At present we use active evidence as the only criteria re which evidence to use in eligibility and entitlement calculations. Therefore as soon as you activate a piece of evidence it causes reassessment.
Verifications are a consideration in getting the evidence to this active state.
Generally for evidence to be considered in eligibility and entitlement, it must be both active and verified. There are exceptions to this rule, for example for expedited cases un-verified evidence can be used. But the norm is that the evidence must be active and verified.
Scenario 1: Expedited Food Stamps
An applicant applies for cash. He attests to an earned income of wages and salaries $1000/month. An outstanding verification is flagged for this evidence. The user uploads proof and clears the verification. He then authorizes the decision and the cash PD case is created and activated. A month later, the applicant applies for expedited food as he has lost his job. His earned income is now 0. A verification is flagged for this new value. Product specific verification waiver is configured i.e, just for expedited FA, and the verification is 'Bypassed', so the user is able to apply the changes. The issue is the customer does not want the cash PD to be reassessed, as the verification for the earned income change to $0 is still outstanding.
Scenario 2: QHP Reasonable opportunity for new case member
Addition of a new member in HCR. The rest of the household members are eligible, some for Medicaid and some for QHP. Their information is already verified and the PD cases are active. The new member's income is pending verification. QHP has reasonable opportunity for a period of 90 days, so he new member will be determined eligible on the QHP PD. The verifications are bypassed because of product (QHP) specific waivers. But the activation of the income evidence impacts the Medicaid case also, which doesnt have reasonable opportunity (verification waiver) for income. The Medicaid PD for the other HH members must not be reassessed, but currently there is no way to stop the reassessment. The new member's income must not be used in the MA determination if it hasnt been verified.
Scenario 3 Verifications Requirements differ for FNS and Medicaid on common evidence
Evidence with bypassed verification should only be used on specific Product Delivery case � not on all
E.g. Medicaid has a Level 3 verification requirement and FNS has Level 2. I can't activate the evidence because I don't have Level 3. But I want to activate that evidence because FNS should react (level 2 has been met) Product Specific Waivers came later but I'm not sure they fix the issue. I don't want to waive to Level 2 for FNS. I want FNS to be able to react when Level 2 is reached but I don't want Medicaid to react. And it isn't valid to not let someone have their foodstamps when we are still gathering information for Medicaid.
We discussed with engineering and as a short term strategy at least we think that the requirement may be satisfied by incorporating into rules loaders.
We would need to spike this to see if this works i.e. each product has its own loader, each loader considers verification data.
If this approach works - customers can satisfy the requirement locally in the short term and we can look at including it into loaders provided in Solutions products.
Hi,
We acknowledge that this is a valid enhancement request. It will be considered for inclusion in a future release of the product. Thank you for your interest in the Cúram product.
Thanks,
Eloise O'Riordan, Cúram SPM Offering Management team