Assess whether to recoup, waive, or refer for prosecution (addc9d)

SITUATION A MAGI mismatch that could be a household-size coding error put EBT out-of-state redemption cluster in front of Medicaid eligibility integrity analyst in a Medicaid agency with a surge in MAGI mismatches. This Public Benefits / Compliance and Integrity Operations close is to recoup, waive, or refer from EBT out-of-state redemption cluster, and the live options are To recoup, waive,, Refer for prosecution.

DECISION Medicaid eligibility integrity analyst in a Medicaid agency with a surge in MAGI mismatches must choose To recoup, waive, / Refer for prosecution using EBT out-of-state redemption cluster after a MAGI mismatch that could be a household-size coding error.

HYPOTHESES TO TEST 1. EBT out-of-state redemption cluster reads as To recoup, waive, once a MAGI mismatch that could be a household-size coding error is lined up to the same Public Benefits population. 2. EBT out-of-state redemption cluster is closer to Refer for prosecution after a MAGI mismatch that could be a household-size coding error; To recoup, waive, would over-claim this Compliance and Integrity Operations extract. 3. A dual reading 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. 4. EBT out-of-state redemption cluster is missing the fact Medicaid eligibility integrity analyst needs after a MAGI mismatch that could be a household-size coding error; stop this Public Benefits close.

ANALYSIS REQUIRED 1. Quantify overpayment if to recoup, waive, or refer is wrong. 2. Separate a case-level error from a program-design failure in a Medicaid agency with a surge in MAGI mismatches. 3. Match household facts in EBT out-of-state redemption cluster to the rule that pays the benefit. 4. For this Public Benefits Compliance and Integrity Operations file, read EBT out-of-state redemption cluster against a MAGI mismatch that could be a household-size coding error and write the one fact that would move to recoup, waive, or refer for Medicaid eligibility integrity analyst.

RECOMMENDATION Choose To recoup, waive, / Refer for prosecution on this Public Benefits / Compliance and Integrity Operations packet (EBT out-of-state redemption cluster after a MAGI mismatch that could be a household-size coding error). If EBT out-of-state redemption cluster cannot force a Public Benefits label under Compliance and Integrity Operations, stop. If EBT out-of-state redemption cluster after a MAGI mismatch that could be a household-size coding error cannot support To recoup, waive, versus Refer for prosecution on this Public Benefits Compliance and Integrity Operations close, Medicaid eligibility integrity analyst must do not pay, recoup, or deny beyond the eligibility record.