As of July 1, 2006, an individual who declares to be a United States citizen or national must show certain documents to establish identity when first applying for Medical Assistance (MA) or when completing the next MA renewal.
NOTE: This also applies to the following programs:
An individual does not have to prove his or her identity more than once unless:
There has been a six-year gap between the date when his or her MA benefits were stopped and the new requested date of MA coverage.
The CAO worker thinks the first documents shown were not valid.
NOTE: These requirements apply when reviewing continued MA eligibility for all TANF cash closings, including Extended Medical Coverage (EMC) and changes to eligibility status (for example, sanctioned individuals). Before closing TANF cash benefits or completing eligibility status changes, the CAO must review the case record for proof of citizenship and identity. If no proof is in the case record, the CAO must change the verification code for citizenship on the e-CIS Demographics screen to “S” (statement).
NOTE: CHIP and BCCPT contractors do not need to provide proof of citizenship and identity when making referrals to DHS. The CAO must refer applications to CHIP when the household is not eligible for MA on the basis of income, whether or not citizenship or identity has been verified. If the household income is equal to or less than the MA income limit and the household has not met citizenship or identity verification requirements, the CAO must not refer the household to CHIP.
NOTE: CHIP recipients may have had their citizenship and identity verified through the Social Security interface. This verification is displayed in the Master Client Index (MCI) and will display in CIS. If this verification is displayed for individuals included in new referrals, the CAO does not need to request proof of citizenship or identity.
NOTE: There has been no change in policy with regard to identity verification for non-citizens. (See Chapter 322 Citizen/Alien.)
Noncooperation means the refusal or failure of an individual or that individual’s representative to work with CAO staff in obtaining documents or in explaining why proof of identity cannot be provided.
There are two kinds of noncooperation:
An individual refuses to provide identity documents.
An individual fails to provide requested items (for example, an affidavit) needed to prove identity.
Exception: An individual with a mental health or mental retardation diagnosis may refuse to cooperate. These cases must be handled separately. The income maintenance caseworker (IMCW) may need to consult with mental health/mental retardation (MH/MR) caseworkers for help in getting needed documents.
An individual who refuses to cooperate with the CAO in getting proof of identity or who refuses to provide requested items needed to get proof of identity may be denied or have MA benefits closed. Notice and appeal rights must be given to the applicant or recipient if the State denies or closes MA benefits.
NOTE: An incomplete PA 1809 does not mean an individual has not cooperated. If information is missing from the PA 1809, the CAO must contact the individual to get the missing information. If the applicant or recipient cannot provide it, then he or she still cooperated as much as he or she could.
When an individual refuses to cooperate or does not provide requested items needed to get proof of identity for TANF-related or SSI-related MA, the individual is also ineligible for MAGI-related MA. Non-citizens are ineligible for GA-related MA if they are noncooperative for TANF-related, SSI-related, or MAGI-related MA.
Example: An individual does not have $10 to pay for a PA state identification (ID) card. The IMCW suggests the individual contact a civic organization, church, or social service agency to get the money to pay for the ID. The IMCW also discusses other forms of acceptable ID. Proof of identity is included in the list of needed items with a due date. The due date has now passed, and all other needed items were received. When the individual is contacted, the IMCW is told that the individual did not try to contact community agencies for the money or to get other proof of identification. The individual is considered noncooperative. An ineligible or adverse action notice is sent at the end of the 30-day application/renewal period to deny or close MA benefits for failure to provide certain information.
NOTE: MA will only be denied or closed for the individual who fails to cooperate.
Examples:
There is one parent and one minor child. All other eligibility requirements are met, but the parent does not cooperate for herself and her child. Both are denied.
There is one parent and one minor child, and all other eligibility factors are met. The parent has cooperated for himself but does not cooperate for his child. The child is denied.
A mother is unable to get required identity documentation for herself but does for her children. The children are found eligible for MA with the parents' income being deemed. The mother is denied.
Updated November 4, 2016, Replacing February 14, 2012