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Issue Alert - Verification Extension for Medicaid

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Jul 01, 2008

Program Area:

Medicaid (MA) PAM 130

Issue Summary:

The number of extensions of the time limit to return verifications for Medicaid applicants and recipients has been increased from once to three times.

Persons Affected:

Medicaid program applicants and recipients

For More Information:

Center for Civil Justice 320 S. Washington, 2nd Floor Saginaw, MI 48607 (989) 755-3120, (800)724-7441 Fax: (989) 755-3558 E-mail:

Michigan Poverty Law Program 611 Church Street, Suite 4A Ann Arbor, MI 48104-3000 (734) 998-6100 (734) 998-9125 Fax (734)998-6125


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. However, this policy was changed as of April 1, 2008, and DHS would not allow the caseworker to grant more than one extension of time.

What's Happening?

Once again, DHS has changed this policy. PAM 130. The number of extensions of the time limit to return verifications for Medicaid programs has been increased to up to three times.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.

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.

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.

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

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