Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 4/28/2024
01000 >>> 01330 >>> 1330 >>> 1330.03
1330.02
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 (TALX) - When the Work Number (TALX) 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 (TALX) 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. 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. 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 may be made to verify the reported information, when deemed appropriate. If verification cannot be made via collateral contact, proceed to Tier 4 level verification.