Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth Eligibility Operations Memo 11-03A August 15, 2011 TO: MassHealth Eligibility Operations Staff FROM: Amy Andrade, Director of Member and Provider Services RE: Change to Eligibility Operations Memo 11-03: Social Security Administration Match to Verify Citizenship and Identity Correction A correction is being made to the “Introduction” section on page 1 of EOM 11-03, issued on April 1, 2011. In the second sentence, the phrase “and the applicant has not received a temporary benefit in the previous 12 months” is being deleted. The corrected EOM 11-03 is repeated here as EOM 11-03A. Introduction Under the Children’s Health Insurance Program Reauthorization Act (CHIPRA) and state law, MassHealth will match with the Social Security Administration (SSA) to verify citizenship and identity for United States citizens or nationals. CHIPRA requires that MassHealth provides a temporary benefit to applicants during a 90-day reasonable opportunity period when a Medical Benefit Request (MBR) or an Eligibility Review Form (ERV) is processed. MA21 Changes Effective March 2011, MA21 logic and noticing will be changed to support the SSA-match process. In MA21, the SSA event will show two requests to the State Verification Eligibility System (SVES). * 1 — request for verification of social security number (SSN)/citizenship and identity * 4 — request for verification of SSN/RSDI/Medicare/SSI Note: MA21 will block the eligibility determination until the overnight match process with SVES is complete. The following are the possible result of the requests. (continued on next page) Eligibility Operations Memo 11-03A August 15, 2011 Page 2 MA21 Changes (cont.) Social security number is matched and citizenship and identity are verified * The social security number is matched and citizenship and identity are verified. No other verifications are outstanding. If the applicant is otherwise eligible, an approval notice is sent. * The social security number is matched and citizenship and identity are verified. However, other verifications are outstanding. A request for verifications (VC-1) with a 30- or 60-day time frame is sent. Social security number is matched, but citizenship and identity cannot be verified * The social security number is matched and citizenship and identity are matched through another source (Department of Transitional Assistance (DTA) or the State Data Exchange (SDX)). If no other verifications are outstanding and the applicant is otherwise eligible, an approval notice is sent. * The social security number is matched and citizenship and identity are the only outstanding verifications. If the applicant is otherwise eligible, an approval notice is sent. The notice includes language that tells the applicant that he or she has an additional 90 days from the date of the notice to verify citizenship and identity. If applicant does not verify citizenship and identity within the 90-day time period, he or she will be downgraded to Health Safety Net. * The social security number is matched, but citizenship and identity are not verified and there are other outstanding verifications. The applicant is sent a VC-1 (with either a 30- or 60-day time frame) for outstanding verifications. The notice includes language that tells the applicant that MassHealth has failed to match with SSA for citizenship and identity. o If citizenship and identity are provided or matched within the 30/60-day time period and all other outstanding verifications are submitted, an approval notice is sent to the applicant, if otherwise eligible. o If the applicant does not submit all outstanding verifications (including citizenship and identity) within the 30/60-day time period, the application is denied. o If the applicant submits all outstanding verifications except citizenship and identity within the 30/60-day time period and the applicant is otherwise eligible, an approval notice is sent giving the applicant a temporary benefit for up to 90 days from the date of the notice. If citizenship and identity remain unverified after the 90-day time period, the applicant will be downgraded to Health Safety Net. (continued on next page) Eligibility Operations Memo 11-03A August 15, 2011 Page 3 MA21 Changes (cont.) Social security number is not matched and citizenship and identity cannot be verified with the Social Security Administration * The social security number is not matched, citizenship and identity are verified through other sources (DTA or SDX), and there are no other outstanding verifications. An approval notice is sent if the applicant is otherwise eligible. * The social security number is not matched, citizenship and identity are not verified through other sources, and there are other outstanding verifications. The applicant is sent a 30/60-day VC-1. This notice includes language that tells the applicant that MassHealth is trying to match with SSA to verify citizenship and identity. * The social security number is not matched and citizenship and identity are matched by another source, but other outstanding verifications are not provided within the 30/60-day time frame. A denial notice is sent to the applicant. * If the social security number and citizenship and identity are the only outstanding verifications and the applicant is otherwise eligible, an approval notice is sent, giving the applicant a temporary benefit for up to 90 days from the date of the notice. The notice is sent with a VC-1 telling the applicant that MassHealth has tried to match with SSA based on the information provided by the applicant. * If citizenship and identity are verified by SSA or a desk review within the 90-day temporary benefit period, the applicant will stay in that benefit. * If there is no match within the 90-day time period, the applicant’s eligibility will be downgraded from the temporary benefit to the Health Safety Net. Desk Review For cases where SSA cannot match the applicant’s social security number or verify citizenship or identity, MassHealth staff will work from a system- generated report to correct any data entry errors. In addition, MassHealth staff may contact applicants to verify that the information provided is correct. The purpose of the desk review is to correct errors in the applicant’s or member’s name or social security number so an additional SVES request can be sent to see if citizenship and identity can be matched. Questions If you have any questions about this memo, please have your MEC designee contact the Policy Hotline.