Asset Verification Service (AVS)

When you apply for MA or MSP, the county or tribal worker will determine if you need to authorize use of the AVS. If so, the worker will send you a request and an authorization form to complete. Return the completed form by the date the worker requests it, so they can determine your MA or MSP eligibility.

If you have a spouse who is living with you, he or she must sign the form, unless you are receiving services through the Brain Injury (BI), Community Alternative Care (CAC), Community Access Disability Inclusion (CADI) or Developmental Disability (DD) waiver program.

If you have a spouse and you are applying for MA for Long-Term Care Services (MA-LTC) for the Elderly Waiver (EW), or for services in a long-term care facility, your spouse must also sign the form.

If you have a sponsor who signed an Affidavit of Support (USCIS I-864) as a condition of you or your spouse’s entry to the United States, the sponsor must sign the form. If your sponsor has a spouse who signed the I-864, that spouse must also sign the form.

Ask your financial worker at your county or tribal agency if you aren’t sure whether your spouse or sponsor should sign the form.

For applicants: Your MA or MSP application will be denied.

For enrollees: Your MA or MSP eligibility will end. The county or tribal agency will send you a closing notice at least 10 days before your coverage ends.

Call the financial worker at your county or tribal agency right away. If you are an applicant or an enrollee, the worker may be able to give you more time to complete the form.

Your coverage can be extended if you return the form before the closing date listed on the notice.

You will need to reapply for MA or MSP if the county or tribal agency does not receive your authorization by the closing date. Find out:

• How to apply for people with disabilities
• How to apply if you are 65 years old or older

The request cover letter gives more information. You can also contact your county or tribal agency at the phone number listed on the request cover letter.

Contact your county or tribal agency or call Health Care Consumer Support at 651-297-3862 or 800-657-3672.