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Southern Business Leadership Council

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2004 Chartbook of Major Indicators

 

The Burden of Proof:

How Much is Too Much for Child Health Coverage?

Verification Requirements at Redetermination

Income

Question 1
What are the minimum requirements for verification according to federal regulations?
For Medicaid, federal regulations require verification of income at redetermination under the IEVS system. At redetermination, states may, with HCFA’s approval, target the use of IEVS information in ways that are most cost-effective and beneficial. The beneficiary must be informed in writing at the time of the redetermination that the agency will be requesting this information.

For CHIP, there are no federal verification requirements.

Question 2
Can the state accept the client’s statement at redetermination without verifying income or changes in income for Medicaid? For CHIP?
Yes. For both Medicaid and CHIP, the state can use self-declaration of income to establish eligibility at redetermination.

For Medicaid, verification of self-declared income at redetermination is required under the IEVS system. For income that cannot be verified under IEVS, HCFA encourages random post-eligibility verifications or the adoption of other procedures designed to assure program integrity is being maintained.

For CHIP, there are no federal income verification requirements. However, HCFA encourages random post-eligibility verification of self-declared income at redetermination or the adoption of other procedures designed to assure program integrity is being maintained.

Question 3
Can the state complete a redetermination for Medicaid without an interview? For CHIP?

Yes in Medicaid. In CHIP, the state determines the rules, but an interview is not required in the law.

Question 4
In general, would verification requirements for redetermination remain the same or differ from verification requirements at application?

Aside from compliance with federal requirements, it is up to the state to determine for both CHIP and Medicaid whether to use the same or different verification requirements.

Resources

Question 1
What are the minimum requirements for verification according to federal regulations?

They are the same as minimum requirements for income. See response to Question 1 under Income above.

Question 2
Is self-declaration acceptable?

Yes. For both Medicaid and CHIP, the state can use self-declaration to establish eligibility. The requirements are the same as those for income. See response to Question 2 under Income above.

Citizenship

Question
Is self-declaration acceptable?

For both Medicaid and CHIP, there is no need to revisit citizenship or national or immigration status except where the beneficiary reports a change in circumstances or the state has reason to believe that a change in circumstance has occurred. In that event, states must follow the applicable requirements for CHIP and Medicaid outlined in the answer to Question 1 in the Citizenship section under "Verification Requirements At Application" in establishing the changed status.

Age of Child

Question 1
Is self-declaration acceptable?

Yes. Under both CHIP and Medicaid, the state can use self-declaration of age to redetermine eligibility. Because age is a circumstance that will not change, the state can rely on the age determination made at the time of the initial eligibility determination.

Question 2
What happens if a child turns 19 during the 12-month recertification period?

Under Medicaid, it depends on whether the state covers children over 18. If it does not, eligibility would end unless the state determines that the child is eligible under Medicaid on some other basis, such as disabled.

Under CHIP, eligibility ends at age 19. (At the time of the last redetermination, the state will know that the child will turn age 19 before the end of the period.)

Question 3
Will a statement from a credible third party be acceptable?

Whether to require a statement is up to the state to determine for both CHIP and Medicaid. As noted in the responses to question one, there is no need to redetermine age.

Question 4
Is there any need to redetermine since, once verified, age can be calculated?

No, for both CHIP and Medicaid.

Family Composition

Question 1
Is self-declaration acceptable?

Yes. Under both CHIP and Medicaid, the state can use self-declaration of family composition to establish eligibility at recertification. HCFA encourages random post-eligibility verification of self-declared family composition or some other process to ensure program integrity where family composition is declared to have changed from the time of application.

Question 2
Would using the same definitions for family and family income for both CHIP and Medicaid help facilitate eligibility determination and recertification?

Yes. Using the same definitions for both Medicaid and CHIP would simplify administration. It would facilitate the screening process required for separate CHIP programs and assure that all Medicaid-eligible children were identified. However, to do this, states would have to conform their CHIP policy to Medicaid because of the statutory restrictions on countable income and family composition that apply under Medicaid.

Question 3
Would a statement from a credible third party be acceptable?

That is for the state to determine for both CHIP and Medicaid. If there has been no declared change in family composition from the time of application, verification may not be warranted.