Classic (non-MAGI) based programs manual

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Asset verification

Revised Date: 
December 3, 2020

Purpose: To explain the asset verification system (AVS) and new program requirements for applicants and recipients of long-term care services. 

WAC 182-503-0055 Asset verification system

Effective September 12, 2020

  1. This rule implements the asset verification system (AVS) outlined in section 1940 of the Social Security Act.
  2. This rule applies to any client, or those financially responsible for them, who is subject to:
    1. The disclosure of resources, as defined in WAC 182-512-0200, to determine eligibility; or
    2. Provisions related to the transfer of assets, as described in WAC 182-513-1363.
  3. For the purposes of this section:
    1. "Financial institution" means the same as defined in section 1101 of the Right to Financial Privacy Act, and may include, but is not limited to:
      1. Banks; or
      2. Credit unions.
    2. "Financial record" means any record held by a financial institution pertaining to a customer's relationship with the financial institution; and
    3. "Financial responsibility" is described in WAC 182-506-0015.
  4. You and any other financially responsible people must provide authorization for us to obtain any financial record held by a financial institution.
    1.  For you, the authorization may be provided by anyone described in WAC 182-503-0010 (1) and (2)(a), (b), or (c), except in the case of an authorized representative who must be designated by the client.
    2. For a financially responsible spouse, authorization may be provided by the spouse, their legal guardian, or their attorney-in-fact.
    3. The agency may grant an exception to rule as described in WAC 182-503-0090 if authorization is not provided by those listed in (a) and (b) of this subsection.
  5. The authorization, provided under subsection (4) of this section, will remain in effect until one of the following occurs:
    1. Your application for apple health is denied;
    2. Your eligibility for apple health is terminated; or
    3. You revoke your authorization in a written notification to us.
  6. We will:
    1. Use the authorization provided under subsection (4) of this section to electronically verify your financial records and those of any other financially responsible person to determine or renew your eligibility for apple health; or
    2. Inform you in writing at the time of application and renewal that we will obtain and use information available through AVS to determine your eligibility for apple health. 

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying information

Section 1940 of the Social Security Act 2008 (42 USC 1396w), requires all states to implement a system to verify resources/assets of aged, blind, or  disabled applicants and recipients of Medicaid through the use of an asset verification system. This includes individuals applying for or receiving long-term services and supports (LTSS) or Medicare Savings Program benefits. 

The AVS searches client financial institution accounts via several methods: 

  • Automatically searches for accounts at the largest financial institutions in the United States
  • Automatically searches for accounts at specific financial institutions based on the client's residential address, via a geographic search algorithm.
  • Allows financial eligibility staff to directly search for accounts at financial institutions where we believe the applicant/recipient has an account. 

AVS reports on the following account types: 

Checking accounts

 

Christmas club accounts

Savings accounts

Trusts

Certificate of deposit

Burial accounts

Money market accounts

Keogh accounts

IRA accounts

Rent security

Financial eligibility staff review the information received from financial institutions and resolve discrepancies with the client prior to the eligibility determination. 

AVS does not change how financial eligibility staff handles questionable situations; AVS is another tool to use to determine eligibility.

Clients, and those financially responsible for them, must provide authorization before an AVS search is submitted.

Once a client or financially responsible person gives authorization for use of AVS, it remains in place until the client or the financially responsible person cancels the authorization in writing, they are no longer eligible for coverage, or the application is withdrawn or denied. 

Worker responsibilities

NOTE: Please refer to your agency's AVS procedures documentation.

 

AVS Authorization

Staff must receive authorization in order to run an AVS search. Tickles will be generated approximately 90 days prior to the end of the renewal month for clients who do not have an AVS authorization in place. 

Staff should review the case record to determine whether authorization was granted on an application or review form previously received, or authorization was granted and documented in the ACES narrative. 

If authorization was granted, update the AVS authorization field to "AVS Authorized."

If authorization is not provided, request AVS authorization from the client. 

If there has been a break in medical coverage for more than 30 days, a new authorization is required. 

At renewal

AVS will provide banking information for the month the AVS search is submitted.

Approximately 60 days prior to the end of the renewal month, if an AVS authorization is in place for the client and financially responsible people (if applicable), an AVS request will be sent overnight via batch process. Fifteen days after submission AVS results will populate in the AVS portal.

At application

For Medicaid programs that do not  have a 60 month look back period, the AVS will provide 4 months of financial institution account balance data from the application date.

For Medicaid programs that have a 60 month look back period, the AVS will review accounts balances and transfers for the 60 month period from the application date.

An AVS request is sent after both the client and financially responsible person (if applicable) have a status of "AVS authorized." At that point, all financial institutions on the ACES resource page that have been added through the financial institution search, will be sent to the AVS vendor to directly search for records at that those financial institutions. An AVS2 tickle will be set for 16 days following submission.

AVS results

Financial staff must contact the applicant or recipient and give them the opportunity to provide the needed information to resolve a discrepancy and determine ongoing eligibility when AVS returns information that indicates: 

  • Inconsistent withdrawals during the look back period (for LTSS programs with a transfer look back period); or 
  • Bank accounts that are over the resource standard; or
  • Accounts not listed on the application, or disclosed during the interview (if an adverse action may be necessary); or 
  • Any other questionable information.

Financial eligibility staff cannot deny or terminate a case based solely on the information received from AVS or LexisNexis. Alternate verification must be requested.

If the client is ineligible due to transfers in the 60 month look back period, determine if there is eligibility for another medical program without a look-back period: 

  • S99 if client is resource eligible
  • MSP if the client is resource eligible
  • HWD if the client is disabled and working
  • TSOA eligibility

At application or eligibility review, once AVS results are received, document the client's resources in ACES.

Once results are reviewed in the portal and documented in ACES, the case must be closed in the portal using closed/withdrawn.