HAR §17-1714.1-38. General requirements

(a) The department shall accept self-attestation of an individual, attestation by an adult individual who is in the applicant’s household, an authorized representative, or, if the individual is a minor, incapacitated or deceased, someone acting on the applicant’s behalf, without requiring further information or documentation, except as allowed under section 17-1714.1-40 or where the law or this chapter requires other procedures, such as for verifying citizenship, immigration status, and SSN. (b) The department shall request and use information relevant to verifying an individual’s eligibility for Medicaid as described in this subchapter. (c) The department shall furnish in a timely manner income and eligibility information, subject to chapter 1702, required for verifying eligibility to the following programs: (1) Other agencies in the State and other states and to the federal programs both listed in section 17-1711.1-34 and identified in section 1137(b) of the Social Security Act; (2) Other insurance affordability programs; UNOFFICIAL 1714.1-23 (3) The child support enforcement program under Part D of title IV of the Social Security Act; and (4) SSA for OASDI under title II and for SSI under title XVI of the Social Security Act. (d) All state eligibility determination systems shall conduct data matching through the Public Assistance Reporting Information System (PARIS). (e) Prior to requesting information for an individual from another agency or program under this subchapter, the department shall inform the individual that the department will obtain and use information available under this subchapter to verify income and eligibility or for other purposes directly connected to the administration of the State Plan. (f) Information exchanged electronically between the department and any other agency or program shall be sent and received via secure electronic interfaces. (g) The department shall execute written agreements with other agencies before releasing data to, or requesting data from, those agencies. These agreements shall provide for appropriate safeguards limiting the use and disclosure of information as required by federal or State law or regulations. (h) The department may request and use information from alternative sources other than those listed in section 17-1714.1-40, or through a mechanism other than the federal and state electronic services, provided it will reduce the administrative costs and burdens on an individual and states while maximizing accuracy, minimizing delay, meeting applicable requirements relating to the confidentiality, disclosure, maintenance, or use of information, and promoting coordination with other insurance affordability programs. [Eff 09/30/13] (Auth: HRS §346-14; 42 C.F.R. §435.945) (Imp: HRS §346-14; 42 C.F.R. §435.945) §17-1714.1-39 Verification of financial information. (a) The department shall request from other agencies in the State or other states and UNOFFICIAL 1714.1-24 federal programs the following information to verify financial eligibility of an individual: (1) Information related to wages, net earnings from self-employment, unearned income and resources from the State Wage Information Collection Agency (SWICA), the Internal Revenue Service(IRS), the Social Security Administration (SSA), the agencies administering the State unemployment compensation laws, the State-administered supplementary payment programs under section 1616(a) of the Social Security Act, and any State program administered under Titles I, X, XIV, or XVI of the Social Security Act; and (2) Information related to eligibility or enrollment from the Supplemental Nutrition Assistance Program (SNAP), the State program funded under Title IV-A of the Social Security Act, and other insurance affordability programs. (b) If the information identified in paragraph (a) is available through the federal and state electronic services the department shall obtain the information through these services. (c) The department shall request the information by an SSN or other personally identifying information in the individual’s electronic account, if possible. [Eff 09/30/13] (Auth: HRS §346-14; 42 C.F.R. §§435.948, 435.949) (Imp: HRS §346-14; 42 C.F.R. §§435.948, 435.949) §17-1714.1-40 Use of information and requests of additional information from an individual. (a) The department shall promptly evaluate the information it receives or obtains in accordance with this chapter to determine whether the information may affect the eligibility or benefits of an individual. (b) If the information provided by or on behalf of an individual is reasonably compatible with information obtained through an electronic service, UNOFFICIAL 1714.1-25 the agency shall determine or renew eligibility based on such information. (c) An individual shall not be required to provide additional information or documentation unless information needed by the department cannot be obtained electronically or the information obtained electronically is not reasonably compatible with information provided by or on behalf of the individual. (1) Income information obtained through an electronic service shall be considered reasonably compatible with income information provided by or on behalf of an individual if both are either above, at or below the applicable income standard or other relevant income threshold within an amount as determined by the department. (2) If the information provided by or on behalf of an individual is not reasonably compatible with the electronic service, the department shall pursue additional information from the individual, including: (A) A statement which reasonably explains the discrepancy; or (B) Other information, provided that documentation from the individual is permitted only to the extent electronic data is not available and establishing a data match through an electronic service would not be feasible; (C) The department shall provide the individual a reasonable period to furnish any additional information required under this subsection. (d) The department shall permit on a case-by- case basis for special circumstances, except for citizenship and immigration status, self-attestation of an individual for all eligibility requirements when documentation does not exist at the time of application or is not reasonably available, such as for an individual who: (1) Is homeless; UNOFFICIAL 1714.1-26 (2) Experienced domestic violence; (3) Was in a natural disaster; or (4) As otherwise determined by the department. (e) The department may not deny or terminate eligibility or reduce benefits for any individual on the basis of information received under this subchapter unless the department pursued additional information from the individual in accordance with subsection (c) and provided proper notice and hearing rights in accordance with chapters 17-1703.1 and 17- 1712.1. [Eff 09/30/13] (Auth: HRS §346-14; 42 C.F.R. §435.952) (Imp: HRS §346-14; 42 C.F.R. §435.952) §