A-870, Verification Requirements

Revision 20-2; Effective April 1, 2020

Medical Programs

Verification is required for the following:

  • Spousal support to establish eligibility for TP 20
  • Unpaid medical bills for three months prior coverage. Exception: Refer to A-831.2, Eligibility for Three Months Prior Coverage, for TP 40 prior coverage
  • Income for each of the three months prior to coverage. Note: For Children's Medicaid, do not request more income verification for prior Medicaid coverage than what is required for ongoing eligibility. See A-1371, Verification Sources, for Children's Medicaid.
  • An application was filed when reopening an application for prior month coverage according to A-831.2.1, Reopening Three Months Prior Applications
  • Gross earnings and the date the person received the earnings for TP 07. Exception: If verification is not readily available, accept the person's statement unless questionable. If the household provides earnings information sufficient to determine eligibility for TP 07 but does not provide verification of the earnings, deny the TP-08 EDG and create a TP 07 EDG if the person meets the eligibility requirements in A-842, TP 07 Transitional Medicaid.
  • When a household requests continuation of Medicaid for children aging out of TP 44, verify the child:
    • is hospitalized on the child's 19th birthday;
    • remains hospitalized (there is not a time limit); and
    • meets all other criteria according to policy in A-825, Medicaid Termination.
  • Third-Party Resource (TPR).  Report to the TPR Unit any household member who:
    • has private medical insurance; or
    • is not enrolled in group medical coverage that is available to him.

Emergency Medicaid

Verify the emergency medical condition by using Form H3038, Emergency Medical Services Certification, or Form H3038-P, CHIP Perinatal – Emergency Medical Services Certification. These forms are the only acceptable sources that can be used to verify an emergency medical condition. A licensed practitioner must complete and sign Form H3038 or Form H3038-P.

Note: An original or a faxed copy of Form H3038 or Form H3038-P is acceptable to verify the emergency medical condition.

TP 40

See A-144.5, Pregnancy, for policy relating to verification of pregnancy.

Related Policy

Pregnancy, A-144.5
Regular Medicaid Coverage, A-820
Verification Requirements, A-1370
A Household with Members on TANF, TANF-State Program (SP), TP 07, TP 08 and TP 20, B-480
Questionable Information, C-920
Providing Verification, C-930