper proof does not exist or is not available.

  • Assets

    • Verification of assets is required at application and when a new asset is reported. If an asset is determined to be excluded it does not need to be verified again at renewal.

      • An applicant or enrollee must verify assets even if the Account Validation Service (AVS) was requested.

    • Verification of the following assets are not required at application or renewal:

  • Certification of Disability through Social Security Administration (SSA) or State Medical Review Team (SMRT)

  • Income from employment

    • For wage income, only the following forms of verification are acceptable:

      • Pay stubs that include:

        • The employee's name or Social Security Number (SSN)

        • Hours worked

        • Gross pay

        • Social Security and Medicare taxes withheld

        • Net pay

        • Period covered by earnings

        • Employer's name

      • A completed Authorization for Release of Employment Information (DHS-2146). This form is only required when the employee does not provide pay stubs containing the required information, or any other statement from the employer that provides the necessary information.

    • For self-employment income, one of the following must be provided as verification of earnings:

      • Federal tax forms if the client has been in business long enough to file taxes and was required to file federal income tax for the previous year. Tax forms must include any of the following:

        • Quarterly Schedules ES (Form 1040) Estimated Tax for Individuals, if they were required to pay quarterly self0employment taxes.

        • Form 1040 U.S. Individual Income Tax Return with the "Self-Employment Tax" line completed.

        • Schedule SE (Form 1040) Self-Employment Tax.

      • Business Records if the client has not been in business long enough to file a federal income tax return, quarterly estimated taxes, or if the tax forms do not accurately reflect the self-employment income.

    • An enrollee must submit a copy of the federal tax return when it becomes available at the next renewal.

        • Business records may include:

          • Business financial statement

          • Detailed records of gross receipts and expenses

          • Business quarterly report

          • Computer printout showing gross receipts and expenses

          • Signed statement from the business's accountant verifying projected business income or expenses

  • Immigration status

  • Royalties, Honoraria, and Stipends

    • Documentation of royalty, honoraria, or stipend income must show:

        • The nature and amount of payments

        • Dates of payments

        • Frequency of payments

        • Social Security and Medicare tax withholding

    • This income can be verified with:

        • Tax forms for previous year identifying royalties, honoraria, or stipends with Medicare and Social Security taxes paid via entries on:

          • Federal Tax form 1040

          • Schedule C

          • Schedule SE

          • Form 1099-Misc

    • Pay stubs or written statement from the source of payment showing:

        • Social Security and Medicare taxes withheld

        • Person's name or Social Security Number

        • Amount of payment

        • Dates of payment

        • Name of issuer

    • Quarterly Schedule ES (Form 1040) Estimated Tax for Individuals

    • Schedule SE (Form 1040) Self-Employment Tax

  • Social Security Number

  • Social Security and Medicare taxes paid

  • U.S. Citizenship

  • American Indian and Alaska Native enrollees need to provide proof of status to be exempt from paying MA-EPD premiums.

Self-Attestation

Self-attestation, either verbal or in writing, of the following eligibility factors may be accepted if electronic data sources are unsuccessful or unavailable and paper proof does not exist or is not available:

  • Income
  • Assets
  • Medical expenses to meet a spenddown
  • Certification of Disability through Social Security Administration (SSA) or State Medical Review Team (SMRT)
  • Exceptions to having a Social Security Number

Paper proof is considered not available if neither the applicant or enrollee, nor the agency can obtain it. The county, tribal and state servicing agency must make efforts to assist the applicant or enrollee in obtaining the requested paper proof, if it exists. This includes obtaining authorization from the applicant or enrollee to contact a third party on their behalf, if appropriate. Decisions to accept an applicant’s or enrollee’s self-attestation must be based on the individual case circumstances.

Self-attestation cannot be accepted in lieu of electronic verification or paper documentation of an applicant or enrollee’s citizenship, immigration status, or social security number.

Legal Citations

Minnesota Statutes, section 256B.057