Application
Application
A state Medicaid agency may require an applicant to provide his/her social security number (SSN). However, Medicaid regulations clarify that the agency has an affirmative obligation to assist an applicant in obtaining an SSN from the Social Security Administration if he or she has not yet applied or cannot recall his or her SSN.[1] Further, “the agency must not deny or delay services to an otherwise eligible applicant pending issuance or verification of the individual’s SSN by SSA.”[2]
Notwithstanding these regulations, some agencies still require (at least in practice) applicants to provide verification of their SSN.[3] Typically, they may do so by showing a Social Security card; a driver’s license[4]; or a tax form, loan document, or pay stub listing the SSN. Also, agency assistance may be limited to handing an applicant the correct form from SSA. It is therefore important to confirm the verification practices used in a particular jurisdiction.
In some cases, jail and prison officials may know an inmate’s Social Security number (e.g., through notes in an inmate’s record or self-reporting) but not have official documentation. To preempt some of the logistical challenges described above, jail and prison officials could develop a form letter of “SSN verification” and negotiate with Medicaid offices to accept this letter as a valid proof of SSN, at least for the initial application.
In addition, jail and prison administrators might want to initiate an interagency agreement with SSA to issue replacement Social Security cards for individuals who were or are enrolled in SSI/SSDI programs. SSI/SSDI records should include information about beneficiaries’ SSNs.
Since the passage of the Deficit Reduction Act (DRA) of 2005 [5] (see sec. 6036), Medicaid applicants claiming to be U.S. citizens are now required to prove their citizenship. Before the passage of the DRA, many if not most states allowed applicants to self-attest to their citizenship status, though there are some exemptions.[6]
Applicants who are subject to the new DRA provisions can satisfy the new verification requirement by providing “primary evidence” of U.S. citizenship (i.e., a U.S. passport, Certificate of Naturalization, or Certificate of U.S. Citizenship). If they cannot provide such documentation, they must produce multiple pieces of “secondary evidence.”[7] To satisfy the “secondary evidence” requirements, applicants normally provide copies of their (1) birth certificates and (2) a sanctioned form of identification.
If individuals do not have birth certificates or other forms of identification, corrections officials may consider purchasing replacement documents. There is variation among states in how replacement birth certificates and other vital records can be obtained, as well as associated costs with replacing documents. One Web site (www.vitalrec.com) provides an online directory of vital-records offices throughout the United States and its territories with contact information and fees for replacing particular documents.
In the light of cost and logistical limitations, it may be challenging for corrections officials to obtain birth certificates and other traditional identification documents. Jail and prison officials can take different approaches to ensure that case managers and other corrections staff have resources to assist applicants in meeting identification requirements outlined in DRA:
- Medicaid
If a birth certificate were unavailable or unobtainable, a Medicaid agency could accept other documents such as “institutional admission papers from a nursing facility, skilled care facility or other institution,” if the document was created at least 5 years before the initial application date and included a U.S. place of birth.[8] Presumably, a corrections inmate record would suffice, although prison officials would need to confirm this with their state agency overseeing Medicaid.
The acceptable forms of proof of identity (required unless an applicant provides “primary evidence” of U.S. citizenship) is also detailed in federal regulations.[9] Before the implementation of the DRA, many states used liberalized verification rules for identity to facilitate eligibility for homeless populations.[10] Despite the general retreat from the more permissive identity document requirements, the Centers for Medicare and Medicaid’s recently published rules allow states some measure of flexibility, and the regulations specifically allow the use of corrections records as identity documents.[11]
To confirm that the federal policy is carried out in local agency practice, it may be advantageous for jail and prison officials to meet with state Medicaid agency staff and (1) share with the Medicaid agency samples of corrections records and (2) request that the Medicaid agency issue new policy guidance to its eligibility staff (and update its Policy Manual) about the acceptability of such records as identity documents.
- SSI/SSDI
SSA’s policy regarding the confirmation of SSI applicants’ identity is available from the Program Operations Manual System SI 00601.062: Verifying Claimant Identity.[12] As per this policy, applicants will be required to answer a series of questions related to identity when meeting with SSA officials. Assuming applicants can answer these questions, they may not need to provide identification documents such as a birth certificate or driver’s license at least during the initial interview.
In general, applicants to Medicaid and SSI/SSDI will need to provide contact information for physicians who provided physical and/or mental health care as well as records from such physicians that outline clinical diagnoses to substantiate claims of disability. State Medicaid agencies will usually offer a standardized form for physicians to fill out that more specifically solicits the type of information needed to substantiate such claims.[13]
State Disability Determination Services (DDS), which evaluate disability claims for applicants for Social Security disability benefit programs, are responsible for gathering medical documentation to support claims of disability. However, when applicants provide medical documentation of disability in an application, it can significantly reduce the time it takes to review these claims. In addition, when DDS staff have insufficient medical evidence to make a determination, they will order an independent consultative evaluation (CE) of an applicant.[14] CEs can add considerable lag time to the processing of applications.
Officials in prisons and jails may wish to take a number of steps to make it easier for staff assisting with benefits applications to gather required medical documentation for SSI/SSDI and Medicaid applications. Particularly in the case of jails, officials may develop information-sharing agreements with local community behavioral health care providers to identify incoming inmates who may have received medical services at these community providers. These providers may be able to provide some clinical evidence for disability claims.[15]
In addition, jail and prison administrators might initiate agreements with community behavioral health providers or medical staff working within jails or prisons to conduct clinical evaluations of individuals that can be used in applications to substantiate disability.
SSDI applications can be submitted electronically. For both SSI and SSDI, the “Disability Report Form,” required for applications, can also be submitted electronically. In addition, whenever possible, medical records can be submitted electronically.
For other types of applications and documentation that must be submitted via U.S. mail, prisons and jail officials can use certified mail or signed receipts to better track the submission of these materials. The rate of “lost” case materials is surprisingly large. This procedure helps to establish accountability on the part of both the jail or prison and the staff of agencies receiving applications and documentation.
In addition, another major hurdle to processing benefit applications is establishing an address for inmates after release to which benefit materials can be mailed. Some jails and prisons have addressed this issue by developing agreements with probation/parole agencies or case management services whereby benefit materials are mailed to those agencies instead of to the beneficiary’s address.
Application ProcessingState Medicaid offices must provide disability evaluations within 90 days.[16] Disability determinations under Social Security can potentially take much longer. According to the National Health Care for the Homeless Council, waiting periods average 1–3 years between application and final eligibility determination[17] and applications can take even longer if appeals are filed.
[1] 42 CFR § 435.910(e)
[2] 42 CFR § 435.910(f)
[3] Such practices may be relatively more common in agencies that determine eligibility for multiple benefits (e.g., TANF, Food Stamps, Medicaid, etc.).
[4] Most state Departments of Motor Vehicles are moving away from including the SSN on drivers licenses.
[5] P.L. 109-171, as amended by § 405©(1) of the Tax Relief and Health Care Act of 2006 (TRHCA), P.L. 109-432.
[6] 42 CFR §§ 435.406(a)(1)(v) and 406(a)(2). The following individuals are exempt from the DRA’s new verification requirements : SSI recipients; SSDI recipients; Medicare enrollees (whether enrolled in Parts A, B, C, and/or D) Foster children and subsidized adopted children ; and Persons claiming to be noncitizens.
[7] 42 CFR §§ 435.406-407, as adopted 71 FR 39214 36813 (July 12, 2006, effective July 6, 2006), and amended at 72 FR 38662 (July 13, 2007). See also CMS’ State Medicaid Directors (SMD) letter (June 9, 2006).
[8] 42 CFR § 435.407(d)(3). See also n. 10 infra.
[9] 42 CFR § 435.407(e). Note that most if not all state drivers licenses are not acceptable forms of identification. See n. 7 infra.
[10] For example, some jurisdictions allow DOC identification cards to suffice as proof of identity.
[11] 42 CFR § 435.407(e)(2) states, “at State option, a State may use a cross match with a Federal or State governmental, public assistance, [p]revious law enforcement or corrections agency’s data system to establish identity if the agency establishes and certifies true identity of individuals. Such agencies may include food stamps, child support, corrections, including juvenile detention, motor vehicle, or child protective services. The State Medicaid Agency is still responsible for assuring the accuracy of the identity determination.”
[13] See sample forms from Washington D.C.
[14] Stepping Stones to Recovery, Chapter 3, page 17 lists types of Medical Information required in applications.
[15] Any agreements should take Health Insurance Portability and Accountability Act (HIPAA) provisions into account
[16] See 42 CFR § 911(a)(1)
[17] Joint Comments from Homeless Advocacy Organizations on Proposed Changes in the Administrative Review Process for Adjudicating Initial Disability Claims, NPRM 05-14845, submitted to the Social Security Administration, October 21, 2005 by National Health Care for the Homeless Council et al.