C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 435—ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA › Subpart J—Eligibility in the States and District of Columbia

42 C.F.R. § 435.948

Verifying financial information

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(a) The agency must in accordance with this section request the following information relating to financial eligibility from other agencies in the State and other States and Federal programs to the extent the agency determines such information is useful to verifying the financial eligibility of an individual:

(1) Information related to wages, net earnings from self-employment, unearned income and resources from the State Wage Information Collection Agency (SWICA), the Internal Revenue Service (IRS), the Social Security Administration (SSA), the agencies administering the State unemployment compensation laws, the State-administered supplementary payment programs under section 1616(a) of the Act, and any State program administered under a plan approved under Titles I, X, XIV, or XVI of the Act; and

(2) Information related to eligibility or enrollment from the Supplemental Nutrition Assistance Program, the State program funded under part A of title IV of the Act, and other insurance affordability programs.

(b) To the extent that the information identified in paragraph (a) of this section is available through the electronic service established in accordance with § 435.949 of this subpart, the agency must obtain the information through such service.

(c) The agency must request the information by SSN, or if an SSN is not available, using other personally identifying information in the individual's account, if possible.

[77 FR 17211, Mar. 23, 2012]
Notes of Decisions
Cited in 8 cases, 2007–2020 · leading case: In Re Lowy (Dept. of Health & Hum. Servs.), 931 A.2d 552 (N.H. 2007).
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In Re Lowy (Dept. of Health & Hum. Servs.), 931 A.2d 552 (N.H. 2007). “As part of an eligibility determination, the State is required by 42 C.F.R. § 435.948 (a)(6) (eff. Feb. 28, 1986) to verify “[a]ny .”
C.F.J. Vs. Div. of Med. Assistance & Health Servs. (Div. of Med. Assistance & Health Servs.) (N.J. Super. Ct. App. Div. 2018). · cites it 4× “[ 42 C.F.R. § 435.948 (a)(1)-(2).] The federal regulations further provide that "[t]o the extent that the information identified in paragraph (a) of this section is available through the electronic service established in accordance with § 435.”
J.F. Vs. Div. of Med. Assistance & Health Servs. (Div. of Med. Assistance & Health Servs.) (N.J. Super. Ct. App. Div. 2019). · cites it 3× “[ 42 C.F.R. § 435.948 (a)(1) to (2) (2013).”
V.S. Vs. Div. of Med. Assistance & Health Servs. (Div. of Med. Assistance & Health Servs.) (N.J. Super. Ct. App. Div. 2018). · cites it 3× “Appellant further argues that under 42 C.F.R. § 435.948 (b), the BCBSS had the "affirmative duty to obtain information regarding" her eligibility.”
M.H. Vs. Div. of Med. Assistance & Health Servs. (Div. of Med. Assistance & Health Servs.) (N.J. Super. Ct. App. Div. 2019). · cites it 3× “[ 42 C.F.R. § 435.948 (a)(1) to (2) (2013).”
Poindexter v. Ohio Dept. of Job & Fam. Servs., 2020 Ohio 4081 (Ohio Ct. App. 2020). · cites it 2× “2020 CA 00005 8 {¶16} Appellant argues 42 C.F.R. 435.948 prevented the County in this case from requesting information from her when it was readily available from the asset verification system or other sources.”
E.T. Vs. Div. of Med. Assistance & Health Servs.(Div. of Med. Assistance & Health Servs.) (N.J. Super. Ct. App. Div. 2017). “See 42 C.F.R. § 435.948 (a). The regulation directs the state Medicaid agency to obtain limited information only "to the extent the agency determines such information is useful to verifying the financial eligibility of an individual.”
L.K. Vs. Div. of Med. Assistance & Health Servs. (new Jersey Dep't of Human Servs., Div. of Med. Assistance & Health Servs.) (N.J. Super. Ct. App. Div. 2018). “'s assertion, the controlling regulations do not require that either CCBSS or DMAHS obtain all application information on their own, see 42 C.F.R. § 435.948 (a), or preclude a state Medicaid agency from obtaining information directly from the applicant.”
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