About These Materials

1. About These Materials Families USA developed these materials under contract with DC Health Link, the District of Columbia's Health Benefits Exchange, for a training program for DC eligibility workers. These workers determine eligibility for Medicaid and other benefit programs (including SNAP and TANF). They will help consumers apply for coverage and financial assistance, report changes, renew coverage, and verify the information that is needed to determine eligibility. These workers will not be responsible for helping consumers select health plans. These training materials are posted here as an example that can be adapted for other training programs. They contain information that is specific to the District of Columbia, which would have to be changed if used in another state. Contact Families USA at stateinfo@familiesusa.org for assistance with adapting these materials.

2. ESA Policy Training Day 4

3. The Verification Process

4. Changes to Verification • Current Medicaid rules: • Documentation required for most eligibility factors • New rules: • Use electronic data sources and self-attestation as much as possible • Use paper documentation as a last resort

5. Electronic Data Sources • DC Health Link will get data from two hubs, which include several sources each: • Federal data hub • Local data hub • DC Health Link will get this information automatically. You will not need to know which source to get information from.

6. The Federal Data Hub • Connects DC Health Link to federal government data sources • Data sources include, among others: • Social Security Administration • Internal Revenue Service (IRS) • The Work Number • Department of Homeland Security

7. The Local Data Hub • Connects DC Health Link to local data sources • Data sources include: • DMV • ACEDS • Department of Employment Services

8. How DC Health Link Uses Electronic Data Sources • Checks federal and local data hubs • Pre-populates information in application • Asks applicant to confirm or change pre-populated information and add additional information • Asks for documentation if needed

9. Important Things to Remember about Electronic Data Sources • Some electronic data will be months old • Always remember to check pre-populated data • If a data source is temporarily unavailable, DC Health Link will automatically check other data sources if one hub is down

10. When is paper documentation needed? • When electronic data sources have no information for applicant • When electronic data sources are not “reasonably compatible” with applicant’s self-attestation • When a non-applicant does not provide a Social Security number

11. New Ways of Accepting Documentation • Accept scanned or photocopied versions of all documentation, including citizenship and immigration status • Documentation can be submitted: • Online through “My Account” • In person • By mail • By fax • By email

12. Timeline for Providing Documentation: Medicaid • If verification needed for an eligibility factor other than citizenship/immigration status: • 45 days to provide documentation • Applicant does not receive Medicaid during this time • If verification needed for citizenship/immigration status: • 90 days to provide documentation • Applicant receives Medicaid during this time

13. Timeline for Providing Documentation: DC Health Link • Applicant has 90 days after receiving notice • If inconsistency is not resolved in this time, financial assistance level may change and/or coverage can be terminated

14. What if applicants cannot provide documentation? • In some circumstances, applicants cannot provide documentation • For example, in cases of homelessness or domestic violence • ESA supervisory staff can waive paper documentation requirements on a case-by-case basis

15. Review: Question #1 TRUE or FALSE: Applicants providing documentation of citizenship or immigration status must bring the original version into an ESA service center.

16. Answer: Question #1 FALSE Scanned and photocopied versions of all documents, including citizenship and immigration status, are accepted.

17. Review: Question #2 TRUE or FALSE: ESA workers will need to remember which data sources are in which hub and choose which hub to ask for information when electronic data is needed.

18. Answer: Question #2 FALSE DC Health Link automatically checks the right hubs and data sources for you.

19. Verifying Household Composition Electronic data sources are not available for household composition, so DC Health Link will accept self-attestation unless: • Two tax filers who do not file jointly say they will claim the same dependent • Two people who do not file taxes claim that the same person lives with them In these cases, documentation is required.

20. Tax Forms to Document Household Composition • Tax forms are the strongest type of documentation • Form 8332 • Custodial parent allows non-custodial parent to claim child • Form 2120 • Multiple taxpayers supported dependent • Form indicates which person gets to claim dependent

21. Other Documentation of Household Composition If neither person has tax forms, use: • School or medical records • Childcare records • Statements from non-relatives • Leases • Mail to or regarding the person being claimed • Records of religious or recreational activities

22. Five Steps for Verifying Income • DC Health Link checks IRS data • If potentially eligible for premium tax credits, application will ask for expected annual income • If potentially eligible for Medicaid,and IRS data is not available or applicant disagrees with IRS data, continue with steps 2-5 • DC Health Link checks federal and local data hubs and pre-populates application

23. Five Steps for Verifying Income (cont’d) • Applicant confirms or changes pre-populated information • DC Health Link asks about any additional sources of income • DC Health Link calculates total income and asks applicant to confirm

24. Reasonable Compatibility Reasonable compatibility: any difference between self-attestation and electronic data sources is either small or does not make a difference in eligibility

25. Reasonable Compatibility for Income: Medicaid As long as both self-attestation and electronic data sources show household income is below Medicaid eligibility level, the information is reasonably compatible.

26. Reasonable Compatibility for Income: DC Health Link • If attestation of household income is above electronic data source amount or is no more than 10% below • Reasonably compatible • DC Health Link uses self-attestation to calculate premium tax credits and cost-sharing reductions • If attestation is more than 10% below electronic data sources • Not reasonably compatible • Documentation is needed

27. Reasonable Compatibility between Medicaid and DC Health Link • When self-attestation is above Medicaid eligibility limit and electronic sources are below, use self-attested data • When self-attestation is below Medicaid eligibility limit and electronic data sources are above: • Not reasonably compatible, unless the difference is less than 10% • Documentation is needed

28. Reasonable Compatibility: Example #1 Sasha is 35 and has no one else in her household. • Electronic data sources say her income is $23,000 (200% of poverty) • She says her income is $9,000 (128% of poverty) Is this reasonably compatible?

29. Reasonable Compatibility: Example #1 Yes, this is reasonably compatible. Even though there is a difference of 72% of poverty between self-attestation and data sources, this is reasonably compatible because both are below the Medicaid eligibility level for childless adults.

30. Reasonable Compatibility: Example #2 Christine is 48 and has no one else in her household. • Electronic data sources say her income is $36,900 (320% of poverty) • She says her income is $33,200 (289% of poverty)

31. Reasonable Compatibility: Example #2 No, this is not reasonably compatible This is not reasonably compatible because she is eligible for premium tax credits and her attestation is more than 10% below what electronic data sources report.

32. Reasonable Compatibility: Example #3 Bernie is 35 and intends to claim his 10-year-old son, Marcus. He has no one else in his household. • Electronic data sources say his income is $34,432 (about 222% of poverty for a family of two) • He says his income is $33,036 (about 213% of poverty) Is this reasonably compatible?

33. Reasonable Compatibility: Example #3 Yes, this is reasonable compatible. Because self-attestation is less than 10% below electronic data sources, the information is reasonably compatible.

34. Documentation of Income Documentation of income includes: • Most recent paystubs • Letter from employer • Award letters (such as Social Security) • Documentation of non-wage income, such as interest, dividends, annuities • Documentation of any planned adjustments to income

35. Verifying Citizenship and Immigration Status • DC Health Link uses federal data hub to verify citizenship and immigration status • If verification is not possible: • Applicant has a 90-day “reasonable opportunity period” to provide documentation • Applicant gets coverage based on income during this time

36. Documentation of Citizenship Two types of documentation: • Primary • Secondary Applicant can provide: • Primary documentation by itself • Secondary documentation plus another form of ID

37. Documentation of Immigration Status DC Health Link will need: • Nine-digit alien number • Copy of something that shows immigration status

38. Verifying Residency • Verification needed only for those over age 19 • DC Health Link checks: • Department of Employment Services • Department of Motor Vehicles • The BENDEX file • Residency verified even if sources show a different DC address

39. Documentation of Residency • Paper documentation of residency: • Current driver’s license • Current lease • Current rent receipt • Current utility bill • Current letter from landlord • Homeless applicants are not required to provide paper documentation

40. Verifying Incarceration Status DC Health Link will accept self-attestation of incarceration status for the applicant and applicant’s household members.

41. Verifying Age • DC Health Link checks federal data sources • Verification needed only if difference between attested age and electronic data sources affects eligibility • Example: a person who has income of 250% of poverty and could qualify for Medicaid as a child, but not as an adult

42. Documentation of Age • Birth certificate • Driver’s license • Other government-issued photo ID • Other photo ID with name and date of birth

43. Verifying Pregnancy Application accepts attestation of: • Pregnancy • Number of children the pregnant woman expects to deliver

44. Verifying Caretaker Relative Status Application accepts attestation that an applicant is a caretaker relative.

45. Review: Availability of Other Coverage • Availability of other coverage affects: • Eligibility for premium tax credits and cost-sharing reductions • Match rate that DC receives for certain pregnant women and children • Coverage can come from: • Other government programs (for example, Medicare or the VA) • An employer (or a family member’s employer)

46. Verifying Availability of Other Coverage • Government coverage • DC Health Link will check for eligibility determination for other programs • If found, applicant must provide documentation that coverage has been cancelled • Employer coverage • Electronic data available for some federal employees • DC Health Link relies on information provided by applicant and employer

47. Verifying an Applicant’s Social Security Number • DC Health link will check federal data hub for match • If no match is found, applicant must provide documentation or resolve the inconsistency with the Social Security Administration

48. Verifying American Indian Status • Important for: • Treatment of income in Medicaid • Ability to enroll in DC Health Link at any time • Higher levels of cost-sharing reductions • DC Health Link does not currently have an electronic data source for this information • Applicant must provide documentation

49. Documentation of American Indian Status Any formal documentation that verifies American Indian status from: • A tribe • Indian Health Services (IHS) • Bureau of Indian Affairs

50. Documentation of American Indian Status (cont’d) For those born outside of the U.S.: • Form 1-94 with a notation of “S1-3” • 1-551 Permanent Resident Card stamped “S1-3” • Temporary 1-551 stamp coded “S1-3” in a Canadian passport • Tribal record or document certifying at least 50% American Indian blood, and satisfactory evidence of birth in Canada