g. Participants in Drug Addiction or Alcoholic Treatment and Rehabilitation Programs

Section 1902(xx)(9)(A)(ii)(VII) of the Act establishes an exclusion for individuals “participating in a drug addiction or alcoholic treatment and rehabilitation program (as defined in section 3(h) of the Food and Nutrition Act of 2008).” The statute establishes an exclusion for active participants in certain drug addiction or alcoholic treatment and rehabilitation programs, which we implement at § 435.554(c)(8). In accordance with requirements under section 1902(xx)(5) of the Act to verify an individual is a specified excluded individual on an ex parte basis using reliable information available to the State without requiring the individual to submit additional information, States must attempt to verify participation in drug addiction or alcoholic treatment and rehabilitation programs using adjudicated claims, payment and encounter data, and other relevant information available to the State to attempt to verify an individual's qualification for the exclusion.

In the absence of reliable information available to the State or if the reliable information available to the State is not reasonably compatible with the information provided by or on behalf of the individual, States must obtain sufficient to verify the individual's current participation in a drug addiction or alcoholic treatment and rehabilitation program. Beginning on January 1, 2028, when there is no reliable information available to the State or the reliable information is not reasonably compatible with the information provided by or on behalf of the individual, the State must require documentation if documentation is reasonably available. If there is no reasonably available documentation, § 435.557(b)(2)(iii) requires that the State accept other information sufficient (as determined by the State) to verify eligibility.