Section 29-9505. VERIFICATION OF NON-FINANCIAL ELIGIBILITY FACTORS

 

9505.1 The Department shall verify the non-financial eligibility factors necessary for a MAGI-based Medicaid eligibility determination at the time of application, at each renewal of eligibility, and at each redetermination of eligibility in accordance with the District Verification Plan pursuant to 42 C.F.R. Sections 435.940 through 435.965 and Section 457.380.

 

9505.2 An applicant, adult who is in a minor applicant’s household, or an authorized representative, as identified in Subsection 9501.33, of an applicant shall attest to the following non-financial eligibility factors:

 

(a) Household composition;

 

(b) Residency;

 

(c) Age;

 

(d) SSN;

 

(e) U.S. citizenship, nationality or satisfactory immigration status;

 

(f) Pregnancy status; 

 

(g) Relationship of a caretaker relative to an applicant or eligible child; and

 

(h) Eligibility for Medicare.

 

9505.3 The Department shall accept attestation without verification, unless the attestation is not reasonably compatible with information available to the Department, for the following eligibility factors:

 

(a) Household composition;

 

(b) Residency for individuals age eighteen (18) and under;

 

(c) Age;

 

(d) Pregnancy (includes attestation of multiple gestation pregnancies, i.e., a woman pregnant with twins would be counted as three people);

 

(e) Relationship of a caretaker relative to an applicant, beneficiary, or eligible child;

 

(f) Homelessness; and

 

(g) Eligibility for Medicare.

 

9505.4 The Department shall require verification through one (1) or more federal and State electronic data sources for the following eligibility factors:

 

(a) Residency for individuals age nineteen (19) and older;

 

(b) SSN; and

 

(c) U.S. citizenship/nationality or satisfactory immigration status.

 

9505.5 The  Department shall not require verification of U.S. citizenship or nationality and satisfactory immigration status  pursuant to Subsection 9505.4(d) for the following:

 

(a) Individuals receiving SSI;

 

(b) Individuals receiving Social Security Disability (SSDI) based on their own disability;

 

(c) Individuals who are entitled to or enrolled in Medicare;

 

(d) Individuals who are eligible for Medicaid as a deemed newborn; and

 

(e) Children in foster care or receiving adoption assistance payments.

 

9505.6 The Department shall use a reasonable compatibility standard to match information obtained from federal and State electronic or other data sources with attested application information as further described in Subsection 9505.7 below.

 

9505.7 Attestation and information from electronic or other data sources shall be considered reasonably compatible by the Department where the data sources match or do not significantly differ from attestation. Only discrepancies that affect eligibility shall be considered significant.

 

9505.8 The Department may require individuals to provide supplemental information where electronic data is unavailable or application information is not reasonably compatible with information obtained from an electronic or other data source.

 

9505.9 The Department may accept supplemental information in the following forms:

 

(a) Paper, electronic, or telephonic documentation; or

 

(b) If other documentation is not available, a statement which explains the discrepancy.

 

9505.10 The Department shall provide a ninety (90) day period to provide supplementary information to verify SSN, U.S. citizenship or nationality, and satisfactory immigration status once per lifetime.  Medicaid coverage may be provided during this period.

 

9505.11 An applicant who makes a good faith effort to obtain the requested documentation may receive an additional ninety (90) day period to produce the documentation necessary to verify citizenship or immigration status once per lifetime.

 

 

9505.12 Excepting citizenship, nationality, and satisfactory immigration status, the Department may waive its verification requirements for exceptional circumstances.

 

 

9505.13 In accordance with the District Verification Plan, exceptional circumstances shall include: 

 

 

(a) Homelessness;

 

(b) Domestic violence;

 

(c) Instances where a noncustodial parent refuses to release documentation germane to verification of one (1) or more eligibility factors; and

 

(d) Other circumstances as identified on a case-by-case basis and approved by the Department.

 

 

authority

An Act to enable the District of Columbia (District) to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat.774; D.C. Official Code § 1-307.02 (2014 Repl.)), and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).

source

Final Rulemaking published at 62 DCR 11142 (August 14, 2015).