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about Applicants' Assets Varies and May Be Insufficient' which was 
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United States Government Accountability Office: 
GAO: 

Report to Congressional Requesters: 

July 2012: 

Medicaid Long-Term Care: 

Information Obtained by States about Applicants' Assets Varies and May 
Be Insufficient: 

GAO-12-749: 

GAO Highlights: 

Highlights of GAO-12-749, a report to congressional requesters. 

Why GAO Did This Study: 

Medicaid-—a joint federal-state health care financing program for 
certain low-income individuals—-paid for nearly half of the nation’s 
$263 billion long-term care expenditures in 2010. To be financially 
eligible for Medicaid coverage for long-term care, applicants cannot 
have assets—income and resources—above certain limits. Federal law 
discourages individuals from artificially impoverishing themselves in 
order to establish financial eligibility for Medicaid. Specifically, 
those who transfer assets for less than fair market value during a 
specified time period-—or “look-back” period—-before applying for 
Medicaid may be ineligible for coverage for long-term care for a 
period of time. The DRA extended the look-back period to 60 months and 
introduced new requirements for the treatment of certain types of 
assets, such as annuities, in determining eligibility. States are 
responsible for assessing applicants’ eligibility for Medicaid, the 
criteria for which varies by state. 

GAO was asked to provide information on states’ requirements and 
practices for assessing the financial eligibility of applicants for 
Medicaid long-term care coverage. GAO examined the extent to which 
states (1) require documentation of assets from applicants, (2) obtain 
information from third parties to verify applicants’ assets, and (3) 
obtain information about applicants’ assets that could be used to 
implement eligibility-related DRA provisions. From October 2011 to 
November 2011, GAO surveyed Medicaid officials from each of the 50 
states and the District of Columbia. GAO also interviewed officials 
from CMS, the agency within HHS that oversees Medicaid. 

What GAO Found: 

States reported requiring applicants to provide documentation for most 
of the 13 types of assets included in GAO’s survey. 

Table: Number of States That Reported Requiring Documentation, by Type 
of Asset: 

Asset type: Income; 
Description: Earned income; 
Number of states: 50. 

Asset type: Income; 
Description: Unearned income; 
Number of states: 49. 

Asset type: Resources; 
Description: Annuity, burial contract and prepaid funeral, financial 
and investment, life estate, and trust; 
Number of states: 51. 

Asset type: Resources; 
Description: Life insurance, promissory note or loan, and real 
property other than primary residence; 
Number of states: 50. 

Asset type: Resources; 
Description: Continuing care retirement community entrance fee; 
Number of states: 46. 

Asset type: Resources; 
Description: Vehicle; 
Number of states: 38. 

Asset type: Resources; 
Description: Primary residence; 
Number of states: 37. 

Source: GAO web-based survey administered to state Medicaid officials. 

[End of table] 

States varied in the extent to which they obtained information from 
third parties to verify applicants’ assets. For example, all states 
conducted data matches with the Social Security Administration but 
used other sources to a lesser extent. While states’ implementation of 
an electronic asset verification system (AVS) was required on a 
rolling basis beginning in 2009, no state had fully implemented an AVS 
at the time of GAO’s survey. Among the implementation challenges 
reported by states were lack of resources and getting financial 
institutions to participate. Officials from the Centers for Medicare & 
Medicaid Services (CMS) were aware of states’ progress and challenges 
and told GAO that they regularly communicated with states on AVS 
implementation. 

On the basis of states’ responses to questions about the extent of 
documentation required from applicants and information obtained from 
third parties, it is unclear whether some states obtain sufficient 
information to implement certain provisions of the Deficit Reduction 
Act of 2005 (DRA). For example, 31 states reported requiring less than 
60 months of documentation from applicants and financial institutions. 
The results of GAO’s survey raise questions about states’ 
implementation of the DRA, but are not conclusive. CMS officials said 
that it is reasonable for states to only conduct reviews when there is 
reason to believe a transfer of assets occurred. GAO has additional 
work planned related to Medicaid long-term care financial eligibility. 
States must balance the costs of eligibility determination efforts 
with the need to ensure that those efforts provide sufficient 
information to implement federal requirements. Given the complexities 
involved, it may be reasonable for states to adhere to a risk-based 
approach and focus their eligibility determination efforts on 
applicants who appear to be more likely to have assets or to have 
transferred assets that would make them ineligible. It is too early to 
assess the effectiveness of the AVS; its utility will ultimately 
depend on the breadth of the financial institutions participating and 
the depth of the information obtained. 

The Department of Health and Human Services (HHS) concurred with GAO’s 
findings and commented that GAO’s comprehensive report will serve as a 
helpful resource for CMS and other interested parties. 

View [hyperlink, http://www.gao.gov/products/GAO-12-749]. For more 
information, contact Carolyn L. Yocom at (202) 512-7114 or 
yocomc@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

States Required Applicants to Document Most Assets, but What Was 
Considered Acceptable Proof Varied: 

All States Obtained Some Amount of Asset Information from Third 
Parties, and No State Had Implemented an Asset Verification System: 

It Is Unclear Whether Some States Obtain Sufficient Information to 
Implement Certain DRA Provisions: 

Concluding Observations: 

Agency Comments: 

Appendix I: GAO Analysis of State Applications: 

Appendix II: States' Asset Documentation Requirements: 

Appendix III: States' Use of Data Matches to Verify Applicants' Assets: 

Appendix IV: States' Contact with Financial Institutions to Verify 
Applicants' Assets: 

Appendix V: States' Use of Property Records Searches to Verify 
Applicants' Assets: 

Appendix VI: States' Use of Vehicle Records Searches to Verify 
Applicants' Assets: 

Appendix VII: States' Collection of Third-Party Information to 
Identify Transfers of Assets: 

Appendix VIII: GAO Analysis of Annuity Language Contained in States' 
Application Forms: 

Appendix IX: Comments from the Department of Health and Human Services: 

Appendix X: GAO Contact and Staff Acknowledgments: 

Tables: 

Table 1: Types of Assets and Examples: 

Table 2: Summary of Selected Provisions in the Deficit Reduction Act 
of 2005 (DRA) Related to Medicaid Eligibility for Long-Term Care and 
Asset Transfers: 

Table 3: Asset Verification System Implementation Timeline, by Fiscal 
Year: 

Table 4: Example of States' Variation in Treatment of Earned Income 
Documentation, by Type of Documentation: 

Table 5: Number of States That Reported Conducting Data Matches with 
Other Sources, the Proportion of Applicants Screened, and When 
Screened in Relation to Eligibility Determination, by Source of Data 
Match, 2011: 

Table 6: Number of States That Contact Financial Institutions to 
Verify Applicants' Assets, by Financial Institutions Contacted and 
Proportion of Applicants, 2011 (n=24): 

Table 7: Number of States That Conduct Property Searches to Verify 
Applicants' Assets, by Geographic Area Covered and Proportion of 
Applicants, 2011 (n=35): 

Table 8: Characteristics of Medicaid Long-Term Care Application 
Processes, by State, 2011: 

Table 9: Time Frame of Information on Transfers of Assets Requested in 
Medicaid Long-Term Care Application Forms, by State, 2011: 

Table 10a: Applicant Documentation Requirements for Medicaid Long-Term 
Care, by State and Type of Asset, 2011: 

Table 10b: Applicant Documentation Requirements for Medicaid Long-Term 
Care, by State and Type of Asset, 2011 (continued): 

Table 11: States' Treatment of Earned Income Documentation, by Type of 
Documentation, 2011: 

Table 12: States' Treatment of Earned Income Documentation, by State 
and Type of Documentation, 2011: 

Table 13: States' Treatment of Unearned Income Documentation, by Type 
of Documentation, 2011: 

Table 14a: States' Treatment of Unearned Income Documentation, by 
State and Type of Documentation, 2011: 

Table 14b: States' Treatment of Unearned Income Documentation, by 
State and Type of Documentation, 2011 (continued): 

Table 15: States' Treatment of Financial and Investment Resources 
Documentation, by Type of Documentation, 2011: 

Table 16: States' Treatment of Financial and Investment Resources 
Documentation, by State and Type of Documentation, 2011: 

Table 17: States' Treatment of Life Insurance Documentation, by Type 
of Documentation, 2011: 

Table 18: States' Treatment of Life Insurance Documentation, by State 
and Type of Documentation, 2011: 

Table 19: States' Treatment of Primary Residence Documentation, by 
Type of Documentation, 2011: 

Table 20: States' Treatment of Primary Residence Documentation, by 
State and Type of Documentation, 2011: 

Table 21: States' Treatment of Documentation of Real Property other 
than Primary Residence, by Type of Documentation, 2011: 

Table 22: States' Treatment of Documentation of Real Property other 
than Primary Residence, by State and Type of Documentation, 2011: 

Table 23: States' Treatment of Vehicle Documentation, by Type of 
Documentation, 2011: 

Table 24: States' Treatment of Vehicle Documentation, by State and 
Type of Documentation, 2011: 

Table 25: Amount of Required Documentation for Financial and 
Investment Resources, by State, 2011: 

Table 26: Proportion of Applicants for Which States Require Additional 
Documentation to Identify Assets Transferred for Less Than Fair Market 
Value, by State, 2011: 

Table 27a: Proportion of Applicants for which States Conduct Data 
Matches with Third Parties to Verify Applicants' Assets, by State and 
Source of Data Match, 2011: 

Table 27b: Proportion of Applicants for which States Conduct Data 
Matches with Third Parties to Verify Applicants' Assets, by State and 
Source of Data Match, 2011 (continued): 

Table 28a: Timing of State Data Matches in Relation to Eligibility 
Determination, by State and Source of Data Match, 2011: 

Table 28b: Timing of State Data Matches in Relation to Eligibility 
Determination, by State and Source of Data Match, 2011 (continued): 

Table 29: Proportion of Applicants for which States Contact Financial 
Institutions to Verify Applicants' Assets, by State and Type of 
Financial Institution, 2011: 

Table 30: Types and Number of Months of Information Requested from 
Financial Institutions, by State, 2011: 

Table 31: Timing of States' Contacts with Financial Institutions in 
Relation to Eligibility Determination, by State, 2011: 

Table 32: Proportion of Applicants for which States Conduct Property 
Records Searches to Verify Applicants' Assets, by State and Geographic 
Area of Property Search Conducted, 2011: 

Table 33: Types of Information That Can Be Used to Conduct Property 
Records Searches, by State, 2011: 

Table 34: Timing of States' Property Records Searches in Relation to 
Eligibility Determination, by State, 2011: 

Table 35: Proportion of Applicants for Which States Conduct Records 
Searches with the Department of Motor Vehicles to Verify Applicants' 
Assets, by State, 2011: 

Table 36: Types of Information That Can Be Used to Conduct Vehicle 
Records Searches, by State, 2011: 

Table 37: Timing of States' Record Searches with the Department of 
Motor Vehicles in Relation to Eligibility Determination, by State, 
2011: 

Table 38: Proportion of Applicants for Which States Take Additional 
Steps to Obtain Information from Third Parties to Identify Assets 
Transferred for Less Than Fair Market Value, by State, 2011: 

Table 39: Characteristics of Medicaid Long-Term Care Application Forms 
Related to Deficit Reduction Act of 2005 (DRA) Annuity Provisions, by 
State, 2011: 

Figures: 

Figure 1: Asset Documentation Requirements, by State, 2011: 

Figure 2: Number of States That Require Financial and Investment 
Resources Documentation, by Number of Months of Documentation 
Required, 2011: 

Figure 3: Number of States Requesting Applicant Asset Information from 
Financial Institutions, by Number of Months and Type of Information 
Requested, 2011 (n=24): 

Abbreviations: 

ADL: activities of daily living: 

AVS: asset verification system: 

CCRC: continuing care retirement community: 

CMS: Centers for Medicare & Medicaid Services: 

DMV: Department of Motor Vehicles: 

DRA: Deficit Reduction Act of 2005: 

FMV: fair market value: 

HHS: Department of Health and Human Services: 

IADL: instrumental activities of daily living: 

IEVS: Income and Eligibility Verification System: 

PARIS: Public Assistance Reporting Information System: 

[End of section] 

United States Government Accountability Office: 
Washington, DC 20548: 

July 26, 2012: 

The Honorable Orrin G. Hatch: 
Ranking Member: 
Committee on Finance: 
United States Senate: 

The Honorable Tom Coburn, M.D. 
Ranking Member: 
Permanent Subcommittee on Investigations: 
Committee on Homeland Security and Governmental Affairs: 
United States Senate: 

Long-term care, particularly nursing home care, can be costly; in 
2010, the average annual cost for care in a nursing home was about 
$79,000.[Footnote 1] Nearly half of the nation's $263 billion long-
term care expenditures in 2010 were paid by Medicaid, a joint federal-
state health care financing program that covers certain categories of 
low-income individuals. Long-term care expenditures represent a 
significant portion of total Medicaid expenditures, comprising over 
one-quarter of the total $401 billion spent in fiscal year 2010. As 
the number of elderly Americans continues to grow and more individuals 
are likely to need long-term care, Medicaid spending for long-term 
care services is projected to increase. In light of the increased 
demand and associated burden that this places on already strained 
federal and state resources, it is important to ensure that only 
eligible individuals receive Medicaid coverage for long-term care. 

Individuals applying for Medicaid coverage for long-term care must 
meet certain financial and functional eligibility criteria.[Footnote 
2] To meet the financial eligibility criteria, individuals must have 
assets that fall below established levels, which vary by state, but 
are within standards set by the federal government. Within the 
Medicaid program, assets have two broad categories: income, which 
includes any funds received during a calendar month that are used or 
could be used to meet food, clothing, or shelter needs; and resources, 
which include anything owned, such as savings accounts, stocks, or 
property, that can be converted to cash.[Footnote 3] Not all assets 
are counted in determining financial eligibility for Medicaid. For 
example, states generally exclude--within specified limits--the value 
of an individual's primary residence, car, and prepaid burial 
arrangements. Additionally, federal law includes provisions to 
discourage individuals from artificially impoverishing themselves--for 
example, by transferring their assets to certain family members--in 
order to establish financial eligibility for Medicaid. Specifically, 
those who transfer assets for less than fair market value (FMV) during 
a specified "look-back" period--a period of time before application in 
which an individual's assets are reviewed--may be deemed ineligible 
for Medicaid coverage for long-term care for a period of time. The 
Deficit Reduction Act of 2005 (DRA), which was enacted in February 
2006, amended certain existing provisions regarding asset transfers 
for less than FMV and introduced new requirements related to financial 
eligibility for Medicaid coverage for long-term care.[Footnote 4] For 
example, the DRA extended the look-back period from 36 months to 60 
months for transfers occurring on or after its enactment and 
introduced new requirements regarding how certain types of assets, 
such as an individual's home, should be considered when determining 
Medicaid eligibility. 

As the day-to-day administrators of the Medicaid program, states are 
responsible for assessing applicants' financial eligibility for 
Medicaid coverage for long-term care; that is, determining whether an 
applicant's income and resources are below the state-established 
standards, and whether an applicant transferred assets for less than 
FMV during the look-back period. Our prior work and the work of others 
found that the proportion of applicants deemed to be financially 
eligible for Medicaid coverage for long-term care varied both across 
and within states.[Footnote 5] 

Given the potential for state variation, you asked us for information 
on states' requirements and practices for assessing the financial 
eligibility of individuals applying for Medicaid coverage for long-
term care, including states' implementation of relevant DRA 
provisions. In this report, we provide details on the extent to which 
states: (1) require individuals to document assets when applying for 
Medicaid coverage for long-term care; (2) obtain information from 
third parties to verify applicants' assets; and (3) obtain information 
about applicants' assets that could be used to implement DRA 
provisions related to eligibility for Medicaid coverage for long-term 
care. 

To address all three objectives, from October 2011 through November 
2011, we administered a web-based survey to Medicaid officials from 
each of the 50 states and the District of Columbia.[Footnote 6] To 
ensure the clarity and precision of our survey questions, we 
interviewed officials from the Centers for Medicare & Medicaid 
Services (CMS), the agency within the Department of Health and Human 
Services (HHS) that oversees Medicaid; interviewed Medicaid officials 
from 3 states; reviewed states' Medicaid applications for long-term 
care coverage; and pretested the survey with Medicaid officials from 3 
states. The survey requested information about the types of 
documentation, if any, that states require applicants for Medicaid 
coverage for long-term care to submit for 13 types of assets: earned 
income, unearned income, financial and investment resources, life 
insurance, primary residence, real property other than primary 
residence, vehicles, annuities, burial contracts and prepaid funeral 
arrangements, continuing care retirement community (CCRC) entrance 
fees, life estates, promissory notes or loans, and trusts.[Footnote 7] 
In addition, the survey asked about the number of months of 
documentation states required for earned income, unearned income, and 
financial and investment resources.[Footnote 8] The survey also asked 
about states' practices to obtain information from third parties to 
verify applicants' assets, such as whether, and to what extent, states 
conduct data matches with 10 sources, including the Social Security 
Administration and the Internal Revenue Service, which primarily allow 
states to verify applicants' income. Finally, the survey asked about 
any additional documentation states require or additional steps states 
take to determine whether applicants transferred assets for less than 
FMV during the 60-month look-back period. We received survey responses 
from officials from all 51 states, although not every official 
responded to every question. We relied on the data as reported by the 
state officials who were identified as the primary contact for states' 
documentation requirements and practices for verifying the financial 
eligibility of applicants for Medicaid coverage for long-term care. We 
did not independently verify these data; however, we reviewed all 
responses for reasonableness and internal consistency, and followed up 
with state officials for clarification where necessary. On the basis 
of these activities, we determined these data were sufficiently 
reliable for the purposes of our report. In addition to administering 
a survey, we collected states' application forms for Medicaid coverage 
for long-term care to assess the types of asset information asked 
about on the applications.[Footnote 9] Finally, we interviewed CMS 
officials about federal requirements related to eligibility 
determinations for Medicaid coverage for long-term care, including the 
DRA provisions. 

We conducted this performance audit from July 2011 to July 2012 in 
accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe 
that the evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. 

Background: 

Long-term care includes many types of services needed by individuals 
who have a physical disability, a mental disability, or both. Long-
term care services can be provided in a variety of settings, including 
an individual's home or an institution, such as a nursing home. To be 
eligible for Medicaid coverage for long-term care, individuals must be 
within certain eligibility categories--such as those that are aged or 
disabled--and meet functional and financial criteria. Within broad 
federal standards, states determine whether an individual meets the 
functional criteria for long-term care coverage by assessing an 
individual's ability to carry out activities of daily living (ADL), 
such as eating and getting around the house; and instrumental 
activities of daily living (IADL), such as preparing meals and 
shopping for groceries. The financial eligibility criteria are based 
on individuals' assets--income and resources together. States are 
responsible for determining whether applicants meet the financial and 
other eligibility criteria for Medicaid coverage for long-term care. 

Financial Eligibility for Medicaid Coverage for Long-Term Care: 

To qualify for Medicaid coverage for long-term care, individuals must 
have assets that fall below established standards, which vary by 
state, but are within standards set by the federal government. The 
Medicaid program bases its characterization of assets--income and 
resources--on that used in the Supplemental Security Income program. 
[Footnote 10] Income is something received during a calendar month, 
paid either in cash or in-kind, that is used or could be used to meet 
food or shelter needs; resources are cash or real or personal property 
that are owned that can be converted to cash and be used for food or 
shelter. (See table 1 for examples of different types of income and 
resources.) In establishing policy for determining financial 
eligibility for Medicaid coverage for long-term care, states can 
decide, within federal standards, which assets are countable. For 
example, states may disregard certain types or amounts of income, and 
may elect not to count certain resources.[Footnote 11] In most states, 
to be financially eligible for Medicaid coverage for long-term care, 
individuals must have $2,000 or less in countable resources ($3,000 
for a married couple).[Footnote 12] 

Table 1: Types of Assets and Examples: 

Type of asset: Income; 
Examples: 
* Money earned from work; 
* Money generated from resources, such as interest, dividends, and 
annuity payments; 
* Money received from other sources, such as Social Security, worker's 
compensation, and unemployment benefits. 

Type of asset: Resources; 
Examples: 
* Cash; 
* Financial and investment resources, such as bank accounts, stocks, 
and bonds; 
* Trusts; 
* Annuities; 
* Real property; 
* Vehicles, such as automobiles and boats; 
* Life insurance. 

Source: GAO analysis of Supplemental Security Income requirements. 

[End of table] 

Transfers of Assets and the DRA: 

Federal law limits Medicaid payment for long-term care services for 
persons who divest themselves of--or "transfer"--their assets for less 
than FMV within a specified time period.[Footnote 13] As a result, 
when an individual applies for Medicaid coverage for long-term care, 
states conduct a review, or "look back," to determine whether the 
applicant (or his or her spouse, if married) transferred assets to 
another person or party. If the state determines an applicant 
transferred an asset for less than FMV during the look-back period, 
the individual may be ineligible for Medicaid coverage for long-term 
care for a period of time, called the penalty period. The DRA extended 
the look-back period for transfers made on or after February 8, 2006, 
to 60 months; prior to that, it was generally 36 months.[Footnote 14] 

The DRA also specified circumstances under which the purchase of 
certain assets--such as an annuity, promissory note or loan, or life 
estate--is considered a transfer for less than FMV, and when entrance 
fees for CCRCs are countable for purposes of determining Medicaid 
eligibility. Additionally, while an individual's primary residence is 
generally not a countable resource for determining Medicaid 
eligibility, the DRA specified when an individual with substantial 
equity interest in his or her home is to be excluded from eligibility 
for Medicaid payment for long-term care; the amount of allowable 
equity interest is established by each state within federal 
guidelines.[Footnote 15] See table 2 for a summary of these DRA 
provisions. Most, but not all, of these DRA provisions became 
applicable on the date the law was enacted, February 8, 2006. 

Table 2: Summary of Selected Provisions in the Deficit Reduction Act 
of 2005 (DRA) Related to Medicaid Eligibility for Long-Term Care and 
Asset Transfers: 

DRA provision: Annuities; 
Description: 
* States are required to treat the purchase of an annuity as a 
transfer for less than fair market value (FMV) unless the annuity 
names the state as either (1) the remainder beneficiary in the first 
position for at least the total amount of Medicaid expenditures paid 
on behalf of the annuitant, or (2) a remainder beneficiary in the 
second position after the community spouse, or minor or disabled child 
(or in the first position if any of those individuals transfer the 
remainder of the annuity for less than FMV); 
* Annuities purchased by or on the behalf of an individual who applied 
for Medicaid coverage for long-term care shall be treated as a 
transfer of assets for less than FMV unless the annuity is 
irrevocable, nonassignable, actuarially sound, and provides for 
payments in equal amounts during the term of the annuity, with no 
deferral and no balloon payments; 
* Annuities purchased by or on the behalf of an individual who applied 
for Medicaid coverage for long-term care services that are defined as 
individual retirement accounts under federal tax code or purchased 
with the proceeds of certain retirement accounts and meet certain 
federal tax code requirements are not considered transfers for less 
than FMV; 
* Applications for Medicaid coverage for long-term care shall: (1) 
describe any interest an applicant or community spouse may have in an 
annuity, regardless of whether the annuity is irrevocable or treated 
as an asset, and (2) include a statement that the state becomes a 
remainder beneficiary of an annuity purchased on or after enactment by 
virtue of the applicant's receipt of Medicaid assistance for long-term 
care. 

DRA provision: Continuing care retirement communities; 
Description: States are required to consider certain entrance fees for 
continuing care retirement communities or life care communities as 
countable resources. 

DRA provision: Home equity; 
Description: An individual with an equity interest in his or her home 
of more than $500,000 is excluded from eligibility for Medicaid 
payment for long-term care unless his/her spouse, child under age 21, 
or child who is considered blind or disabled lives in the home. A 
state can elect to increase this value up to $750,000. Beginning in 
2011, the limit was to be increased each year based on the percentage 
increase in the consumer price index for all urban consumers[A]. 

DRA provision: Life estates; 
Description: States are required to consider a purchase of a life 
estate interest in another person's home as a transfer of assets for 
less than FMV unless the purchaser lived in the home for at least 1 
year after the date of purchase. 

DRA provision: Promissory notes and loans; 
Description: States are required to consider funds used to purchase a 
promissory note, loan, or mortgage as a transfer of assets for less 
than FMV unless the repayment terms are actuarially sound, provide for 
payments to be made in equal amounts during the term of the loan with 
no deferral or balloon payments, and prohibit the cancellation of the 
balance upon the death of the lender. 

Source: GAO analysis of the DRA. 

[A] In 2012, states' home equity limits could range from $525,000 
through $786,000. 

[End of table] 

States' Determination of Applicants' Financial Eligibility: 

To assess applicants' financial eligibility for Medicaid coverage for 
long-term care, and to determine whether they transferred assets for 
less than FMV, states generally require applicants to submit 
applications and to provide documentation of certain assets reported 
on the applications. State Medicaid programs may also obtain 
information from third parties, such as financial institutions or 
other government agencies, such as the Social Security Administration. 
Such information helps states verify the accuracy of applicants' 
reported assets, as well as determine whether applicants have assets 
they failed to report or transferred for less than FMV during the look-
back period. The processing of Medicaid applications--including the 
collection of documentation and information from applicants and third 
parties--is generally performed by local or county-based eligibility 
workers. 

In 2008, Congress passed legislation that required states to implement 
electronic asset verification systems (AVS) to verify the assets of 
aged, blind, or disabled applicants for Medicaid, including those 
seeking Medicaid coverage for long-term care, with financial 
institutions.[Footnote 16] An AVS would provide states with an 
electronic mechanism to contact multiple financial institutions, 
including those not reported by an applicant, to determine if an 
applicant has, or had, an account and the value of any existing 
accounts.[Footnote 17] The law provides for states' implementation of 
these systems to occur on a rolling basis; the first systems were to 
be implemented by the end of fiscal year 2009, with all states 
implementing systems by the end of fiscal year 2013.[Footnote 18] (See 
table 3.) 

Table 3: Asset Verification System Implementation Timeline, by Fiscal 
Year: 

Fiscal year: 2009; 
Number of states: 9; 
States: California, Missouri, New Hampshire, New Jersey, New Mexico, 
New York, Oregon, South Carolina, Washington. 

Fiscal year: 2010; 
Number of states: 9; 
States: Connecticut, Georgia, Kentucky, Mississippi, Nevada, Oklahoma, 
Rhode Island, Vermont, Wisconsin. 

Fiscal year: 2011; 
Number of states: 7; 
States: Hawaii, Indiana, Michigan, Maryland, North Carolina, Ohio, 
Wyoming. 

Fiscal year: 2012; 
Number of states: 11; 
States: Alaska, Arizona, Florida, Iowa, Illinois, North Dakota, South 
Dakota, Tennessee, Texas, Utah, West Virginia. 

Fiscal year: 2013; 
Number of states: 15; 
States: Alabama, Arkansas, Colorado, District of Columbia, Delaware, 
Idaho, Kansas, Louisiana, Massachusetts, Maine, Minnesota, Montana, 
Nebraska, Pennsylvania, Virginia. 

Source: Supplemental Appropriations Act, 2008, Pub. L. No. 110-252, § 
7001(d)(1), 122 Stat. 2323, 2391 (codified at 42 U.S.C. § 1396w) and 
the Centers for Medicare & Medicaid Services. 

Note: The Supplemental Appropriations Act, 2008, required California, 
New Jersey, and New York to implement an asset verification system for 
aged, blind, and disabled applicants by the end of fiscal year 2009 
and directed the Secretary of the Department of Health and Human 
Services to require the remaining states to implement their systems in 
a manner that results in a specified percentage of aged, blind, and 
disabled Medicaid applicants being subject to this type of asset 
verification each year over the 5-year period of fiscal year 2009 
through fiscal year 2013. 

[End of table] 

States Required Applicants to Document Most Assets, but What Was 
Considered Acceptable Proof Varied: 

States reported requiring applicants to provide documentation for most 
of the 13 types of assets contained in our survey; however, the types 
and number of months of documentation that the states considered to be 
acceptable proof for determining an applicant's financial eligibility 
for Medicaid coverage for long-term care varied.[Footnote 19] 
Specifically, 44 states required documentation for at least 12 of the 
13 types of assets. All states reported requiring documentation of 
annuities, burial contracts and prepaid funeral arrangements, 
financial and investment resources, life estates, and trusts, while 
fewer states reported requiring documentation of other types of 
assets. States were least likely to require documentation of vehicles 
(38 states) and primary residence (37 states), resources that states 
may choose not to count for purposes of determining financial 
eligibility for Medicaid coverage for long-term care.[Footnote 20] 
(See figure 1.) 

Figure 1: Asset Documentation Requirements, by State, 2011: 

[Refer to PDF for image: interactive map and associated data] 

Interactive Instructions: 
Roll your mouse over the state name to see more information. To print 
expanded information, see appendix II. 

Type of asset: Income: Earned; 
Total number of states that require documentation for this asset type: 
50. 

Type of asset: Income: Unearned; 
Total number of states that require documentation for this asset type: 
49. 
  
Type of asset: Resources: Annuity; 
Total number of states that require documentation for this asset type: 
51. 

Type of asset: Resources: Burial contract and pre-paid funeral; 
Total number of states that require documentation for this asset type: 
51. 

Type of asset: Resources: Financial and investment; 
Total number of states that require documentation for this asset type: 
51. 

Type of asset: Resources: Life estate; 
Total number of states that require documentation for this asset type: 
51. 

Type of asset: Resources: Trust; 
Total number of states that require documentation for this asset type: 
51. 

Type of asset: Resources: Life insurance; 
Total number of states that require documentation for this asset type: 
50. 

Type of asset: Resources: Promissory note or loan[A]; 
Total number of states that require documentation for this asset type: 
50. 

Type of asset: Resources: Real property other than primary residence; 
Total number of states that require documentation for this asset type: 
50. 

Type of asset: Resources: Continuing care retirement community 
entrance fee; 
Total number of states that require documentation for this asset type: 
46. 

Type of asset: Resources: Vehicle; 
Total number of states that require documentation for this asset type: 
38. 

Type of asset: Resources: Primary residence; 
Total number of states that require documentation for this asset type: 
37. 
  
Source: GAO web-based survey administered to state Medicaid officials 
(data); Map Resources (map). 

[A] The District of Columbia did not respond to the question about 
whether or not documentation of promissory notes or loans is required. 

[End of figure] 

Officials from several states reported not requiring documentation for 
a particular type of asset because the state was able to obtain the 
necessary information from a third party. For example, while 50 states 
reported requiring applicants to submit documentation of earned 
income, one state did not have such a requirement because the amount 
of earned income was verified through an interface with the state's 
Department of Labor. It was less clear how states assessed other 
assets--such as vehicles or CCRC entrance fees--absent documentation. 

Our survey also showed that states varied in how they treated specific 
types of documentation; that is, whether the documentation was 
required, acceptable as proof by itself, acceptable as proof with 
other documentation, or Most (more than half) applicants of an 
applicant's assets. For example, while states generally found a 
written statement of earnings from an employer as acceptable 
documentation of earned income, there was more variation in how they 
treated other types of documentation. (See table 4.) 

Table 4: Example of States' Variation in Treatment of Earned Income 
Documentation, by Type of Documentation: 

Type of documentation: Copy of check or check stub[A]; 
Number of states: 
Required: 3; 
Acceptable as proof itself: 33; 
Acceptable with other documentation: 9; 
Not acceptable: 4. 

Type of documentation: Itemized bank statement[A]; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 6; 
Acceptable with other documentation: 20; 
Not acceptable: 22. 

Type of documentation: Written statement of earnings from employer; 
Number of states: 
Required: 0; 
Acceptable as proof itself: 49; 
Acceptable with other documentation: 1; 
Not acceptable: 0. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 50 states that 
required documentation of earned income. 

[A] One state did not specify the level of acceptability for this type 
of documentation. 

[End of table] 

States also varied in the number of months of documentation required 
from applicants, especially as it related to financial and investment 
resources. Although all 51 states reported requiring documentation of 
financial and investment resources, 27 required only current 
documentation, while the remaining 24 required both current and past 
documentation. Of the 24 states that required documentation of both 
current and past financial and investment resources, most required 60 
months of documentation, while the remaining states required fewer 
months of documentation. (See figure 2.) There was some variation, but 
to a lesser extent, in the amount of documentation of earned and 
unearned income that states required from applicants. Of the 50 states 
that required applicants to provide earned income documentation, 47 
required only current documentation. Of the 3 remaining states, 2 
required 3 months of documentation and 1 required 2 months of 
documentation.[Footnote 21] Of the 49 states that required unearned 
income documentation, 47 only required documentation of current 
unearned income. The other 2 states required 3 months of 
documentation.[Footnote 22] 

Figure 2: Number of States That Require Financial and Investment 
Resources Documentation, by Number of Months of Documentation 
Required, 2011: 

[Refer to PDF for image: vertical bar graph] 

Number of states: 

Current month: 27; 
Current and past months[A]: 2 months: 1; 
Current and past months[A]: 3 months: 4; 
Current and past months[A]: 36 months: 1; 
Current and past months[A]: 60 months: 17. 

Source: GAO web-based survey administered to state Medicaid officials. 

[A] One state reported it required both current and past documentation 
for financial and investment resources, but did not specify the number 
of months of documentation required because it is determined on a case-
by-case basis. In some cases, the state may require up to 60 months of 
documentation. 

[End of figure] 

In addition to the documentation required to assess whether 
applicants' assets were within state financial eligibility levels, 38 
states reported requiring additional documentation from at least some 
applicants to identify assets transferred for less than FMV. Of these 
38 states, 16 indicated they required additional documentation only if 
an applicant reported making a transfer, 5 reported doing so only if 
an applicant's information was questionable, and 8 reported both of 
these reasons. Of the remaining 9 states, 7 required additional 
documentation from all applicants, and 2 did not specify the 
circumstances that would result in a request for additional 
documentation. 

Appendix II provides additional information on states' asset 
documentation requirements for individuals applying for Medicaid 
coverage for long-term care. 

All States Obtained Some Amount of Asset Information from Third 
Parties, and No State Had Implemented an Asset Verification System: 

All 51 states reported that they obtained some amount of asset 
information from third parties, although the extent of the screenings 
conducted varied by state. No state had implemented an electronic AVS, 
which would allow them to contact multiple financial institutions--
including those not reported by an applicant--to determine the 
existence and value of any accounts belonging to an applicant. States 
reported challenges to implementing an AVS including not having 
sufficient resources. 

States Varied in the Extent to Which They Obtained Information from 
Third Parties: 

To varying degrees, states reported obtaining information from third 
parties through a variety of mechanisms, including data matches, 
direct contact with financial institutions, and property and vehicle 
records searches. Some states also reported taking additional 
verification steps to determine if an applicant transferred assets for 
less than FMV during the look-back period. 

Conduct Data Matches: 

All 51 states reported that they conduct data matches with the Social 
Security Administration to verify at least some applicants' assets. 
However, states' use of data matches with other sources of asset 
information--primarily related to income--varied, ranging from 48 
states reporting data matches with state unemployment records, to as 
few as 6 states reporting data matches with state tax records. On 
average, states conducted data matches with 6 of the 10 sources 
included in our survey; the number of sources states reported using 
ranged from 1 to 9.[Footnote 23] In addition to variations in the use 
of data match sources, states varied in terms of the proportion of 
applicants screened, and when during the eligibility process the state 
conducted the screen. For example, most states reported conducting a 
data match with the Social Security Administration generally before 
determining an applicant's eligibility. In contrast, of the 30 states 
that reported conducting a data match with the Internal Revenue 
Service for at least some applicants, 21 reported doing so generally 
after determining eligibility. (See table 5 for summary information 
and appendix III for more detailed information about the data matches 
conducted by states.) 

Table 5: Number of States That Reported Conducting Data Matches with 
Other Sources, the Proportion of Applicants Screened, and When 
Screened in Relation to Eligibility Determination, by Source of Data 
Match, 2011: 

Source of the data match: Social Security Administration; 
States that conduct data match[A]: 51; 
Proportion of applicants[B]: 
All: 43; 
Most[D]: 6; 
Some: 2; 
None: 0; 
When screened in relation to eligibility determination[C]: 
Generally before: 40; 
Varied[E]: 6; 
Generally after: 2. 

Source of the data match: State unemployment records; 
States that conduct data match[A]: 48; 
Proportion of applicants[B]: 
All: 31; 
Most[D]: 5; 
Some: 12; 
None: 2; 
When screened in relation to eligibility determination[C]: 
Generally before: 29; 
Varied[E]: 7; 
Generally after: 6. 

Source of the data match: Income and Eligibility Verification 
System[F]; 
States that conduct data match[A]: 44; 
Proportion of applicants[B]: 
All: 36; 
Most[D]: 4; 
Some: 4; 
None: 6; 
When screened in relation to eligibility determination[C]: 
Generally before: 21; 
Varied[E]: 6; 
Generally after: 14. 

Source of the data match: Public Assistance Reporting Information 
System[G]; 
States that conduct data match[A]: 42; 
Proportion of applicants[B]: 
All: 31; 
Most[D]: 2; 
Some: 9; 
None: 6; 
When screened in relation to eligibility determination[C]: 
Generally before: 4; 
Varied[E]: 6; 
Generally after: 30. 

Source of the data match: State wage files/directory of new hires; 
States that conduct data match[A]: 41; 
Proportion of applicants[B]: 
All: 26; 
Most[D]: 7; 
Some: 8; 
None: 8; 
When screened in relation to eligibility determination[C]: 
Generally before: 20; 
Varied[E]: 9; 
Generally after: 8. 

Source of the data match: Internal Revenue Service; 
States that conduct data match[A]: 30; 
Proportion of applicants[B]: 
All: 22; 
Most[D]: 1; 
Some: 7; 
None: 20; 
When screened in relation to eligibility determination[C]: 
Generally before: 6; 
Varied[E]: 2; 
Generally after: 21. 

Source of the data match: Department of Veterans Affairs; 
States that conduct data match[A]: 22; 
Proportion of applicants[B]: 
All: 9; 
Most[D]: 0; 
Some: 13; 
None: 26; 
When screened in relation to eligibility determination[C]: 
Generally before: 11; 
Varied[E]: 6; 
Generally after: 3. 

Source of the data match: State workman's compensation records; 
States that conduct data match[A]: 17; 
Proportion of applicants[B]: 
All: 7; 
Most[D]: 1; 
Some: 9; 
None: 30; 
[Empty]; 
When screened in relation to eligibility determination[C]: 
Generally before: 6; 
Varied[E]: 5; 
Generally after: 4. 

Source of the data match: National Directory of New Hires[H]; 
States that conduct data match[A]: 14; 
Proportion of applicants[B]: 
All: 9; 
Most[D]: 2; 
Some: 3; 
None: 33;
When screened in relation to eligibility determination[C]: 
Generally before: 7; 
Varied[E]: 3; 
Generally after: 4. 

Source of the data match: State tax records; 
States that conduct data match[A]: 6; 
Proportion of applicants[B]: 
All: 2; 
Most[D]: 1; 
Some: 3; 
None: 42; 
[Empty]; 
When screened in relation to eligibility determination[C]: 
Generally before: 3; 
Varied[E]: 1; 
Generally after: 2. 

Source: GAO web-based survey administered to state Medicaid officials. 

[A] Represents the number of states that reported conducting the data 
match for at least some applicants. 

[B] In each row, the number of states may not add to 51 because not 
all states answered the question regarding the proportion of 
applicants, if any, for the respective data match source. 

[C] In each row, the number of states may not add to the total number 
that conduct a data match with that source because not all states 
specified when the screening occurred in relation to eligibility 
determination. 

[D] "Most" is more than half of applicants. 

[E] "Varied" is sometimes before and sometimes after eligibility 
determination. 

[F] Each state is required to operate an Income and Eligibility 
Verification System that allows the state to match applicant-reported 
income information with data from the Internal Revenue Service, the 
Social Security Administration, and state wage and unemployment 
insurance benefit records. States that reported using this system to 
verify applicants' assets may use some or all of the data available. 

[G] The Public Assistance Reporting Information System (PARIS) is an 
electronic data matching and information exchange system that is 
designed to match state enrollment information, including Medicaid 
enrollment, with data from other participating states and from a 
selected group of federal databases. The federal databases include, 
among other things, information on individuals' receipt of income from 
the Department of Veterans Affairs, the Department of Defense, and the 
Office of Personnel Management. States that reported conducting a 
PARIS data match may use some or all of the data available. 

[H] The National Directory of New Hires is a national database of 
employment wage and unemployment insurance information for use by 
federal and state agencies. 

[End of table] 

Contact Financial Institutions: 

Twenty-four states reported that they contact financial institutions 
to verify at least some applicants' financial and investment 
resources, while the remaining 27 did not. However, these 24 states 
varied in terms of the range of financial institutions they contacted 
and the proportion of applicants about whom they inquired. (See table 
6.) 

Table 6: Number of States That Contact Financial Institutions to 
Verify Applicants' Assets, by Financial Institutions Contacted and 
Proportion of Applicants, 2011 (n=24): 

Type of financial institution: Institutions with accounts reported by 
applicant; 
Total: 24; 
Proportion of applicants: 
All: 11; 
Most: 0; 
Some: 13. 

Type of financial institution: Local institutions that were not 
reported by applicant; 
Total: 11; 
Proportion of applicants: 
All: 4; 
Most: 1; 
Some: 6. 

Type of financial institution: Statewide institutions that were not 
reported by applicant; 
Total: 7; 
Proportion of applicants: 
All: 3; 
Most: 1; 
Some: 3. 

Type of financial institution: National institutions that were not 
reported by applicant; 
Total: 5; 
Proportion of applicants: 
All: 1; 
Most: 2; 
Some: 2. 

Source: GAO web-based survey administered to state Medicaid officials. 

[End of table] 

Some states reported contacting multiple types of financial 
institutions, such as institutions applicants reported having accounts 
with, and some that applicants did not report. However, 13 of the 24 
states reported contacting only financial institutions with whom the 
applicant reported having an account; of these 13 states, 3 states 
contacted financial institutions for all applicants, while the other 
10 states did so for some applicants. These 13 states, and the 27 that 
reported not contacting any financial institutions, are unlikely to 
identify accounts that an applicant failed to report. Of the remaining 
11 states that reported contacting financial institutions not reported 
by an applicant, 3 reported contacting only local institutions, 
whereas the other 8 contacted a combination of local, statewide, and 
national institutions. Regarding the proportion of applicants for 
which states contact financial institutions, half of the 24 states 
reported they only contact financial institutions if an applicant 
submits insufficient information or provides questionable information. 

Of the 24 states that reported they contact financial institutions to 
request information, the type of information--account balances or 
itemized statements--and the number of months they request varied. 
(See figure 3.) Specifically, half of these states requested itemized 
statements that include information on each transaction, while the 
other half requested monthly account balances. Most of the states that 
requested account balances did so for 3 or fewer months. Of the 12 
states that requested itemized statements, 5 requested 60 months of 
statements, 3 requested only the statement for the current month, and 
the other 4 states requested between 3 and 36 months of information. 

Figure 3: Number of States Requesting Applicant Asset Information from 
Financial Institutions, by Number of Months and Type of Information 
Requested, 2011 (n=24): 

[Refer to PDF for image: stacked vertical bar graph] 

Number of states: 

Number of months: 1; 
Itemized statements: 3; 
Account balances[B]: 4[A]. 

Number of months: 3; 
Itemized statements: 1; 
Account balances[B]: 6. 

Number of months: 6; 
Itemized statements: 1; 
Account balances[B]: 0. 

Number of months: 12; 
Itemized statements: 1; 
Account balances[B]: 1. 

Number of months: 36; 
Itemized statements: 1; 
Account balances[B]: 0. 

Number of months: 60; 
Itemized statements: 5; 
Account balances[B]: 0. 

Source: GAO analysis of survey administered to state Medicaid 
officials. 

[A] One state reported that it requests the current balance for any 
open accounts and the closing balance for any accounts that were 
closed within the past 60 months. 

[B] Twelve states reported that they request account balances from 
financial institutions; however, one of these states did not specify 
the number of months of information it requested and noted it would 
request whatever amount is needed. 

[End of figure] 

Most of the states (20 of 24) reported that they contact financial 
institutions for asset information before determining eligibility. 
Appendix IV provides additional information about states' contact with 
financial institutions to verify applicants' assets. 

Search Property Records: 

Thirty-five states reported that they conduct some type of property 
records search to verify at least some applicants' real property. The 
extent of the searches varied in terms of the geographic area covered 
and the proportion of applicants for which property searches were 
conducted. (See table 7.) 

Table 7: Number of States That Conduct Property Searches to Verify 
Applicants' Assets, by Geographic Area Covered and Proportion of 
Applicants, 2011 (n=35): 

Geographic area of property search conducted: Applicant's county of 
residence; 
Total: 34;
Proportion of applicants: 
All: 16; 
Most: 7; 
Some: 11. 

Geographic area of property search conducted: Some other counties in 
state; 
Total: 31; 
Proportion of applicants: 
All: 6; 
Most: 3; 
Some: 22. 

Geographic area of property search conducted: All counties in state; 
Total: 19; 
Proportion of applicants: 
All: 6; 
Most: 1; 
Some: 12. 

Geographic area of property search conducted: Locations in other 
states; 
Total: 16; 
Proportion of applicants: 
All: 2; 
Most: 0; 
Some: 14. 

Source: GAO web-based survey administered to state Medicaid officials. 

[End of table] 

Of the 35 states that reported conducting property searches, 2 states 
conduct property searches only within an applicant's county of 
residence. Of the 33 states that reported conducting property searches 
beyond an applicant's county of residence, 8 do so only if they have 
reason to believe the applicant lived in another county or state. 
Additionally, 12 of the 35 states indicated they conduct property 
searches only when an applicant submits questionable or insufficient 
information, an applicant reports the property, or a combination of 
both factors. 

States reported being able to conduct property searches using several 
types of information, including an applicant's name (33 states), 
property address (32 states), property zip code (12 states), or an 
applicant's Social Security number (10 states). Most of the states (29 
of the 35) reported that they generally conduct property searches 
before determining eligibility. Appendix V provides additional 
information about the property searches conducted by states. 

Search Vehicle Records: 

Thirty states reported that they conduct searches of Department of 
Motor Vehicles' (DMV) records to verify at least some applicants' 
vehicles. Specifically, 14 states reported conducting vehicle searches 
for all applicants and 1 state reported conducting searches for most 
of its applicants. The remaining 15 reported conducting such searches 
for less than half of their applicants; of these 15 states, 6 
indicated that they only conduct searches of vehicle records if they 
receive information from an applicant that they deem questionable. 
States reported being able to search these records using several types 
of information, including an applicant's name (29 states), a vehicle 
identification number (20 states), and an applicant's driver's license 
or license plate number (18 states each). Most of the states (25 of 
the 30 states) reported that they generally conduct DMV searches 
before determining eligibility. Appendix VI provides additional 
information about the vehicle searches conducted by states. 

Take Additional Steps to Identify Asset Transfers: 

Twenty-two states reported taking additional steps to obtain 
information from third parties, such as conducting additional property 
searches, to identify assets transferred for less than FMV; 7 states 
reported doing this for all applicants; and 15 states reported doing 
this for some applicants. Of the 15 states that reported taking 
additional verification steps for just some applicants, most of them 
indicated they do so only if they question the information provided by 
applicants or have reason to believe a transfer may have occurred, 
such as if an applicant reported making a transfer. Appendix VII 
provides information on the proportion of applicants for which each 
state reported taking additional verification steps to identify assets 
transferred for less than FMV during the look-back period. 

No State Had Implemented an Asset Verification System to Obtain 
Information from Financial Institutions: 

Although 25 states were supposed to have implemented their electronic 
AVS to obtain information from financial institutions by the end of 
fiscal year 2011, no state had implemented one at the time of our 
survey. Eighteen states reported that they were in the process of 
implementing an AVS, while the remaining 33 states had yet to begin 
implementation. 

When asked about the challenges to implementing an AVS, 32 states 
reported that they did not have enough resources--such as money, 
staff, or time--required to implement such a system, and 18 states 
reported that it had been or would be challenging to get financial 
institutions to participate and provide information. One state 
reported that it had initially planned to have its AVS implemented by 
December 2011, but was unable to do so because financial institutions 
in the state were unwilling to participate in the AVS until state 
legislation is passed that releases the financial institutions from 
any liability, ensures they are fairly reimbursed for their services, 
and makes the process voluntary. The state Medicaid program is seeking 
such legislation during the state's 2012 legislative session and then 
plans to proceed with implementing its AVS. 

CMS acknowledged that states may have challenges that could affect 
their ability to implement an AVS as scheduled. CMS officials were 
aware of states' progress in implementing the AVS and told us that the 
agency was regularly communicating with states regarding AVS 
implementation. 

It Is Unclear Whether Some States Obtain Sufficient Information to 
Implement Certain DRA Provisions: 

On the basis of states' responses to questions about the documentation 
required from applicants and the asset information obtained from third 
parties, it is unclear whether some states obtain sufficient 
information to implement certain DRA provisions, particularly the 
provisions related to the look-back period and home equity. The 
results of our survey raise questions about some states' 
implementation of the DRA, but are not conclusive, and we have 
additional work planned related to Medicaid long-term care financial 
eligibility. 

* Look-back Period. We asked states about (1) the number of months of 
financial and investment resources documentation required to determine 
eligibility, (2) additional documentation required to identify assets 
transferred for less than fair market value, and (3) number of months 
of documentation obtained directly from financial institutions. When 
considering states' responses to those questions, we found that 31 
states reported obtaining less than 60 months of information about at 
least some applicants' assets.[Footnote 24] Three of the 31 states 
reported requiring a single month of documentation from applicants and 
did not obtain any information from financial institutions.[Footnote 
25] CMS officials noted that it is costly and time consuming to 
conduct a review for the 60 month look-back period. Thus, these 
officials stated, it was understandable for states to use discretion 
and only conduct reviews when there is reason to believe that a 
transfer could have been made during the look-back period. For 
example, a state might determine the need to conduct a more thorough 
review as a result of red flags found through other checks, such as 
when an applicant has very high income and no resources. However, the 
application forms in 6 of the 31 states did not ask about transfers 
made during the entire look-back period.[Footnote 26] Thus, it is 
unclear how these 6 states would know whether assets were transferred 
for less than FMV in the 60 months prior to application, and how all 
31 states would be able to detect unreported transfers of assets made 
during the entire look-back period. In contrast, 20 states reported 
requiring 60 months of documentation from all applicants, 5 of which 
also requested 60 months of information from financial institutions 
for at least some applicants.[Footnote 27] 

* Home Equity. Fourteen states reported not requiring documentation of 
a primary residence. Of these 14 states, 8 indicated that they conduct 
property record searches in the county of residence for at least some 
applicants to try to obtain information about property the applicant 
may own.[Footnote 28] Additionally, 1 state indicated that it could 
obtain information about an applicant's primary residence from a third 
party.[Footnote 29] The remaining 5 states reported they did not 
conduct property records searches; as such, it is unclear how these 
states would determine if an applicant owns a home that he or she 
failed to report, and the value of an applicant's equity interest in 
the home.[Footnote 30] Of the 37 states that reported requiring 
applicants to submit documentation of a primary residence, only 3 
reported requiring documentation that could provide the state with 
information on the value of the home or an applicant's equity interest 
in the home.[Footnote 31] The remaining 34 states reported requiring 
documentation about applicants' primary residence, but the 
documentation received may not provide all of the information 
necessary to determine if applicants' equity interest in their homes 
exceeds the state's allowable amount. 

* Life Estates. Among the 32 states that provided information on our 
survey about life estates, 2 states reported not assessing the length 
of time an applicant with a life estate resided in the property. 
[Footnote 32] The remaining 30 states reported requiring some type of 
proof in order to determine the amount of time an applicant resided in 
the property after the purchase of the life estate interest.[Footnote 
33] On the basis of our analysis of state responses, 7 of the 30 
states reported relying only on a statement from an applicant or 
another person who owns the residence to determine the length of time 
an applicant resided in the property; however, 2 of these 7 states 
said that they would require more documentation if they determined 
that the information they received was questionable. The remaining 23 
states reported relying on documentation, such as a utility bill; a 
statement from an applicant; a statement from a third party; or some 
combination of these sources to determine the length of time an 
applicant lived in the property. 

* CCRCs. On the basis of our survey results, most states--46 of 51--
reported requiring applicants to provide documentation of CCRC or life 
care community entrance fees, such as a copy of the contract or 
agreement. Thus, these states should have sufficient information to 
determine if, under the DRA, an applicant's entrance fees should be 
countable resources for determining Medicaid eligibility. However, it 
is unclear how the remaining 5 states would be able to determine if an 
applicant has paid such fees, and whether they should be counted 
toward the applicant's Medicaid long-term care eligibility 
determination. 

* Promissory Notes. Fifty states reported on our survey that they 
require applicants to provide documentation of promissory notes or 
loans; such documentation should allow the state to determine if a 
note meets the requirements specified in the DRA, such as providing 
for payments to be made in equal installments throughout the course of 
the loan, or if a note should be treated as a transfer of assets for 
less than FMV.[Footnote 34] 

* Annuities. In responding to our survey, all states reported 
requiring documentation of annuities and thus should have sufficient 
information to determine whether an annuity should be considered a 
transfer of assets for less than FMV under the DRA. Additionally, our 
review of 49 states' long-term care application forms found that 45 
required the disclosure of any interest the applicant or spouse has in 
an annuity and 27 contained statements regarding the state becoming a 
remainder beneficiary of such annuities. (See appendix VIII.)[Footnote 
35] 

Concluding Observations: 

As the demand for long-term care services increases and federal and 
state resources continue to be strained, it is important to ensure 
that only eligible individuals receive Medicaid coverage for long-term 
care. Since each state is responsible for day-to-day implementation of 
its Medicaid program, variation in policies and practices for 
determining financial eligibility is expected. However, some of the 
variation we found may raise questions regarding how states determine 
Medicaid eligibility for long-term care and enforce certain provisions 
of the DRA. 

States must balance the costs of eligibility determination efforts 
with the need to ensure that those efforts provide sufficient 
information to implement federal requirements. While third-party 
verification of applicants' financial information likely provides 
states with the best assurance of having a complete picture of an 
applicant's financial status, it can be a complex and costly process 
that requires a significant amount of information and review. Given 
the complexities involved, it may be reasonable for states to adhere 
to a risk-based approach and focus their eligibility determination 
efforts on applicants who appear to be more likely to have assets or 
to have transferred assets that would make them ineligible. The 
electronic AVS that is required by law may help states identify some 
unreported or transferred assets. However, it is too early to assess 
its overall effectiveness, which will ultimately depend on the breadth 
of the financial institutions participating and the depth of the 
information obtained. 

Agency Comments: 

We provided a draft of this report to HHS for its review, and HHS 
provided written comments (see appendix IX). HHS concurred with our 
findings and noted that the results of our comprehensive report will 
serve as a resource for all interested parties. Further, HHS indicated 
that the report will be helpful for targeting CMS's ongoing technical 
assistance and oversight efforts with states. 

As agreed with your offices, unless you publicly announce the contents 
of this report earlier, we plan no further distribution until 30 days 
from the report date. At that time, we will send copies to the 
Administrator of CMS and other interested parties. In addition, the 
report will be available at no charge on the GAO website at 
[hyperlink, http://www.gao.gov]. 

If you or your staff have any questions about this report, please 
contact me at (202) 512-7114 or yocomc@gao.gov. Contact points for our 
Offices of Congressional Relations and Public Affairs may be found on 
the last page of this report. GAO staff who made key contributions to 
this report are listed in appendix X. 

Signed by: 

Carolyn L. Yocom: 
Director, Health Care: 

[End of section] 

Appendix I: GAO Analysis of State Applications: 

Table 8: Characteristics of Medicaid Long-Term Care Application 
Processes, by State, 2011: 

State: Alabama; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: Alaska; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: Arizona; 
Level of information on assets requested on application form: 
Comprehensive[A]: [B]; 
Interviews are conducted for all applicants. 

State: Arkansas; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: California; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Colorado; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Connecticut; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants: [Empty]; 
Interviews are conducted for some applicants: [Empty]. 

State: Delaware; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: District of Columbia; 
Level of information on assets requested on application form: General; 
Interviews are conducted for all applicants: [Empty]; 
Interviews are conducted for some applicants: [Empty]. 

State: Florida; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Georgia; 
Level of information on assets requested on application form: General; 
Interviews are conducted for all applicants. 

State: Hawaii; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: Idaho; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Illinois; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants: [Empty]; 
Interviews are conducted for some applicants: [Empty]. 

State: Indiana; 
Level of information on assets requested on application form: General; 
Interviews are conducted for all applicants. 

State: Iowa; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Kansas; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants: [Empty]; 
Interviews are conducted for some applicants: [Empty]. 

State: Kentucky; 
Level of information on assets requested on application form: 
Comprehensive[A]: [C]; 
General: [C]; 
Interviews are conducted for all applicants. 

State: Louisiana; 
Level of information on assets requested on application form: 
Comprehensive[A]: [Empty]; 
Level of information on assets requested on application form: General: 
[Empty]; 
[Empty]; 
Interviews are conducted for all applicants. [Empty]; 
Interviews are conducted for some applicants. [Empty]. 

State: Maine; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Maryland; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Massachusetts; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Michigan; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Minnesota; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Mississippi; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: Missouri; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Montana; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Nebraska; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: Nevada; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants: [Empty]; 
Interviews are conducted for some applicants: [Empty]. 

State: New Hampshire; 
Level of information on assets requested on application form: General; 
Interviews are conducted for all applicants. 

State: New Jersey; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: New Mexico; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: New York; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants: [Empty]; 
Interviews are conducted for some applicants: [Empty]. 

State: North Carolina; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants: [Empty]; 
Interviews are conducted for some applicants: [Empty]. 

State: North Dakota; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Ohio; 
Level of information on assets requested on application form: General; 
Interviews are conducted for some applicants. 

State: Oklahoma; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: Oregon; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: Pennsylvania; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Rhode Island; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: South Carolina; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: South Dakota; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Tennessee; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: Texas; 
Level of information on assets requested on application form: 
Comprehensive[A; 
Interviews are conducted for some applicants. 

State: Utah; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Vermont; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: Virginia; 
Level of information on assets requested on application form: 
Comprehensive[A; 
Interviews are conducted for some applicants. 

State: Washington; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: West Virginia; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: Wisconsin; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for some applicants. 

State: Wyoming; 
Level of information on assets requested on application form: 
Comprehensive[A]; 
Interviews are conducted for all applicants. 

State: Total; 
Level of information on assets requested on application form: 
Comprehensive[A]: 44; 
General: 5; 
Interviews are conducted for all applicants: 23; 
Interviews are conducted for some applicants: 21. 

Source: GAO analysis of state application forms for Medicaid coverage 
for long-term care and GAO web-based survey administered to state 
Medicaid officials. 

[A] Application forms requesting comprehensive information on assets 
asked applicants to provide detailed information on several types of 
assets, such as specifically requesting or referencing checking and 
savings accounts, stocks and bonds, retirement accounts, burial 
insurance, real property, and vehicles. 

[B] State collected information from applicants through an interview 
rather than a paper application form. A state official provided the 
form eligibility workers use during their interviews with applicants, 
and this form requests comprehensive information on applicants' assets. 

[C] State collected information from applicants through an interview 
rather than a paper application form. 

[End of table] 

Table 9: Time Frame of Information on Transfers of Assets Requested in 
Medicaid Long-Term Care Application Forms, by State, 2011: 

State: Alabama; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Alaska; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Arizona; 
Application form requested information on transfers: 
Within another time frame [A]. 

State: Arkansas; 
Application form requested information on transfers: 
Within previous 60 months [B]; 
Within another time frame [B]. 

State: California; 
Application form requested information on transfers: 
Within another time frame [C]. 

State: Colorado; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Connecticut; 
Application form requested information on transfers: 
Within another time frame [D]. 

State: Delaware; 
Application form requested information on transfers: 
Within previous 60 months. 

State: District of Columbia; 
Application form requested information on transfers: 
Within another time frame [E]. 

State: Florida; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Georgia; 
Application form requested information on transfers: 
Within previous 60 months [F]; 
Within another time frame [F]. 

State: Hawaii; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Idaho; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Illinois; 
Application form requested information on transfers: 
Within another time frame [D]. 

State: Indiana; 
Application form requested information on transfers: 
Within previous 60 months [F]; 
Within another time frame [F]. 

State: Iowa; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Kansas; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Kentucky; 
Application form requested information on transfers: 
Within previous 60 months [G]; 
Within another time frame [G]. 

State: Louisiana; 
Application form requested information on transfers: 
Within another time frame [H]. 

State: Maine; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Maryland; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Massachusetts; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Michigan; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Minnesota; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Mississippi; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Missouri; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Montana; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Nebraska; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Nevada; 
Application form requested information on transfers: 
Within previous 60 months. 

State: New Hampshire; 
Application form requested information on transfers: 
Within previous 60 months. 

State: New Jersey; 
Application form requested information on transfers: 
Within another time frame [I]. 

State: New Mexico; 
Application form requested information on transfers: 
Within previous 60 months. 

State: New York; 
Application form requested information on transfers: 
Within previous 60 months. 

State: North Carolina; 
Application form requested information on transfers: 
Within another time frame [D]. 

State: North Dakota; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Ohio; 
Application form requested information on transfers: 
Within previous 60 months [F]; 
Within another time frame [F]. 

State: Oklahoma; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Oregon; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Pennsylvania; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Rhode Island; 
Application form requested information on transfers: 
Within previous 60 months. 

State: South Carolina; 
Application form requested information on transfers: 
Within previous 60 months. 

State: South Dakota; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Tennessee; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Texas; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Utah; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Vermont; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Virginia; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Washington; 
Application form requested information on transfers: 
Within previous 60 months. 

State: West Virginia; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Wisconsin; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Wyoming; 
Application form requested information on transfers: 
Within previous 60 months. 

State: Total; 
Application form requested information on transfers: 
Within previous 60 months: 38; 
Within another time frame: 7. 

Source: GAO analysis of state application forms for Medicaid coverage 
for long-term care. 

Notes: Our review was limited to state application forms for Medicaid 
coverage for long-term care provided to us by state officials. Some 
states might ask about transfers of assets through other means, such 
as a form other than the long-term care application form or through an 
interview conducted as part of the application process. 

[A] State collected information from applicants through an interview 
rather than a paper application form. A state official provided the 
form eligibility workers use during their interviews with applicants, 
and this form asked about transfers made in the last 36 months; 60 
months for trusts. 

[B] State's application form did not ask about transfers, but did ask 
whether the applicant or his/her spouse sold or gave away a home or 
other real property. 

[C] State's application form asked about transfers made in the last 30 
months; 60 months for trusts. 

[D] State's application form asked about transfers made in the last 36 
months; 60 months for trusts. 

[E] State's application form asked about transfers greater than $1,000 
that were made during the last 36 months. 

[F] State's application form did not ask about transfers. 

[G] State collected information from applicants through an interview 
rather than a paper application form. 

[H] State's application form asked about transfers ever made. 

[I] State's application form asked about transfers made in the last 36 
months. 

[End of table] 

[End of section] 

Appendix II: States' Asset Documentation Requirements: 

Table 10: Applicant Documentation Requirements for Medicaid Long-Term 
Care, by State and Type of Asset, 2011: 

Alabama; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Alaska; 
Earned income: [Check]; 
Unearned income: [A]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [B]; 
Other real property: [Check]; 
Vehicles: [Empty]. 

Arizona; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Arkansas; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [C]; 
Other real property: [Check]; 
Vehicles: [Check]. 

California; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [D]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Colorado; 
Earned income: [E]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Connecticut; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Delaware; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

District of Columbia; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [F]; 
Life insurance: [Check]; 
Primary residence: [G]; 
Other real property: [Check]; 
Vehicles: [Empty]. 

Florida; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Georgia; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Hawaii; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Idaho; 
Earned income: [Check]; 
Unearned income: [A]; 
Financial and investment resources: [F]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [H]. 

Illinois; 
Earned income: [Check]; 
Unearned income: [A]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Indiana; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Iowa; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [I]; 
Other real property: [I]; 
Vehicles: [Empty]. 

Kansas; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Empty]. 

Kentucky; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Louisiana; 
Earned income: [Check]; 
Unearned income: [I]; 
Financial and investment resources: [Check]; 
Life insurance: [J]; 
Primary residence: [Empty]; 
Other real property: [Check]; 
Vehicles: [Empty]. 

Maine; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Empty]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Maryland; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [I]; 
Other real property: [Check]; 
Vehicles: [K]. 

Massachusetts; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Michigan; 
Earned income: [Check]; 
Unearned income: [A]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Minnesota; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [I]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Mississippi; 
Earned income: [Check]; 
Unearned income: [A]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Empty]. 

Missouri; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Montana; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [I]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Nebraska; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Nevada; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

New Hampshire; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

New Jersey; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

New Mexico; 
Earned income: [Check]; 
Unearned income: [I]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

New York; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [D]; 
Other real property: [Check]; 
Vehicles: [Check]. 

North Carolina; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

North Dakota; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Empty]. 

Ohio; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Oklahoma; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [I]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Oregon; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Pennsylvania; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Rhode Island; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

South Carolina; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

South Dakota; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Empty]. 

Tennessee; 
Earned income: [Check]; 
Unearned income: [A]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [C]; 
Other real property: [Check]; 
Vehicles: [Empty]. 

Texas; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Utah; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [L]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Empty]. 

Vermont; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [M]; 
Primary residence: [N]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Virginia; 
Earned income: [Check]; 
Unearned income: [A]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [B]; 
Other real property: [Check]; 
Vehicles: [Empty]. 

Washington; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [O]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Empty]. 

West Virginia; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Wisconsin; 
Earned income: [Check]; 
Unearned income: [I]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Wyoming; 
Earned income: [Check]; 
Unearned income: [Check]; 
Financial and investment resources: [Check]; 
Life insurance: [Check]; 
Primary residence: [Check]; 
Other real property: [Check]; 
Vehicles: [Check]. 

Total; 
Earned income: 50; 
Unearned income: 49; 
Financial and investment resources: 51; 
Life insurance: 50; 
Primary residence: 37; 
Other real property: 50; 
Vehicles: 38. 

Source: GAO web-based survey administered to state Medicaid officials. 

[A] State reported it did not require documentation of at least some 
types of unearned income that could be verified with third parties. 

[B] State reported it did not count a primary residence when 
determining an applicant's eligibility--and therefore did not require 
documentation--if an applicant was living in the home or intended to 
return home. 

[C] State reported it did not require documentation of primary 
residence unless it appeared as though the primary residence could 
exceed the allowable amount of equity interest. 

[D] State reported it did not require documentation of primary 
residence because it was not countable when determining an applicant's 
eligibility. 

[E] State reported it did not require documentation of earned income 
because it was verified through an interface with the state's 
Department of Labor. 

[F] State reported it did not require documentation of financial and 
investment resources if reported resources were below a designated 
level. 

[G] State reported it did not count a primary residence when 
determining an applicant's eligibility--and therefore did not require 
documentation--if an applicant's spouse, child under 20 years old, or 
disabled child was living in the home. 

[H] State reported requiring documentation of vehicle loan value only 
if it affected eligibility determination. 

[I] State reported it did not require documentation of this type of 
asset if it could be verified with a third party. 

[J] State reported requiring documentation of a life insurance policy 
if the applicant reported that it had a face value of $10,000 or more. 

[K] State reported only requiring documentation of vehicles other than 
automobiles. 

[L] State reported it may not require documentation of financial and 
investment resources if applicant reported having resources valued at 
well below the standard. 

[M] State reported it did not require documentation of term life 
insurance policies. State also did not require documentation of a life 
insurance policy if the applicant reported that it had a face value of 
$1,500 or less. 

[N] State reported it did not require documentation of primary 
residence unless the applicant reported the value of the residence was 
within $200,000 of the allowable amount of equity interest. 

[O] State reported requiring documentation of financial and investment 
resources if the applicant was applying for the first time, was 
previously denied coverage, had not received benefits in many years, 
or if the applicant's reported resources were deemed questionable; 
otherwise, state did not require documentation. 

[End of table] 

Table 10b: Applicant Documentation Requirements for Medicaid Long-Term 
Care, by State and Type of Asset, 2011 (continued): 

State: Alabama; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Alaska; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Arizona; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Arkansas; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: California; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Empty]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Colorado; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Connecticut; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Empty]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Delaware; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Empty]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: District of Columbia; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Empty]; 
Life estate[C]: [Check]; 
Promissory note or loan: response not provided; 
Trust: [Check]. 

State: Florida; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Georgia; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Hawaii; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Idaho; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Illinois; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Indiana; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Iowa; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Kansas; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Kentucky; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Louisiana; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Maine; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Maryland; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Massachusetts; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Michigan; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Minnesota; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Mississippi; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Missouri; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Montana; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Nebraska; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Nevada; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: New Hampshire; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: New Jersey; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: New Mexico; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: New York; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: North Carolina; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: North Dakota; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Ohio; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Oklahoma; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Oregon; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Pennsylvania; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Rhode Island; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Empty]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: South Carolina; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: South Dakota; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Tennessee; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Texas; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Utah; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Vermont; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Virginia; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Washington; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: West Virginia; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Wisconsin; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Wyoming; 
Annuity: [Check]; 
Burial contract[A]: [Check]; 
CCRC entrance fee[B]: [Check]; 
Life estate[C]: [Check]; 
Promissory note or loan: [Check]; 
Trust: [Check]. 

State: Total; 
Annuity: 51; 
Burial contract[A]: 51; 
CCRC entrance fee[B]: 46; 
Life estate[C]: 51; 
Promissory note or loan: 50; 
Trust: 51. 

Source: GAO web-based survey administered to state Medicaid officials. 

Legend: 

[A] Includes burial contracts and prepaid funeral arrangements. 

[B] CCRC is an abbreviation for continuing care retirement community. 

[C] A life estate is an interest in real property that gives the owner 
of the interest the right to use and possess the property only for the 
duration of the life of a person, usually the person who occupies the 
premises. 

[End of table] 

Table 11: States' Treatment of Earned Income Documentation, by Type of 
Documentation, 2011: 

Type of documentation: Earning statement or pay stub; 
Number of states: 
Required: 4; 
Acceptable as proof itself: 45; 
Acceptable with other documentation: 1; 
Not acceptable: 0. 

Type of documentation: Copy of check or check stub[A]; 
Number of states: 
Required: 3; 
Acceptable as proof itself: 33; 
Acceptable with other documentation: 9; 
Not acceptable: 4. 

Type of documentation: Itemized bank statement[A]; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 6; 
Acceptable with other documentation: 20; 
Not acceptable: 22. 

Type of documentation: Income tax return[A]; 
Number of states: 
Required: 0; 
Acceptable as proof itself: 20; 
Acceptable with other documentation: 25; 
Not acceptable: 4. 

Type of documentation: W-2 tax form[A]; 
Number of states: 
Required: 0; 
Acceptable as proof itself: 17; 
Acceptable with other documentation: 16; 
Not acceptable: 16. 

Type of documentation: 1099 tax form[B]; 
Number of states: 
Required: 0; 
Acceptable as proof itself: 16; 
Acceptable with other documentation: 17; 
Not acceptable: 15. 

Type of documentation: Written statement of earnings from employer; 
Number of states: 
Required: 0; 
Acceptable as proof itself: 49; 
Acceptable with other documentation: 1; 
Not acceptable: 0. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 50 states that 
reported requiring documentation of earned income. In each row, the 
number of states may not add to 50 because not all states specified 
the level of acceptability for the respective type of documentation. 

[A] One state did not specify the level of acceptability for this type 
of documentation. 

[B] Two states did not specify the level of acceptability for this 
type of documentation. 

[End of table] 

Table 12: States' Treatment of Earned Income Documentation, by State 
and Type of Documentation, 2011: 

State: Alabama; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Alaska[A,B]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Arizona[A,B]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Arkansas; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: California[C]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Connecticut; 
Earning statement or pay stub: Required; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Delaware; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: District of Columbia; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Florida[D]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Most (more than half) applicants; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Georgia[A,D]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Hawaii; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Idaho[D]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Most (more than half) applicants; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Illinois; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Indiana; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Iowa[B]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Kansas; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Kentucky[A]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Response not provided; 
Income tax return: Response not provided; 
W-2 tax form: Response not provided; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Louisiana; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Maine; 
Earning statement or pay stub: Required; 
Copy of check or check stub: Required; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Maryland; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Massachusetts; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Michigan[A,B]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Minnesota[D]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Mississippi; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Missouri; 
Earning statement or pay stub: Acceptable as proof with other 
documentation; 
Copy of check or check stub: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Montana; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Nebraska; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Nevada; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: New Hampshire; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: New Jersey; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: New Mexico; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: New York[C]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: North Carolina[C]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: North Dakota; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Ohio; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Most (more than half) applicants; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Oklahoma; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Oregon; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Response not provided; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Pennsylvania; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Rhode Island; 
Earning statement or pay stub: Required; 
Copy of check or check stub: Required; 
Itemized bank statement: Required; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof with 
other documentation. 

State: South Carolina; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Response not provided; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: South Dakota; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Tennessee[D]; 
Earning statement or pay stub: Required; 
Copy of check or check stub: Required; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Texas[C]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Acceptable as proof by itself; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Utah; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof by itself; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Vermont[D]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Virginia[D]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Response not provided; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Washington; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: West Virginia; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Wisconsin[B]; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
W-2 tax form: Acceptable as proof with other documentation; 
1099 tax form: Acceptable as proof with other documentation; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

State: Wyoming; 
Earning statement or pay stub: Acceptable as proof by itself; 
Copy of check or check stub: Most (more than half) applicants; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
W-2 tax form: Most (more than half) applicants; 
1099 tax form: Most (more than half) applicants; 
Written statement of earnings from employer: Acceptable as proof by 
itself. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 50 states that 
reported requiring documentation of earned income. One state--
Colorado--reported it did not require documentation of earned income. 

[A] State reported that it verified applicants' earned income using 
The Work Number, which is a national database of employment and income 
information contributed directly by over 2,200 employers. The state 
considered The Work Number acceptable as proof by itself for 
documenting earned income. 

[B] State reported that it verified applicants' earned income by 
contacting the employer directly, which it considered acceptable as 
proof by itself for documenting earned income. 

[C] State reported that it may accept applicants' self-attestation in 
lieu of earned income documentation. 

[D] State reported that tax forms are acceptable only to show proof of 
earned income for self-employed applicants. 

[End of table] 

Table 13: States' Treatment of Unearned Income Documentation, by Type 
of Documentation, 2011: 

Type of documentation: Statement or letter from Social Security 
Administration[A]; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 45; 
Acceptable with other documentation: 0; 
Not acceptable: 1. 

Type of documentation: Statement or letter from Veterans 
Administration; 
Number of states: 
Required: 4; 
Acceptable as proof itself: 45; 
Acceptable with other documentation: 0; 
Not acceptable: 0. 

Type of documentation: Pension statement; 
Number of states: 
Required: 3; 
Acceptable as proof itself: 44; 
Acceptable with other documentation: 2; 
Not acceptable: 0. 

Type of documentation: Retirement statement; 
Number of states: 
Required: 3; 
Acceptable as proof itself: 41; 
Acceptable with other documentation: 5; 
Not acceptable: 0. 

Type of documentation: Statement of investment earnings; 
Number of states: 
Required: 3; 
Acceptable as proof itself: 40; 
Acceptable with other documentation: 5; 
Not acceptable: 1. 

Type of documentation: Copy of check or check stub[B]; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 25; 
Acceptable with other documentation: 16; 
Not acceptable: 6. 

Type of documentation: Itemized bank statement; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 10; 
Acceptable with other documentation: 23; 
Not acceptable: 15. 

Type of documentation: Income tax return; 
Number of states: 
Required: 0; 
Acceptable as proof itself: 13; 
Acceptable with other documentation: 27; 
Not acceptable: 9. 

Type of documentation: Tax form showing interest, dividends, etc.; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 18; 
Acceptable with other documentation: 21; 
Not acceptable: 9. 

Type of documentation: Annuity schedule of payments; 
Number of states: 
Required: 3; 
Acceptable as proof itself: 33; 
Acceptable with other documentation: 11; 
Not acceptable: 2. 

Type of documentation: Promissory note schedule of 
payments/interest[B]; 
Number of states: 
Required: 2; 
Acceptable as proof itself: 30; 
Acceptable with other documentation: 15; 
Not acceptable: 1. 

Type of documentation: Copy of court documents; 
Number of states: 
Required: 2; 
Acceptable as proof itself: 30; 
Acceptable with other documentation: 17; 
Not acceptable: 0. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 49 states that 
reported requiring documentation of unearned income. In each row, the 
number of states may not add to 49 because not all states specified 
the level of acceptability for the respective type of documentation. 

[A] Two states did not specify the level of acceptability for this 
type of documentation. 

[B] One state did not specify the level of acceptability for this type 
of documentation. 

[End of table] 

Table 14a: States' Treatment of Unearned Income Documentation, by 
State and Type of Documentation, 2011: 

State: Alabama; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Alaska; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Arizona; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Arkansas; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: California; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Colorado; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Connecticut; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof with other documentation; 
Statement of investment earnings: Acceptable as proof with other 
documentation; 
Copy of check or check stub: Most (more than half) applicants. 

State: Delaware; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof with other documentation; 
Statement of investment earnings: Acceptable as proof with other 
documentation; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: District of Columbia; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Florida; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Most (more than half) applicants. 

State: Georgia; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Hawaii; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Idaho; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Illinois; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Indiana; 
Statement or letter from SSA[A]: Response not provided; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Iowa; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Kansas; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Kentucky; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof with other documentation; 
Statement of investment earnings: Acceptable as proof with other 
documentation; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Maine; 
Statement or letter from SSA[A]: Required; 
Statement or letter from VA[B]: Required; 
Pension statement: Required; 
Retirement statement: Required; 
Statement of investment earnings: Required; 
Copy of check or check stub: Required. 

State: Maryland; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Required; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Most (more than half) applicants. 

State: Massachusetts; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Michigan; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Minnesota; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Mississippi; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Missouri; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Montana; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Nebraska; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Nevada; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof with other documentation; 
Retirement statement: Acceptable as proof with other documentation; 
Statement of investment earnings: Acceptable as proof with other 
documentation; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: New Hampshire; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: New Jersey; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: New York; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: North Carolina; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: North Dakota; 
Statement or letter from SSA[A]: Response not provided; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Most (more than half) applicants; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Ohio; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Most (more than half) applicants. 

State: Oklahoma; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof with other documentation; 
Retirement statement: Acceptable as proof with other documentation; 
Statement of investment earnings: Acceptable as proof with other 
documentation; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Oregon; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Pennsylvania; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Most (more than half) applicants. 

State: Rhode Island; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: South Carolina; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Response not provided. 

State: South Dakota; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Tennessee; 
Statement or letter from SSA[A]: Most (more than half) applicants; 
Statement or letter from VA[B]: Required; 
Pension statement: Required; 
Retirement statement: Required; 
Statement of investment earnings: Required; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Texas; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Utah; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Required; 
Pension statement: Required; 
Retirement statement: Required; 
Statement of investment earnings: Required; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Vermont; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Virginia; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Most (more than half) applicants. 

State: Washington; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: West Virginia; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

State: Wisconsin; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof by itself. 

State: Wyoming; 
Statement or letter from SSA[A]: Acceptable as proof by itself; 
Statement or letter from VA[B]: Acceptable as proof by itself; 
Pension statement: Acceptable as proof by itself; 
Retirement statement: Acceptable as proof by itself; 
Statement of investment earnings: Acceptable as proof by itself; 
Copy of check or check stub: Acceptable as proof with other 
documentation. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 49 states that 
reported requiring documentation of unearned income. The two states 
that reported they generally did not require documentation of unearned 
income were Louisiana and New Mexico. 

[A] SSA is an abbreviation for the Social Security Administration. 

[B] VA is an abbreviation for the Veterans Administration. 

[End of table] 

Table 14b: States' Treatment of Unearned Income Documentation, by 
State and Type of Documentation, 2011 (continued): 

State: Alabama; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Alaska; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Tax form showing interest/dividends: Most (more than half) applicants; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Arizona; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Arkansas; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof with other 
documentation; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof with other documentation. 

State: California; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Most (more than half) applicants; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Colorado; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof by itself. 

State: Connecticut; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Most (more than half) applicants; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof with other documentation. 

State: Delaware; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof with other documentation. 

State: District of Columbia; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Florida; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Georgia; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Hawaii; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof with other documentation. 

State: Idaho; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Illinois; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Indiana; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof with other 
documentation; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof with other documentation. 

State: Iowa; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Kansas; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof with other 
documentation; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof with other documentation. 

State: Kentucky; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Most (more than half) applicants; 
Annuity schedule of payments: Acceptable as proof with other 
documentation; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof with other documentation. 

State: Maine; 
Itemized bank statement: Required; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Required; 
Annuity schedule of payments: Required; 
Promissory note schedule of payments/interest: Required; 
Copy of court documents: Acceptable as proof by itself. 

State: Maryland; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof with other 
documentation; 
Promissory note schedule of payments/interest: Response not provided; 
Copy of court documents: Acceptable as proof by itself. 

State: Massachusetts; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Michigan; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof with other documentation. 

State: Minnesota; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Tax form showing interest/dividends: Most (more than half) applicants; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Mississippi; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Missouri; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Montana; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof with other documentation. 

State: Nebraska; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof with other 
documentation; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Nevada; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: New Hampshire; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: New Jersey; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof with other 
documentation; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof with other documentation. 

State: New York; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: North Carolina; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: North Dakota; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Most (more than half) applicants; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Ohio; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Oklahoma; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Tax form showing interest/dividends: Most (more than half) applicants; 
Annuity schedule of payments: Most (more than half) applicants; 
Promissory note schedule of payments/interest: Most (more than half) 
applicants; 
Copy of court documents: Acceptable as proof with other documentation. 

State: Oregon; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof with other 
documentation; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof by itself. 

State: Pennsylvania; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof with other documentation. 

State: Rhode Island; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: South Carolina; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: South Dakota; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Tax form showing interest/dividends: Most (more than half) applicants; 
Annuity schedule of payments: Acceptable as proof with other 
documentation; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof with other documentation. 

State: Tennessee; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Required; 
Promissory note schedule of payments/interest: Required; 
Copy of court documents: Required. 

State: Texas; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof with other documentation. 

State: Utah; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Required; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Required. 

State: Vermont; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof with other 
documentation; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof by itself. 

State: Virginia; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Tax form showing interest/dividends: Most (more than half) applicants; 
Annuity schedule of payments: Most (more than half) applicants; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof with other documentation. 

State: Washington; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof with other documentation. 

State: West Virginia; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
Tax form showing interest/dividends: Acceptable as proof by itself; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Wisconsin; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof by itself; 
Promissory note schedule of payments/interest: Acceptable as proof by 
itself; 
Copy of court documents: Acceptable as proof by itself. 

State: Wyoming; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Tax form showing interest/dividends: Acceptable as proof with other 
documentation; 
Annuity schedule of payments: Acceptable as proof with other 
documentation; 
Promissory note schedule of payments/interest: Acceptable as proof 
with other documentation; 
Copy of court documents: Acceptable as proof with other documentation. 

Source: GAO web-based survey administered to state Medicaid officials. 

Note: This table only includes responses from the 49 states that 
reported requiring documentation of unearned income. The two states 
that reported they generally did not require documentation of unearned 
income were Louisiana and New Mexico. 

[End of table] 

Table 15: States' Treatment of Financial and Investment Resources 
Documentation, by Type of Documentation, 2011: 

Type of documentation: Bank statement showing monthly balance; 
Number of states: 
Required: 7; 
Acceptable as proof itself: 31; 
Acceptable with other documentation: 8; 
Not acceptable: 5. 

Type of documentation: Itemized bank statement; 
Number of states: 
Required: 4; 
Acceptable as proof itself: 41; 
Acceptable with other documentation: 4; 
Not acceptable: 2. 

Type of documentation: Income tax return[A]; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 10; 
Acceptable with other documentation: 21; 
Not acceptable: 18. 

Type of documentation: Retirement account statement; 
Number of states: 
Required: 7; 
Acceptable as proof itself: 39; 
Acceptable with other documentation: 5; 
Not acceptable: 0. 

Type of documentation: Retirement account award letter; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 30; 
Acceptable with other documentation: 16; 
Not acceptable: 4. 

Type of documentation: Statement or letter from investment 
brokerages[A]; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 40; 
Acceptable with other documentation: 8; 
Not acceptable: 1. 

Type of documentation: Certificate of stock or bond ownership; 
Number of states: 
Required: 4; 
Acceptable as proof itself: 29; 
Acceptable with other documentation: 16; 
Not acceptable: 2. 

Source: GAO web-based survey administered to state Medicaid officials. 

[A] One state did not specify the level of acceptability for this type 
of documentation. 

[End of table] 

Table 16: States' Treatment of Financial and Investment Resources 
Documentation, by State and Type of Documentation, 2011: 

State: Alabama; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Alaska; 
Bank statement showing monthly balance: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Most (more than half) applicants; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Arizona; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Arkansas; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: California; 
Bank statement showing monthly balance: Most (more than half) 
applicants; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Most (more than half) applicants; 
Statement or letter from investment brokerages: Response not provided; 
Certificate of stock or bond ownership: Most (more than half) 
applicants. 

State: Colorado; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Connecticut; 
Bank statement showing monthly balance: Acceptable as proof with other 
documentation; 
Itemized bank statement: Required; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof with other 
documentation; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof 
with other documentation; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Delaware; 
Bank statement showing monthly balance: Required; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Required; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Required. 

State: District of Columbia; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Florida; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Georgia; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Most (more than half) applicants; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Hawaii; 
Bank statement showing monthly balance: Most (more than half) 
applicants; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Idaho; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof with other 
documentation; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Illinois; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Indiana; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof 
with other documentation; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Iowa; 
Bank statement showing monthly balance: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Kansas; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Kentucky; 
Bank statement showing monthly balance: Most (more than half) 
applicants; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Louisiana; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Maine; 
Bank statement showing monthly balance: Required; 
Itemized bank statement: Required; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Required; 
Retirement account award letter: Required; 
Statement or letter from investment brokerages: Required; 
Certificate of stock or bond ownership: Required. 

State: Maryland; 
Bank statement showing monthly balance: Most (more than half) 
applicants; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof 
with other documentation; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Massachusetts; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Michigan; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Minnesota; 
Bank statement showing monthly balance: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Mississippi; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Missouri; 
Bank statement showing monthly balance: Required; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Required; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Montana; 
Bank statement showing monthly balance: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Nebraska; 
Bank statement showing monthly balance: Required; 
Itemized bank statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Required; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Most (more than half) 
applicants; 
Certificate of stock or bond ownership: Required. 

State: Nevada; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof with other 
documentation; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof 
with other documentation; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: New Hampshire; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: New Jersey; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: New Mexico; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: New York; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: North Carolina; 
Bank statement showing monthly balance: Required; 
Itemized bank statement: Required; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: North Dakota; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Ohio; 
Bank statement showing monthly balance: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Oklahoma; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof with other 
documentation; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Oregon; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof 
with other documentation; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Pennsylvania; 
Bank statement showing monthly balance: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Rhode Island; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: South Carolina; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Response not provided; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: South Dakota; 
Bank statement showing monthly balance: Most (more than half) 
applicants; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Most (more than half) 
applicants. 

State: Tennessee; 
Bank statement showing monthly balance: Required; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Required; 
Retirement account award letter: Most (more than half) applicants; 
Statement or letter from investment brokerages: Acceptable as proof 
with other documentation; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Texas; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Utah; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Required; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Required. 

State: Vermont; 
Bank statement showing monthly balance: Required; 
Itemized bank statement: Required; 
Income tax return: Required; 
Retirement account statement: Acceptable as proof with other 
documentation; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof 
with other documentation; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Virginia; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Required; 
Retirement account award letter: Acceptable as proof with other 
documentation; 
Statement or letter from investment brokerages: Acceptable as proof 
with other documentation; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

State: Washington; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: West Virginia; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Wisconsin; 
Bank statement showing monthly balance: Acceptable as proof by itself; 
Itemized bank statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof by itself. 

State: Wyoming; 
Bank statement showing monthly balance: Acceptable as proof with other 
documentation; 
Itemized bank statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Retirement account statement: Acceptable as proof by itself; 
Retirement account award letter: Acceptable as proof by itself; 
Statement or letter from investment brokerages: Acceptable as proof by 
itself; 
Certificate of stock or bond ownership: Acceptable as proof with other 
documentation. 

Source: GAO web-based survey administered to state Medicaid officials. 

[End of table] 

Table 17: States' Treatment of Life Insurance Documentation, by Type 
of Documentation, 2011: 

Type of documentation: Copy of life insurance policy[A]; 
Number of states: 
Required: 4; 
Acceptable as proof itself: 33; 
Acceptable with other documentation: 12; 
Not acceptable: 0. 

Type of documentation: Written statement from insurance company 
showing current/face value of life insurance policy; 
Number of states: 
Required: 5; 
Acceptable as proof itself: 39; 
Acceptable with other documentation: 6; 
Not acceptable: 0. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 50 states that 
reported requiring documentation of life insurance. In each row, the 
number of states may not add to 50 because not all states specified 
the level of acceptability for the respective type of documentation. 

[A] One state did not specify the level of acceptability for this type 
of documentation. 

[End of table] 

Table 18: States' Treatment of Life Insurance Documentation, by State 
and Type of Documentation, 2011: 

State: Alabama; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Alaska; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Arizona[A]; 
Copy of life insurance policy: Acceptable as proof with other 
documentation; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Arkansas; 
Copy of life insurance policy: Acceptable as proof with other 
documentation; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: California; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof with other documentation. 

State: Colorado; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Connecticut; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Delaware; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: District of Columbia; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Florida; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Georgia; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Hawaii; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Idaho; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Illinois; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Indiana; 
Copy of life insurance policy: Required; 
Written statement from insurance company showing current/face value of 
life insurance policy: Required. 

State: Iowa; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Kansas; 
Copy of life insurance policy: Acceptable as proof with other 
documentation; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof with other documentation. 

State: Kentucky; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Maine; 
Copy of life insurance policy: Required; 
Written statement from insurance company showing current/face value of 
life insurance policy: Required. 

State: Maryland; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Massachusetts; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Michigan[A]; 
Copy of life insurance policy: Acceptable as proof with other 
documentation; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Minnesota; 
Copy of life insurance policy: Acceptable as proof with other 
documentation; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Mississippi; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Missouri; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Montana; 
Copy of life insurance policy: Acceptable as proof with other 
documentation; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof with other documentation. 

State: Nebraska; 
Copy of life insurance policy: Required; 
Written statement from insurance company showing current/face value of 
life insurance policy: Required. 

State: Nevada; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: New Hampshire; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof with other documentation. 

State: New Jersey; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: New Mexico; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: New York; 
Copy of life insurance policy: Acceptable as proof with other 
documentation; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof with other documentation. 

State: North Carolina; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: North Dakota; 
Copy of life insurance policy: Acceptable as proof with other 
documentation; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Ohio; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Oklahoma; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Oregon; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Pennsylvania; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Rhode Island; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: South Carolina[A]; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: South Dakota; 
Copy of life insurance policy: Acceptable as proof with other 
documentation; 
Written statement from insurance company showing current/face value of 
life insurance policy: Required. 

State: Tennessee; 
Copy of life insurance policy: Required; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Texas[A]; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Utah; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof with other documentation. 

State: Vermont[A]; 
Copy of life insurance policy: Response not provided; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Virginia; 
Copy of life insurance policy: Acceptable as proof with other 
documentation; 
Written statement from insurance company showing current/face value of 
life insurance policy: Required. 

State: Washington; 
Copy of life insurance policy: Acceptable as proof with other 
documentation; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: West Virginia; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Wisconsin; 
Copy of life insurance policy: Acceptable as proof by itself; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

State: Wyoming; 
Copy of life insurance policy: Acceptable as proof with other 
documentation; 
Written statement from insurance company showing current/face value of 
life insurance policy: Acceptable as proof by itself. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 50 states that 
reported requiring documentation of life insurance. One state--
Louisiana--reported it generally did not require documentation of life 
insurance. 

[A] State reported it would contact insurance companies directly to 
verify ownership and value of life insurance. 

[End of table] 

Table 19: States' Treatment of Primary Residence Documentation, by 
Type of Documentation, 2011: 

Type of documentation: Property deed; 
Number of states: 
Required: 3; 
Acceptable as proof itself: 20; 
Acceptable with other documentation: 13; 
Not acceptable: 1. 

Type of documentation: Property tax assessment statement or bill[A]; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 23; 
Acceptable with other documentation: 12; 
Not acceptable: 0. 

Type of documentation: Assessment of current value[A]; 
Number of states: 
Required: 2; 
Acceptable as proof itself: 26; 
Acceptable with other documentation: 8; 
Not acceptable: 0. 

Type of documentation: Mortgage statement[A]; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 14; 
Acceptable with other documentation: 15; 
Not acceptable: 6. 

Type of documentation: Income tax return[B]; 
Number of states: 
Required: 0; 
Acceptable as proof itself: 4; 
Acceptable with other documentation: 9; 
Not acceptable: 21. 

Type of documentation: Purchase or sale agreement; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 16; 
Acceptable with other documentation: 16; 
Not acceptable: 4. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 37 states that 
reported requiring documentation of a primary residence. In each row, 
the number of states may not add to 37 because not all states 
specified the level of acceptability for the respective type of 
documentation. 

[A] One state did not specify the level of acceptability for this type 
of documentation. 

[B] Three states did not specify the level of acceptability for this 
type of documentation. 

[End of table] 

Table 20: States' Treatment of Primary Residence Documentation, by 
State and Type of Documentation, 2011: 

State: Alabama; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Arizona; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Colorado; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Connecticut; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Required. 

State: Delaware; 
Property deed: Required; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Required; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Florida; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Georgia; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Hawaii; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Idaho; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Illinois; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Indiana; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Required; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Response not provided; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Kansas; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Kentucky; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Most (more than half) applicants. 

State: Maryland; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Massachusetts; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Most (more than half) applicants. 

State: Michigan; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Mississippi; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Missouri; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Nebraska; 
Property deed: Required; 
Property tax assessment statement or bill: Required; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Required; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Most (more than half) applicants. 

State: Nevada; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: New Hampshire; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: New Jersey; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: New Mexico; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: North Carolina; 
Property deed: Most (more than half) applicants; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: North Dakota; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Ohio; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Oregon; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Pennsylvania; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Rhode Island; 
Property deed: Required; 
Property tax assessment statement or bill: Response not provided; 
Assessment of current value: Response not provided; 
Mortgage statement: Response not provided; 
Income tax return: Response not provided; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: South Carolina; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Response not provided; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: South Dakota; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Texas; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Utah; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Washington; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: West Virginia; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Wisconsin; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Wyoming; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Most (more than half) applicants. 

Source: GAO web-based survey administered to state Medicaid officials. 

Note: This table only includes responses from the 37 states that 
reported requiring documentation of a primary residence. The following 
14 states reported they generally did not require documentation of a 
primary residence: Alaska, Arkansas, California, District of Columbia, 
Iowa, Louisiana, Maine, Minnesota, Montana, New York, Oklahoma, 
Tennessee, Vermont, and Virginia. 

[End of table] 

Table 21: States' Treatment of Documentation of Real Property other 
than Primary Residence, by Type of Documentation, 2011: 

Type of documentation: Property deed; 
Number of states: 
Required: 7; 
Acceptable as proof itself: 24; 
Acceptable with other documentation: 16; 
Not acceptable: 3. 

Type of documentation: Property tax assessment statement or bill[A]; 
Number of states: 
Required: 2; 
Acceptable as proof itself: 32; 
Acceptable with other documentation: 14; 
Not acceptable: 1. 

Type of documentation: Assessment of current value; 
Number of states: 
Required: 4; 
Acceptable as proof itself: 34; 
Acceptable with other documentation: 10; 
Not acceptable: 2. 

Type of documentation: Mortgage statement[B]; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 13; 
Acceptable with other documentation: 23; 
Not acceptable: 11. 

Type of documentation: Income tax return[C]; 
Number of states: 
Required: 0; 
Acceptable as proof itself: 3; 
Acceptable with other documentation: 14; 
Not acceptable: 30. 

Type of documentation: Purchase or sale agreement[A]; 
Number of states: 
Required: 3; 
Acceptable as proof itself: 20; 
Acceptable with other documentation: 25; 
Not acceptable: 1. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 50 states that 
reported requiring documentation of real property other than a primary 
residence. In each row, the number of states may not add to 50 because 
not all states specified the level of acceptability for the respective 
type of documentation. 

[A] One state did not specify the level of acceptability for this type 
of documentation. 

[B] Two states did not specify the level of acceptability for this 
type of documentation. 

[C] Three states did not specify the level of acceptability for this 
type of documentation. 

[End of table] 

Table 22: States' Treatment of Documentation of Real Property other 
than Primary Residence, by State and Type of Documentation, 2011: 

State: Alabama; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof by itself; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Alaska; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Arizona; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Arkansas; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: California; 
Property deed: Most (more than half) applicants; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Colorado; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Connecticut; 
Property deed: Required; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Required; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Required. 

State: Delaware; 
Property deed: Required; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Required; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: District of Columbia; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Response not provided; 
Income tax return: Acceptable as proof by itself; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Florida; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Georgia; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Hawaii; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Idaho; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Illinois; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Indiana; 
Property deed: Required; 
Property tax assessment statement or bill: Response not provided; 
Assessment of current value: Required; 
Mortgage statement: Response not provided; 
Income tax return: Response not provided; 
Purchase or sale agreement: Required. 

State: Kansas; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Kentucky; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Response not provided; 
Purchase or sale agreement: Response not provided. 

State: Louisiana; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Maine; 
Property deed: Required; 
Property tax assessment statement or bill: Required; 
Assessment of current value: Required; 
Mortgage statement: Required; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Required. 

State: Maryland; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof by itself; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Massachusetts; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Michigan; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Minnesota[A]; 
Property deed: Most (more than half) applicants; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Most (more than half) applicants; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Mississippi; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Missouri; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Montana[B]; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Nebraska; 
Property deed: Required; 
Property tax assessment statement or bill: Most (more than half) 
applicants; 
Assessment of current value: Most (more than half) applicants; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Most (more than half) applicants. 

State: Nevada; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: New Hampshire; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: New Jersey; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: New Mexico; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: New York; 
Property deed: Required; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: North Carolina; 
Property deed: Most (more than half) applicants; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: North Dakota; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Ohio; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Oklahoma; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Oregon; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Pennsylvania; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Rhode Island; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: South Carolina; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Response not provided; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: South Dakota; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof with 
other documentation; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Tennessee; 
Property deed: Required; 
Property tax assessment statement or bill: Required; 
Assessment of current value: Acceptable as proof with other 
documentation; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Texas; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Utah; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Vermont; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Most (more than half) applicants; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Virginia[C]; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: Washington; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

State: West Virginia; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Wisconsin; 
Property deed: Acceptable as proof by itself; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof by itself; 
Income tax return: Acceptable as proof with other documentation; 
Purchase or sale agreement: Acceptable as proof by itself. 

State: Wyoming; 
Property deed: Acceptable as proof with other documentation; 
Property tax assessment statement or bill: Acceptable as proof by 
itself; 
Assessment of current value: Acceptable as proof by itself; 
Mortgage statement: Acceptable as proof with other documentation; 
Income tax return: Most (more than half) applicants; 
Purchase or sale agreement: Acceptable as proof with other 
documentation. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 50 states that 
reported requiring documentation of real property other than a primary 
residence. One state--Iowa--generally did not require documentation of 
real property other than the primary residence. 

[A] State reported requiring a statement from a licensed appraiser if 
there was no online access to property tax statements or if the 
applicant disputed the property tax value. 

[B] State reported requiring documentation of value, but verified 
ownership of property with a third party. 

[C] State reported requiring a purchase or sale agreement only if the 
applicant sold the property. 

[End of table] 

Table 23: States' Treatment of Vehicle Documentation, by Type of 
Documentation, 2011: 

Type of documentation: Vehicle title; 
Number of states: 
Required: 3; 
Acceptable as proof itself: 25; 
Acceptable with other documentation: 8; 
Not acceptable: 2. 

Type of documentation: Vehicle registration document[A]; 
Number of states: 
Required: 1; 
Acceptable as proof itself: 25; 
Acceptable with other documentation: 9; 
Not acceptable: 1. 

Type of documentation: Statement of vehicle loan balance; 
Number of states: 
Required: 2; 
Acceptable as proof itself: 13; 
Acceptable with other documentation: 17; 
Not acceptable: 6. 

Type of documentation: Written assessment of vehicle value from 
vehicle dealer; 
Number of states: 
Required: 2; 
Acceptable as proof itself: 23; 
Acceptable with other documentation: 12; 
Not acceptable: 1. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 38 states that 
reported requiring documentation of vehicles. In each row, the number 
of states may not add to 38 because not all states specified the level 
of acceptability for the respective type of documentation. 

[A] Two states did not specify the level of acceptability for this 
type of documentation. 

[End of table] 

Table 24: States' Treatment of Vehicle Documentation, by State and 
Type of Documentation, 2011: 

State: Alabama; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Arizona; 
Vehicle title: Acceptable as proof with other documentation; 
Vehicle registration document: Acceptable as proof with other 
documentation; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof with other documentation. 

State: Arkansas; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: California; 
Vehicle title: Most (more than half) applicants; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Colorado; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Connecticut; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof with other 
documentation; 
Statement of vehicle loan balance: Most (more than half) applicants; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof with other documentation. 

State: Delaware; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Most (more than half) applicants; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof with other documentation. 

State: Florida; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Georgia; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Most (more than half) applicants; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Hawaii; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof with other documentation. 

State: Illinois; 
Vehicle title: Acceptable as proof with other documentation; 
Vehicle registration document: Acceptable as proof with other 
documentation; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof with other documentation. 

State: Indiana; 
Vehicle title: Required; 
Vehicle registration document: Response not provided; 
Statement of vehicle loan balance: Required; 
Written assessment of vehicle value from vehicle dealer: Required. 

State: Kentucky; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Maine; 
Vehicle title: Required; 
Vehicle registration document: Required; 
Statement of vehicle loan balance: Most (more than half) applicants; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof with other documentation. 

State: Maryland; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Massachusetts; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof with other documentation. 

State: Michigan; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Minnesota; 
Vehicle title: Most (more than half) applicants; 
Vehicle registration document: Most (more than half) applicants; 
Statement of vehicle loan balance: Most (more than half) applicants; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Missouri; 
Vehicle title: Acceptable as proof with other documentation; 
Vehicle registration document: Acceptable as proof with other 
documentation; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof with other documentation. 

State: Montana; 
Vehicle title: Acceptable as proof with other documentation; 
Vehicle registration document: Acceptable as proof with other 
documentation; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof with other documentation. 

State: Nebraska; 
Vehicle title: Required; 
Vehicle registration document: Response not provided; 
Statement of vehicle loan balance: Required; 
Written assessment of vehicle value from vehicle dealer: Required. 

State: Nevada; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: New Hampshire; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: New Jersey; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof with other documentation. 

State: New Mexico; 
Vehicle title: Acceptable as proof with other documentation; 
Vehicle registration document: Acceptable as proof with other 
documentation; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof with other documentation. 

State: New York; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: North Carolina; 
Vehicle title: Acceptable as proof with other documentation; 
Vehicle registration document: Acceptable as proof with other 
documentation; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Ohio; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Oklahoma; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof with other documentation. 

State: Oregon; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Pennsylvania; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Rhode Island; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Most (more than half) applicants; 
Written assessment of vehicle value from vehicle dealer: Most (more 
than half) applicants. 

State: South Carolina; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Texas; 
Vehicle title: Acceptable as proof with other documentation; 
Vehicle registration document: Acceptable as proof with other 
documentation; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Vermont; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: West Virginia; 
Vehicle title: Acceptable as proof with other documentation; 
Vehicle registration document: Acceptable as proof with other 
documentation; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Wisconsin; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof by itself; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

State: Wyoming; 
Vehicle title: Acceptable as proof by itself; 
Vehicle registration document: Acceptable as proof by itself; 
Statement of vehicle loan balance: Acceptable as proof with other 
documentation; 
Written assessment of vehicle value from vehicle dealer: Acceptable as 
proof by itself. 

Source: GAO web-based survey administered to state Medicaid officials. 

Note: This table only includes responses from the 38 states that 
reported requiring documentation of vehicles. The following 13 states 
reported they generally did not require documentation of vehicles: 
Alaska, District of Columbia, Idaho, Iowa, Kansas, Louisiana, 
Mississippi, North Dakota, South Dakota, Tennessee, Utah, Virginia, 
and Washington. 

[End of table] 

Table 25: Amount of Required Documentation for Financial and 
Investment Resources, by State, 2011: 

State: Alabama; 
Current and past months: 60 months. 

State: Alaska; 
Current month. 

State: Arizona; 
Current month. 

State: Arkansas; 
Current month. 

State: California; 
Current month. 

State: Colorado; 
Current month. 

State: Connecticut; 
Current and past months: 60 months. 

State: Delaware; 
Current and past months: 60 months. 

State: District of Columbia; 
Current month. 

State: Florida; 
Current month. 

State: Georgia; 
Current month. 

State: Hawaii; 
Current and past months: 60 months. 

State: Idaho; 
Current month. 

State: Illinois; 
Current and past months: 60 months. 

State: Indiana[A]. 

State: Iowa; 
Current and past months: 3 months. 

State: Kansas; 
Current month. 

State: Kentucky;
Current and past months: 3 months. 

State: Louisiana; 
Current month. 

State: Maine; 
Current and past months: 60 months. 

State: Maryland; 
Current month. 

State: Massachusetts; 
Current month. 

State: Michigan; 
Current month. 

State: Minnesota; 
Current month. 

State: Mississippi; 
Current month: [Empty]; 
Current and past months: 60 months. 

State: Missouri; 
Current and past months: 60 months. 

State: Montana; 
Current and past months: 60 months. 

State: Nebraska; 
Current month. 

State: Nevada; 
Current and past months: 60 months. 

State: New Hampshire; 
Current and past months: 60 months. 

State: New Jersey; 
Current and past months: 60 months. 

State: New Mexico; 
Current month. 

State: New York; 
Current month. 

State: North Carolina; 
Current month. 

State: North Dakota; 
Current month. 

State: Ohio; 
Current and past months: 60 months. 

State: Oklahoma; 
Current month. 

State: Oregon; 
Current and past months: 60 months. 

State: Pennsylvania; 
Current month. 

State: Rhode Island; 
Current month. 

State: South Carolina; 
Current and past months: 60 months. 

State: South Dakota; 
Current month. 

State: Tennessee; 
Current and past months: 2 months. 

State: Texas; 
Current and past months: 3 months. 

State: Utah; 
Current and past months: 60 months. 

State: Vermont; 
Current and past months: 60 months. 

State: Virginia; 
Current month. 

State: Washington; 
Current and past months: 3 months. 

State: West Virginia; 
Current month. 

State: Wisconsin; 
Current and past months: 36 months. 

State: Wyoming; 
Current month. 

State: Total; 
Current month: 27; 
Current and past months: 2 months: 1; 
Current and past months: 3 months: 4; 
Current and past months: 36 months: 1; 
Current and past months: 60 months: 17. 

Source: GAO web-based survey administered to state Medicaid officials. 

[A] State reported it required both current and past documentation for 
financial and investment resources, but did not specify the number of 
months of documentation required because it is determined on a case-by-
case basis. In some cases, the state may require up to 60 months of 
documentation. 

[End of table] 

Table 26: Proportion of Applicants for Which States Require Additional 
Documentation to Identify Assets Transferred for Less Than Fair Market 
Value, by State, 2011: 

State: Alabama; 
Proportion of applicants: All applicants. 

State: Alaska[A]; 
Proportion of applicants: Some applicants. 

State: Arizona; 
Proportion of applicants: No applicants. 

State: Arkansas; 
Proportion of applicants: No applicants. 

State: California[A]; 
Proportion of applicants: Some applicants. 

State: Colorado[A]; 
Proportion of applicants: Some applicants. 

State: Connecticut; 
Proportion of applicants: All applicants. 

State: Delaware; 
Proportion of applicants: No applicants. 

State: District of Columbia; 
Proportion of applicants: No applicants. 

State: Florida[A]; 
Proportion of applicants: Some applicants. 

State: Georgia[A]; 
Proportion of applicants: Some applicants. 

State: Hawaii; 
Proportion of applicants: All applicants. 

State: Idaho[A]; 
Proportion of applicants: Some applicants. 

State: Illinois[B]; 
Proportion of applicants: Some applicants. 

State: Indiana; 
Proportion of applicants: Response not provided. 

State: Iowa[A,B]; 
Proportion of applicants: Some applicants. 

State: Kansas[A]; 
Proportion of applicants: Some applicants. 

State: Kentucky[A,B]; 
Proportion of applicants: Some applicants. 

State: Louisiana[A]; 
Proportion of applicants: Some applicants. 

State: Maine; 
Proportion of applicants: No applicants. 

State: Maryland; 
Proportion of applicants: All applicants. 

State: Massachusetts; 
Proportion of applicants: All applicants. 

State: Michigan[A,B]; 
Proportion of applicants: Some applicants. 

State: Minnesota; 
Proportion of applicants: No applicants. 

State: Mississippi; 
Proportion of applicants: No applicants. 

State: Missouri[A]; 
Proportion of applicants: Some applicants. 

State: Montana[A,B]; 
Proportion of applicants: Some applicants. 

State: Nebraska[A,B]; 
Proportion of applicants: Some applicants. 

State: Nevada[B]; 
Proportion of applicants: Some applicants. 

State: New Hampshire; 
Proportion of applicants: Some applicants. 

State: New Jersey; 
Proportion of applicants: No applicants. 

State: New Mexico[A]; 
Proportion of applicants: Some applicants. 

State: New York; 
Proportion of applicants: All applicants. 

State: North Carolina; 
Proportion of applicants: All applicants. 

State: North Dakota[B]; 
Proportion of applicants: Some applicants. 

State: Ohio; 
Proportion of applicants: No applicants. 

State: Oklahoma; 
Proportion of applicants: No applicants. 

State: Oregon; 
Proportion of applicants: No applicants. 

State: Pennsylvania[A]; 
Proportion of applicants: Some applicants. 

State: Rhode Island[A,B]; 
Proportion of applicants: Some applicants. 

State: South Carolina; 
Proportion of applicants: No applicants. 

State: South Dakota[A]; 
Proportion of applicants: Some applicants. 

State: Tennessee[B]; 
Proportion of applicants: Some applicants. 

State: Texas[A,B]; 
Proportion of applicants: Some applicants. 

State: Utah[A]; 
Proportion of applicants: Some applicants. 

State: Vermont; 
Proportion of applicants: Some applicants. 

State: Virginia[A]; 
Proportion of applicants: Some applicants. 

State: Washington[B]; 
Proportion of applicants: Some applicants. 

State: West Virginia[A,B]; 
Proportion of applicants: Some applicants. 

State: Wisconsin[A]; 
Proportion of applicants: Some applicants. 

State: Wyoming[A]; 
Proportion of applicants: Some applicants. 

Source: GAO web-based survey administered to state Medicaid officials. 

[A] State reported requiring additional documentation only if an 
applicant reported a transfer. 

[B] State reported requiring additional documentation only if it 
questioned the applicant's information or had reason to believe a 
transfer may have occurred. 

[End of table] 

[End of section] 

Appendix III: States' Use of Data Matches to Verify Applicants' Assets: 

Table 27a: Proportion of Applicants for which States Conduct Data 
Matches with Third Parties to Verify Applicants' Assets, by State and 
Source of Data Match, 2011: 

State: Alabama; 
Social Security Administration: All applicants; 
State unemployment records: Some applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: Some applicants. 

State: Alaska; 
Social Security Administration: Most applicants; 
State unemployment records: Most applicants; 
IEVS[A]: All applicants; 
PARIS[B]: Some applicants; 
State wage files/directory of new hires: No applicants. 

State: Arizona; 
Social Security Administration: All applicants; 
State unemployment records: Some applicants; 
IEVS[A]: No applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: Some applicants. 

State: Arkansas; 
Social Security Administration: All applicants; 
State unemployment records: Some applicants; 
IEVS[A]: All applicants; 
PARIS[B]: Response not provided; 
State wage files/directory of new hires: Some applicants. 

State: California; 
Social Security Administration: All applicants; 
State unemployment records: Most applicants; 
IEVS[A]: Most applicants; 
PARIS[B]: Some applicants; 
State wage files/directory of new hires: Most applicants. 

State: Colorado; 
Social Security Administration: All applicants; 
State unemployment records: No applicants; 
IEVS[A]: All applicants; 
PARIS[B]: Most applicants; 
State wage files/directory of new hires: All applicants. 

State: Connecticut; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: No applicants; 
State wage files/directory of new hires: No applicants. 

State: Delaware; 
Social Security Administration: All applicants; 
State unemployment records: Response not provided; 
IEVS[A]: Response not provided; 
PARIS[B]: Response not provided; 
State wage files/directory of new hires: Response not provided. 

State: District of Columbia; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: No applicants. 

State: Florida; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Georgia; 
Social Security Administration: All applicants; 
State unemployment records: Some applicants; 
IEVS[A]: Some applicants; 
PARIS[B]: No applicants; 
State wage files/directory of new hires: Some applicants. 

State: Hawaii; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Idaho; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: Some applicants; 
State wage files/directory of new hires: All applicants. 

State: Illinois; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: No applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Indiana; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: Response not provided; 
State wage files/directory of new hires: All applicants. 

State: Iowa; 
Social Security Administration: Most applicants; 
State unemployment records: Most applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: Most applicants. 

State: Kansas; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: No applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Kentucky; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: Some applicants; 
State wage files/directory of new hires: Most applicants. 

State: Louisiana; 
Social Security Administration: All applicants; 
State unemployment records: Some applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: Some applicants. 

State: Maine; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Maryland; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Massachusetts; 
Social Security Administration: All applicants; 
State unemployment records: Some applicants; 
IEVS[A]: All applicants; 
PARIS[B]: Some applicants; 
State wage files/directory of new hires: Response not provided. 

State: Michigan; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: No applicants; 
PARIS[B]: Some applicants; 
State wage files/directory of new hires: All applicants. 

State: Minnesota; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Mississippi; 
Social Security Administration: All applicants; 
State unemployment records: Most applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: No applicants. 

State: Missouri; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Montana; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: No applicants. 

State: Nebraska; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Nevada; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: Most applicants. 

State: New Hampshire; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: New Jersey; 
Social Security Administration: Some applicants; 
State unemployment records: All applicants; 
IEVS[A]: Most applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: New Mexico; 
Social Security Administration: All applicants; 
State unemployment records: Most applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: Most applicants. 

State: New York; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: No applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: North Carolina; 
Social Security Administration: All applicants; 
State unemployment records: Some applicants; 
IEVS[A]: All applicants; 
PARIS[B]: No applicants; 
State wage files/directory of new hires: Some applicants. 

State: North Dakota; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Ohio; 
Social Security Administration: Most applicants; 
State unemployment records: Some applicants; 
IEVS[A]: Most applicants; 
PARIS[B]: Some applicants; 
State wage files/directory of new hires: Most applicants. 

State: Oklahoma; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Oregon; 
Social Security Administration: Most applicants; 
State unemployment records: Some applicants; 
IEVS[A]: Most applicants; 
PARIS[B]: Most applicants; 
State wage files/directory of new hires: Some applicants. 

State: Pennsylvania; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Rhode Island; 
Social Security Administration: All applicants; 
State unemployment records: No applicants; 
IEVS[A]: All applicants; 
PARIS[B]: Some applicants; 
State wage files/directory of new hires: No applicants. 

State: South Carolina; 
Social Security Administration: Some applicants; 
State unemployment records: Some applicants; 
IEVS[A]: All applicants; 
PARIS[B]: No applicants; 
State wage files/directory of new hires: No applicants. 

State: South Dakota; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Tennessee; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: No applicants; 
PARIS[B]: No applicants; 
State wage files/directory of new hires: All applicants. 

State: Texas; 
Social Security Administration: All applicants; 
State unemployment records: All applicants[C]; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants[C]. 

State: Utah; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: Some applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Vermont; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: Some applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Virginia; 
Social Security Administration: Most applicants; 
State unemployment records: Some applicants; 
IEVS[A]: Some applicants; 
PARIS[B]: Some applicants; 
State wage files/directory of new hires: No applicants. 

State: Washington; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: Most applicants. 

State: West Virginia; 
Social Security Administration: Most applicants; 
State unemployment records: Some applicants; 
IEVS[A]: All applicants; 
PARIS[B]: No applicants; 
State wage files/directory of new hires: Some applicants. 

State: Wisconsin; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

State: Wyoming; 
Social Security Administration: All applicants; 
State unemployment records: All applicants; 
IEVS[A]: All applicants; 
PARIS[B]: All applicants; 
State wage files/directory of new hires: All applicants. 

Source: GAO web-based survey administered to state Medicaid officials. 

[A] IEVS is an abbreviation for Income and Eligibility Verification 
System; this system allows a state to match applicant-reported income 
information with data from the Internal Revenue Service, the Social 
Security Administration, and state wage and unemployment insurance 
benefit records. States that reported using this system to verify 
applicants' assets may use some or all of the data available. 

[B] PARIS is an abbreviation for Public Assistance Reporting 
Information System. PARIS is an electronic data matching and 
information exchange system that is designed to match state enrollment 
information, including Medicaid enrollment, with data from other 
participating states and from a selected group of federal databases. 
The federal databases include, among other things, information on 
individuals' receipt of income from the Department of Veterans 
Affairs, the Department of Defense, and the Office of Personnel 
Management. States that reported conducting a PARIS data match may use 
some or all of the data available. 

[C] State contracted with a data broker to perform various data 
matches including matches with state wage, unemployment, and workman's 
compensation sources. 

[End of table] 

Table 27b: Proportion of Applicants for which States Conduct Data 
Matches with Third Parties to Verify Applicants' Assets, by State and 
Source of Data Match, 2011 (continued): 

State: Alabama; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: All applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Alaska; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Arizona; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Arkansas; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: All applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: Response not provided; 
State tax records: No applicants. 

State: California; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: Most (more than half) applicants. 

State: Colorado; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Connecticut; 
Internal Revenue Service: Some applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Delaware; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: District of Columbia; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: All applicants; 
State tax records: No applicants. 

State: Florida; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: All applicants; 
National Directory of New Hires[A]: All applicants; 
State tax records: No applicants. 

State: Georgia; 
Internal Revenue Service: Some applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: Some applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Hawaii; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: All applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Idaho; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Illinois; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: All applicants; 
State tax records: No applicants. 

State: Indiana; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: Some applicants; 
State tax records: Some applicants. 

State: Iowa; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Kansas; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Kentucky; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: All applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Louisiana; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Maine; 
Internal Revenue Service: Some applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: All applicants; 
State tax records: No applicants. 

State: Maryland; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: All applicants; 
State tax records: No applicants. 

State: Massachusetts; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: No applicants; 
State tax records: Response not provided. 

State: Michigan; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Minnesota; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: All applicants; 
National Directory of New Hires[A]: All applicants; 
State tax records: All applicants. 

State: Mississippi; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Missouri; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: All applicants; 
State workman's compensation records: All applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Montana; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Nebraska; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Nevada; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: Some applicants; 
National Directory of New Hires[A]: Most (more than half) applicants; 
State tax records: No applicants. 

State: New Hampshire; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: All applicants; 
State workman's compensation records: All applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: New Jersey; 
Internal Revenue Service: Most (more than half) applicants; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Some applicants; 
State tax records: Some applicants. 

State: New Mexico; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: Most (more than half) applicants; 
National Directory of New Hires[A]: All applicants; 
State tax records: No applicants. 

State: New York; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: North Carolina; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: Some applicants; 
National Directory of New Hires[A]: Some applicants; 
State tax records: No applicants. 

State: North Dakota; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Ohio; 
Internal Revenue Service: Some applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: Some applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Oklahoma; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: All applicants; 
National Directory of New Hires[A]: All applicants; 
State tax records: No applicants. 

State: Oregon; 
Internal Revenue Service: Some applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: Some applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: Some applicants. 

State: Pennsylvania; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: All applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: All applicants; 
State tax records: No applicants. 

State: Rhode Island; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: Some applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: South Carolina; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: All applicants; 
State workman's compensation records: Some applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: South Dakota; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: All applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Tennessee; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: Most (more than half) applicants; 
State tax records: No applicants. 

State: Texas; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: All applicants[B]; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Utah; 
Internal Revenue Service: Some applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Vermont; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: Response not provided; 
State tax records: No applicants. 

State: Virginia; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Washington; 
Internal Revenue Service: Some applicants; 
Department of Veterans Affairs: All applicants; 
State workman's compensation records: Some applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: West Virginia; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: All applicants. 

State: Wisconsin; 
Internal Revenue Service: All applicants; 
Department of Veterans Affairs: No applicants; 
State workman's compensation records: No applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

State: Wyoming; 
Internal Revenue Service: No applicants; 
Department of Veterans Affairs: Some applicants; 
State workman's compensation records: Some applicants; 
National Directory of New Hires[A]: No applicants; 
State tax records: No applicants. 

Source: GAO web-based survey administered to state Medicaid officials. 

[A] The National Directory of New Hires is a national database of 
employment wage and unemployment insurance information for use by 
federal and state agencies. 

[B] State contracted with a data broker to perform various data 
matches including matches with state wage, unemployment, and workman's 
compensation sources. 

[End of table] 

Table 28a: Timing of State Data Matches in Relation to Eligibility 
Determination, by State and Source of Data Match, 2011: 

State: Alabama; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Response not provided; 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Response not provided. 

State: Alaska; 
Social Security Administration: Sometimes before and sometimes after 
eligibility determination; 
State unemployment records: Sometimes before and sometimes after 
eligibility determination; 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Response not provided. 

State: Arizona; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Response not provided; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally after eligibility 
determination. 

State: Arkansas; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: N/A; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: California; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Colorado; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: N/A; 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Connecticut; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Response not provided; 
State wage files/directory of new hires: Response not provided. 

State: Delaware; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Response not provided; 
IEVS[A]: Response not provided; 
PARIS[B]: Response not provided; 
State wage files/directory of new hires: Response not provided. 

State: District of Columbia; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Response not provided. 

State: Florida; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Response not provided; 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Georgia; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Response not provided; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Hawaii; 
Social Security Administration: Sometimes before and sometimes after 
eligibility determination; 
State unemployment records: Sometimes before and sometimes after 
eligibility determination; 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Sometimes before and 
sometimes after eligibility determination. 

State: Idaho; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Illinois; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally after eligibility determination; 
IEVS[A]: N/A; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally after eligibility 
determination. 

State: Indiana; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Response not provided; 
IEVS[A]: Response not provided; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Response not provided. 

State: Iowa; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Kansas; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: N/A; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Kentucky; 
Social Security Administration: Generally after eligibility 
determination; 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Louisiana; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally before eligibility determination 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Maine; 
Social Security Administration: Response not provided; 
State unemployment records: Response not provided; 
IEVS[A]: Response not provided; 
PARIS[B]: Response not provided; 
State wage files/directory of new hires: Response not provided. 

State: Maryland; 
Social Security Administration: Response not provided; 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Sometimes before and sometimes after eligibility 
determination; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Massachusetts; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: N/A. 

State: Michigan; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: N/A; 
PARIS[B]: Sometimes before and sometimes after eligibility 
determination; 
State wage files/directory of new hires: Generally after eligibility 
determination. 

State: Minnesota; 
Social Security Administration: Sometimes before and sometimes after 
eligibility determination; 
State unemployment records: Generally after eligibility determination; 
IEVS[A]: Sometimes before and sometimes after eligibility 
determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally after eligibility 
determination. 

State: Mississippi; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Response not provided; 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Response not provided. 

State: Missouri; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: N/A; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Montana; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Sometimes before and sometimes after eligibility 
determination; 
PARIS[B]: Sometimes before and sometimes after eligibility 
determination; 
State wage files/directory of new hires: Response not provided. 

State: Nebraska; 
Social Security Administration: Response not provided; 
State unemployment records: Response not provided; 
IEVS[A]: Response not provided; 
PARIS[B]: Response not provided; 
State wage files/directory of new hires: Response not provided. 

State: Nevada; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Sometimes before and sometimes after eligibility 
determination; 
State wage files/directory of new hires: Sometimes before and 
sometimes after eligibility determination. 

State: New Hampshire; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally after eligibility determination; 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally after eligibility 
determination. 

State: New Jersey; 
Social Security Administration: Sometimes before and sometimes after 
eligibility determination; 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: New Mexico; 
Social Security Administration: Generally after eligibility 
determination; 
State unemployment records: Sometimes before and sometimes after 
eligibility determination; 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Sometimes before and 
sometimes after eligibility determination. 

State: New York; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Response not provided; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: North Carolina; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Sometimes before and sometimes after eligibility 
determination; 
PARIS[B]: Response not provided; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: North Dakota; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally after eligibility determination; 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally after eligibility 
determination. 

State: Ohio; 
Social Security Administration: Sometimes before and sometimes after 
eligibility determination; 
State unemployment records: Generally after eligibility determination; 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Sometimes before and 
sometimes after eligibility determination. 

State: Oklahoma; 
Social Security Administration: Sometimes before and sometimes after 
eligibility determination; 
State unemployment records: Sometimes before and sometimes after 
eligibility determination; 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Oregon; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally after eligibility 
determination. 

State: Pennsylvania; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally before eligibility determination 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Rhode Island; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Response not provided; 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Sometimes before and sometimes after eligibility 
determination; 
State wage files/directory of new hires: Response not provided. 

State: South Carolina; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Response not provided; 
State wage files/directory of new hires: Response not provided. 

State: South Dakota; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Sometimes before and sometimes after 
eligibility determination; 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Sometimes before and sometimes after eligibility 
determination; 
State wage files/directory of new hires: Sometimes before and 
sometimes after eligibility determination. 

State: Tennessee; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally after eligibility determination; 
IEVS[A]: Response not provided; 
PARIS[B]: Response not provided; 
State wage files/directory of new hires: Generally after eligibility 
determination. 

State: Texas; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Utah; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Sometimes before and sometimes after eligibility 
determination; 
PARIS[B]: Generally before eligibility determination 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Vermont; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Sometimes before and sometimes after 
eligibility determination; 
IEVS[A]: Sometimes before and sometimes after eligibility 
determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Sometimes before and 
sometimes after eligibility determination. 

State: Virginia; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Response not provided. 

State: Washington; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Sometimes before and 
sometimes after eligibility determination. 

State: West Virginia; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Sometimes before and sometimes after 
eligibility determination; 
IEVS[A]: Sometimes before and sometimes after eligibility 
determination; 
PARIS[B]: Response not provided; 
State wage files/directory of new hires: Sometimes before and 
sometimes after eligibility determination. 

State: Wisconsin; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally before eligibility determination 
PARIS[B]: Generally before eligibility determination 
State wage files/directory of new hires: Generally before eligibility 
determination. 

State: Wyoming; 
Social Security Administration: Generally before eligibility 
determination 
State unemployment records: Generally before eligibility determination 
IEVS[A]: Generally after eligibility determination; 
PARIS[B]: Generally after eligibility determination; 
State wage files/directory of new hires: Sometimes before and 
sometimes after eligibility determination. 

Source: GAO web-based survey administered to state Medicaid officials. 

Legend: 

[A] IEVS is an abbreviation for Income and Eligibility Verification 
System; 
this system allows a state to match applicant-reported income 
information with data from the Internal Revenue Service, the Social 
Security Administration, and state wage and unemployment insurance 
benefit records. States that reported using this system to verify 
applicants' assets may use some or all of the data available. 

[B] PARIS is an abbreviation for Public Assistance Reporting 
Information System. PARIS is an electronic data matching and 
information exchange system that is designed to match state enrollment 
information, including Medicaid enrollment, with data from other 
participating states and from a selected group of federal databases. 
The federal databases include, among other things, information on 
individuals' receipt of income from the Department of Veterans 
Affairs, the Department of Defense, and the Office of Personnel 
Management. States that reported conducting a PARIS data match may use 
some or all of the data available. 

[End of table] 

Table 28b: Timing of State Data Matches in Relation to Eligibility 
Determination, by State and Source of Data Match, 2011 (continued): 

State: Alabama; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Generally before eligibility 
determination; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Alaska; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Arizona; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Generally before eligibility 
determination; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Arkansas; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Generally before eligibility 
determination; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: N/A; 
State tax records: Response not provided. 

State: California; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Sometimes before and sometimes after 
eligibility determination; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Generally before eligibility determination. 

State: Colorado; 
Internal Revenue Service: N/A; 
Department of Veterans Affairs: N/A; 
State workman's compensation records: N/A; 
National Directory of New Hires[A]: N/A; 
State tax records: N/A. 

State: Connecticut; 
Internal Revenue Service: Sometimes before and sometimes after 
eligibility determination; 
Department of Veterans Affairs: Sometimes before and sometimes after 
eligibility determination; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Delaware; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: District of Columbia; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Generally before eligibility 
determination; 
State tax records: Response not provided. 

State: Florida; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: N/A; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Generally before eligibility 
determination; 
State tax records: Response not provided. 

State: Georgia; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Generally before eligibility 
determination; 
State workman's compensation records: Generally before eligibility 
determination; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Hawaii; 
Internal Revenue Service: Sometimes before and sometimes after 
eligibility determination; 
Department of Veterans Affairs: Sometimes before and sometimes after 
eligibility determination; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Idaho; 
Internal Revenue Service: Generally before eligibility determination; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Illinois; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: N/A; 
State workman's compensation records: N/A; 
National Directory of New Hires[A]: Generally after eligibility 
determination; 
State tax records: N/A. 

State: Indiana; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Generally after eligibility 
determination; 
State tax records: Generally before eligibility determination. 

State: Iowa; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Kansas; 
Internal Revenue Service: N/A; 
Department of Veterans Affairs: N/A; 
State workman's compensation records: N/A; 
National Directory of New Hires[A]: N/A; 
State tax records: N/A. 

State: Kentucky; 
Internal Revenue Service: Generally before eligibility determination; 
Department of Veterans Affairs: N/A; 
State workman's compensation records: N/A; 
National Directory of New Hires[A]: Generally before eligibility 
determination; 
State tax records: N/A. 

State: Louisiana; 
Internal Revenue Service: N/A; 
Department of Veterans Affairs: N/A; 
State workman's compensation records: N/A; 
National Directory of New Hires[A]: N/A; 
State tax records: N/A. 

State: Maine; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Maryland; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Sometimes before and sometimes 
after eligibility determination; 
State tax records: Response not provided. 

State: Massachusetts; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: N/A; 
National Directory of New Hires[A]: Response not provided; 
State tax records: N/A. 

State: Michigan; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: N/A; 
National Directory of New Hires[A]: N/A; 
State tax records: N/A. 

State: Minnesota; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Generally after eligibility 
determination; 
National Directory of New Hires[A]: Generally before eligibility 
determination; 
State tax records: Generally after eligibility determination. 

State: Mississippi; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Missouri; 
Internal Revenue Service: Generally before eligibility determination; 
Department of Veterans Affairs: Generally after eligibility 
determination; 
State workman's compensation records: Generally before eligibility 
determination; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Montana; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Nebraska; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: N/A; 
State tax records: Response not provided. 

State: Nevada; 
Internal Revenue Service: N/A; 
Department of Veterans Affairs: Generally before eligibility 
determination; 
State workman's compensation records: Generally before eligibility 
determination; 
National Directory of New Hires[A]: Sometimes before and sometimes 
after eligibility determination; 
State tax records: Response not provided. 

State: New Hampshire; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Generally after eligibility 
determination; 
State workman's compensation records: Generally after eligibility 
determination; 
National Directory of New Hires[A]: N/A; 
State tax records: N/A. 

State: New Jersey; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Sometimes before and sometimes 
after eligibility determination; 
State tax records: Sometimes before and sometimes after eligibility 
determination. 

State: New Mexico; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Sometimes before and sometimes after 
eligibility determination; 
State workman's compensation records: Sometimes before and sometimes 
after eligibility determination; 
National Directory of New Hires[A]: Generally before eligibility 
determination; 
State tax records: Response not provided. 

State: New York; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: North Carolina; 
Internal Revenue Service: N/A; 
Department of Veterans Affairs: Generally before eligibility 
determination; 
State workman's compensation records: Generally after eligibility 
determination; 
National Directory of New Hires[A]: Generally after eligibility 
determination; 
State tax records: N/A. 

State: North Dakota; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: N/A; 
State workman's compensation records: N/A; 
National Directory of New Hires[A]: N/A; 
State tax records: N/A. 

State: Ohio; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Generally after eligibility 
determination; 
National Directory of New Hires[A]: N/A; 
State tax records: Response not provided. 

State: Oklahoma; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Sometimes before and sometimes after 
eligibility determination; 
State workman's compensation records: Sometimes before and sometimes 
after eligibility determination; 
National Directory of New Hires[A]: Generally after eligibility 
determination; 
State tax records: Response not provided. 

State: Oregon; 
Internal Revenue Service: Generally before eligibility determination; 
Department of Veterans Affairs: Generally before eligibility 
determination; 
State workman's compensation records: Generally before eligibility 
determination; 
National Directory of New Hires[A]: N/A; 
State tax records: Generally before eligibility determination. 

State: Pennsylvania; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Generally before eligibility 
determination; 
State workman's compensation records: N/A; 
National Directory of New Hires[A]: Generally before eligibility 
determination; 
State tax records: N/A. 

State: Rhode Island; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: South Carolina; 
Internal Revenue Service: Generally before eligibility determination; 
Department of Veterans Affairs: Generally before eligibility 
determination; 
State workman's compensation records: Generally before eligibility 
determination; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: South Dakota; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: N/A; 
State workman's compensation records: Sometimes before and sometimes 
after eligibility determination; 
National Directory of New Hires[A]: N/A; 
State tax records: N/A. 

State: Tennessee; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Generally before eligibility 
determination; 
State tax records: Response not provided. 

State: Texas; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Generally before eligibility 
determination; 
State workman's compensation records: Generally before eligibility 
determination; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Utah; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: N/A; 
State workman's compensation records: N/A; 
National Directory of New Hires[A]: N/A; 
State tax records: N/A. 

State: Vermont; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Sometimes before and sometimes after 
eligibility determination; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Virginia; 
Internal Revenue Service: Response not provided; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Washington; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Generally after eligibility 
determination; 
State workman's compensation records: Sometimes before and sometimes 
after eligibility determination; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: West Virginia; 
Internal Revenue Service: Generally after eligibility determination; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Generally after eligibility determination. 

State: Wisconsin; 
Internal Revenue Service: Generally before eligibility determination; 
Department of Veterans Affairs: Response not provided; 
State workman's compensation records: Response not provided; 
National Directory of New Hires[A]: Response not provided; 
State tax records: Response not provided. 

State: Wyoming; 
Internal Revenue Service: N/A; 
Department of Veterans Affairs: Generally before eligibility 
determination; 
State workman's compensation records: Sometimes before and sometimes 
after eligibility determination; 
National Directory of New Hires[A]: N/A; 
State tax records: N/A. 

Source: GAO web-based survey administered to state Medicaid officials. 

[A] The National Directory of New Hires is a national database of 
employment wage and unemployment insurance information for use by 
federal and state agencies. 

[End of table] 

[End of section] 

Appendix IV: States' Contact with Financial Institutions to Verify 
Applicants' Assets: 

Table 29: Proportion of Applicants for which States Contact Financial 
Institutions to Verify Applicants' Assets, by State and Type of 
Financial Institution, 2011: 

State: Alaska[A]; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: Some applicants; 
Institutions not reported by applicant: Statewide: Some applicants; 
Institutions not reported by applicant: National: Some applicants. 

State: Arizona[A]; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Connecticut; 
Institutions with accounts reported by applicant: All applicants; 
Institutions not reported by applicant: Local: Some applicants; 
Institutions not reported by applicant: Statewide: Some applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Illinois[A]; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Indiana[A]; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: Some applicants; 
Institutions not reported by applicant: Statewide: Response not 
provided; 
Institutions not reported by applicant: National: Response not 
provided. 

State: Kentucky; 
Institutions with accounts reported by applicant: All applicants; 
Institutions not reported by applicant: Local: All applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Louisiana[A]; 
Institutions with accounts reported by applicant: All applicants; 
Institutions not reported by applicant: Local: Some applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Maine; 
Institutions with accounts reported by applicant: All applicants; 
Institutions not reported by applicant: Local: Some applicants; 
Institutions not reported by applicant: Statewide: Some applicants; 
Institutions not reported by applicant: National: Some applicants. 

State: Maryland[A]; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Michigan[A]; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Missouri; 
Institutions with accounts reported by applicant: All applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: New Jersey[A]; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: Most (more than half) 
applicants; 
Institutions not reported by applicant: Statewide: Most (more than 
half) applicants; 
Institutions not reported by applicant: National: Most (more than 
half) applicants. 

State: New York; 
Institutions with accounts reported by applicant: All applicants; 
Institutions not reported by applicant: Local: All applicants; 
Institutions not reported by applicant: Statewide: All applicants; 
Institutions not reported by applicant: National: No applicants. 

State: North Carolina; 
Institutions with accounts reported by applicant: All applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Oklahoma; 
Institutions with accounts reported by applicant: All applicants; 
Institutions not reported by applicant: Local: Some applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Pennsylvania; 
Institutions with accounts reported by applicant: All applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Rhode Island; 
Institutions with accounts reported by applicant: All applicants; 
Institutions not reported by applicant: Local: All applicants; 
Institutions not reported by applicant: Statewide: All applicants; 
Institutions not reported by applicant: National: All applicants. 

State: South Carolina[A]; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Texas[A]; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Vermont; 
Institutions with accounts reported by applicant: All applicants; 
Institutions not reported by applicant: Local: All applicants; 
Institutions not reported by applicant: Statewide: All applicants; 
Institutions not reported by applicant: National: Most (more than 
half) applicants. 

State: Virginia; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Washington[A]; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Wisconsin[A]; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

State: Wyoming; 
Institutions with accounts reported by applicant: Some applicants; 
Institutions not reported by applicant: Local: No applicants; 
Institutions not reported by applicant: Statewide: No applicants; 
Institutions not reported by applicant: National: No applicants. 

Source: GAO web-based survey administered to state Medicaid officials. 

Legend: 

Notes: This table only includes responses from the 24 states that 
reported contacting financial institutions. The following 27 states 
reported they did not contact financial institutions: Alabama, 
Arkansas, California, Colorado, Delaware, District of Columbia, 
Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Massachusetts, 
Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New 
Mexico, North Dakota, Ohio, Oregon, South Dakota, Tennessee, Utah, and 
West Virginia. Although Oregon reported that it generally did not 
contact financial institutions, the state noted it may request 
information from financial institutions with which an applicant 
reported having an account if an applicant did not provide sufficient 
documentation. 

[A] State reported only contacting financial institutions if an 
applicant submitted questionable or insufficient information. 

[End of table] 

Table 30: Types and Number of Months of Information Requested from 
Financial Institutions, by State, 2011: 

State: Alaska; 
Type of information requested: Itemized statements; 
Number of months requested: 3. 

State: Arizona; 
Type of information requested: Account balances; 
Number of months requested: 1. 

State: Connecticut; 
Type of information requested: Itemized statements; 
Number of months requested: 60. 

State: Illinois; 
Type of information requested: Itemized statements; 
Number of months requested: 60. 

State: Indiana; 
Type of information requested: Account balances; 
Number of months requested: 3. 

State: Kentucky; 
Type of information requested: Account balances; 
Number of months requested: 3. 

State: Louisiana; 
Type of information requested: Account balances; 
Number of months requested: 3. 

State: Maine; 
Type of information requested: Itemized statements; 
Number of months requested: 60. 

State: Maryland; 
Type of information requested: Itemized statements; 
Number of months requested: 60. 

State: Michigan; 
Type of information requested: Itemized statements; 
Number of months requested: 1. 

State: Missouri; 
Type of information requested: Account balances; 
Number of months requested: 3. 

State: New Jersey; 
Type of information requested: Itemized statements; 
Number of months requested: 60. 

State: New York; 
Type of information requested: Account balances; 
Number of months requested: 1. 

State: North Carolina; 
Type of information requested: Account balances; 
Number of months requested: 1. 

State: Oklahoma; 
Type of information requested: Itemized statements; 
Number of months requested: 12. 

State: Pennsylvania; 
Type of information requested: Itemized statements; 
Number of months requested: 1. 

State: Rhode Island; 
Type of information requested: Itemized statements; 
Number of months requested: 6. 

State: South Carolina; 
Type of information requested: Account balances; 
Number of months requested: 12. 

State: Texas; 
Type of information requested: Account balances; 
Number of months requested: 3. 

State: Vermont; 
Type of information requested: Account balances; 
Number of months requested: 1[A]. 

State: Virginia; 
Type of information requested: Account balances; 
Number of months requested: 3. 

State: Washington; 
Type of information requested: Account balances; 
Number of months requested: Response not provided[B]. 

State: Wisconsin; 
Type of information requested: Itemized statements; 
Number of months requested: 36. 

State: Wyoming; 
Type of information requested: Itemized statements; 
Number of months requested: 1. 

State: Total; 
Type of information requested: Itemized statements: 12; 
Type of information requested: Account balances: 12. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 24 states that 
reported contacting financial institutions. The following 27 states 
reported they did not contact financial institutions: Alabama, 
Arkansas, California, Colorado, Delaware, District of Columbia, 
Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Massachusetts, 
Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New 
Mexico, North Dakota, Ohio, Oregon, South Dakota, Tennessee, Utah, and 
West Virginia. 

[A] State reported that it requested the current balance for any open 
accounts and the closing balance for any accounts that were closed 
within the past 60 months. 

[B] State did not specify the number of months of information it 
requested and noted it would request whatever amount is needed. 

[End of table] 

Table 31: Timing of States' Contacts with Financial Institutions in 
Relation to Eligibility Determination, by State, 2011: 

State: Alaska; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: Arizona; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Connecticut; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Illinois; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: Indiana; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Kentucky; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Louisiana; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Maine; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Maryland; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Michigan; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Missouri; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: New Jersey; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: New York; 
Point during eligibility determination process: Generally after 
eligibility determination. 

State: North Carolina; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Oklahoma; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Pennsylvania; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Rhode Island; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: South Carolina; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Vermont; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Virginia; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Texas; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Washington; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Wisconsin; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Wyoming; 
Point during eligibility determination process: Generally before 
eligibility determination. 

Source: GAO web-based survey administered to state Medicaid officials. 

Note: This table only includes responses from the 24 states that 
reported contacting financial institutions. The following 27 states 
reported they did not contact financial institutions: Alabama, 
Arkansas, California, Colorado, Delaware, District of Columbia, 
Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Massachusetts, 
Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New 
Mexico, North Dakota, Ohio, Oregon, South Dakota, Tennessee, Utah, and 
West Virginia. 

[End of table] 

[End of section] 

Appendix V: States' Use of Property Records Searches to Verify 
Applicants' Assets: 

Table 32: Proportion of Applicants for which States Conduct Property 
Records Searches to Verify Applicants' Assets, by State and Geographic 
Area of Property Search Conducted, 2011: 

State: Alabama; 
Applicant's county of residence: All applicants; 
Some other counties in state: All applicants; 
All counties in state: All applicants; 
Locations in other states: All applicants. 

State: Alaska[A]; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: No applicants. 

State: Arizona[B]; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: No applicants. 

State: Colorado[A]; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: No applicants. 

State: Connecticut[A]; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: No applicants; 
All counties in state: No applicants; 
Locations in other states: Most (more than half) applicants. 

State: Delaware; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: No applicants. 

State: Georgia; 
Applicant's county of residence: All applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: No applicants; 
Locations in other states: Most (more than half) applicants. 

State: Hawaii; 
Applicant's county of residence: All applicants; 
Some other counties in state: All applicants; 
All counties in state: All applicants; 
Locations in other states: No applicants. 

State: Illinois[A]; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: Most (more than half) applicants. 

State: Iowa[C]; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: Most (more than half) applicants. 

State: Kansas[A,B]; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: No applicants; 
Locations in other states: Response not provided. 

State: Kentucky; 
Applicant's county of residence: All applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Response not provided; 
Locations in other states: Response not provided. 

State: Louisiana[A]; 
Applicant's county of residence: All applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: No applicants; 
Locations in other states: Most (more than half) applicants. 

State: Maine; 
Applicant's county of residence: All applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: Most (more than half) applicants. 

State: Maryland; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: All applicants; 
Locations in other states: Most (more than half) applicants. 

State: Michigan[A]; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: No applicants; 
Locations in other states: No applicants. 

State: Mississippi; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: No applicants; 
Locations in other states: No applicants. 

State: Missouri[A]; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: Most (more than half) applicants. 

State: Montana; 
Applicant's county of residence: All applicants; 
Some other counties in state: All applicants; 
All counties in state: All applicants; 
Locations in other states: Most (more than half) applicants. 

State: Nevada[D]; 
Applicant's county of residence: All applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: No applicants. 

State: New Hampshire[E]; 
Applicant's county of residence: All applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: All applicants; 
Locations in other states: All applicants. 

State: New York; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: No applicants; 
All counties in state: No applicants; 
Locations in other states: No applicants. 

State: North Carolina; 
Applicant's county of residence: All applicants; 
Some other counties in state: All applicants; 
All counties in state: Response not provided; 
Locations in other states: Response not provided. 

State: Ohio[A]; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: No applicants; 
Locations in other states: No applicants. 

State: Oklahoma; 
Applicant's county of residence: All applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: No applicants. 

State: Oregon[B]; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: Most (more than half) applicants. 

State: Pennsylvania[A]; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: No applicants; 
Locations in other states: No applicants. 

State: Rhode Island; 
Applicant's county of residence: All applicants; 
Some other counties in state: All applicants; 
All counties in state: All applicants; 
Locations in other states: No applicants. 

State: South Carolina; 
Applicant's county of residence: All applicants; 
Some other counties in state: All applicants; 
All counties in state: Response not provided; 
Locations in other states: Most (more than half) applicants. 

State: South Dakota; 
Applicant's county of residence: All applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: Most (more than half) applicants. 

State: Texas; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: No applicants; 
Locations in other states: Most (more than half) applicants. 

State: Vermont; 
Applicant's county of residence: No applicants; 
Some other counties in state: No applicants; 
All counties in state: Most (more than half) applicants; 
Locations in other states: No applicants. 

State: Washington; 
Applicant's county of residence: All applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: No applicants; 
Locations in other states: Most (more than half) applicants. 

State: Wisconsin; 
Applicant's county of residence: All applicants; 
Some other counties in state: No applicants; 
All counties in state: No applicants; 
Locations in other states: No applicants. 

State: Wyoming; 
Applicant's county of residence: Most (more than half) applicants; 
Some other counties in state: Most (more than half) applicants; 
All counties in state: No applicants; 
Locations in other states: No applicants. 

Source: GAO web-based survey administered to state Medicaid officials. 

Notes: This table only includes responses from the 35 states that 
reported conducting property searches. The following 16 states 
reported they did not conduct property searches: Arkansas, California, 
District of Columbia, Florida, Idaho, Indiana, Massachusetts, 
Minnesota, Nebraska, New Jersey, New Mexico, North Dakota, Tennessee, 
Utah, Virginia, and West Virginia. 

[A] State reported conducting a property search only if an applicant 
submits questionable or insufficient information. 

[B] State reported conducting a property search only if an applicant 
reports a property. 

[C] State reported it did not conduct a property search when an 
applicant intended to return home, was receiving Supplemental Security 
Income, or was already receiving Medicaid and had an apartment as a 
home address. 

[D] State reported it did not conduct a property search when an 
applicant was already receiving Medicaid or other government 
assistance. 

[E] State contracted with a company that conducted nationwide property 
searches. 

[End of table] 

Table 33: Types of Information That Can Be Used to Conduct Property 
Records Searches, by State, 2011: 

State: Alabama; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Check]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Alaska; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Arizona; 
Applicant's name: [Check]; 
Applicant's Social Security number: Response not provided; 
Property street address: [Check]; 
Property zip code: Response not provided. 

State: Colorado; 
Applicant's name: [Check]; 
Applicant's Social Security number: Response not provided; 
Property street address: [Check]; 
Property zip code: Response not provided. 

State: Connecticut; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Delaware; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: Georgia; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Hawaii; 
Applicant's name: [Empty]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Illinois; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Check]; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: Iowa; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Kansas; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Kentucky; 
Applicant's name: [Check]; 
Applicant's Social Security number: Response not provided; 
Property street address: [Check]; 
Property zip code: Response not provided. 

State: Louisiana; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Maine; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Check]; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: Maryland; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Check]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Michigan; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Check]; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: Mississippi; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Missouri; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: Montana; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Check]; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: Nevada; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Empty]; 
Property zip code: [Empty]. 

State: New Hampshire; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Check]; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: New York; 
Applicant's name: [Check]; 
Applicant's Social Security number: Response not provided; 
Property street address: Response not provided; 
Property zip code: Response not provided. 

State: North Carolina; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Ohio; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: Oklahoma; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Check]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Oregon; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Pennsylvania; 
Applicant's name: [Check]; 
Applicant's Social Security number: Response not provided; 
Property street address: [Check]; 
Property zip code: Response not provided. 

State: Rhode Island; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Check]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: South Carolina; 
Applicant's name: [Check]; 
Applicant's Social Security number: Response not provided; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: South Dakota; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Check]; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: Texas; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: Vermont; 
Applicant's name: Response not provided; 
Applicant's Social Security number: Response not provided; 
Property street address: Response not provided; 
Property zip code: Response not provided. 

State: Washington; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Empty]. 

State: Wisconsin; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Check]; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: Wyoming; 
Applicant's name: [Check]; 
Applicant's Social Security number: [Empty]; 
Property street address: [Check]; 
Property zip code: [Check]. 

State: Total; 
Applicant's name: 33; 
Applicant's Social Security number: 10; 
Property street address: 32; 
Property zip code: 12. 

Source: GAO web-based survey administered to state Medicaid officials. 

Note: This table only includes responses from the 35 states that 
reported conducting property searches. The following 16 states 
reported they did not conduct property searches: Arkansas, California, 
District of Columbia, Florida, Idaho, Indiana, Massachusetts, 
Minnesota, Nebraska, New Jersey, New Mexico, North Dakota, Tennessee, 
Utah, Virginia, and West Virginia. 

[End of table] 

Table 34: Timing of States' Property Records Searches in Relation to 
Eligibility Determination, by State, 2011: 

(Continued From Previous Page) 

State: Alabama; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Alaska; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: Arizona; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Colorado; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: Connecticut; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Delaware; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Georgia; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Hawaii; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Illinois; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: Iowa; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Kansas; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Kentucky; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Louisiana; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Maine; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Maryland; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Michigan; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: Mississippi; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Missouri; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: Montana; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Nevada; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: New Hampshire; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: New York; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: North Carolina; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Ohio; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Oklahoma; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Oregon; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Pennsylvania; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Rhode Island; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: South Carolina; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: South Dakota; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Texas; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Vermont; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Washington; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Wisconsin; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Wyoming; 
Point during eligibility determination process: Generally before 
eligibility determination. 

Source: GAO web-based survey administered to state Medicaid officials. 

Note: This table only includes responses from the 35 states that 
reported conducting property searches. The following 16 states 
reported they did not conduct property searches: Arkansas, California, 
District of Columbia, Florida, Idaho, Indiana, Massachusetts, 
Minnesota, Nebraska, New Jersey, New Mexico, North Dakota, Tennessee, 
Utah, Virginia, and West Virginia. 

[End of table] 

[End of section] 

Appendix VI: States' Use of Vehicle Records Searches to Verify 
Applicants' Assets: 

Table 35: Proportion of Applicants for Which States Conduct Records 
Searches with the Department of Motor Vehicles to Verify Applicants' 
Assets, by State, 2011: 

State: Alabama; 
Proportion of applicants: No applicants. 

State: Alaska[A]; 
Proportion of applicants: Some applicants. 

State: Arizona; 
Proportion of applicants: No applicants. 

State: Arkansas; 
Proportion of applicants: No applicants. 

State: California; 
Proportion of applicants: No applicants. 

State: Colorado; 
Proportion of applicants: Some applicants. 

State: Connecticut; 
Proportion of applicants: All applicants. 

State: Delaware; 
Proportion of applicants: All applicants. 

State: District of Columbia; 
Proportion of applicants: No applicants. 

State: Florida; 
Proportion of applicants: Some applicants. 

State: Georgia; 
Proportion of applicants: No applicants. 

State: Hawaii; 
Proportion of applicants: No applicants. 

State: Idaho; 
Proportion of applicants: No applicants. 

State: Illinois; 
Proportion of applicants: No applicants. 

State: Indiana; 
Proportion of applicants: No applicants. 

State: Iowa; 
Proportion of applicants: No applicants. 

State: Kansas; 
Proportion of applicants: Some applicants. 

State: Kentucky; 
Proportion of applicants: All applicants. 

State: Louisiana; 
Proportion of applicants: No applicants. 

State: Maine; 
Proportion of applicants: All applicants. 

State: Maryland; 
Proportion of applicants: All applicants. 

State: Massachusetts; 
Proportion of applicants: No applicants. 

State: Michigan[A]; 
Proportion of applicants: Some applicants. 

State: Minnesota; 
Proportion of applicants: No applicants. 

State: Mississippi; 
Proportion of applicants: No applicants. 

State: Missouri[A]; 
Proportion of applicants: Some applicants. 

State: Montana; 
Proportion of applicants: All applicants. 

State: Nebraska; 
Proportion of applicants: All applicants. 

State: Nevada[A]; 
Proportion of applicants: Some applicants. 

State: New Hampshire; 
Proportion of applicants: No applicants. 

State: New Jersey; 
Proportion of applicants: No applicants. 

State: New Mexico; 
Proportion of applicants: All applicants. 

State: New York; 
Proportion of applicants: No applicants. 

State: North Carolina; 
Proportion of applicants: Most (more than half) applicants. 

State: North Dakota; 
Proportion of applicants: Some applicants. 

State: Ohio; 
Proportion of applicants: Some applicants. 

State: Oklahoma; 
Proportion of applicants: No applicants. 

State: Oregon; 
Proportion of applicants: Some applicants. 

State: Pennsylvania; 
Proportion of applicants: Some applicants. 

State: Rhode Island[A]; 
Proportion of applicants: Some applicants. 

State: South Carolina; 
Proportion of applicants: Some applicants. 

State: South Dakota; 
Proportion of applicants: All applicants. 

State: Tennessee; 
Proportion of applicants: No applicants. 

State: Texas; 
Proportion of applicants: No applicants. 

State: Utah; 
Proportion of applicants: All applicants. 

State: Vermont[A]; 
Proportion of applicants: Some applicants. 

State: Virginia; 
Proportion of applicants: Some applicants. 

State: Washington; 
Proportion of applicants: All applicants. 

State: West Virginia; 
Proportion of applicants: All applicants. 

State: Wisconsin; 
Proportion of applicants: All applicants. 

State: Wyoming; 
Proportion of applicants: All applicants. 

Source: GAO web-based survey administered to state Medicaid officials. 

[A] State reported conducting vehicle searches only if an applicant 
submitted questionable information. 

[End of table] 

Table 36: Types of Information That Can Be Used to Conduct Vehicle 
Records Searches, by State, 2011: 

State: Alaska; 
Applicant's name: [Check]; 
Applicant's driver license number: [Empty]; 
Applicant's license plate number: [Empty]; 
Applicant's Social Security number: [Empty]; 
Vehicle identification number: [Empty]. 

State: Colorado; 
Applicant's name: Response not provided; 
Applicant's driver license number: Response not provided; 
Applicant's license plate number: Response not provided; 
Applicant's Social Security number: Response not provided; 
Vehicle identification number: [Check]. 

State: Connecticut; 
Applicant's name: [Check]; 
Applicant's driver license number: [Empty]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Empty]; 
Vehicle identification number: [Check]. 

State: Delaware; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Empty]; 
Vehicle identification number: [Check]. 

State: Florida; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Check]. 

State: Kansas; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Empty]. 

State: Kentucky; 
Applicant's name: [Check]; 
Applicant's driver license number: Response not provided; 
Applicant's license plate number: Response not provided; 
Applicant's Social Security number: Response not provided; 
Vehicle identification number: Response not provided. 

State: Maine; 
Applicant's name: [Check]; 
Applicant's driver license number: [Empty]; 
Applicant's license plate number: [Empty]; 
Applicant's Social Security number: [Empty]; 
Vehicle identification number: [Empty]. 

State: Maryland; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Empty]; 
Vehicle identification number: [Check]. 

State: Michigan; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Check]. 

State: Missouri; 
Applicant's name: [Check]; 
Applicant's driver license number: [Empty]; 
Applicant's license plate number: [Empty]; 
Applicant's Social Security number: [Empty]; 
Vehicle identification number: [Empty]. 

State: Montana; 
Applicant's name: [Check]; 
Applicant's driver license number: [Empty]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Empty]; 
Vehicle identification number: [Check]. 

State: Nebraska; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Empty]; 
Vehicle identification number: [Check]. 

State: Nevada; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Check]. 

State: New Mexico; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Check]. 

State: North Carolina; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Empty]; 
Vehicle identification number: [Check]. 

State: North Dakota; 
Applicant's name: [Check]; 
Applicant's driver license number: [Empty]; 
Applicant's license plate number: [Empty]; 
Applicant's Social Security number: [Empty]; 
Vehicle identification number: [Empty]. 

State: Ohio; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Check]. 

State: Oregon; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Empty]; 
Vehicle identification number: [Check]. 

State: Pennsylvania; 
Applicant's name: [Check]; 
Applicant's driver license number: [Empty]; 
Applicant's license plate number: [Empty]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Empty]. 

State: Rhode Island; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: Response not provided; 
Applicant's Social Security number: Response not provided; 
Vehicle identification number: [Check]. 

State: South Carolina; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: Response not provided; 
Vehicle identification number: [Check]. 

State: South Dakota; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Empty]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Check]. 

State: Utah; 
Applicant's name: [Check]; 
Applicant's driver license number: [Empty]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Check]. 

State: Vermont; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Empty]. 

State: Virginia; 
Applicant's name: [Check]; 
Applicant's driver license number: [Empty]; 
Applicant's license plate number: [Empty]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Empty]. 

State: Washington; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Check]. 

State: West Virginia; 
Applicant's name: [Check]; 
Applicant's driver license number: [Empty]; 
Applicant's license plate number: [Empty]; 
Applicant's Social Security number: [Empty]; 
Vehicle identification number: [Check]. 

State: Wisconsin; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Check]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Check]. 

State: Wyoming; 
Applicant's name: [Check]; 
Applicant's driver license number: [Check]; 
Applicant's license plate number: [Empty]; 
Applicant's Social Security number: [Check]; 
Vehicle identification number: [Check]. 

State: Total; 
Applicant's name: 29; 
Applicant's driver license number: 18; 
Applicant's license plate number: 18; 
Applicant's Social Security number: 12; 
Vehicle identification number: 20. 

Source: GAO web-based survey administered to state Medicaid officials. 

Note: This table only includes responses from the 30 states that 
reported conducting vehicle searches. The following 21 states reported 
they did not conduct vehicle searches: Alabama, Arizona, Arkansas, 
California, District of Columbia, Georgia, Hawaii, Idaho, Illinois, 
Indiana, Iowa, Louisiana, Massachusetts, Minnesota, Mississippi, New 
Hampshire, New Jersey, New York, Oklahoma, Tennessee, and Texas. 

[End of table] 

Table 37: Timing of States' Record Searches with the Department of 
Motor Vehicles in Relation to Eligibility Determination, by State, 
2011: 

State: Alaska; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: Colorado; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Connecticut; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Delaware; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Florida; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Kansas; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Kentucky; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Maine; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Maryland; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Michigan; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Missouri; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: Montana; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Nebraska; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Nevada; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: New Mexico; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: North Carolina; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: North Dakota; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Ohio; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Oregon; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Pennsylvania; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Rhode Island; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: South Carolina; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: South Dakota; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Utah; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Vermont; 
Point during eligibility determination process: Sometimes before and 
sometimes after eligibility determination. 

State: Virginia; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Washington; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: West Virginia; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Wisconsin; 
Point during eligibility determination process: Generally before 
eligibility determination. 

State: Wyoming; 
Point during eligibility determination process: Generally before 
eligibility determination. 

Source: GAO web-based survey administered to state Medicaid officials. 

Note: This table only includes responses from the 30 states that 
reported conducting vehicle searches. The following 21 states reported 
they did not conduct vehicle searches: Alabama, Arizona, Arkansas, 
California, District of Columbia, Georgia, Hawaii, Idaho, Illinois, 
Indiana, Iowa, Louisiana, Massachusetts, Minnesota, Mississippi, New 
Hampshire, New Jersey, New York, Oklahoma, Tennessee, and Texas. 

[End of table] 

[End of section] 

Appendix VII: States' Collection of Third-Party Information to 
Identify Transfers of Assets: 

Table 38: Proportion of Applicants for Which States Take Additional 
Steps to Obtain Information from Third Parties to Identify Assets 
Transferred for Less Than Fair Market Value, by State, 2011: 

State: Alabama; 
Proportion of applicants: All applicants. 

State: Alaska[A]; 
Proportion of applicants: Some applicants. 

State: Arizona; 
Proportion of applicants: No applicants. 

State: Arkansas; 
Proportion of applicants: No applicants. 

State: California; 
Proportion of applicants: No applicants. 

State: Colorado; 
Proportion of applicants: Some applicants. 

State: Connecticut; 
Proportion of applicants: All applicants. 

State: Delaware; 
Proportion of applicants: No applicants. 

State: District of Columbia; 
Proportion of applicants: No applicants. 

State: Florida; 
Proportion of applicants: No applicants. 

State: Georgia; 
Proportion of applicants: No applicants. 

State: Hawaii; 
Proportion of applicants: No applicants. 

State: Idaho; 
Proportion of applicants: No applicants. 

State: Illinois; 
Proportion of applicants: No applicants. 

State: Indiana; 
Proportion of applicants: Response not provided. 

State: Iowa; 
Proportion of applicants: No applicants. 

State: Kansas; 
Proportion of applicants: No applicants. 

State: Kentucky[A,B]; 
Proportion of applicants: Some applicants. 

State: Louisiana[A]; 
Proportion of applicants: Some applicants. 

State: Maine; 
Proportion of applicants: No applicants. 

State: Maryland[B]; 
Proportion of applicants: Some applicants. 

State: Massachusetts; 
Proportion of applicants: No applicants. 

State: Michigan[A]; 
Proportion of applicants: Some applicants. 

State: Minnesota; 
Proportion of applicants: No applicants. 

State: Mississippi; 
Proportion of applicants: No applicants. 

State: Missouri; 
Proportion of applicants: No applicants. 

State: Montana[A]; 
Proportion of applicants: Some applicants. 

State: Nebraska; 
Proportion of applicants: No applicants. 

State: Nevada[A]; 
Proportion of applicants: Some applicants. 

State: New Hampshire; 
Proportion of applicants: All applicants. 

State: New Jersey[A]; 
Proportion of applicants: Some applicants. 

State: New Mexico; 
Proportion of applicants: No applicants. 

State: New York; 
Proportion of applicants: All applicants. 

State: North Carolina; 
Proportion of applicants: All applicants. 

State: North Dakota; 
Proportion of applicants: Some applicants. 

State: Ohio; 
Proportion of applicants: No applicants. 

State: Oklahoma; 
Proportion of applicants: No applicants. 

State: Oregon; 
Proportion of applicants: No applicants. 

State: Pennsylvania; 
Proportion of applicants: No applicants. 

State: Rhode Island; 
Proportion of applicants: Some applicants. 

State: South Carolina[B]; 
Proportion of applicants: Some applicants. 

State: South Dakota; 
Proportion of applicants: All applicants. 

State: Tennessee[A]; 
Proportion of applicants: Some applicants. 

State: Texas; 
Proportion of applicants: No applicants. 

State: Utah; 
Proportion of applicants: No applicants. 

State: Vermont; 
Proportion of applicants: No applicants. 

State: Virginia; 
Proportion of applicants: No applicants. 

State: Washington; 
Proportion of applicants: Some applicants. 

State: West Virginia; 
Proportion of applicants: No applicants. 

State: Wisconsin[A]; 
Proportion of applicants: Some applicants. 

State: Wyoming[A]; 
Proportion of applicants: All applicants. 

Source: GAO web-based survey administered to state Medicaid officials. 

Legend: 

[A] State reported taking additional steps only if it questioned the 
applicant's information or had reason to believe a transfer may have 
occurred. 

[B] State reported taking additional steps only if an applicant 
reported a transfer. 

[End of table] 

[End of section] 

Appendix VIII: GAO Analysis of Annuity Language Contained in States' 
Application Forms: 

Table 39: Characteristics of Medicaid Long-Term Care Application Forms 
Related to Deficit Reduction Act of 2005 (DRA) Annuity Provisions, by 
State, 2011: 

State: Alabama; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Alaska; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Arizona; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [A]; 
Name the state as a remainder beneficiary: [A]. 

State: Arkansas; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [B]; 
Name the state as a remainder beneficiary: [Check]. 

State: California; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Colorado; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [C]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Connecticut; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Delaware; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: District of Columbia; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Empty]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Florida; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [D]. 

State: Georgia; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Empty]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Hawaii; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Idaho; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Empty]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Illinois; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Indiana; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [C]; 
Name the state as a remainder beneficiary: [E]. 

State: Iowa; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [C]; 
Name the state as a remainder beneficiary: [F]. 

State: Kansas; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Kentucky; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [G]; 
Name the state as a remainder beneficiary: [G]. 

State: Louisiana; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Maine; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Maryland; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Massachusetts; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [H]. 

State: Michigan; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Minnesota; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Mississippi; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Missouri; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Montana; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Nebraska; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Nevada; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: New Hampshire; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: New Jersey; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: New Mexico; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: New York; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: North Carolina; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [D]. 

State: North Dakota; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Ohio; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Oklahoma; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [C]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Oregon; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Pennsylvania; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Empty]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Rhode Island; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: South Carolina; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: South Dakota; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Tennessee; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Texas; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Utah; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Vermont; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Virginia; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: Washington; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Check]. 

State: West Virginia; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Wisconsin; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [I]. 

State: Wyoming; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: [Check]; 
Name the state as a remainder beneficiary: [Empty]. 

State: Total; 
Application form contained language regarding requirements to: 
Disclose interest in an annuity: 45; 
Name the state as a remainder beneficiary: 27. 

Source: GAO analysis of state application forms for Medicaid coverage 
for long-term care. 

Notes: Our review was limited to state application forms for Medicaid 
coverage for long-term care provided to us by state officials. Some 
states might require disclosure of an interest in an annuity and 
include a statement regarding the state becoming a remainder 
beneficiary through another means, such as a form other than the long-
term care application form or through an interview conducted as part 
of the application process. 

[A] State collected information from applicants through an interview 
rather than a paper application form. A state official provided the 
form eligibility workers use during their interviews with applicants 
and this form contained language regarding requirements to disclose 
interest in an annuity. It also contained language regarding the state 
becoming a remainder beneficiary, but specified this was for annuities 
purchased on or after July 1, 2006 (rather than the date included in 
the DRA provision--February 8, 2006). 

[B] State's application form included a statement regarding having to 
disclose interest in an annuity, but the sections of the application 
form that ask applicants to list their income or resources did not 
mention annuities. 

[C] State's application form did not specify that annuities must be 
disclosed for the applicant's spouse. 

[D] State's application form contained language regarding the state 
becoming a remainder beneficiary, but specified this was for annuities 
purchased on or after November 1, 2007 (rather than the date included 
in the DRA provision--February 8, 2006). 

[E] State's application form contained language regarding the state 
becoming a remainder beneficiary, but specified this was for annuities 
purchased on or after November 1, 2009 (rather than the date included 
in the DRA provision--February 8, 2006). 

[F] State's application form contained language regarding the state 
becoming a remainder beneficiary, but did not indicate that this is a 
requirement. 

[G] State collected information from applicants through an interview 
rather than a paper application form. 

[H] State's application form specified that the applicant may be 
required to name the state as a remainder beneficiary, and referred 
the applicant to a booklet for more information. 

[I] State's application form contained language regarding the state 
becoming a remainder beneficiary, but specified this was for annuities 
purchased on or after January 1, 2009 (rather than the date included 
in the DRA provision--February 8, 2006). 

[End of table] 

[End of section] 

Appendix IX: Comments from the Department of Health and Human Services: 

Department of Health & Human Services: 
Office of The Secretary: 
Assistant Secretary for Legislation: 
Washington, DC 20201: 

July 11, 2012: 

Carolyn L. Yocom: 
Director, Health Care: 
U.S. Government Accountability Office: 
441 G Street NW: 
Washington, DC 20548: 

Dear Ms. Yocom: 

Attached are comments on the U.S. Government Accountability Office's 
(GAO) report entitled, "Medicaid Long-Term Care: Information Obtained 
by States about Applicants' Assets Varies and May Be Insufficient" 
(GAO-12-749). 

The Department appreciates the opportunity to review this report prior 
to publication. 

Sincerely, 

Signed by: 

Jim R. Esquea: 
Assistant Secretary for Legislation: 

Attachment: 

[End of letter] 

General Comments Of The Department Of Health And Human Services (HHS) 
On The Government Accountability Office's (GAO) Draft Report Entitled, 
"Medicaid Long-Term Care: Information Obtained By States About 
Applicants' Assets Varies And May Be Insufficient" (GAO-12-749): 

The Department appreciates the opportunity to comment on this draft 
report. 

HHS concurs with the findings of this draft report. The objective of 
this report was to provide information on states' requirements and 
practices for assessing the financial eligibility of applicants for 
Medicaid long-term care coverage. GAO examined the extent to which 
states: 1) Require documentation from individuals applying for 
Medicaid long-term care coverage; 2) Verify applicants' financial 
information with third parties; and 3) Obtain information about 
applicants' assets that could be used to implement eligibility-related 
Deficit Reduction Act of 2005 provisions. 

GAO concluded that states vary in the types of documentation they 
require to determine if an individual's assets are within the Medicaid 
standards and their efforts to verify if assets have been transferred 
for less than fair market value. Because they do not have sufficient 
third party sources for verifying assets, many states limit deeper 
investigations to those individuals who appear to be more likely to 
have assets or to have transferred assets inappropriately. In the 
concluding observations, GAO asserts that states are challenged by the 
balance they must seek between the high cost of third-party 
verification procedures and their obligations to comply with federal 
requirements. GAO further indicates that it may be most practical for 
states to adhere to a risk-based approach in determining asset 
transfers by focusing on applicants who appear to be more likely to 
have assets or to have made transfers, and, while acknowledging the 
possible benefits of Asset Verification Systems (AVS), notes that it 
is too soon to assess their effectiveness. 

GAO's report is detailed and comprehensive and will be a helpful 
resource for all interested parties. As noted in the report, CMS has 
been keeping in contact with states as they work toward implementation 
of their AVS, and this report will be helpful for purposes of 
targeting our ongoing technical assistance and oversight efforts with 
states. 

We appreciate the effort that went into this report and look forward 
to working with GAO on this and other issues. 

[End of section] 

Appendix X: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Carolyn L. Yocom, (202) 512-7114 or yocomc@gao.gov: 

Staff Acknowledgments: 

In addition to the contact named above, Michelle B. Rosenberg, 
Assistant Director; Emily Binek; Julianne Flowers; Kaycee M. Glavich; 
Shirin Hormozi; Emily Loriso; Christina Ritchie; and Phillip J. 
Stadler made key contributions to this report. 

[End of section] 

Footnotes: 

[1] Metlife Mature Market Institute, The 2011 MetLife Market Survey of 
Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs 
(Westport, Conn.: October 2011). 

[2] For this report, we focus on financial eligibility--specifically 
financial eligibility for Medicaid coverage for long-term care. 
However, individuals applying for Medicaid coverage for long-term care 
must also meet functional eligibility criteria that are established by 
each state and generally involve a degree of impairment measured by 
limitations in an individual's ability to carry out activities of 
daily living--eating, bathing, dressing, using the toilet, getting in 
and out of bed, and getting around the house--and instrumental 
activities of daily living, such as preparing meals, shopping for 
groceries, and getting around outside. 

[3] This terminology is based on definitions provided in The State 
Medicaid Manual issued by the Centers for Medicare & Medicaid Services 
(CMS), which specifies that assets include both income and resources. 

[4] See Pub. L. No. 109-171, §§ 6011-6016, 120 Stat. 4, 61-67 (2006). 

[5] GAO, Medicaid Long-Term Care: Few Transferred Assets before 
Applying for Nursing Home Coverage; Impact of Deficit Reduction Act on 
Eligibility Is Uncertain, [hyperlink, 
http://www.gao.gov/products/GAO-07-280] (Washington, D.C.: Mar. 26, 
2007); Nelson A. Rockefeller Institute of Government, Assessing Asset 
Transfer for Medicaid Eligibility in New York State (March 2009). 

[6] Throughout this document, the term state refers to the 50 states 
and the District of Columbia. 

[7] A CCRC is generally a residential facility established in a campus-
like setting that provides access for older individuals to three 
levels of housing and care: independent homes or apartments where 
residents live much as they did in their own homes; assisted living, 
which provides help with the daily tasks of living; and skilled 
nursing care for those with greater physical needs. Most residents 
must be able to live independently when they enter into a contract 
with a CCRC, with the intent of moving through the three levels of 
care as their needs change. A life estate is an interest in real 
property that gives the owner of the interest the right to use and 
possess the property only for the duration of the life of a person, 
usually the person who occupies the premises. 

[8] The survey did not ask about the number of months of documentation 
required for other types of assets, such as real property and trusts, 
as the documentation and value of these assets are less likely to 
fluctuate over time. 

[9] The application forms reviewed were those provided by the state 
officials who were identified as the contacts for our survey. See 
appendix I for information on states' application forms for Medicaid 
coverage for long-term care. 

[10] The Supplemental Security Income program provides cash assistance 
to aged, blind, or disabled individuals with limited income and 
resources. 42 U.S.C. §§1381-1383f. 

[11] Although noncountable resources vary by state, for purposes of 
determining Medicaid eligibility for long-term care, they generally 
include an individual's home (typically if the individual expresses 
the intent to return home), an automobile, household goods and 
personal effects, burial spaces, and life insurance and burial 
arrangements up to a certain value, among other things. 

[12] For married couples, the Medicaid statute requires states to use 
specific minimum and maximum resource standards in determining 
eligibility when one spouse is in an institution, such as a nursing 
home, and the other remains in the community (referred to as the 
community spouse). 42 U.S.C. § 1396r-5. The community spouse may 
retain an amount equal to one-half of the couple's combined countable 
resources, up to a state-specified maximum level. States' maximum 
resource levels cannot exceed the maximum federal standard ($113,640 
in 2012). If one-half of the couple's combined resources is less than 
a state-specified minimum resource level (which has to be at least 
$22,728 in 2012), then the community spouse may retain resources up to 
that minimum level. 

[13] Federal law requires states to apply the transfer of asset 
provisions to institutionalized individuals, who are defined in the 
Social Security Act as individuals who are inpatients in a nursing 
facility or in a medical institution that is being paid based on a 
level of care received in a nursing home, or certain recipients of 
home and community-based services. 42 U.S.C. § 1396p(h)(3). States 
have the option to apply such provisions to noninstitutionalized 
individuals. 

[14] Among other things, the DRA also changed the beginning date of 
the penalty period; included provisions regarding how the penalty 
period was to be calculated; and established criteria and application, 
notice, and appeal requirements for undue hardship waivers. Undue 
hardship exists when the application of a penalty period would deprive 
an individual of (1) medical care such that the individual's health or 
life would be endangered or (2) food, clothing, shelter, or other 
necessities of life. Prior to the DRA, the criteria for determining 
undue hardship had been established by the Secretary of HHS in 
Medicaid guidance, namely The State Medicaid Manual. These provisions 
regarding the penalty period and undue hardship are outside the scope 
of our study. 

[15] The DRA also included a provision regarding how a married 
applicant's income should be treated when determining how much of the 
applicant's resources the community spouse is entitled to retain. This 
provision is outside the scope of our study. 

[16] Supplemental Appropriations Act, 2008, Pub. L. No. 110-252, § 
7001(d)(1), 122 Stat. 2323, 2391 (codified at 42 U.S.C. § 1396w). 

[17] According to guidance issued by CMS, verification requests 
through a state's AVS must be sent to financial institutions not 
identified by applicants based on some logic, such as geographic 
proximity to the applicant's home address, or other reasonable factors 
whenever the state determines that such requests are needed for 
eligibility determination. Additionally, per CMS guidance, the 
verification requests must include a request for information on both 
open and closed accounts, going back for a period up to 5 years, as 
determined by the state. 

[18] The Supplemental Appropriations Act, 2008, required California, 
New Jersey, and New York to implement an AVS for aged, blind, and 
disabled applicants by the end of fiscal year 2009 and directed the 
Secretary of HHS to require the remaining states to implement their 
systems in a manner that results in a specified percentage of aged, 
blind, and disabled Medicaid applicants being subject to this type of 
asset verification each year over the 5-year period of fiscal year 
2009 through fiscal year 2013. 

[19] As previously noted, the 13 types of assets included in our 
survey were: earned income, unearned income, financial and investment 
resources, life insurance, primary residence, real property other than 
primary residence, vehicles, annuities, burial contracts and prepaid 
funeral arrangements, CCRC entrance fees, life estates, promissory 
notes or loans, and trusts. 

[20] Officials from several states reported not requiring 
documentation of an applicant's vehicle, primary residence, or both 
because the state does not count them for purposes of determining 
financial eligibility for Medicaid coverage for long-term care. 

[21] Missouri and Montana required 3 months of earned income 
documentation and Tennessee required 2 months of earned income 
documentation. 

[22] The 2 states are New Hampshire and Vermont. 

[23] While all states provided some information about their use of 
data matches, some states did not provide responses about their use of 
all 10 of the sources included in our survey. 

[24] The 31 states are: Alaska, Arizona, Arkansas, California, 
Colorado, District of Columbia, Florida, Georgia, Idaho, Indiana, 
Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, 
Nebraska, New Mexico, North Dakota, Oklahoma, Pennsylvania, Rhode 
Island, South Dakota, Tennessee, Texas, Virginia, Washington, West 
Virginia, Wisconsin, and Wyoming. Ten of these states reported they 
may require up to 60 months of additional documentation from at least 
some applicants to identify assets that were transferred for less than 
FMV or may request additional information from financial institutions 
or a combination of both factors, in situations where, for example, an 
applicant reported making a transfer or submitted insufficient 
information. 

[25] The 3 states are: Arkansas, District of Columbia, and Minnesota. 

[26] The 6 states are: Arizona, Arkansas, California, District of 
Columbia, Georgia, and Indiana. These states' application forms either 
did not ask about transfers of assets or asked about transfers made 
for a period of time less than 60 months. Our review was limited to 
state application forms for Medicaid coverage for long-term care 
provided to us by state officials. Some states might ask about 
transfers made during the look-back period through other means, such 
as a form other than the long-term care application form or through an 
interview conducted as part of the application process. 

[27] The 20 states are: Alabama, Connecticut, Delaware, Hawaii, 
Illinois, Maine, Maryland, Mississippi, Missouri, Montana, Nevada, New 
Hampshire, New Jersey, New York, North Carolina, Ohio, Oregon, South 
Carolina, Utah, and Vermont. 

[28] Of the 8 states, 4 conduct searches of property records from the 
county of residence for all applicants (Louisiana, Maine, Montana, and 
Oklahoma); 1 conducts such searches for most applicants (Iowa); and 3 
do so for less than half of applicants (Alaska, New York, and 
Vermont). Additionally, although Vermont reported not requiring 
documentation of a primary residence, the state indicated that 
documentation would be required if it appeared as though an 
applicant's equity interest in his or her primary residence might 
exceed the allowable amount. 

[29] The state is Minnesota. 

[30] The 5 states are: Arkansas, California, District of Columbia, 
Tennessee, and Virginia. Although Arkansas reported not requiring 
documentation of a primary residence and not conducting property 
searches, the state indicated that documentation would be required if 
it appeared as though an applicant's equity interest in his or her 
primary residence might exceed the allowable amount. 

[31] The 3 states are: Delaware, Indiana, and Nebraska. Delaware and 
Indiana reported requiring applicants to provide documentation of the 
current assessed value of their primary residence; this documentation 
should provide the states with sufficient information to know if a 
home is valued above the states' home equity limit and thus whether 
additional information about an applicant's equity interest is needed. 
Nebraska required applicants to submit mortgage statements and 
property tax assessments; this combination of documentation should 
provide the state with sufficient information to determine if an 
applicant's equity interest exceeds the state-specified maximum level. 

[32] The 2 states are Iowa and Maine; it is unclear how these 2 states 
would have the necessary information to implement the DRA provision 
that life estates are to be considered a transfer for less than FMV 
unless the purchaser resided in the home for at least a year after the 
date of purchase. 

[33] Nineteen states either did not provide an answer to this question 
or they did not provide a response that adequately answered the 
question. 

[34] One state, the District of Columbia, did not indicate whether 
documentation of promissory notes was required. 

[35] Two states, Arizona and Kentucky, collected information from 
applicants through an interview rather than a paper application form 
and, as such, were not included in our analysis. Our review was 
limited to state application forms for Medicaid coverage for long-term 
care provided to us by state officials. Some states might require 
disclosure of an interest in an annuity or include a statement 
regarding the need to name the state as a remainder beneficiary 
through other means, such as a form other than the long-term care 
application form or through an interview conducted as part of the 
application process. 

[End of section] 

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