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 388-490-0005 The department requires proof before authorizing benefits for cash, medical, and Basic Food.
This rule applies to cash, medical, and Basic Food.
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.
After that, we will ask you to give us proof when:
You report a change;
We find out that your circumstances have changed; or
The information we have is questionable, confusing or outdated.
Whenever we ask for proof, we will give you a notice as described in WAC 388-458-0020.
You must give us the proof within the time limits described in:
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:
Clearly relate to what you are trying to prove;
Be from a reliable source; and
Be accurate, complete, and consistent.
We cannot make you give us a specific type or form of proof.
If the only type of proof that you can get costs money, we will pay for it.
If the proof that you give to us is questionable or confusing, we may:
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;
Schedule a visit to come to your home and verify your circumstances; or
Send an investigator from the Division of Fraud Investigations (DFI) to make an unannounced visit to your home to verify your circumstances.
By signing the application, eligibility review, or change of circumstances form, you give us permission to contact other people, agencies, or institutions.
If you do not give us all of the proof that we have asked for, 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.
For all Medicaid programs, you must provide proof of citizenship and identity as specified at Section 6036 of the Deficit Reduction Act of 2005 (PL 109-171 amending USC 1396b).Exempt from this requirement are recipients of :
See CONFIDENTIALITY for instructions on verification if the client is a participant in the Address Confidentiality Program (ACP).
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;
Previously unreported medical expenses;
Total ongoing medical costs if they have changed by more than $25;
Change in legal obligation to pay child support, the obligated amount, and the amount the AU pays to someone outside of the assistance unit; and·
Any information that is incomplete, inaccurate, or outdated.
Income if the source hasn’t changed and the amount has changed $50 or less;
Medical expenses that have changed by $25 or less;
Unchanged utility costs; or
Unchanged child support obligation and payments made to persons outside of the AU.
EXAMPLE
Client is in the CSO on March 14, 2003 for recertification. Client reports that the rent is $475. You have a copy of the lease in the file that states the rent is $475, but it is a six-month lease from July 2002 through December 2002. You should request new verification of the rental amount and document why you did this.
EXAMPLE
Client applies for assistance on December 15, 2003 and states that she just began a new job on December 10, 2003. Her employer states that he anticipates that she will be working 20 hours per week and will make $7.01 per hour. She is certified for December through February. At her recertification on February 10,2004 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.
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.
Verification of citizenship and identity for Medicaid programs:
Effective July1, 2006, under the terms of the federal Deficit Reduction Act 2005 (DRA), States are required to verify citizenship and identity for all applicants and recipients of Medicaid (this includes Medical Assistance for AF/F01 coverage and GA/G02 coverage as well as other Medicaid programs).
Documents which, comply with the DRA are broken down into four tiers and are itemized in Appendix A below.
Only Tier 1 documents are acceptable to verify both citizenship and identity.
Documents from Tier 2 through Tier 4 used to verify citizenship must be submitted along with separate documents verifying the identity of the applicant/recipient.
WashingtonStatehas developed a Citizenship Documentation and Identity Declaration form (13-789) in English, in Spanish and other supported languages which a client may sign under Penalty of Perjury to attest to their citizenship/identity if they are unable to provide any Tier 1 - Tier 2 documents to verify their citizenship status at application or review.
The 13-789 declaration form is also acceptable verification of identity for children 15 and younger, and once accepted, the child is verified for life (when the child turns 16 they do not need to re-verify identity).
Tier 3 and 4, are coded by the CCU. Applicants and Recipients must first provide either Tier 1 or Tier 2 documents. If these are not available to the client, then the CCU will work with them to provide Tier 3 or Tier 4 documents.
EXAMPLE
Mom applies for medical for her two children ages 10 and 11. Mom has provided her birth certificate and driver’s license and hospital records of the birth of her two children born in Kansas. She completes the Citizenship Documentation and Identity Declaration form for Id for the children. Worker would code the children’s citizenship VV as “AF” (Declaration, Federal Verification Pending) not “T3”. The CCU will follow up and request copies of out of state birth certificates for the children.
An automated cross match with Center for Health Statistics Vital Records was completed in September 2006. The cross match meets the federal requirements for T2 citizenship verification and is coded in ACES with “EW” (electronically verified by Washington database). This code is system generated and cannot be changed or updated by the CSO worker.
NOTE:
When citizenship is verified with EW the client must still present an acceptable form of identity verification.
An automated cross match with Center for Health Statistics Vital Records was completed in September 2006. The cross match meets the federal requirements for T2 citizenship verification and is coded in ACES with “EW” (electronically verified by Washington database). This code is system generated and cannot be changed or updated by the CSO worker.
NOTE:
When identity is verified with E the client must still present an acceptable form of citizenship verification.
Verification of citizenship or alien status for Basic Food, GAU and State funded medical programs:
For these programs, we only require verification of citizenship or alien status when:
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 of Arab descent 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.
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 program the client receives benefits from specifically requires the factor to be re-verified; or
There is a change in that specific factor or the information is incomplete, inaccurate, inconsistent, or outdated.
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.
DSHS 14-393 Statement of Shared Living Arrangement
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.
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
At initial application, obtain mandatory verification of each eligibility factor for the program(s) the client has requested. 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.
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.
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
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.
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.
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:
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.
Help the client get proof that will not put them at risk.
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.
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.
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.
See NSA for additional procedures if the client has been designated as needing Necessary Supplemental Accommodation (NSA).
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:
For Medicaid, out of State citizenship/identity verification from Vital Statistics will be handled through the CCU. Local COS/HCS offices do not need to request this verification at the time of the Medicaid application. The Citizenship Documentation and Identity Declaration form will be used until the Vital Statistics verification is received.
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.
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.
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.
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.
When the checks are returned to your office, send the check and the state’s form to the appropriate state’s address.
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.
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:
The information you have received is questionable. Consider the information questionable when it:
Contradicts or conflicts with other statements made by the client;
Is received from a third-party source that contradicts or conflicts with other statements made by the client; or
Causes you to question the accuracy of the information provided by the client.
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
You need precise information in order to determine eligibility, e.g., a client's resources are close to the resource limit.
Use the following criteria to evaluate documents and verbal/written statements used for verification:
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.)
Is the document/statement the most reliable available evidence?
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).
Is the document/statement signed and dated?
Has the time period the document/statement covers expired?
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.
Is there a phone number to contact the person who prepared the document/statements?
For what purpose was the document/statement prepared?
Does the document/statement deny knowledge of a fact although the statement maker was clearly in a position to know the facts?
Was there a legal process involved in establishing the document/statement? Was an oath administered? Was an affidavit taken? Were witnesses present?
Are there any inconsistencies in the document/statement itself?
Is the document/statement consistent with other information?
Is the document/statement based upon first-hand knowledge rather than opinion, inference, or hearsay?
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®)?
Is there any other reason to question the validity of the document?
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.
When there are conflicts in documents or verbal/written statements:
Obtain in writing a clarifying statement from the client or other person that reasonably explains or resolves the conflict.
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.
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.
What to document for each case:
What verification you requested;
Why you requested verification/additional verification;
What verification you received;
When you received the verification;
Who prepared the verification document/statement;
What action you took, if any, to help the client get the verification;
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;
Whether the client has been designated as NSA, and if so, whether you followed the NSA Accommodation Plan;
What decision or action you took; and
Any other information you consider pertinent to the situation.
