Or. Admin. Code § 410-200-0230

Current through Register Vol. 63, No. 11, November 1, 2024

Section 410-200-0230 - Verification

(1) Applicants, beneficiaries, or an individual authorized to act on their behalf shall attest to the following information:

(a) Age and date of birth;

(b) Application for other benefits;

(c) Caretaker relative status;

(d) Household composition;

(e) Legal name;

(f) Medicare;

(g) Pregnancy;

(h) Receipt or availability of other healthcare coverage;

(i) Residency;

(j) Social Security number; and

(k) American Indian/Alaska Native status.

(2) Applicants, beneficiaries, or individuals authorized to act on their behalf shall make a declaration of US citizenship, US national, or non-citizen status;

(a) Self-attested information shall be verified via the federal data services hub (FDSH) or by electronic verification source available to the Agency;

(b) In the event that attested status cannot be verified via the FDSH or by electronic verification sources available to the Agency, self-attested information shall be used to determine eligibility, and the individual provided a reasonable opportunity period to provide verification of US citizen, US national, or non-citizen status as outlined in section (e) of this part. Exceptions to this verification requirement are described in sections (c) and (d) of this part

(c) Applicants or beneficiaries attesting to US citizenship are exempt from the requirement to verify their citizenship if they are one of the following:

(A) Individuals who are assumed eligible (OAR 410-200-0135);

(B) Individuals who are entitled to or enrolled in Medicare;

(C) Individuals who are presumptively eligible for the BCCTP program through the BCCTP screening program or through the Hospital Presumptive Eligibility process (OAR 420-200-0400 and 410-200-0105);

(D) Individuals receiving Social Security Disability Income (SSDI); or

(E) Individuals whose citizen status was previously documented by the Agency. The Agency may not re-verify or require an individual to re-verify citizenship at a renewal of eligibility or subsequent application following a break in coverage.

(d) Applicants or beneficiaries age 19 and older who attest to having an immigration status that is not a qualified non-citizen status (see OAR 410-200-0215(2)) are exempt from the requirement to verify non-citizen status;

(e) US Citizen, US National, and Non-citizen status verification guidelines:

(A) Individuals attesting to US citizenship shall verify their status by submitting any of the documents permitted under section 1903(x) of the Social Security Act (42 U.S.C. 1396b);

(B) Individuals attesting to non-citizen status shall verify their status by:

(i) Submitting documentation or other proof from the Immigration and Naturalization Service which contains the individual's U.S. Citizenship and Immigrations Services (USCIS) number (or numbers if the individual has more than one number); or

(ii) Submitting other documents the State determines constitutes reasonable evidence indicating a satisfactory immigration status.

(C) Non-citizens who attest to having no immigration status shall not be required to verify.

(f) For individuals with a qualified non-citizen status (see OAR 410-200-0215(2)), the Agency shall not require verification of the following unless questionable:

(A) Attestation to being continuously present in the U.S. since August 22, 1996;

(B) Attestation to being an honorably discharged veteran or in active military duty status; and

(C) Attestation to being the spouse or unmarried dependent child of an individual identified in subsection (B) of this part.

(g) Non-citizen status shall be reviewed and verified at the following times:

(A) Initial determination of eligibility;

(B) When a report of change of non-citizen status is received by the Agency.

(3) Applicants, beneficiaries, or individuals authorized to act on their behalf shall make a declaration of income:

(a) If the attested income exceeds the threshold that would produce eligibility for all EDG members, the Authority shall accept the attested information, deny HSD Medical Programs, and refer to the Federally Facilitated Marketplace for potential APTC eligibility;

(b) Attested income that would result in eligibility for one or more EDG members is compared to documentary evidence through a match with the FDSH or electronic verification sources available to the Agency. The attestation is considered reasonably compatible, and thus does not require further verification if:

(A) Income information obtained via FDSH or other available electronic verification sources is not discrepant by more than 10% when compared to the attestation; or

(B) Both the attested income and information obtained via FDSH or other available electronic verification sources are within the income threshold for the same HSD Medical Program.

(c) In the event that attested income is not reasonably compatible with information obtained via the FDSH or electronic verification sources available to the agency, prior to the determination of eligibility the agency will:

(A) Request documentary verification of income from the individual; or

(B) If the individual cannot obtain verification of income, a reasonable explanation as to why.

(4) Applicants, beneficiaries, or individuals authorized to act on their behalf shall make a declaration of receipt of private health insurance:

(a) Self-attested information shall be used to determine eligibility for HSD Medical Programs if:

(A) Information obtained through a match with the FDSH or electronic verification sources available to the agency does not conflict with attested information;

(B) Information obtained through a match with available electronic data conflicts with attested information but does not affect eligibility; or

(C) Verification is not available via a match with available electronic data or by any other method at the time of application processing.

(b) In the event that information obtained through a match with the FDSH or electronic verification sources available to the agency conflicts with attested information and may affect eligibility, private health insurance information shall be verified prior to eligibility determination.

(5) The Authority may request that applicants and beneficiaries of medical assistance provide additional information, including documentation, to verify most eligibility criteria if attested information is questionable or a discrepancy is identified.

Or. Admin. Code § 410-200-0230

DMAP 54-2013(Temp), f. & cert. ef. 10-1-13 thru 3-30-14; DMAP 4-2014(Temp), f. & cert. ef. 1-15-14 thru 3-30-14; DMAP 20-2014, f. & cert. ef. 3-28-14; DMAP 67-2014(Temp), f. 11-14-14, cert. ef. 11-15-14 thru 5-13-15; DMAP 3-2015, f. & cert. ef. 1/30/2015; DMAP 78-2015(Temp), f. & cert. ef. 12-22-15 thru 6-18-16; DMAP 24-2016, f. & cert. ef. 6/2/2016; DMAP 23-2020, amend filed 05/07/2020, effective 5/8/2020; DMAP 84-2022, amend filed 11/29/2022, effective 11/29/2022

Statutory/Other Authority: ORS 411.402, 411.404, 413.042 & 414.534

Statutes/Other Implemented: ORS 411.400, 411.402, 411.404, 411.406, 411.439, 411.443, 413.032, 413.038, 414.025, 414.231, 414.447, 414.534, 414.536 & 414.706