Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/22/2024
01330
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 sources are used prior to contacting the consumer. The verification process will proceed in order from Tier 1 through Tier 4 and is not limited only to verification of income. When a Reasonable Compatibility test has been previously run and it has been determined that an administrative error was made or a new self-attestation is received, it is acceptable to return to a prior tier to verify the information (including running a new RC test with the updated information).
The four tiers apply to all family medical assistance programs. See also 1333.04(3) (Earned Income), 6125 (Pre-tax and Federal Deductions), 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. If reported SSA or SSI is not showing on the EATSS record, a collateral contact with SSA may be needed.
Reported unearned income not verifiable through a payer source interface shall be verified as indicated in 1330.04(2).
Also included as a payer 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 payer 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 (TALX) 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.
The Reasonable Compatibility test is used in Tier 2. See 6122 for Reasonable Compatibility. When income is not determined to be Reasonably Compatible and the Both Below is not applicable, the following Tier 3 sources are used in the order presented and should always be used prior to requesting verification from the applicant.
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.
1330.04 Tier 4: Request for Information - If the earnings cannot be verified using the above methods, Tier 4 verification is used, and the information is requested from the consumer. See also 6122 (Reasonable Compatibility) and 6120 (Budgeting Method).
(1) Self-employment Income - Self-employment income must be verified through Tier 3 or Tier 4 as there is not a data-source for this information. 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 the IRS mandated filing deadline (typically 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 through KEES 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 1 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 1, self-attestation is accepted as verification of all unearned income with the exception of the following types which will need to be requested from the consumer as Tier 4 verification:
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 request for information is sent to the applicant and "the last 30 days of income" is requested as proof. Proof of income is acceptable as long as the date of paystubs or employer statement falls within the three months prior to the month of application. If partial income is received from within this timeframe, it may be budgeted using the Partial Month Budgeting Method, see 6124.
1330.05 Verification of Pre-Tax Income and Federal Deductions - When total reported pre-tax or federal deductions is over $300.00 per month, verification of deductions will be required for them to be used in the income determination. If proof is not received, processing may be completed without them, and the applicant advised by notice that the amount was not used. Eligibility may not be denied due to failure to provide proof of deductions.
Verification of pre-tax income and/or federal deductions will follow the tiered approach of earned income in 1330. Information on hand, such as the case file and the Work Number (TALX) records must be used if available prior to requesting the information from the consumer. Paystubs must be no older than three months prior to the month of application to be used. Collateral contact with the employer may also be used but is not required. If there is no available information on file, the information must be requested from the consumer as noted below:
a) Pre-tax income deductions – Paystubs from the last 30 days or a statement from the employer
b) Federal/IRS deductions – Corresponding tax form or most recent tax return
Note: If based on the consumer’s self-attestation of both wages and deductions, the income will exceed guidelines for all programs, it is not necessary to request proof of the deductions.