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

SITUATION Child-care provider integrity lead in a Medicaid agency with a surge in MAGI mismatches has one working extract — housing overlapping-address and income file — after a CDR where treating-source evidence conflicts with a CE. If housing overlapping-address and income file cannot support to brief the legislature, the only defensible Public Benefits output is hold.

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 CDR where treating-source evidence conflicts with a CE.

HYPOTHESES TO TEST 1. Authorize Pay or continue now; housing overlapping-address and income file already has the discriminator after a CDR where treating-source evidence conflicts with a CE. 2. Keep Recoup in force until housing overlapping-address and income file is completed after a CDR where treating-source evidence conflicts with a CE for child-care provider integrity lead. 3. Treat housing overlapping-address and income file as Deny because both readings appear after a CDR where treating-source evidence conflicts with a CE. 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. Match household facts in housing overlapping-address and income file to the rule that pays the benefit. 2. Trace the notice and appeal path child-care provider integrity lead must preserve. 3. Test eligibility, recoupment, and improper-payment facts in housing overlapping-address and income file after a CDR where treating-source evidence conflicts with a CE. 4. For this Public Benefits Trafficking and Eligibility Fraud file, read housing overlapping-address and income file against a CDR where treating-source evidence conflicts with a CE 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 CDR where treating-source evidence conflicts with a CE). The follow-on Trafficking and Eligibility Fraud action is what child-care provider integrity lead does next: implement the option, assign an owner, and log the missing fact.

COMMAND RETURNS - Bottom-line Public Benefits option on to brief the legislature, then the evidence in housing overlapping-address and income file, then the action for child-care provider integrity lead - Hypothesis scorecard against housing overlapping-address and income file: supported / rejected / untestable - What changes to brief the legislature if a CDR where treating-source evidence conflicts with a CE is later withdrawn - Named option among Pay or continue, Recoup, Deny and the fact that kills the others