157.03 Required Verification for Redeterminations SR 14-09, 01/14 (MAM-A)

Notify the individual in writing of any required information or verification needed to complete the redetermination and the time frame for returning the verifications. Use New HEIGHTS-generated AE0026, Verification Checklist, which explains what information or verification is needed and the date the information or verification is due. The AE0026 is automatically generated anytime something is entered onto the Application Entry screen, marked “Not Yet Verified,” and eligibility is run. If New HEIGHTS is unavailable, use the paper backup DFA Form 808, Proof Needed to Determine Your Assistance.

The individual must provide verification of all eligibility factors and circumstances including returning the completed DFA Form TAX INFO(T), Rede Request for Tax Info, if required.

The individual must provide the required verifications no later than:

• 10 working days after the personal interview; or

• if a personal interview is not required, no later than 10 working days after the required return date for DFA Form 771A, Nursing Facility Care Renewal, DFA Form 800PR, Renewal Application For Children’s Medicaid (CM) and Medical Coverage For Pregnant Women (MCPW), or DFA Form 800R, Application for Continued Eligibility for Financial, Medical, Child Care, and Food Stamp Benefits.

Terminate assistance if the individual refuses or fails to provide the required verifications within the time frame.

Exceptions:

• When a third party has not responded to a request for verification within the timeframe, send a follow-up request to the third party and to the individual. Allow an additional 10 working days for a response. If the verification is not provided within the second waiting period, terminate assistance unless the individual provides other acceptable verification.

• If assistance is being terminated due to lack of required verification and the individual provides the required verification within the advance notice period, stop the termination action and reinstate assistance.

Completion of Verification Requirements After the ANP Has Expired

If the assistance was terminated due to lack of verification and the individual provides all the required verification within the 10 days following the end of the advance notice period:

• have the individual fill out DFA Form 800, Application for Assistance, or DFA Form 800MA, Application for Health Coverage & Help Paying Costs, if the case is Medicaid-only, with their name, address, and signature;

• ensure that no other changes have occurred in the case that would affect eligibility and that no new program services have been requested on DFA Form 800 other than those which were originally terminated;

• if the individual meets all program eligibility requirements, reinstate assistance based on the new application date, with no new interview required; and

• generate medical benefits in accordance with PART 121, INITIATION OF MEDICAL ASSISTANCE, assuming the individual has requested retroactive medical coverage back to the date of closing, if applicable.

Policy about redeterminations and verification required at redeterminations will change under the Affordable Care Act (ACA). This policy will be updated to incorporate these changes at that time.

References: He-W 606.01, He-W 606.100-.101, He-W 636.01, He-W 644.01, He-W 684.01-.02, RSA 167:79,III(j), RSA 167:83,II(d), 42 CFR 435.916, 45 CFR 206.10, 42 USC 1397bb