SECTION 3, Nonfinancial Criteria

Nonfinancial criteria are conditions of eligibility, other than income and resources, that must be met before Health Care Assistance can be authorized. (7-1-04)T

The participant must voluntarily live in Idaho and have no immediate intention of leaving. (7-1-97)

The "State of residence" is the state where an individual intends to live.

There is no time limit to determine residency.

Accept the participant's declaration of Idaho residence. No additional verification is necessary.

An individual who received Medicaid in another state can receive Medicaid in Idaho the same month. The individual must meet all other eligibility conditions. Treat Medicaid coverage in the other state as a third party resource.

(7-1-04)

To be eligible, an individual must be a member of one of the groups listed in Subsections 204.01 through 204.12 of this rule. (4-1-03)T

Qualified Immigrant Children. Qualified immigrant, as defined in 8 U.S.C. §1641(b) or (c), and PL 106-395, who is under age eighteen (18) –natural or adopted—of a U.S. Citizen, who is living in the US with his/her American parent as a permanent resident, is automatically a US citizen with out the need to apply for naturalization. Citizenship is not an issue for Family Medicaid regardless of their date of entry into the United States

Children who already met these requirements as of February 27, 2001 became US citizens automatically on that date.

This law means that a minor child of an alien permanent resident automatically becomes a US citizen upon the naturalization of either parent. (9-1-05)

02. U.S. National, National of American Samoa or Swains Island. A U. S. National, National of American Samoa or Swains Island; or (4-1-03)T

To be considered a U.S. citizen or non-citizen national the applicant must have been born in:

            -One of the 50 states
            -The District of Columbia
            -Puerto Rico
            -Guam
            -The Virgin Islands
            -American Samoa
            -Swains Island
            -The Northern Mariana Islands
                                                                                    (7/1/03)

03. Full-time Active Duty U.S. Armed Forces Member. A qualified non-citizen as defined in 8 U.S.C. 1641(b) or (c) currently on full-time active duty with the U.S. Army, U.S. Air Force, U.S. Marine Corps, U.S. Navy or U.S. Coast Guard, or a spouse or unmarried dependent child of the U.S. Armed Forces member; or (4-1-03)T

04. Veteran of the U.S. Armed Forces. A qualified non-citizen as defined in 8 U.S.C. 1641 (b) or (c) honorably discharged from the U.S. Army, U.S. Air Force, U.S. Marine Corps, U.S. Navy or U.S. Coast Guard for a reason other than their citizenship status or a spouse, including a surviving spouse who has not remarried, or an unmarried dependent child of the veteran; or (4-1-03)T

05. Non-citizen Entering The U.S. Before August 22, 1996. A non-citizen who entered the U.S. before August 22, 1996, and is currently a qualified non-citizen as defined in 8 U.S.C. 1641 (b) or (c); or (4-1-03)T

To be considered a ‘qualified’ non-citizen, the applicant must meet one of categories listed below. The Bureau of Citizenship and Immigration Services (BCIS formerly INS) determine the non-citizen’s status.

            -Lawful Permanent Residents (LPR)
            -Refugees
            -Asylees
            -Cuban and Haitian Entrants
            -Parolees
            -Non-citizens whose deportation has been withheld
            -Conditional Entrants
            -Battered Immigrants
            -Victims of a severe form of trafficking             (7/1/03)

PAROLEE

Definition: The Justice Department has discretionary authority to permit certain persons or groups to enter the U.S. in an emergency or because it serves the public interest. Parole may be granted for humanitarian, legal or medical reasons.

Verification: I-94, titled Arrival Departure Record@. Admitted under INA '212(d)(5) and status is granted for at least 1 year and the I-94 will read AIndefinite@.

SAVE Inquiry to verify name, alien #, birth date, entry date, status code, SSN.

PAROLEE

A person paroled into the U.S. for a period of at least one (1) year or who is a veteran honorably discharged for a reason other than citizenship status or on active duty in the U.S. Armed Forces for other than training, or the spouse or unmarried dependent of the veteran or person on active duty is eligible.

NOTE: A parolee remains eligible for the period of time they are granted Parolee status by the Attorney General. Parolee status also ends

     - When the parolee status changes to one of the qualified alien status

     -   The parolee returns to their country of origin

     -   The parolee is accepted for legal admission to the United States

Complete a SAVE at renewals to verify Citizenship status (3/25/05)

06. Non-citizen Entering On Or After August 22, 1996. A non-citizen who entered on or after August 22, 1996, and (4-1-03)T

a. Is a refugee admitted into the U.S. under 8 U.S.C. 1157, and can be eligible for seven (7) years from their date of entry; or (4-1-03)T

A Refugee is an individual who fled their country due to persecution, or a fear of persecution, because of race, religion, nationality, political opinion, or membership in a social group, admitted under Section 207 of the INA.

BCIS Document - I-94, Arrival Departure Record sometimes annotated with "Refugee" or "Refugee-Conditional Entrant".

For refugees, the date of entry is the status date.

Status Codes: RF, REF, RE6, RE7, RE8 (7/1/03)

b. An asylee granted asylum into the U.S. under 8 U.S.C. 1158, and can be eligible for seven (7) years from the date their asylee status is assigned; or (4-1-03)T

An asylee is similar to a refugee, but the individual seeking asylum is already in the U.S. when they request permission to stay.

BCIS Document: I-94 "Arrival Departure Record" and/or BCIS letter.

Status Codes: AS1, AS2, AS3, AS6, AS7, AS8 (7/1/03)

c. An individual whose deportation or removal has been withheld under 8 U.S.C. 1253 or 1231(b)(3) as amended by Section 305(a) of Division C of Public Law 104-208, and can be eligible for seven (7) years from the date their deportation or removal was withheld; or (4-1-03)T

An individual whose status is "Deportation withheld" is similar to refugees and asylees. The person was in the U.S. and requested permission to stay but their request was denied. The person appealed the denial and an immigration judge withheld deportation to allow the person to prove asylee status could be met.

BCIS Document: I-94, "Arrival Departure Record" and/or a letter from an immigration judge.

Status Codes: AS1, AS2, AS3, AS6, AS7, AS8 (7/1/03)

d. An Amerasian immigrant admitted under 8 U.S.C. 1612(b)(2)(A)(i)(V), can be eligible for seven (7) years from the date of entry; or (4-1-03)T

An Amerasian is a person born in Vietnam after 1/1/62, and before 1/1/76, fathered by a U.S. citizen. The Amerasian’s mother, her spouse, her other children or someone who has acted as the Amerasian’s mother, father or next of kin (and the spouse and children of that person) are also included in this eligible legal non-citizen category.

BCIS Document - I-94, Arrival Departure Record sometimes annotated with "Refugee" or "Refugee-Conditional Entrant."

Status Codes: AM1, AM2, AM3 (7/1/03)

e. A Cuban or Haitian entrant under Section 501(e) of the Refugee Assistance Act, and can be eligible for seven (7) years from their date of entry; or (4-1-03)T

An individual in one of the groups of Cuban and Haitian immigrants admitted before 1980.

BCIS Document - I-94, Arrival Departure Record sometimes annotated with "Refugee" or "Refugee-Conditional Entrant."

Status Codes: CU6, CU7, CH6, C7P (7/1/03)

07. Qualified Non-citizen Entering On Or After August 22, 1996. A qualified non-citizen under 8 U.S.C. 1641(b) or (c), entering the U.S. on or after August 22, 1996, and who has had a qualified non-citizen status for at least five (5) years; or (4-1-03)T

A Lawful Permanent Resident (LPR) is a person residing permanently in the United States with qualified non-citizen status. After the person has held Lawful Permanent Resident status and resided in the United States for five years, the person can apply for U.S. citizenship.

BCIS Document - I-151 commonly known as a "Green Card." INS stopped issuing I-151 documents March 1996. The I-551, "Resident Alien Card" replaced the I-151.

Status Code: LPR                                                       (7/1/03)

A battered immigrant is a non-citizen who has been battered, or whose child has been battered, by a spouse, a parent, or a member of the family in the same household.

BCIS Document: Proof of legal entrance into the U.S.

Status Codes: BX1, BX2, BX3, BX6, BX7, BX8, B11, B12, B16, B17, B20, B21, B22, B23, B24, B25, B26, B27, B28, B29, B31, B32, B33, B36, B37, B38, IB1, IB2, IB3, IB6, IB7, IB8                                                                               (7/1/03)

NOTE: Parolee status does not apply to non-citizens entering on or after August 22, 1996 (3/25/05)

08. American Indian Born In Canada. An American Indian born in Canada under 8 U.S.C. 1359 applies; or (4-1-03)T

09. American Indian Born Outside The U.S. An American Indian born outside of the United States, and is a member of a U.S. federally recognized tribe under 25 U.S.C. 450 b(e); or (4-1-03)T

10. Qualified Non-citizen Child Receiving Federal Foster Care. A qualified non-citizen child as defined in 8 U.S.C. 1641(b) or (c), and receiving federal foster care assistance; or (4-1-03)T

11. Victim Of Severe Form Of Trafficking. A victim of a severe form of trafficking in persons, as defined in 22 U.S.C. 7102(13); who meets one (1) of the following: (4-1-03)T

b. Is certified by the U.S. Department of Health and Human Services as willing to assist in the investigation and prosecution of a severe form of trafficking in persons; and (4-1-03)T

i. Has made a bona fide application for a T visa under 8 U.S.C. 1104(a)(15)(T), which has not been denied, or (4-1-03)T

ii. Is remaining in the U.S. to assist the U.S. Attorney General in the prosecution of traffickers in persons. (4-1-03)T

What is a trafficking victim?

A trafficking victim is a person brought into the U.S. and forced into prostitution, slavery or forced labor. The victim is forced by coercion, physical threats, psychological abuse, torture or imprisonment. Trafficking victims are usually women and children.

Treat trafficking victims like refugees.

Immigration Documentation: The federal Office of Relocation of Refugees issues the certification letters to victims willing to help in the investigation and prosecution of the trafficking crime. Adults must also apply for a T Visa, or get permission from the U.S Attorney General to stay in the U.S.

Use the verification phone number (202) 401-5510 to confirm the certification letter is valid. (7/1/03)

SAVE ONLINE VERIFICATION

To verify citizenship status, go to the SAVE Online Verification Web Site using the link below. A user ID and password are required to log onto the system. If you do not have an ID and password contact your supervisor.

There is an online tutorial provided to help you navigate through the system.

SAVE Logon

On the first screen, under On-line Resources, there is a link to the SAVE Users Manual. You can also click on the link below. Review the manual when you have a question about the SAVE process or the information you receive from an inquiry.  Save Users Manual

                                                                                P (7-1-04)

Income and resources of a legal non-citizen's sponsor and the sponsor's spouse are counted in determining eligibility. (8-22-97)

The sponsor or sponsor’s spouse’s income and resources should only count for the non-citizens that they have agreed to support. If the non-citizen has children who are citizens, the sponsor’s income does not count towards the child when determining eligibility.

EXCEPTIONS TO SPONSOR DEEMING:

1. A Legal Non-citizen whose sponsor signed an affidavit of support is exempt from deeming if:

a. The legal non-citizen is sponsored by an organization or group.
b. The legal non-citizen has become a U.S. citizen
c. The legal non-citizen did not sign a form I-864 Affidavit of Support.
d. The legal non-citizen’s sponsor is deceased.
e. The legal non-citizen is not required to have a sponsor

2. For sponsor deeming, a battered legal non-citizen includes the non-citizen and the child of the non-citizen. The non-citizen or child must be battered in the U.S. by a spouse, parent, or member of the family in the same household. The non-citizen must not participate in or acquiesce to the battering of the child.

3. A non-citizen is indigent if the household income does not exceed 130 percent of the poverty guideline for the household size.

a. A legal non-citizen can elect to decline the indigent exemption to avoid: Sponsor liability and Notification to the INS

b. If the legal non-citizen declines the indigent exemption the household is subject to sponsor deeming.

The sponsor or sponsor’s spouse’s income and resources should only count for the non-citizens that they have agreed to support. If the non-citizens have children who are citizens, the sponsor’s income does not count towards them when determining eligibility.

Section 213 of the Immigration and Naturalization Act requires that a sponsor signing Form I-864, Affidavit of Support, must reimburse the Department for Health Care Assistance benefits paid for a sponsored qualified noncitizen. (7-1-04)T

An applicant must provide his Social Security Number (SSN), or proof he has applied for an SSN, to the Department before approval of eligibility. If the applicant has more than one (1) SSN, all numbers must be provided. The SSN must be verified by the Social Security Administration (SSA) electronically. When an SSN is unverified, the applicant is not eligible for Health Care Assistance. The Department must notify the applicant in writing if eligibility is being denied or lost for failure to meet the SSN requirement. (7-1-04)T

01. Application for SSN. The applicant must apply for an SSN, or a duplicate SSN, when he cannot provide his SSN to the Department. If the SSN has been applied for but not issued by the SSA, the Department cannot deny, delay or stop benefits. The Department will help an applicant with required documentation when the applicant applies for an SSN. (3-8-04)

02. Failure to Apply for SSN. The applicant may be granted good cause for failure to apply for an SSN if they have a well-established religious objection to applying for an SSN. A well-established religious objection means the applicant: (3-8-04)

a. Is a member of a recognized religious sect or division of the sect; and (3-8-04)

b. Adheres to the tenets or teachings of the sect or division of the sect and for that reason is conscientiously opposed to applying for or using a national identification number. (3-8-04)

03. SSN Requirement Waived. An applicant may have the SSN requirement waived when he is: (3-8-04)

a. Only eligible for emergency medical services as described in Section 602 of these rules; or (7-1-04)T

SSN Requirement Handbook Material

If EPICS receives an ‘E’ (error code) from SOLQ, an ‘E’ will be entered on CLRE and CLPR in the VER G/C field and an alert will be generated on ALEN and CLAL for the individual. The applicant must provide proof they have corrected the discrepancy with SSA before they can be eligible for benefits.

If one of the following alerts is generated for an applicant, check the applicant’s name, SSN, and date of birth to ensure the information has been keyed in EPICS correctly. If the applicant’s information was entered as it is shown on the AFA, notify the applicant that they must correct the described discrepancy with SSA. Give the applicant at least 10 days to provide proof they have corrected the problem with SSA. The applicant must provide proof they have corrected the problem with SSA and the SSN must Numident before they can be eligible for benefits.

SSN Not Verified, SSA Did Not Find SSN In File

SSN Not Verified, SSA Has DOB XX/XX/XXXX

SSN Not Verified, Name Does Not Match SSA Name

If an applicant has more than one SSN and the following alert is generated for the applicant, notify the applicant that they must provide all of their SSNs to the Department. Give the applicant at least 10 days to provide the requested information. The applicant must provide all SSNs before they can be eligible for benefits.

SSN Verified, Additional SSNs Found

If one of the following alerts is generated for an applicant, the alert is for your information only and can be deleted without taking any additional action.

            -Unable to Verify SSN On-Line. Verification Pending.
            -SSN Verified by SSA
            -SSN Verified w/Last Name Ignored
            -SSN Verified by SSA & Changed to XXX-XX-XXXX
(7-1-03)

Title XIX Medicaid and CHIP A participants must apply for and enroll in a cost effective group health plan if one is available. A cost effective health plan is one which has premiums and co-payments at a lower cost than Medicaid would pay for full medical services. Medicaid will pay premiums and other co-payments for plans the Department finds cost effective. (7-1-04)T

A group health plan is one offered by employers.

A child's eligibility is not affected by a parent or caretaker's failure to cooperate in group health plan enrollment.

A child receiving Medicaid in the CHIP coverage group remains eligible if enrolled in a cost-effective group health plan, when the cost of the plan is paid by Medicaid.

Get medical insurance information from participants on the "Health Insurance Premium Payment" (HIPP) application form. If an applicant states they have access to insurance that they cannot afford, or expresses an intention of dropping coverage already in place if they qualify for Medicaid, fill out a HIPP application and send it to Medicaid. If there is an interview, give the HIPP application to the participant during the interview. If there is no interview, mail the HIPP application with the Medicaid approval notice. Do not send a new HIPP application at redetermination. Send a new HIPP application if the participant reports new insurance.

Assume the participant provided the Division of Medicaid with the insurance information. (7-1-04)

By operation of Section 56-203B and Section 56-209b(3), Idaho Code, medical support rights are assigned to the Department by signature on the application for assistance. The participant must cooperate to secure medical support from any liable third party. The cooperation requirement may be waived if the participant has good cause for not cooperating. (7-1-04)T

EARLY REFERRAL TO CSS

The Early Referral process automatically opens the full service child support case for persons applying for assistance, before the assistance is approved or denied. This gives CSS a head start on collecting support.

For Early Referral, key information into DEPR before approval or denial of benefits.

When and How to Request an Early Referral:

A participant can request early referral any time during the application process. If the participant wants full child support services they must complete the HW 0430.

The minimum information required to key DEPR for early referral is the non-custodial parent's name and current address. If this information is not available, do not request early referral until the information is received.

Send the referral information and any supporting documents to CSS as soon as possible (at the latest, when assistance is approved.)

If the participant does not want full child support services, do not request early referral. EPICS will refer the case to ICSES after assistance is approved and benefits issued to the participant. (7-1-04)

A participant enrolled in the Health Care Assistance programs must cooperate to identify and locate the non-custodial parent, establish paternity, and establish, modify and enforce a medical support order. A participant who cannot legally assign his own rights, such as a child, must not be denied Health Care Assistance if the legally responsible person does not cooperate. A parent of any age can legally assign rights to medical support for his own child or children. The cooperation requirement may be waived if the participant has good cause for not cooperating as described in Subsection 217.02 or if the participant is a poverty level pregnant woman exempt from cooperating in establishing paternity and obtaining medical support from, or derived from, the father of the unborn child. (7-1-04)T

Custodial parents or Relative Caretakers must cooperate with Child Support Services (CSS) to:

            -Identify and locate a non-custodial parent
            -Establish paternity
            -Establish and enforce an order for medical support for a child born out-of-wedlock

Custodial parents or Relative Caretakers that do not cooperate and do not have good cause for not cooperating, are not personally eligible for Medicaid. The exception to CSS cooperation is a pregnant woman who fails to cooperate in establishing paternity for her unborn or newborn child.

If the Department has record of the minimum information required, the participant is in compliance with cooperation requirements.

A parent or caretaker's failure to cooperate does not affect the child's eligibility.

If a child is applying for or receiving Medicaid, and there is a parent absent from the home, get the following information and make a referral to CSS:

            -Child/Medical Support referral (HW 0429). The information may be obtained by telephone. A tool other than the HW0429 may be used to get equivalent information.

            -Acknowledgement of Paternity (HW0142, HWWP001) or Filiations Declaration (CSS354), if appropriate

            -Child Support Agreement form (Needed for full services)

If the application is for Medicaid for children only, do not delay processing until the information and forms are received. If the parent or caretaker is also applying for Medicaid, allow the participant ten days to provide the information. If the participant fails to provide the information, process Medicaid for the child. Deny Medicaid for the adult, unless they have good cause for not cooperating.    (7-1-04)

01. Cooperation Defined. Cooperation includes providing all information to identify and locate the noncustodial parent and identifying other liable third party payers. The participant must provide the first and last name of the noncustodial parent. The participant must also provide at least two (2) pieces of information about the noncustodial parent, listed in Subsections 217.01.a. through 217.01.g. (7-1-04)T

f. Make, model, and license number of any motor vehicle owned by the noncustodial parent. (7-1-99)

g. Names, phone numbers and addresses of the parents of the noncustodial parent. (7-1-99)

Cooperation in getting cash support is not a condition of Medicaid eligibility. Participants applying for or receiving Medicaid for a child have the right to request full child support services, including collection of cash support. The advantages of cooperating with Child Support Services and the benefits of receiving full services should be discussed with all participants. (7-1-04)

02. Good Cause Defined. The participant may claim good cause for failure to cooperate in securing medical support for a minor child. Good cause is limited to the reasons listed in Subsections 217.02.a. through 217.02.c. (4-5-00)

a. There is proof the child was conceived as a result of incest or rape. (7-1-99)

b. There is proof the child's noncustodial parent may inflict physical or emotional harm to the participant, the child, the custodial parent or the caretaker relative. (7-1-99)

c. A credible explanation is provided showing the participant cannot provide the minimum information regarding the noncustodial parent. (3-30-01)

See Appendix A for instructions on Acknowledgment of Paternity Affidavit (HWHP001). (7-1-04)

CREDIBLE EXPLANATION

A credible explanation, showing the participant cannot provide information on the non-custodial parent, includes:

            1. Participant's statement of the circumstances of the pregnancy.
            2. Participant's statement of what she does know about the child's father.
            3. Collateral statements from people knowledgeable of the circumstances.
            4. Information from other states where the participant applied for benefits.
            5. Participant's statement of attempts made to find the identity of the child's father.

The statement should include:
            a. Who the participant contacted.
            b. When she talked to them.
            c. Where they live.
            d. Information they gave.                                 (7-1-04)

PROCEDURES FOR MEDICAL SUPPORT FAILURE TO COOPERATE GOOD CAUSE CLAIM

A person claiming good cause for failure to cooperate must sign and date an HW 0431 for the case record. The person must also submit a statement:

            1. Identifying the child for whom the exemption is claimed.
            2. Listing the reasons for the good cause claim.

Allow the person twenty (20) days to supply evidence supporting the claim. The SRS and Supervisor review the evidence submitted.

Self Reliance makes the final decision on the claim after consultation with CSS. Make a decision on the claim within thirty (30) days of the claim. Do not delay, deny or stop Medicaid pending the decision on a good cause claim.

Waive the cooperation requirement if good cause exists. Take no further action to establish paternity or obtain support.

If good cause does not exist:

            1. Notify the participant about the decision.
            2. Inform the participant they have the option to withdraw the application, or close the case if it is already open.
            3. Tell them about the cooperation requirement again and that the SRS will refer the case to CSS.
            4. Tell them about using the family violence indicator.
            5. Disqualify the person if they still refuse to cooperate.                                                        (7-1-04)

CHIP A, CHIP B and Children’s Access Card participants must cooperate with Child Support unless there is good cause. All participants in CHIP A, CHIP B and Children’s Access Card are children; therefore, closure or denial for not cooperating with Child Support will only happen in the scenario below:

A minor parent applies for CHIP A, CHIP B, or Children’s Access Card for themselves and their child. The father of the child does not live in the home. The minor parent does not cooperate with Child Support on their child. The minor parent is denied coverage for not cooperating with Child Support for their child. The child is eligible and enrolled in CHIP A, CHIP B, or Children’s Access Card. (7-1-04)

A Medicaid participant who also receives Temporary Assistance for Families in Idaho (TAFI) must meet work program requirements of TAFI. A participant ineligible for TAFI because of a work program requirement is ineligible for Medicaid unless the participant is pregnant or is a minor child who is not the head of the household. (7-1-97)

For the first occurrence, the participant is ineligible for Medicaid for one calendar month. For any subsequent occurrence, the participant is ineligible for three calendar months. (7-1-04)

When the Department or federal government selects a case for review in the quality control process, the participant must cooperate in the review of the case. (10-1-98)

When a participant is unwilling to participate in or provide information for a Quality Control (QC) review :

            -Send a notice to the participant
            -Close the case 10 days after the notice was sent

A QC review period follows the federal fiscal year and is from October 1^st through September 30^th. If a participant reapplies within the review period or within 95 days of the end of the review period, they must cooperate with the QC review before they receive benefits.                           (7-1-04)

EFFECT OF NONCOOPERATION ON MEDICAID FOR PREGNANT WOMEN
In each situation described: The pregnant woman is NOT married to the unborn’s father. The born children are living with her.
COVERAGE GROUPS	SITUATION	ACTION
PW	No other children living with her. Not cooperating on unborn.	Eligible through postpartum period.
PW	Also has born children receiving Medicaid. IS NOT cooperating for born children.	Not eligible because of failure to cooperate on born children.
PW	Also has born children. IS cooperating for born children.	Eligible through postpartum period.
PW	Also has born children. IS cooperating for born children but IS NOT cooperating for unborn.	Eligible through postpartum period.
MA/MU, ME, QP	No other children. Not cooperating on unborn.	Not eligible for MA/MU, ME or QP. Close, register and open PW through postpartum period.