The applicant must be the main source of information when determining his or her eligibility for Medical Assistance (MA). The CAO must help the applicant, when necessary, in getting the required proof. 55 Pa. Code § 201.1
The individual who signs the Application for Benefits must, to the best of his or her ability, prove that the information he or she gives to the CAO is true. The individual must give information including, but not limited to, the age, residence, citizenship, identity, income, and resources of the members of the applicant/recipient group and legally responsible relatives (LRRs) living with the applicant/recipient group.
The caseworker should keep in mind that, because of age, physical, or mental disabilities, language problems, and other reasons, an individual may not be able to help or prove he or she is eligible for MA. The individual will always be told that the worker can help him or her. The CAO will take an active role in helping individuals with mental or physical disabilities obtain needed citizenship or identity papers or third-party resources that can help pay medical expenses.
The CAO will verify conditions of eligibility, need, income, and resource items at the time of application and renewal. 55 Pa. Code § 201.3
If the applicant cooperates in getting proof, the CAO will approve benefits within thirty calendar days from the date when the application is received. If all other conditions of eligibility for MA are met except for proof of citizenship or identity, and the individual is cooperating with CAO staff in getting this proof, MA will not be denied or stopped. If the individual cooperates during renewal, assistance will continue until proof is received.
NOTE: For applications that include children, a parent’s or caretaker’s statement will be accepted for Social Security numbers (SSNs), age and date of birth, and who is in the family. SSNs must be given to the CAO within sixty days of approval of MA and approval of children’s health care benefits. The only time a Social Security card must be shown is when the number does not match information in CIS/e-CIS.. The CAO will set an alert for the sixtieth day from the eligibility start date if the SSN is not confirmed. 55 Pa. Code § 155.2
The CAO will confirm eligibility factors that are subject to change at renewal, such as income and resources.
Sources of proof include the following:
Written information.
Public records.
Collateral contacts.
Automated sources (see Section 378.6).
Anything that shows that an individual’s statement is true.
Updated February 14, 2012, Replacing October 29, 2008