219.03 Required Verification SR 99-03, 02/99 (FAM-A)

The individual who signs Form 800, Application, Form 800H, HEIGHTS Application Form, or Form 800P, Application For New Hampshire Healthy Kids Medical Insurance and Medical Coverage For Pregnant Women, on behalf of the child, must provide verification of all Healthy Kids-Gold eligibility criteria.

• Require written verification of the child’s:

- residency,

- date of birth,

- enumeration status,

- alien or citizenship status,

- family income, and

- income deductions if the family claims to have allowable expenses for child care, child support, allocation to legal dependents, or garnishment.

• Require verification of resources if required by policy for the coverage group through which medical coverage is requested.

Exception: Written verification is not required with Form 800P, Application For New Hampshire Healthy Kids Medical Insurance and Medical Coverage For Pregnant Women if the application for HKG-185 or HKG-300 is received by an authorized outreach agency.

• The required verifications listed above may be provided to the outreach agency staff. The worker signs and provides Form 808P, Information Necessary to Support your Medical Coverage Application, which includes information on the types of verifications seen, to the applicant and to the District Office.

• Qualified entities making presumptive eligibility determinations for HKG-185 or HKG-300 must complete Form 808P and provide a copy to the District Office along with Form 800P indicating a determination of presumptive eligibility. See 117, Application Processing Time Frames.

• The attachment of copies of verification is not mandatory but is encouraged when feasible.