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Example 4: A suspended member fails to verify resources by the end of the 60-day suspension period, then the Medicaid (MA) is closed. The notice is sent and gives appeal rights that if they appeal timely, benefits will continue without change. In this scenario, the correct action is to suspend, not reopen the benefits. • 03/01 – The Medicaid (MA) is suspended • 05/01 – The Medicaid (MA) is closed for failure to verify resources • 05/15 – Appeal is filed, the member does not qualify for continued benefits but for suspended benefits

Example 5: A suspended members Medicaid gets closed, but the unsolicited documents are in the ECF (within 60 days of suspension). The member was eligible in month 2 of the suspension period. The worker should fiat months in which the member was eligible (in this scenario, month 2 and open ongoing). • 03/01 – The Medicaid (MA) is suspended • 03/30 – Verification is received that the member was under the resource limit as of 04/01 with verification that the funds were used to privately pay the nursing home • 05/01 – The Medicaid (MA) is closed • 05/15 – The worker finds that the verification was received 03/30, the Medicaid (MA) is reinstated as of 04/01

Example 6: A suspended member submits bank statements showing they are under the resource limit, but it is unknown how the resources were spent down. A 2032 must be sent to verify how the funds were spent. • 03/01 – The Medicaid (MA) is suspended • 03/30 – Verification is received that the member was under the resource limit as of 04/01, but there is no verification showing how the resources were spent down • A 2032 is mailed requesting verification of how the funds were spent (due 04/13) • 04/10 – Verification that the resources were spent to pay the nursing home charges (this is allowable) so the Medicaid (MA) is reinstated as of 04/01