Medicaid Verification: When the Agency is Required to Help

Some Medicaid classes of assistance do not require verification, but most long-term care classes of assistance do. Verification documentation includes financial and non-financial information. Sometimes, tracking documentation down can be problematic. If you’re having trouble getting documentation, especially when a caseworker demands it on an unreasonable time-table, here’s what the manuals say:

• You are not required to provide all information at the time of application. Section 2050 of the Georgia Medicaid Policy Manual states:  “It is NOT necessary for the applicant to complete all questions, as missing or incomplete information may be obtained by telephone, mail, fax, secure email, or in person.”
• Section 2060 says: “Do not deny an application for failure to provide verification if the verification can be obtained by the caseworker.”
• If you need assistance completing the application, Section 2050 states: “Assist the AU as needed to complete the application form.”
• Section 2051 states: “The agency is responsible for assisting applicants/recipients in obtaining verification when the applicant/recipient requests assistance. Refer to Section 2020 – Americans with Disability Act (ADA) and Section 504.”
• Rather than immediately denying an application if a verification deadline is missed, Section 2060 of Georgia’s Manual states: “If the A/R or AREP fails to meet the deadline for providing additional information, attempt to contact the A/R or AREP to assess the need for an extension of the deadline or the possibility of assisting in obtaining required verification.” Georgia is required to be no more restrictive than the SSI program and POMS SI 00601.100.B.2 states: “If the individual … fails to provide the requested information/evidence by the expiration of the 30-day final request period, attempt to contact the individual by telephone to determine if additional time is needed and offer assistance. Make several attempts to call at different times on different days.”
• POMS SI 00601.100.C states: “Technicians must … Grant further extensions on a case-by-case basis based on the special circumstances involved. Extensions should not exceed 30-day increments.” They must also “Assist the claimant in obtaining necessary information or evidence from third parties, organizations, or independent sources if the individual is having difficulty (e.g., homeless individuals).”

The bottom line is this: If you are having trouble securing verification documents requested by Medicaid, the caseworker is required to work with you. If that does not happen, then you have a right to appeal. It is worth noting that if Medicaid does not provide assistance, it is violating a State Plan requirement. 42 U.S.C.§ 1396a(a)(19) provides: “A State plan for medical assistance must— provide such safeguards as may be necessary to assure that eligibility for care and services under the plan will be determined, and such care and services will be provided, in a manner consistent with simplicity of administration and the best interests of the recipients.” (Emphasis added). See also 42 C.F.R. § 435.902.