(1) A random sample of enrolled individuals will be required to participate in an eligibility verification review and provide documentation to verify the income as stated on the application.

(2) An individual will have 30 days from the date of the written request by the department to submit the required income documentation. The client will remain enrolled during the verification process.

(a) If the required documentation is not received by the department after 30 days, the enrolled individual will be disenrolled from the program the following month.

(b) An individual who provides income verification documentation after 30 will have the application reprocessed as if it is a new application.

(3) If verified income is over 200% FPL, the applicant will be disenrolled effective the last day of the month in which the determination was made and the client was notified.

(4) For purposes of this rule, necessary income documentation may include one or more of the following:

(a) state or federal income tax returns;

(b) pay stubs or other pay statements;

(c) employee's W-2 forms;

(d) self employment records documenting income and expenses;

(e) check copies;

(f) correspondence from an employer specifying a benefit;

(g) records of any government payor; or

(h) other appropriate, persuasive documentation may be accepted at the discretion of the department.