9.8 General Rules

Over-verification, including requiring excessive pieces of evidence for any one item or requesting verification that is not needed to determine eligibility, is prohibited. Once the accuracy of a written or verbal statement has been established, additional verification can’t be required. For example, once U.S. citizenship is verified, a member or applicant never has to verify it again (see Section 4.2 Verifying U.S. Citizenship).
If information has already been verified, the applicant or member does not need to verify it again except in the following situations:
1. There is reason to believe the information is fraudulent or differs from more recent information. If fraud is suspected, the IM agency will determine if a referral for fraud or for front-end verification should be made (see Section 9.10 Questionable Items).
2. The member reported a change to information that is subject to mandatory verification rules or is questionable.
3. At renewal, information is subject to mandatory verification rules or is questionable.
One particular type of verification can’t be exclusively required when various types are adequate and available.
Verification may be submitted in person, by mail, fax, e-mail, or electronically through ACCESS or the MyACCESS mobile app. Verification is not required to be presented in person.
Special groups or persons can’t be targeted based on race, color, national origin, age, disability, sex, religion, or migrant status for special verification requirements.
The applicant or member can’t be required to sign a release form (either blanket or specialized) when the applicant or member provides required verification.
Verification can’t be required for information that is not used to determine eligibility.
During verification, the applicant or member can’t be harassed or have their privacy, personal dignity, or constitutional rights violated.

Except for verification of access to employer-sponsored health insurance (see Section 9.9.7 Access to Employer-Sponsored Health Insurance), Child Welfare parent cooperation (see Section 10.1 Eligibility for Parent or Caretaker Relative of Child Removed from Home), and former Foster Care status (see Section 11.2 Former Foster Care Youth), the applicant or member has primary responsibility for providing verification and resolving questionable information. However, the IM worker must use all available data exchanges to verify information rather than requiring the applicant to provide it, unless the information from the data source is not reasonably compatible with what the applicant or member has reported (see Section 9.12 Reasonable Compatibility for Health Care).

IM agencies must assist the applicant or member in obtaining verification if they request help or have difficulty in obtaining it.

The best information available should be used to process the applicationA request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. or change within the time limit when both of the following conditions exist:

The applicant or member does not have the power to produce verification.
Information is not obtainable timely even with the IM worker's assistance.

Applicants meeting the health care program eligibility criteria based on this best available information are eligible for benefits. Even after the application or change is processed using best available information, the IM agency is required to continue in their attempts to obtain verification. When the verification is received, benefits may need to be adjusted based on the new information. The agency must explain this to the applicant or member when requesting verification.

This page last updated in Release Number: 23-04
Release Date: 12/18/2023
Effective Date: 12/18/2023