Regulatory Statute
42 CFR 435.948
42 CFR 435.949
42 CFR 435.952
42 CFR 435.956
Attestation will be accepted for most factors of eligibility at application, renewal, and for a change in circumstances. Attestation will be accepted by the individual; an adult who is in the applicant's household; an authorized representative; or if the individual is a minor or incapacitated someone acting responsibly for the individual. Certain factors of eligibility will be verified post-enrollment, post-renewal, and after a redetermination of eligibility due to a change in circumstances.
Verification will be obtained electronically using the Federal Data Services Hub (FDSH) and other electronic data sources. The FDSH is a service that enables access to multiple data bases via a single electronic transaction. Data will be available from the Social Security Administration (SSA), Department of Homeland Security (DHS), Internal Revenue Service (IRS), and Equifax Workforce Solutions (also known as TALX). TALX is a contracted service that verifies earned income as reported by employers. The agency will not be obtaining IRS data.
Other electronic data sources include the following:
| * | State Wage Information Collection Agency (SWICA) |
| * | State Unemployment Compensation |
| * | General Assistance Program |
| * | Supplemental Nutrition Assistance Program (SNAP) |
| * | Temporary Assistance for Needy Families (TANF) |
| * | Child Care Subsidy Program |
| * | Office of Vital Statistics |
| * | Department of Motor Vehicles |
| * | Office of Child Support Enforcement |
| * | Public Assistance Reporting Information System (PARIS). |
Attestation will be accepted without post-enrollment verification for the following factors of eligibility:
| * | household relationships |
| * | application for other benefits |
| * | pregnancy - unless other available information, such as a medical claim, is not reasonably compatible with such attestation. |
Attestation will be accepted with post-enrollment verification for the following factors of eligibility:
Attestation will not be accepted and must be verified via the FDSH for the following factors of eligibility:
| * | citizenship and identity |
| * | Social Security number (SSN). |
If citizenship and immigration status cannot be verified via the FDSH, the individual will be provided with a 90-day reasonable opportunity period to submit other documentation and may be found eligible during that time period. The reasonable opportunity period will be extended beyond 90 days if the individual is making a good faith effort to obtain the documentation.
Verification of SSN will be in accordance with Sections 14105-14105.1.
Individuals will not be required to provide additional information or documentation unless the information cannot be obtained electronically or is not reasonably compatible with the attested information.
Reasonably compatible means that the information provided by an electronic data source is generally consistent with the information reported by the applicant or beneficiary. Income verification obtained through an electronic data source shall be considered reasonably compatible when:
| * | attestation of income and the electronic verification are at or below the income standard; |
| * | attestation of income and the electronic verification are above the income standard; and |
| * | attestation of income is at or below the income standard and the electronic verification is above the income standard and the difference between the two is 25% or less. |
When the difference between the attestation of income and the electronic verification is more than 25%, a reasonable explanation will be sought from the applicant or beneficiary. A reasonable explanation may include, but is not limited to, a loss of employment or reduced hours of employment. If both the reported income and the data source indicate that the income is below the applicable standard then no additional information is needed.
Post-enrollment verification will be completed in accordance with the agency's verification plan approved by the Centers for Medicare & Medicaid Services (CMS). Post-enrollment verification of income and Medicare will be completed within thirty (30) days of the date of enrollment. When additional information is needed to complete the eligibility determination, the agency will request such additional information from the individual. The individual will be provided thirty (30) days to respond to the request for additional information. If the additional information requested is not provided, eligibility will be terminated unless the child is in a continuous eligibility period. See Section 14810.2 Continuous Eligibility for Children in Medicaid.
Exceptions to the verification requirements will be permitted on a case-by-case basis when documentation does not exist or is not reasonably available, such as for individuals who are homeless or have experienced domestic violence or a natural disaster. The exception does not apply to the verification requirements for citizenship and immigration status.
16 Del. Admin. Code § 14000-14800
17 DE Reg. 503(11/1/2013)
17 DE Reg. 731(1/1/2014)
26 DE Reg. 590(1/1/2023)
27 DE Reg. 680( 3/1/2024) (Final)