Suspension of the benefit due to the outstanding verification past reasonable opportunity period and past proc./grace period

Problem description and business impact Requires system functionality required to implement case closure, verification tracking with reasonable opportunity during initial application, change in circumstances/life even and during annual case renewal or periodic data matching processing. The process will be batch- driven, and as such this is predominantly a system process with minimal user involvement. Once cases, eligibility determinations and outstanding verifications have been created as a part of a) initial application b) annual renewal processing c) periodic data matching d) change in circumstances event the process to request additional verifications and measure progress of processing outstanding verification will take place. This process will be used to update and track received verification in METS and progress of obtaining them via supported channels direct case worker intervention of Citizen Portal account document upload. The process will also include tracking of reasonable opportunity period for clients where the initial self-attested information is not reasonable comparable with responses from the Fed Hub. The processing for tracking the co-operation of the citizen with the Medicaid System after reasonable opportunity has expired is included in the process. Batch processing to suspend benefit based on lack of co-operation when reasonable opportunity period expired Taking into consideration the following conditions: a)the grace period (timer for approved PDC), b)the reasonable opportunity period and c)the co-operation evidence the System will re-determine household eligibility based on outstanding verification d)as a reasonable opportunity period for verifications generated as part of a renewal is not given then if verifications are not resolved before the renewal month they should be closed for not completing a renewal. the System will make a person suspended from receiving eligibility. The suspension is going to be individual based and person specific so other household members continue being eligible for a program. Some verifications are person-specific; and some verifications affect other household members. When System close someone on the case for not resolving verifications, it may not impact other people on the case. Functionality is needed so that people who are ineligible remain ineligible when the case remains open for other household members. Similarly, functionality to close a case only applies when all household members requesting coverage are closed for failure to resolve verifications. Please see attachment.