citizenship and identity verification for medicaid
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citizenship and identity verification for medicaid


Revised August 22, 2013



Who must provide verification of citizenship and identity as a condition of medical eligibility?

 

How do I code ACES to show that the client has provided acceptable verification of citizenship?

 

How do I code ACES to show that the client has provided acceptable verification of identity?

 

What happens if a client does not provide verification of citizenship or identity?

 

What happens when the client provides verification of citizenship or identity?

Who must provide verification of citizenship and identity as a condition of medical eligibility?

·         Clients must provide specific verification of their identity and citizenship status to qualify for Medicaid benefits. See EAZ Manual – WAC 388-490-0005 The department requires proof before authorizing benefits for cash, medical, and Basic Food.

 

·         Clients must provide citizenship and identity verification in order to receive Medicaid benefits from the following programs:

 

o        Cash Programs: Aged, Blind, or Disabled (GA/G02), or Inpatient Psychiatric (GI/I01).

 

o        Medical coverage groups: F02, F03, F04, F06, F10, F99, G03, G95, G99, P02, P06, P99, K01, K95, K99, S02, S30, S95, S99, L02, L21, L22, L95, and L99.

 

·         Clients don't have to provide citizenship/identity verification in order to receive medical coverage from the following programs:

     

o        Clients who receive Medicare and have active MEDA or MEDB coded on their TPL screens or who receive S01 medical are exempted from providing verification of their citizenship or identity. These clients will not be denied or terminated by ACES for Reason Code 120 .

 

o        See EAZ Manual – Verification – Clarifying Information for other exemption criteria.  These clients may be closed or terminated by ACES if coded as failing to meet the citizenship or identity verification requirements.


How do I code ACES to show that the client has provided acceptable verification of citizenship?

·         Enter one of the following codes in the Citizenship Verification field on DEM2 to show the type of documentation used to verify the client's citizenship status:

 

o        T1 (Meets Tier 1 Federal Requirements) – Use when citizenship has been verified using a document that meets Federal Tier 1 requirements to verify both Citizenship and Identity.

 

o        T2 (Meets Tier 2 Federal Requirements) – Use when citizenship has been verified using a document that meets Federal Tier 2 requirements to verify citizenship.

 

o        T3 (Meets Tier 3 Federal Requirements) or T4 (Meets Tier 4 Federal Requirements) – The Citizenship Centralized Unit (CCU) will enter this code when they have verified a client's citizenship using a document that meets Federal Tier 3 or Tier 4 requirements to verify citizenship.

 

o        AF (Declaration, Federal Verification Pending) – Use when citizenship has been verified using the Citizenship and Identity Declaration Form (13-789).

 

o        EW (Electronically Verified by Washington Database) – This code is system generated based on the result of an automated cross-match with the Department of Health (DOH).  This code cannot be manually entered, and value can only be changed by workers from the CCU.

 

o        All other codes (See F1 Help) – Any other appropriate code may be used for clients who are exempt or not applying for Medicaid. Use of these other codes is also allowed at Medicaid reviews when T1 or T2 verification is not available.

 

o        FR (Failed to Return Declaration) – Use this code when neither citizenship verification nor the Declaration Form has been provided.

 

·         See the EAZ – Citizenship and Identity Verification Documents - Tier 1-4 handout for additional information on what types of documents are acceptable for verification of citizenship and identity.


How do I code ACES to show that the client has provided acceptable verification of identity?

·         Enter one of the following codes in the Identity field on DEM2 to show the type of documentation used to verify the client's identity:

 

o        V (Verified Identity) – Use when identity has been verified using one of the documents indicated in the EAZ – Citizenship and Identity Verification Documents - Tier 1-4 handout.

 

o        D (Declaration Accepted) – Use when identity has been verified using Citizenship and Identity Declaration Form 13-789 for clients age 16 or older.  This code is also used for exempt clients or clients not applying for Medicaid.

 

o        E (Electronically Verified by Washington Database) – This code is system generated based on the result of an automated cross-match with the Department of Health (DOH).

 

o        P (Pending Verification) – Use when an application has been pended for identity verification, or when an eligibility review is being completed and no other verification is available.

 

o        R (Refused to Provide) – Use when the client has refused to provide either identity verification or a completed Citizenship and Identity Declaration Form 13-789.


What happens if a client does not provide verification of citizenship or identity?

·         Medicaid coverage will be terminated for Reason Code – 120 Failed to Provide Proof of Citizenship\Identity any time valid value FR (Failed to Return Declaration) is entered in the Citizenship Verification field or valid value R (Refused to Provide) is entered in the Identity field on the DEM2 screen. It does not have to be at the time of an eligibility review.

 

·         The system determines Medicaid eligibility separate from cash eligibility for all household members applying for both cash and medical assistance.  Therefore, a client who fails to verify their citizenship or identity can be an active recipient on a cash AU, such as TANF, but not receive medical coverage.


What happens when the client provides verification of citizenship or identity?

·         When the client provides the information necessary to establish eligibility and the Citizenship Verification and/or Identity field on the DEM2 screen is updated to reflect this, Medicaid eligibility shall begin the 1st of the benefit month in which the change is made.

 

Modification Date: August 22, 2013