An individual who declares to be a United States citizen or national must verify identity when first applying for Medical Assistance (MA) or when completing the next MA renewal.
NOTE: Gender does not need to be verified.
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: BCCPT contractors do not need to provide proof of citizenship and identity when making referrals to DHS.
NOTE: See Chapter 322 Citizen/Alien for policy regarding verification of identity for non-citizens.
Individuals who report a change in name must provide proof of identity before their name can be updated in eCIS. Changes in gender do not need to be verified and can be updated based on client statement.
For acceptable verification of identity, see Section 320.2, Proof of Identity.
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.
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.
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 April 29, 2024, Replacing November 5, 2019