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Issue Alert - 08-04-03

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Date:

Apr 07, 2008

Program Area:

Medicaid (MA)

Issue Summary:

Medicaid applicants and recipients will only be given a single extension of time for providing requested verifications, even if they are making a good faith effort to get the requested items and even if they request additional time

Persons Affected:

Medicaid applicants or recipients who have difficulty obtaining requested verification within 20 days of the original request

For More Information:

Medicaid applicants or recipients who have difficulty obtaining requested verification within 20 days of the original request

Michigan Poverty Law Program 611 Church Street, Suite 4A Ann Arbor, MI 48104-3000 (734) 998-6100 (734) 998-9125 Fax


Background

Prior to April 1, 2008, the Michigan Department of Human Services (DHS) used the same policy on timeliness of verification for all programs.  Under that policy, clients were given 10 days (or the time specified in other policy sections) to submit requested verifications and the DHS caseworker could extend the time if the individual was unable to provide it despite a reasonable effort to do so.   Caseworkers were required to provide AT LEAST one extension of time to clients who were making reasonable efforts. 

What's Happening?

Effective April 1, 2008, the verification policy for MEDICAID applicants and recipients has been changed. DHS will no longer allow the caseworker to grant more than one extension of time.  Caseworkers may extend the time NO MORE THAN ONCE.  DHS Program Administrative Manual (PAM) Item 130 p. 4.  DHS policy manuals are online at http://www.mfia.state.mi.us/olmweb/ex/html/.

Verification policy for programs OTHER THAN MEDICAID have not been changed and caseworkers may extend the time for those programs more than once.

THE POLICY ITSELF DOES NOT LIMIT THE LENGTH OF THE ONE-TIME-ONLY EXTENSION granted for Medicaid verifications.  Therefore, advocates should request an extension that will give the client or advocate enough time to submit the verification before the deadline.  However, be aware that analysts from the Department of Community Health have indicated the extension cannot be for more than 10 days. 

DHS CONTINUES TO HAVE THE OBLIGATION TO ASSIST THE CLIENT IN OBTAINING VERIFICATION when the client asks for help.  PAM 105 p. 10.  Therefore, clients should be encouraged to ask their caseworkers for help (and document the request in writing, keeping a copy on file) whenever the clients are unable to obtain verification within the time period granted by the caseworker.  The policy does not have a time limit on how long the caseworker may take to get the verification for the client.

REQUIRED VERIFICATION (PEM 130 p. 2-3)

For most eligibility factors, when documentary verification is unavailable, the caseworker can verify the factor through a collateral contact (i.e. phone contact).  If no verification is available, the caseworker can use the best available information or his/her own best judgment.  However, the following factors MUST be verified through documentation:

·         Alien status for non-citizens (unless seeking only Emergency Services Medicaid or benefits for other family members)

·         Disability, blindness, or incapacity

·         Lack of capacity to declare residency

·         Pregnancy (only for FIP)

In addition, for U.S. citizens seeking Medicaid, Family Independence Program, or State Disability Assistance, citizenship and identity must be verified through documents specified in policy.   However, when both the individual and the caseworker are unable to obtain this verification, the caseworker should request a Department of Community Health assistance in determining eligibility.

POLICY EXCEPTIONS

Caseworkers may request exceptions to the verification policy when necessary.  See PAM 120 p. 1-2  and PEM 100 p. 8-9.  Encourage caseworkers to request exceptions when appropriate. Note, however, that exceptions are supposed to be for unique or rare circumstances.

What Should Advocates Do?

1.  Help clients ask for adequate extensions of time for submitting verification.

2.  Help clients request help from DHS in obtaining verification if they will not be able to get the verification themselves within the time allowed.   Help clients document their requests for help.

3.  Share your experiences with this policy.   The Center for Civil Justice is interested in hearing from advocates regarding problems experienced by clients because of this new policy so we can inform policy makers about the impact of the policy on Medicaid applicants.

What Should Clients Do?

1.     Ask for help from DHS right away if you have trouble getting verifications for DHS.  Put it in writing and keep a copy.

2.   Ask DHS for an extension that will give you plenty of time if you cannot get the verification within the initial 10 day period.

3.     Seek legal advice if DHS will not help with verifications or your benefits are denied, reduced, or terminated. See “Finding Legal Help” below.

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee.

You can locate various sources of legal and related services, including the free legal aid office that serves your county, at MichiganLegalAid.org.

You can also look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.