Assess whether continuing disability review supports cessation (d8e278)

SITUATION A MAGI mismatch that could be a household-size coding error put issuance file-control totals that will not balance in front of disability continuing-eligibility reviewer in a disability unit facing a backlog of CDRs. This Public Benefits / Compliance and Integrity Operations close is continuing disability review supports from issuance file-control totals that will not balance, and the live options are Pay or continue, Recoup, Deny.

DECISION Disability continuing-eligibility reviewer in a disability unit facing a backlog of CDRs must choose Pay or continue / Recoup / Deny / Hold using issuance file-control totals that will not balance after a MAGI mismatch that could be a household-size coding error.

HYPOTHESES TO TEST 1. Disability continuing-eligibility reviewer can defend Pay or continue from issuance file-control totals that will not balance after a MAGI mismatch that could be a household-size coding error in a Public Benefits challenge. 2. Disability continuing-eligibility reviewer cannot defend Pay or continue from issuance file-control totals that will not balance; Recoup is what the extract actually supports after a MAGI mismatch that could be a household-size coding error. 3. A MAGI mismatch that could be a household-size coding error never reached the population in issuance file-control totals that will not balance — reopen intake, do not close continuing disability review supports. 4. Two facts in issuance file-control totals that will not balance after a MAGI mismatch that could be a household-size coding error conflict for disability continuing-eligibility reviewer; hold this Compliance and Integrity Operations file.

ANALYSIS REQUIRED 1. Quantify overpayment if continuing disability review supports is wrong. 2. Separate a case-level error from a program-design failure in a disability unit facing a backlog of CDRs. 3. Match household facts in issuance file-control totals that will not balance to the rule that pays the benefit. 4. For this Public Benefits Compliance and Integrity Operations file, read issuance file-control totals that will not balance against a MAGI mismatch that could be a household-size coding error and write the one fact that would move continuing disability review supports for disability continuing-eligibility reviewer.

RECOMMENDATION Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Compliance and Integrity Operations packet (issuance file-control totals that will not balance after a MAGI mismatch that could be a household-size coding error). The follow-on Compliance and Integrity Operations action is what disability continuing-eligibility reviewer does next: implement the option, assign an owner, and log the missing fact.