General Verification Requirements

General Verification Requirements. A. Generally, resources must be verified for any month for which you must determine eligibility. For the following types of action, verify as follows: 1. Applications. a) Specifically, for initial applications, verify the value of resources for the month of application and each month(s) of possible retroactive eligibility. Verify months subsequent to the month of application as necessary. 2. Redeterminations. a) For redeterminations, verify, as needed, the value of resources for up to 3 months prior to the review month. It is permissible for resources to be developed as of the most recent month for which verification is available for regular reviews, rather than requiring resource balances for the review month. 3. Appeals. a) If a client appeals a denial related to a particular resource, the evidence in the file must clearly establish the value of that resource. If must do so even if the issue under appeal is not the value itself (e.g., when the issue under appeal is ownership). This requirement ensures that at each level in the appeals process, the file contains complete documentation of the resource in question. B. There are some exceptions to the above. Do not verify the value of resources for a given month if: 1. The resource is totally excluded, regardless of its value; 2. The alleged value of total countable resources exceed the applicable limit for that month; or 3. The individual is ineligible that month for reasons other than excess resources C. Develop the equity value of a resource (liquid or nonliquid) when an individual alleges a debt against it and the difference between equity and CMV could mean the difference between eligibility and ineligibility: 1. Verify, at a minimum, the outstanding principal balance (payoff), the rate of interest and the schedule and amount of payments (to permit the projection of increases in equity); and 2. Obtain a copy of the agreement or note that establishes the debt. If this does not provide all the information needed, use other records of the individual, the creditor or both. D. At a minimum, resources owned by a client are verified at the time of application and at each regular review scheduled annually. However, circumstances may warrant re- verification of resource(s) at shorter intervals. The following describes situations which mandate re-verification of resources at shorter intervals than annually, but it is not an all- inclusive list. Any reported changes in resources or discovery of changes in resources may warrant verification or re-verification. 1. Individuals/couples determined eligible for Medicaid who own countable resources valued within $100 of the applicable limit must have resources renewed/verified every six months, rather than annually. a) The purpose of the 6-month special review will be to verify the value of countable resources in order to determine if the individual/couple remains eligible based on resources. b) A tickler must be utilized to control the timing of the required special review of cases with countable resources close to the resource limit. 2. Client cases, especially long term care cases that receive excess VA income that is not countable as income must be monitored closely for excess resources. a) The amount of the monthly income that is not counted will determine the frequency review/re-verification is deemed necessary. b) Long Term Care Recipients in Medicare Beds. Individuals who are placed in Medicare-certified nursing facilities are not required to pay any of their income toward the cost of their care which means that income may be allowed to accumulate and result in excess resources during the first 100 days of possible Medicare coverage. This means it is necessary to re-verify resources during the period of Medicare coverage to check for possible excess resources.