Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)


Eligibility Policy - 12/16/2019

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1330 Verification - A four-tiered approach is used to verify information needed to determine eligibility. Federal law requires that information available through interfaces and other means are used prior to contacting the applicant. The verification process will proceed in order from Tier 1 through Tier 4 and is not limited only to verification of income. When a new self-attestation is received or when an administrative error is made, it is acceptable to return to a prior Tier to verify information. Even when a Reasonable Compatibility test has already been completed in Tier 2, staff may return to Tier 2 to repeat the RC test when the consumer has clarified information or provides new information.

The four tiers apply to all family medical assistance programs. See also 1333.04(3) (Earned Income), 6122 (Reasonable Compatibility) and 6120 (Budgeting Method). See 2040 for requirements regarding citizenship/identity verification.

1330.01 Tier 1: Payer Interfaces - Reported information is verified through the use of a payer source interface (Federal Hub, Social Security, Unemployment Compensation, KPERS). Since this data comes directly from the source of the reported information, it is considered verified.

Note: If there is a difference between the reported SSA or SSI amount and the amount verified through the Federal HUB, the Social Security interface (EATSS) may be accessed to resolve the discrepancy.

Reported unearned income not verifiable through a payer source interface shall be verified as indicated in 1333.04(2).

Also included as a payor source for purposes of this section are paystubs, or other comparable documentation voluntarily provided by the employee or employer at the time of application or request for assistance, which are sufficient to determine the countable amount of earned income without request for further verification. To be considered sufficient, the information provided must meet one of the following:

a. All paystubs received in the 30 days immediately preceding the date of application or request for assistance;

b. Paystubs which allow calculation via year-to-date totals of gross earnings received in the 30 days immediately preceding the date of application or request for assistance;

c. A written statement from the employer attesting to the employee’s gross earnings received in the 30 days immediately preceding the date of application or request for assistance, including the date(s) and frequency of payment; or

d. Any other document or documents from either the employee or employer which verifies the total amount of gross earnings received by the employee in the 30 days immediately preceding the date of application or request for assistance.

If the information voluntarily provided is sufficient to verify earned income, no further verification is required. The information voluntarily provided shall be used to determine the amount of earnings. If insufficient to verify the earned income, the information voluntarily provided is not considered a payor source.

Note: If sufficient information as described above is not voluntarily provided at the time of application or request for assistance, eligibility staff shall not request paystubs or additional information as part of the Tier 1 process. Verification shall proceed through the remaining Tiers 2 through 4, in order.

1330.02 Tier 2: Automatic Interfaces - Reported information is verified through the use of a secondary non-payer source interface. Tier 2 interfaces include wage verification from either The Work Number or Kansas Department of Labor (KDOL) wages. All resources used to verify citizenship and identity are also included in Tier 2, such as Kansas VRV and KSWebIZ.

1330.03 Tier 3: Research - Manual research by the eligibility worker is required. This may include review of the case file, reconciling information received from Tier 2 interfaces, checking other available program information, and making collateral contacts. Any decision to verify reported information at this level must be thoroughly documented.

When an IBU for an applicant/recipient meets the Household RC test for ‘Both Below’ (see 6122.02) and all other factors of eligibility have been satisfied, additional verification is not required. The individual is eligible for Medicaid. It is not appropriate to continue to Tier 3 verification for this applicant or to delay approval of coverage while pending for information for other household members.

Manual research shall progress through the following steps in the order listed:

a. The Work Number - When the Work Number data is not successful in establishing reasonable compatibility in Tier 2, the income details may be used to verify income reported. Staff will obtain the TALX Monthly Income Amount from the Reasonable Compatibility Test Detail in KEES and use this for the determination. If Work Number data is not available, proceed to researching the case file.

b. Case File - The medical case file record shall be searched for hard copy verification of the reported information. This includes the images located in the medical case. If no hard copy information is found in the case file, proceed to the DCF images.

c. Department for Children and Families (DCF) Images- A manual search of the DCF case records shall be completed for usable images to satisfy verification requirements if a consumer was part of a DCF case for a relevant time period. If verification cannot be obtained from DCF images, proceed to collateral contact.

d. Collateral Contact – Collateral contact shall be made to verify the reported information, when deemed appropriate. If verification cannot be made via collateral contact, proceed to Tier 4 level verification.

1330.04 Tier 4:Request for Information - Unless otherwise indicated, income must be verified. See also 6122 (Reasonable Compatibility) and 6120 (Budgeting Method).

(1) Self-employment Income - Self-employment income must be verified. It is verified through either the tax return or the KC-5150 Self-Employment worksheet as indicated below.

When the applicant indicates they have filed taxes, a copy of their tax return is required. If it is after April 15th and the applicant has not filed their tax return, the prior year's return may be used if they have filed an extension with the IRS. Verification of the extension is not required.

The KC-5150 Self-Employment Worksheet is used to request income and expenses for the 12 months prior to the month of application. This form is generated off-system by staff and mailed locally. It is used in the following circumstances:

a) It is a new business and a tax return has not yet been filed

b) It is an existing business, but the applicant has not (or will not) file a tax return.

c) A change in the amount of self-employment income is reported.

d) The tax return is no longer representative of the self-employment income. The reason for the discrepancy must be clearly documented and is only allowed when there is a definitive change in the amount or type of business. When the applicant indicates their tax return is not representative of the existing self-employment income, both the tax return and the KC-5150 Self-Employment Worksheet are required.

(2) Unearned Income - Tier One payer interfaces are used to verify SSA income and Unemployment Compensation. Because this information is directly from the source, the amount verified through the interface shall be used regardless of what has been reported by the applicant.

For unearned income types not verifiable through Tier One, self-attestation is accepted as verification of all unearned income with the exception of the following types:

a) Annuity Income

b) Trust Income

c) Contract Sales

d) Insurance Payments

e) Oil Royalties and Mineral Rights

f) Railroad Retirement

(3) Earned Income – Verification of earned income is required for all individuals.

a) When paystubs (or other documentation provided by the employee or employer) necessary to determine the amount of countable earnings is available at the time the application or request for assistance is received, additional verification of earnings may not be required. This will normally occur where the consumer voluntarily provides paystubs at the time the application or request for assistance is filed.

When paystubs are voluntarily provided or available at the time of application or request for assistance, eligibility staff must determine if the information provided is sufficient (without further verification) to establish the amount of earnings to budget on the case. Sufficiency for purposes of this provision is defined as the following:

1. All paystubs received in the 30 days immediately preceding the date of application or request for assistance;

2. Paystubs which allow calculation via year-to-date totals of gross earnings received in the 30 days immediately preceding the date of application or request for assistance;

3. A written statement from the employer attesting to the employee’s gross earnings received in the 30 days immediately preceding the date of application or request for assistance, including the date(s) and frequency of payment; or

4. Any other document or documents from either the employee or employer which verifies the total amount of gross earnings received by the employee in the 30 days immediately preceding the date of application or request for assistance.

If the information voluntarily provided is sufficient to verify earned income, no further verification is required. The information provided shall be used to determine the amount of earnings. If the information voluntarily provided at the time of application or request for assistance is insufficient to verify the earned income, the tiered verification process described in subsection b) below must be followed.

b) When earnings have not been reported, or voluntarily verified at the time of application or request for assistance as indicated above, the tiered verification process applies. Earnings shall be verified against available earned income data sources, as outlined below in section (4).

No Tier One interfaces exist to verify earnings. The Reasonable Compatibility test is used in Tier Two. See 6122 for Reasonable Compatibility. When income is not determined to be Reasonably Compatible and the Both Below is not applicable, the following Tier Three sources are used in the order presented and should always be used prior to requesting verification from the applicant.

1. The Work Number - When the Work Number data is not successful in establishing reasonable compatibility, the income details may be used to verify income reported. Staff will obtain the TALX Monthly Income Amount from the Reasonable Compatibility Test Detail in KEES and use this for the determination.

2. Hard-copy Wage Verifications - Staff shall review the medical case file to determine if hard copy verification has been submitted by the applicant. This could be in the form of paystubs or a statement from an employer. The date of wage verification must be within the three months prior to the month of application when processing a new application. When processing a review or case change, the income must be from the three months prior to when the initial RC test was run.

3. DCF Images - A manual search of the DCF case records shall be completed for usable images to satisfy verification requirements if a consumer was part of a DCF case for a relevant time period. If verification cannot be obtained from DCF images, proceed to collateral contact.

4. Collateral Contact – Collateral contact shall be made to verify the reported information, when deemed appropriate. If verification cannot be made via collateral contact, proceed to Tier 4 level verification.

5. Request Information – If the earnings cannot be verified using the above methods, Tier 4 verification is used. A request for information is sent to the applicant and "the last 30 days of income" is requested as proof.

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