Or. Admin. Code § 461-115-0700

Current through Register Vol. 63, No. 12, December 1, 2024

Section 461-115-0700 - Required Verification; GA, OSIPM, and QMB

In the General Assistance (GA), Oregon Supplemental Income Program Medical (OSIPM), and Qualified Medicare Beneficiaries (QMB) programs:

(1) All eligibility (see OAR 461-001-0000) factors, including identity, must be verified at initial application, when there is a change to any factor, and whenever eligibility for benefits becomes questionable. See OAR 461-115-0704 for the requirements to provide verification of citizenship and immigration status.

(2) Methods of verifying information include the following:

(a) Electronic. Information available and provided to the Department from an electronic source, including but not limited to:

(A) State Wage Information Collection Agency.

(B) Internal Revenue Service.

(C) Social Security Administration.

(D) State Unemployment Compensation Agency.

(E) State agencies administering programs under Title 1, 10, 14, or 16 of the Social Security Act.

(F) SNAP agencies.

(G) Other insurance affordability programs.

(H) The Department of Treasury.

(I) The Department of Homeland Security.

(J) Asset Verification System.

(b) Self-attestation. Information provided orally or in writing by or on behalf of an individual.

(c) Documentation. Documentary evidence provided by or on behalf of an individual or obtained by the Department from a third party.

(3) If necessary, information needed to determine eligibility must be provided by or on behalf of the individual requesting benefits.

(4) The Department must allow a reasonable amount of time to provide additional information, if necessary.

(5) Financial eligibility.

(a) Resources.

(A) In the OSIP, OSIPM, and QMB-DW programs, if the total self-attested value of gross "liquid resources" of the financial group (see OAR 461-110-0530) is less than $400, further verification of the value of "liquid resources" is only required if questionable. For the purposes of this rule, "liquid resources" include cash as well as other resources that can be converted to cash within 20 business days, except that the cash surrender value of a life insurance policy is not considered a liquid resource.

(B) The Department must request and use information from available electronic sources, without requiring additional documentation, to verify a resource, unless:

(i) The information is not available to the Department electronically.

(ii) The information provided by self-attestation differs from the information received electronically and the individual or person acting on the individual's behalf could not provide a statement which reasonably explains the discrepancy.

(C) The Department must use the Asset Verification System when a resource or transfer of assets (see OAR 461-140-0210 to 461-140-0300) evaluation is necessary to determine eligibility, subject to the following provisions:

(i) Consent to use the Asset Verification System is required and a condition of eligibility.

(ii) If resource information is not available, or not returned, through the Asset Verification System, or differs from self-attested information, resource documentation may be requested directly from the individual, subject to the other requirements of this section and subparagraph (iii) below.

(iii) If the reported value of total countable real property and bank accounts differs from what is returned by the Asset Verification System, including resources that were not reported, no further verification is needed if both of the following are true:

(I) Both values are below the applicable resource limit.

(II) No other countable resources are reported.

(b) Income. The Department verifies income through electronic, self-attestation, and documentary methods. Except for as provided in paragraph (A) of this subsection, individuals may self-attest to income that is not subject to verification by the Federal Data Services Hub (FDSH), such as self-employment or private pension. Income subject to verification by the FDSH is compared to self-attested income to determine if further verification is needed. Self-attestation may otherwise be accepted subject to the provisions in paragraph (B) of this subsection.

(A) Supplemental Security Income (SSI) and all Social Security Title II income will be verified via means separate from the FDSH check described in part (B) of this subsection. The verified amounts shall be used to determine eligibility.

(B) FDSH check. Self-attested income is compared to information obtained through a match with the FDSH.

(i) Step One. The self-attested income of each individual in the financial group is compared to the values returned by the FDSH for that individual to determine if it is considered "reasonably compatible," meaning no further verification is needed. The income is reasonably compatible if it meets any of the following:

(I) The FDSH returns a value greater than $0, but less than the individual's attested amount.

(II) The FDSH returns a value greater than the attested amount, but within 110% of the individual's attested amount.

(III) The individual attests to $0 income, and the FDSH returns $0 or absent value.

(ii) Step Two. If any member of the financial group has income that is not reasonably compatible as described in paragraph (i) of this part above, the total self-attested income of each individual's financial group is compared to the total income obtained by the FDSH for the financial group to determine if it is considered reasonably compatible, meaning no further verification is required. The income is reasonably compatible if the total income of the individual's financial group obtained via the FDSH and the total self-attested income of the financial group are both within the income threshold for the benefit for which the individual is evaluated.

(iii) If the total self-attested income of the financial group results in financial ineligibility, the Department shall accept the attested information and deny benefits.

(iv) If self-attested income is not reasonably compatible under Step One or Step Two and does not result in financial ineligibility:

(I) Self-attested income will be used for the initial eligibility determination and documentary verification will be requested post-eligibility.

(II) Upon receipt of documentary verification, the Department will confirm or adjust ongoing eligibility as appropriate.

(III) If documentary verification cannot be obtained, the individual must provide a reasonable explanation as to why, which the Department may accept.

(6) Identity.

(a) Except as provided for in subsections (c), (d) and (e) of this section, individuals must provide documentation to verify identity.

(b) The Department must accept the following as proof of identity, provided such document has a photograph or other identifying information sufficient to establish identity, such as name, age, race, height, weight, eye color, or address:

(A) Driver's license issued by a state or territory.

(B) School identification card.

(C) U.S. military card or draft record.

(D) Identification card issued by the federal, state, or local government.

(E) Military dependent identification card.

(F) U.S. Coast Guard Merchant Mariner card.

(G) For children under the age 19, a clinic, doctor, hospital, or school record, including preschool or day care records.

(H) Two other documents containing consistent information that corroborates an applicant's identity. Such documents can include employer identification cards; high school, high school equivalency, and college diplomas; marriage certificates; divorce decrees; and property deeds or titles.

(c) The Department may accept the finding of identity from a federal or another state agency for the purposes of public assistance, law enforcement, internal revenue or tax bureau, or corrections, if the agency has verified and certified the identity of the individual.

(d) If the Department has verified an individual's citizenship via either a cross match with a state vital statistics agency documenting a record of birth, or a data match with the Department of Homeland Security's Systematic Alien Verification for Entitlements (SAVE) program, no additional proof of identity is needed.

(e) If the individual does not have any document specified in subsection (b) of this section, and identity cannot be verified under subsections (c) or (d) of this section, the Department must accept an affidavit signed, under penalty of perjury, by an individual other than the applicant who can reasonably attest to the applicant's identity. Such affidavit must contain the individual's name and other identifying information described in subsection (b) of this section.

(7) Social Security numbers. The Department must verify that the SSN furnished by an individual was issued to that individual. Acceptable sources of verification must show a correct Social Security number, including but not limited to:

(a) Social Security Card.

(b) Social Security award letters or other correspondence or forms bearing the individual's SSN.

(c) Medicare card, if the individual is receiving Medicare off their own record.

(d) Information provided electronically to the Department from the Social Security Administration.

(e) Wage stubs or unemployment records.

(f) IRS forms or letters.

(8) Pregnancy. The Department must accept self-attestation of pregnancy unless the Department has information that is not reasonably compatible with such attestation.

(9) Residency, age, date of birth, household size. The Department may accept self-attestation as verification of residency, age, date of birth, and household size, unless the statement differs from information available to the Department electronically or otherwise, in which case the Department may require the individual to provide documentation.

(10) If the Department is unable to verify information electronically or from a third party, the Department will accept, on a case-by-case basis, self-attestation to verify all eligibility criteria, except citizenship and immigration status, under the following circumstances:

(a) Documentation does not exist at initial application or redetermination; or

(b) Documentation is not reasonably available at initial application or redetermination, such as in the case of homelessness, domestic violence, or natural disaster.

(11) The Department may not deny, close, or reduce benefits if verification available to the Department is incompatible or absent, and the Department did not request additional information from the individual.

Or. Admin. Code § 461-115-0700

AFS 19-1993, f. & cert. ef. 10-1-93; AFS 1-2000, f. 1-13-00, cert. ef. 2-1-00; SSP 14-2007, f. 12-31-07, cert. ef. 1-1-08; SSP 25-2015, f. 9-29-15, cert. ef. 10/1/2015; SSP 35-2015, f. 12-23-15, cert. ef. 1/1/2016; SSP 25-2016(Temp), f. 6-30-16, cert. ef. 7-1-16 thru 12-27-16; SSP 31-2016, f. & cert. ef. 9/1/2016; SSP 33-2017, amend filed 12/8/2017, effective 1/1/2018; SSP 12-2018, minor correction filed 03/16/2018, effective 3/16/2018; SSP 33-2020, amend filed 09/21/2020, effective 10/1/2020; SSP 50-2022, amend filed 09/30/2022, effective 10/1/2022; SSP 55-2024, amend filed 09/30/2024, effective 10/1/2024

Statutory/Other Authority: 411.070, 411.404, 411.706, 413.085, 414.685, ORS 409.050, 411.060, 411.402, 42 USC 1396W & 42 CFR 435.940 - 435.965

Statutes/Other Implemented: ORS 409.010, 409.050, 411.060, 411.070, 411.404, 411.706, 413.085, 414.685, 414.839, 411.402, 42 USC 1396W & 42 CFR 435.940 - 435.965