Section 210-RICR-30-00-5.8 - Verification ProcessA. As indicated in Part 10-00-3 of this Title, attestations are accepted without verification for residency, household composition, pregnancy and caretaker relative status. In general, this verification process proceeds as follows: 1. Data matching - The State must assure that an applicant's information is entered into the integrated eligibility system (IES) and matched electronically to the full extent feasible through the federal data hub and State data sources.a. Federal Data Hub. The federal data hub contains electronic information from various agencies of the United States government, including the IRS, Social Security Administration (SSA), HHS (Centers for Medicare and Medicaid Services (CMS) and other agencies), Department of Homeland Security (USDHS), Department of Veterans Affairs (VA), Department of Defense (DoD), Peace Corps, and Office of Personnel Management (OPM). Various categories of data from these sources are used to match on income, employment, health, entitlements, citizenship, and criminal history. A full list of the data included in the federal hub and the rules governing its use are located in 42 C.F.R. §§ 435.948 and 435.949.b. State data sources. The State draws from databases from an array of public agencies to verify income including the RI Department of Labor and Training (DLT), Divisions of Revenue and Motor Vehicles, and EOHHS agencies including Department of Human Services (DHS). Specific databases include State Wage Information Collection Agency (SWICA) and State unemployment compensation information (UI).2. Reasonable compatibility - The State must use a reasonable compatibility standard, or an allowable difference, to match data sources with self-reported application information. If the data sources match the applicant's attestation, or are found "reasonably compatible," the State must ensure that the IES bases the determination on the information in the application. The State uses this standard for income verification and may apply it to other eligibility factors in the future.3. Reasonable explanation - The State must provide the applicant with the opportunity to provide an explanation and documentation if the data sources do not match the attestation or are not reasonably compatible. Accordingly, the IES issues a request to the applicant for this information and provides a list of reasonable explanation options.4. Reconciliation process - The explanation provided by an applicant must be used to determine whether it is feasible to reconcile a discrepancy between an attestation and data matches to determine whether reconciliation is feasible. If the applicant provides a reasonable explanation, the final determination of eligibility will be based on the information the applicant provided. If the applicant is unable to provide a reasonable explanation, documentation will then be required to verify or correct the attestation and reconcile the discrepancy.5. Privacy - The verification process utilizes personally identifiable information (PII) from both the federal data hub and State data sources. An account is maintained for each person who completes and submits an application through the State's IES. This account includes PII and other eligibility-related information used in the determination and annual renewal process. The State must assure the privacy of the information in these accounts in accordance with the Health Insurance Portability and Accountability Act (HIPAA) Standards for Privacy of Individually Identifiable Health Information and R.I. Gen. Laws §§ 40-6-12 and 40-6-12.1. Also, the State must limit any use of account information to matters related to the administration of the Medicaid program including eligibility determinations, Medicaid health plan enrollment, appeals, and customer services. See also Part 10-05-1 of this Title, Confidentiality Rule.6. Account Duration - Once an account in the IES is established, a person seeking Medicaid has ninety (90) days to complete and submit the application for a determination. The IES eliminates the account and all eligibility information from all sources, federal and State, if an application has not been completed by the end of that period. The State must determine eligibility within thirty (30) days from the date the competed application is submitted.7. Post-eligibility verification - See § 5.15 of this Part.B. The following lists key eligibility factors, the types of verification required for attestations, if any, and the verification sources for MACC Group applicants/beneficiaries:1. Identity - An applicant must provide proof of identity when applying through the IES or filing a paper application. The requirements related to identify proofing are set forth in Part 30-00-3 of this Title. Certain applicants may not be able to obtain identity proofing through the federal hub due to data limitations. Pre-eligibility verification is required through an alternative electronic paper documentation source in these instances to establish an account.2. Income - Electronic verification of attested income is required by the State. Multiple electronic data sources may be used for this purpose. In general, State data sources (such as SWICA UI) will be used first. The reasonable compatibility standard applies when there are discrepancies between the applicant's income self-attestation and information from electronic data sources.3. General Eligibility - Non-Financial Factors - (Social Security Numbers, Age, Citizenship, Death, Date of Birth, Residency, and Incarceration). Information on these eligibility factors is verified against various State and federal data sources. Information specific to verification requirements for MAGI populations is located in Part 30-00-3 of this Title; for Medicaid and CHIP-funded eligibility more generally, the applicable provisions are set forth in Part 30-00-3 of this Title.210 R.I. Code R. 210-RICR-30-00-5.8
Amended effective 8/25/2020
Amended effective 10/1/2024