4. Verifying Community Engagement at Application, Renewal and More Frequent Verifications

At § 435.557(c), we implement the requirement that the State verify an applicable individual has demonstrated or is to deemed to have demonstrated community engagement for the period specified at § 435.556(a) and described in section II.H. of this IFC. The State must first attempt to complete the verification on an ex parte basis and, as described at § 435.557(c)(1), may not limit the reliable information available to the State that is checked to specific activities or other means of demonstrating community engagement or being deemed to have demonstrated community engagement, or to specific excluded statuses. As specified at § 435.557(c)(1)(i), the State must attempt to verify an individual's specified excluded individual status or that the individual demonstrated or was deemed to have demonstrated community engagement using all reliable information available to the State for all relevant months and may only request additional information or initiate noncompliance procedures under § 435.558 if, after reviewing the reliable information available to the State, the State lacks sufficient information to confirm that the individual is a specified excluded individual or that the applicable individual demonstrated or was deemed to have demonstrated community engagement based on a mandatory or optional exception (if applicable) for the required number of months during the review period.

As an example, consider an enrolled, applicable individual who demonstrated community engagement at application on the basis of working 80 hours per month. At renewal, after confirming the individual is not a specified excluded individual, the State checks the data sources relied upon to verify work hours but does not locate information in the data sources sufficient to verify continued compliance on this basis. Before requesting information from the individual, the State must also check available information to determine if the individual meets an exception under §§ 435.553 or 435.555, if applicable, and to verify whether the individual met the community engagement requirement in another way provided at § 435.552 (for example, participation in an educational program, participation in a work program, community service, or income sufficient to meet the standard at § 435.552(a)(6) or (7)). Only after completing these steps, if still unable to verify that the individual has demonstrated community engagement, is deemed to have demonstrated community engagement, or is a specified excluded individual, may the State send the renewal form to request information from the individual or initiate the noncompliance process concurrently with the renewal form, consistent with § 435.558(b).

We note that, as provided at § 435.557(c)(1)(ii), the State is not generally required to check additional sources of reliable information available to the State after the State verifies compliance, deemed compliance, or that the individual is a specified excluded individual. For example, if the State confirms an applicable individual has a monthly income equal to the Federal minimum wage multiplied by 80 hours for the required number of months in the review period, the State does not need to check any additional reliable information available to the State to verify other qualifying activities or exceptions, because the State has already confirmed the individual demonstrated community engagement. The only exception is when the State has information (for example, information provided on the application) indicating the individual may also qualify for an exclusion. As implemented at § 435.557(c)(2), the State must always determine an individual to be a specified excluded individual when the State has sufficient information to make such determination. This requirement stems from the fact that specified excluded individuals are not applicable individuals and therefore not required to demonstrate community engagement as a condition of eligibility. Thus, as described throughout this IFC, States must confirm an individual is subject to the community engagement requirement prior to assessing their compliance. As a result, the exclusion takes precedence even if the State has also verified an individual demonstrates community engagement or meets the criteria for an exception.

However, we recognize that in some cases, it may appear that an individual could qualify for an exclusion, but the State may need more information to verify the individual's specified excluded individual status. If the State has enough information to determine that the individual demonstrates compliance or meets the criteria for an exception without requesting additional information, the State may not delay the individual's enrollment solely to complete the verification of the individual's qualification for the exclusion. As implemented at § 435.557(c)(3), the State must enroll the individual promptly based on the information available (for example, income verifying compliance), provided all other eligibility criteria are satisfied, and then proceed to verify post-enrollment whether the individual meets the criteria for the exclusion (for example, an exclusion based on the individual's status as a veteran with a total disability rating) consistent with the requirements at § 435.557(b)(2).

We also encourage States to design their process in such a manner to reduce administrative burden. States should consider prioritizing categories under which an individual may be excluded or, in the case of applicable individuals, excepted for a longer period of time over those that require more frequent verification based on the State's verification policies. For example, if an individual qualifies for an exclusion on the basis of being an American Indian as well as being a parent to a dependent child 13 years of age or under, we encourage the State to apply the exclusion based on their American Indian status because American Indian status is not subject to change and therefore does not need to be reverified. In developing their process, States may also wish to consider factors such as the availability of reliable information and reasonably available documentation in the absence of reliable information available to the State, as well as how the number of months for which an individual must demonstrate or be deemed to demonstrate community engagement and the State's election with respect to conducting more frequent verifications may impact the level of administrative burden.