5101:1-37-03.1 Medicaid: income and eligibility verification system (IEVS).

(A) This rule describes the requirements in section 1137 of the Social Security Act (as in effect on November 1, 2009) and in section 42 C.F.R. 435.940 (as in effect on November 1, 2009), requiring state agencies administering certain federally funded, state administered public assistance programs, to establish procedures for obtaining, using and verifying information relevant to determinations of eligibility. The Ohio department of job and family services shall obtain and share income and benefit information with the following sources:

(1) The social security administration (SSA).

(2) The internal revenue service (IRS).

(B) Definition of IEVS. "IEVS" means income and eligibility verification system that shares income and asset information among SSA, IRS and the administrative agency.

(C) Administrative agency responsibilities. The administrative agency shall:

(1) Provide adequate safeguards in accordance with rule 5101:1-37-01.1 of the Administrative Code.

(2) Inform all individuals in writing at the time of application and reapplication that the agency will obtain and use information available from IEVS to assist in the determination of eligibility under section 1137 of the Social Security Act.

(3) Within forty-five days of receipt of the information, review and compare against the case file all information received to determine whether it affects the individual's eligibility. Obtain verification, if appropriate, to determine eligibility and initiate appropriate action in accordance with 42 C.F.R. 435.952(c) (as in effect on November 1, 2009). For applicants, if the information is received during the application period, it must be used to the extent possible to make eligibility determinations, in accordance with 42 C.F.R. 435.952(b) (as in effect on November 1, 2009).

(4) Verify the information, in accordance with 42 C.F.R. 435.955(b) (as in effect on November 1, 2009) by:

(a) Contacting the originating entity, from which the information came, to verify the fact and amount of the income, resources or both; or

(b) Sending the individual a letter which includes the information received and requesting a response within a specified period. The letter must clearly explain what information was received and the relevance to the individual's past, current or future eligibility. The individual shall be given an opportunity to contest such findings.

(c) The number of determinations delayed beyond forty-five days from receipt, must not exceed twenty per cent of the reviews provided the reason for the delay is due to nonreceipt of verifications. Otherwise, all determinations shall be made promptly.

(5) Not terminate, deny, suspend benefits until appropriate steps have been taken to verify the information in accordance with 42 C.F.R. 435.955(a) (as in effect on November 1, 2009). The administrative agency must verify information relating to:

(a) The amount of the income and resource that generated the item involved;

(b) Whether the individual actually has or had access and use of the resource, income, or both;

(c) The period of time during which the individual actually has or had access to the resource, income, or both.

(6) Make the decision to exclude duplicate information or earnings information previously researched in accordance with 42 C.F.R. 435.953(c) (as in effect on November 1, 2009).

(7) Maintain the individual's data in a standardized format that allows the administrative agency to furnish and to obtain eligibility and income information from the agencies listed in paragraph (A) of this rule or programs referenced in 42 C.F.R. 435.948(a) in accordance with 42 C.F.R. 435.960(a) (as in effect on November 1, 2009).

Replaces: 5101:1-37- 03.1

Effective: 11/01/2009
R.C. 119.032 review dates: 11/01/2014
Promulgated Under: 111.15
Statutory Authority: 5111.01 , 5111.011
Rule Amplifies: 5111.01 , 5111.011
Prior Effective Dates: 1/1/83, 12/1/86, 3/13/87 (Emer.), 5/4/87, 9/1/89 (Emer.), 11/30/89, 1/1/90 (Emer.), 4/1/90, 1/1/93, 9/1/94, 11/1/96, 7/1/98, 7/1/99, 10/1/02, 10/6/03