Assess whether a policy change would reduce error without harming access

Situation

EBT out-of-state redemption cluster arrived with a hearing officer reversing 40% of trafficking cases for Medicaid eligibility integrity analyst. That is a Public Benefits Compliance and Integrity Operations decision on a policy change would in a Medicaid agency with a surge in MAGI mismatches.

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 a hearing officer reversing 40% of trafficking cases.

Hypotheses to test

• EBT out-of-state redemption cluster reads as Pay or continue once a hearing officer reversing 40% of trafficking cases is lined up to the same Public Benefits population.
• EBT out-of-state redemption cluster is closer to Recoup after a hearing officer reversing 40% of trafficking cases; Pay or continue would over-claim this Compliance and Integrity Operations extract.
• Deny is still live in EBT out-of-state redemption cluster for Medicaid eligibility integrity analyst in a Medicaid agency with a surge in MAGI mismatches.
• EBT out-of-state redemption cluster is missing the fact Medicaid eligibility integrity analyst needs after a hearing officer reversing 40% of trafficking cases; stop this Public Benefits close.

Analysis required

• 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.
• Trace the notice and appeal path Medicaid eligibility integrity analyst must preserve.
• For this Public Benefits Compliance and Integrity Operations file, read EBT out-of-state redemption cluster against a hearing officer reversing 40% of trafficking cases 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 a hearing officer reversing 40% of trafficking cases). The follow-on Compliance and Integrity Operations action is what Medicaid eligibility integrity analyst does next: implement the option, assign an owner, and log the missing fact.