11122 Claim Not Required

Even though a technical overstatement of eligibility may have occurred, a claim shall not be established in the following instances.

The agency failed to ensure the application used to approve eligibility was signed.

Coverage granted in accordance with the treatment of income policies or the inability of the agency to act on available information due solely to system cutoff dates. Assistance provided under these circumstances does not constitute incorrect coverage.

Overstatement of eligibility that occurred as the result of the household failing to report a change in circumstances they were not required to report. See 9121 .

The overstated eligibility was the result of agency error and the recipient did not receive any medical services within the month, even if capitation payments have been made on their benefit.

An eligibility error related to citizenship or alien status is not considered overstated eligibility when: Eligibility was based on verification of satisfactory immigration status by the Immigration and Naturalization Service (INS). Eligibility was approved to meet timely processing guidelines, but no INS response to a request for verification of immigration status has been received. Eligibility was approved to meet timely processing guidelines, but the reasonable opportunity period for alien applicants to provide documentation of their alien status had not expired.

A previously met spenddown is increased within the base period due to a change in income and the new spenddown amount is not met.

Continued SI medical coverage pending a determination of eligibility under another medical assistance program due to loss of SSI recipient status. See 2636 . However, if the transition is not timely processed, overstated eligibility may have occurred. See 11121.1(5) .