Section 210-RICR-10-00-3.6 - Non-financial Eligibility FactorsA. Self-attestations and attestations at the time of initial application are accepted for certain non-financial eligibility requirements. Verification of this information is required in some by Federal or State law or Regulation, as indicated in § 3.6(B) of this Part below. Rhode Island has opted to utilize approved Federal and State electronic interfaces with the IES for verification purposes when available, as authorized in 42 C.F.R. §§ 435.948 through 435.956. Paper documentation is therefore utilized only in instances when there is no information available through an electronic data source or there is a discrepancy between a self-attestation or an attestation and the electronic data source.B. All persons seeking Medicaid eligibility must provide a date of birth (age) and an SSN. Rhode Island resident children under the age of nineteen (19) are not subject to the eligibility requirements related to citizenship and immigration status and are not required to provide proof of legal immigration status or to have an SSN. Attestations and self-attestations about Rhode Island residency are accepted and require no verification, However, attestations and self-attestations about age and SSN are verified through electronic data sources. All applicants must provide an SSN, show proof that one has been requested, or seek the assistance of an agency representative to apply for an SSN before a determination of eligibility can be made.1. Information and verification by coverage category - The respective responsibilities of applicants and the State associated with non-financial eligibility factors such as SSN and residency may vary by category of coverage. Accordingly, the applicable provisions are set forth in the Chapters of this Title related to each category of coverage, as indicated below:a. Medicaid Affordable Care Coverage (MACC) Groups and Non-MAGI eligible children and youth. Required information and verification for families, children, ACA expansion adults and pregnant women whose eligibility is determined using the MAGI standard is located at Part 30-00-1 of this Title; For members of these populations deemed eligible due to a characteristic (newborns) or by current or past participation in a Federal or State program (SSI or Rhode Island Department of Children, Youth and Families (DCYF)) are set forth in Part 30-00-1 of this Title.b. Integrate Health Care Coverage (IHCC) Groups and Non-MAGI eligible adults and elders - Information related to non-financial eligibility requirements for all coverage groups subject to determinations using the SSI methodology, including the SSI and Community Medicaid eligibility pathway and Medicare Premium Payment Program (MPPP) are set forth in the application provisions in Part 40-00-1 of this Title and general eligibility section of Part 40-05-1 of this Title.c. LTSS - All new applicants for LTSS must meet the general eligibility requirements related to age, SSN and residency. Existing Medicaid beneficiaries who are seeking LTSS do not have to provide additional information about these non-financial factors if already known to the State and, therefore, are not subject to verification. For applicants pursing the ACA adult MAGI pathway, the non-financial eligibility requirements are set forth in Part 30-00-1 of this Title. For all other LTSS applicants, the provisions related to the SSI methodology for Community Medicaid located in Part 40-05-1 of this Title apply.2. State responsibilities - The State must provide assistance upon request to help applicants obtain and verify information about non-financial eligibility factors. Such information must be accessible to persons with limited English proficiency as well as persons with disabilities. The State's responsibilities related to application information and verification include, but are not limited to: a. Information for applicants/beneficiaries. The State must inform applicants in both on-line and paper application forms whether attestations related to non-financial eligibility factors are verified, by what means, and how the information will be used in accordance with the applicable provisions of this Title. In addition, when a discrepancy is noted between a data source and an attestation, the State must provide any assistance requested by the applicant to validate and/or correct the information from the data source.b. Information from applicants. An applicant is only required to provide the information necessary to determine eligibility. In addition, the following limits apply: (1) Any information requested by the State about non-applicants in the household must be related to the applicant's eligibility. Therefore, information pertaining to a non-applicant's tax filing status, relationship, or income is requested when constructing a MAGI household. Information about the income and resources of a nonapplicant spouse is generally required to determine Medicaid eligibility for most of the Integrated Health Care Coverage Group members (request, income, and resources may be required for some types of eligibility).(2) Request for the SSN of a non-applicant is permitted only if the State indicates clearly that it is being provided voluntarily and for purposes directly connected to initial or continuing eligibility for Medicaid. A non-applicant requesting eligibility for someone else in the household is not required to provide an SSN.(3) The State does not request information about the citizenship and immigration status of non-applicants in the household.210 R.I. Code R. 210-RICR-10-00-3.6
Adopted effective 12/29/2022