Medicaid Renewals Playbook

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Worst case scenario challenges

Description

There are many pieces of information that could be utilized (and verified) during an eligibility determination. Some of these pieces of information are not able to be verified. A good example is tax deductions:

• If a person has a tax deduction on their case, their MAGI should be lowered by the deduction listed
• However, there may not be a way to verify the deduction
• The state may then choose to exclude the person from ex parte because of this

However, there’s another option: ignore the deduction, and run the person against ex parte anyway with the higher income.

• If they’re under the limit without the deduction, then we know they’ll be under the limit with the deduction!
• If they’re over the limit, they’ll get a packet anyway; they’re no worse off than before.

The goal is to test them at the “worst case scenario” instead of excluding them altogether. Many states do not opt for this strategy, and exclude anyone with an attribute that cannot be verified.

What this looks like

This most often comes up in MAGI calculation rules. This may look like “X cannot be verified”, or “Unverified X on case”.

Potential solutions

Explain the “worst case scenario” option to the state. Gain policy alignment that, by ignoring these unverified attributes, the state (and person) are at no greater risk than they were before.