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State Hearing Decision - Hearing Decisions

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STATE HEARING DECISION CONTINUATION<br />

5. Appellant reported that she and the boyfriend lived together and then that they had never<br />

lived together, that she had not been employed since January 2011 but listed employment<br />

through at least June 30, 2011.<br />

6. Appellant and authorized representative failed to provide the requested verifications.<br />

7. Authorized Representative testified that they have also not been successful in obtaining the<br />

requested information from the Appellant.<br />

8. Agency denied the application by notice mailed January 10, 2012.<br />

CONCLUSIONS OF POLICY<br />

If information needed to determine an individual's initial or continuing eligibility for a medical<br />

assistance program must be verified, but was not submitted with the application the Agency shall<br />

send a verification request checklist to the Appellant and authorized representative. If the<br />

information is not returned, a second notice is sent.<br />

The administrative agency shall deny an application for medical assistance or terminate<br />

eligibility if an individual fails or refuses, without good cause, to cooperate by providing<br />

necessary verifications or by providing consent for the administrative agency to obtain the<br />

verifications. The administrative agency shall:<br />

(a) Allow the individual a reasonable opportunity, not to exceed the time limits for timely<br />

determination of eligibility, to obtain verifications and resolve discrepancies prior to<br />

determining the individual's eligibility.<br />

(b) Deny or terminate medical assistance if:<br />

(i) An individual provides incomplete or inconsistent information, is noncooperative,<br />

or is unable to clarify information; and<br />

(ii) (ii)The administrative agency is unable to verify a required eligibility factor. 1<br />

Analysis<br />

There was no dispute that the Appellant provided conflicting information on her application for<br />

Medicaid and two notices were sent requesting information. The information was not provided<br />

by the Appellant to either the Agency or the authorized representative. The information<br />

requested is necessary to determine eligibility as income and who is to be included in the<br />

assistance group are eligibility factors that must be considered. I find the Appellant has failed to<br />

cooperate with the determination of eligibility for Medicaid and the denial of Low-Income<br />

Families and Healthy Start Medicaid is correct.<br />

HEARING OFFICER’S RECOMMENDATION<br />

Based on the record and policy before me I recommend appeal numbers 1753253 and 1753254<br />

be overruled.<br />

FINAL DECISION AND ADMINISTRATIVE ORDER<br />

Finding the hearing officer’s decision to be supported by the evidence, the recommendation<br />

above is adopted and the appeals are overruled.<br />

1 OAC 5101:1-38-01.2 Medicaid: Application, Determination, and Redetermination Processes (2009)<br />

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