The verification process for Medicaid eligibility is usually through an electronic eligibility verification system. Medicaid agencies verify individual eligibility for Medicaid programs based on relevant provisions of the Affordable Care Act, according to the Medicaid website. This verification uses the criteria established by a state's preapproved verification plan.Continue Reading
As of 2013, Medicaid eligibility for individuals and families is based on several factors including income, residency status, age, Social Security status, citizenship, immigration status, family composition and pregnancies in the family, explains the Medicaid website. The federal government requires all state Medicaid agencies to develop and deploy an eligibility plan in compliance with requirements of the U.S. Federal Code. However, the practices governing the determination of eligibility are based on state guidelines. For example, some states permit their agencies to accept attested evidence without having to request more documentation from the applicant and act on factors that affect the applicant's eligibility for Medicaid.
Most states rely on electronically available data to determine eligibility, states the Medicaid website. Some states such as Nebraska and Louisiana have specific guidelines that require health care providers to verify patient eligibility under Medicaid before providing any services. Providers are also required to verify that patients are enrolled under Medicaid or Medicare through the state Eligibility Verification System or by telephone before processing a claim, according to the Louisiana Department of Health and Hospitals and the Nebraska Department of Health & Human Services.Learn more about Health Insurance