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Medical Assistance for People Who Are Age 65 or Older or People Who Are Blind or Have a Disability

2.3.1.1 Mandatory Verifications (Archived)

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.

Medical Assistance for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability (MA-ABD) has the following mandatory verifications.

Pre-Eligibility Verification

The following eligibility factors must be verified prior to the eligibility determination:

  • Assets

    • Verification of assets is required at application, renewal, and when a new asset is reported.

      • At renewal, an excluded asset that was verified does not need to be verified again unless the asset has changed, to determine whether the change affects the exclusion.

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

      Assets that are counted for a person with an asset limit must be verified even if the asset belongs to a person who is not applying for Medical Assistance (MA) or does not have an asset limit.

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

  • Certification of Disability through Social Security Administration (SSA) or State Medical Review Team (SMRT) for people claiming a blind or disabled basis of eligibility

  • Income

    • If a person is receiving Supplemental Security Income (SSI), only the SSI income is verified. Eligibility for SSI is accepted as verification of other income SSA considers in determining eligibility.

      Note: Veteran's Administration (VA) Aid and Attendance benefits and VA unusual medical expense payments must be verified even if the person is receiving SSI.

  • Medical expenses to meet a spenddown

County, tribal and state servicing agencies must retain verification documentation in accordance with the County Human Service Records Retention Schedule (DHS-6928).

Post-Eligibility Verification

If the following factors cannot be verified at application, they can be verified after eligibility has been approved so long as the applicant meets all other eligibility requirements. If proof is not provided by the conclusion of the reasonable opportunity period (ROP), eligibility may end.

County, tribal and state servicing agencies must retain verification documentation in accordance with the County Human Services Records Retention Schedule (DHS-6928).

Verification Received After Denial

When an applicant’s MA eligibility is denied and the applicant provides a required verification after the 10-day deadline indicated on the denial notice, the submission is considered a new request to apply that sets a new date of application. See 1.2.3 MHCP Date of Application for more information.

When a former enrollee provides a requested verification after the effective date of closure, the submission is considered a new request to apply that sets a new date of application. A new application must be completed to reapply, unless the proof is received within the four-months following closure for failure to complete a renewal. See 2.3.4.2 MA-ABD Renewals for more information.

Standard application and begin date policies and procedures apply based on the date the agency received the proof. See 2.1.4.1 MA Begin and End Dates for the more information.

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)
  • 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 place of electronic verification or paper documentation of an applicant or enrollee’s citizenship, immigration status, or social security number.

Legal Citations

Code of Federal Regulations, title 42, section 435.407

Code of Federal Regulations, title 42, section 435.541

Code of Federal Regulations, title 42, section 435.920

Code of Federal Regulations, title 42, section 435.945

Code of Federal Regulations, title 42, section 435.948

Code of Federal Regulations, title 42, section 435.949

Code of Federal Regulations, title 42, section 435.952

Code of Federal Regulations, title 42, section 435.956

Published: May 30, 2024

Archived: October 21, 2024