Assess whether to brief the legislature with a number that will survive audit

SITUATION A MAGI mismatch that could be a household-size coding error put housing overlapping-address and income file in front of child-care provider integrity lead in a Medicaid agency with a surge in MAGI mismatches. This Public Benefits / Trafficking and Eligibility Fraud close is to brief the legislature from housing overlapping-address and income file, and the live options are Pay or continue, Recoup, Deny.

DECISION Child-care provider integrity lead in a Medicaid agency with a surge in MAGI mismatches must choose Pay or continue / Recoup / Deny / Hold using housing overlapping-address and income file after a MAGI mismatch that could be a household-size coding error.

HYPOTHESES TO TEST 1. Authorize Pay or continue now; housing overlapping-address and income file already has the discriminator after a MAGI mismatch that could be a household-size coding error. 2. Keep Recoup in force until housing overlapping-address and income file is completed after a MAGI mismatch that could be a household-size coding error for child-care provider integrity lead. 3. Treat housing overlapping-address and income file as Deny because both readings appear after a MAGI mismatch that could be a household-size coding error. 4. Refuse a Public Benefits close: child-care provider integrity lead does not have the decision to brief the legislature turns on in housing overlapping-address and income file.

ANALYSIS REQUIRED 1. Quantify overpayment if to brief the legislature is wrong. 2. Separate a case-level error from a program-design failure in a Medicaid agency with a surge in MAGI mismatches. 3. Match household facts in housing overlapping-address and income file to the rule that pays the benefit. 4. For this Public Benefits Trafficking and Eligibility Fraud file, read housing overlapping-address and income file against a MAGI mismatch that could be a household-size coding error and write the one fact that would move to brief the legislature for child-care provider integrity lead.

RECOMMENDATION Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Trafficking and Eligibility Fraud packet (housing overlapping-address and income file after a MAGI mismatch that could be a household-size coding error). If housing overlapping-address and income file cannot force a Public Benefits label under Trafficking and Eligibility Fraud, stop. If housing overlapping-address and income file after a MAGI mismatch that could be a household-size coding error cannot support Pay or continue versus Recoup on this Public Benefits Trafficking and Eligibility Fraud close, child-care provider integrity lead must do not pay, recoup, or deny beyond the eligibility record.