Assess whether a household is receiving duplicate subsidies (8d8e34)

Situation

EBT out-of-state redemption cluster arrived with a skimming complaint cluster around one terminal for Medicaid eligibility integrity analyst. That is a Public Benefits Trafficking and Eligibility Fraud decision on a household is receiving in a child-care subsidy program with related-provider clusters.

Decision

Medicaid eligibility integrity analyst in a child-care subsidy program with related-provider clusters must choose Pay or continue / Recoup / Deny / Hold using EBT out-of-state redemption cluster after a skimming complaint cluster around one terminal.

Hypotheses to test

• The population in EBT out-of-state redemption cluster is the one a skimming complaint cluster around one terminal named, so Pay or continue follows for this Trafficking and Eligibility Fraud file.
• The population in EBT out-of-state redemption cluster is adjacent only to a skimming complaint cluster around one terminal; Recoup is the honest Public Benefits call.
• A child-care subsidy program with related-provider clusters already contained a skimming complaint cluster around one terminal before EBT out-of-state redemption cluster arrived; no new Trafficking and Eligibility Fraud path.
• Provenance on EBT out-of-state redemption cluster after a skimming complaint cluster around one terminal is broken; do not pick Pay or continue or Recoup yet.

Analysis required

• 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.
• Test eligibility, recoupment, and improper-payment facts in EBT out-of-state redemption cluster after a skimming complaint cluster around one terminal.
• For this Public Benefits Trafficking and Eligibility Fraud file, read EBT out-of-state redemption cluster against a skimming complaint cluster around one terminal and write the one fact that would move a household is receiving for Medicaid eligibility integrity analyst.

Recommendation

Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Trafficking and Eligibility Fraud packet (EBT out-of-state redemption cluster after a skimming complaint cluster around one terminal). Lead with the Public Benefits option EBT out-of-state redemption cluster can support after a skimming complaint cluster around one terminal, then the two facts that force it, then the Monday action for Medicaid eligibility integrity analyst in a child-care subsidy program with related-provider clusters.