Assess whether a policy change would reduce error without harming access

Situation

In a Medicaid agency with a surge in MAGI mismatches, EBT out-of-state redemption cluster is the evidence after an identity-proofing vendor outage that opened a manual path. Medicaid eligibility integrity analyst has to pick Pay or continue or Recoup for this Public Benefits Compliance and Integrity Operations close using EBT out-of-state redemption cluster.

Decision

Medicaid eligibility integrity analyst in a Medicaid agency with a surge in MAGI mismatches must choose Pay or continue / Recoup / Deny / Hold using EBT out-of-state redemption cluster after an identity-proofing vendor outage that opened a manual path.

Hypotheses to test

• Authorize Pay or continue now; EBT out-of-state redemption cluster already has the discriminator after an identity-proofing vendor outage that opened a manual path.
• Keep Recoup in force until EBT out-of-state redemption cluster is completed after an identity-proofing vendor outage that opened a manual path for Medicaid eligibility integrity analyst.
• Treat EBT out-of-state redemption cluster as Deny because both readings appear after an identity-proofing vendor outage that opened a manual path.
• Refuse a Public Benefits close: Medicaid eligibility integrity analyst does not have the page a policy change would turns on in EBT out-of-state redemption cluster.

Analysis required

• Quantify overpayment if a policy change would is wrong.
• Separate a case-level error from a program-design failure in a Medicaid agency with a surge in MAGI mismatches.
• Match household facts in EBT out-of-state redemption cluster to the rule that pays the benefit.
• For this Public Benefits Compliance and Integrity Operations file, read EBT out-of-state redemption cluster against an identity-proofing vendor outage that opened a manual path and write the one fact that would move a policy change would for Medicaid eligibility integrity analyst.

Recommendation

Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Compliance and Integrity Operations packet (EBT out-of-state redemption cluster after an identity-proofing vendor outage that opened a manual path). Lead with the Public Benefits option EBT out-of-state redemption cluster can support after an identity-proofing vendor outage that opened a manual path, then the two facts that force it, then the Monday action for Medicaid eligibility integrity analyst in a Medicaid agency with a surge in MAGI mismatches.