State Hearing Decision - Hearing Decisions

STATE HEARING DECISION CONTINUATION
5. Appellant reported that she and the boyfriend lived together and then that they had never
lived together, that she had not been employed since January 2011 but listed employment
through at least June 30, 2011.
6. Appellant and authorized representative failed to provide the requested verifications.
7. Authorized Representative testified that they have also not been successful in obtaining the
requested information from the Appellant.
8. Agency denied the application by notice mailed January 10, 2012.
CONCLUSIONS OF POLICY
If information needed to determine an individual's initial or continuing eligibility for a medical
assistance program must be verified, but was not submitted with the application the Agency shall
send a verification request checklist to the Appellant and authorized representative. If the
information is not returned, a second notice is sent.
The administrative agency shall deny an application for medical assistance or terminate
eligibility if an individual fails or refuses, without good cause, to cooperate by providing
necessary verifications or by providing consent for the administrative agency to obtain the
verifications. The administrative agency shall:
(a) Allow the individual a reasonable opportunity, not to exceed the time limits for timely
determination of eligibility, to obtain verifications and resolve discrepancies prior to
determining the individual's eligibility.
(b) Deny or terminate medical assistance if:
(i) An individual provides incomplete or inconsistent information, is noncooperative,
or is unable to clarify information; and
(ii) (ii)The administrative agency is unable to verify a required eligibility factor. 1
Analysis
There was no dispute that the Appellant provided conflicting information on her application for
Medicaid and two notices were sent requesting information. The information was not provided
by the Appellant to either the Agency or the authorized representative. The information
requested is necessary to determine eligibility as income and who is to be included in the
assistance group are eligibility factors that must be considered. I find the Appellant has failed to
cooperate with the determination of eligibility for Medicaid and the denial of Low-Income
Families and Healthy Start Medicaid is correct.
HEARING OFFICER’S RECOMMENDATION
Based on the record and policy before me I recommend appeal numbers 1753253 and 1753254
be overruled.
FINAL DECISION AND ADMINISTRATIVE ORDER
Finding the hearing officer’s decision to be supported by the evidence, the recommendation
above is adopted and the appeals are overruled.
1 OAC 5101:1-38-01.2 Medicaid: Application, Determination, and Redetermination Processes (2009)
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