a. Applicable Individuals in Certain Medical Institutions or Receiving Outpatient Services

As specified at § 435.555(d)(1), in a State that elects to offer exceptions for short-term hardships, an applicable individual experiences a short-term hardship if they receive inpatient hospital services, nursing facility services, services in an ICF/IID, inpatient psychiatric hospital services, or such other services of similar acuity as discussed in section II.G.4. of this IFC. Consistent with existing verification policy and § 435.557(g)(2)(i), the State must attempt to verify that an applicable individual has received these services using reliable information available to the State before requesting information from the individual. As defined at § 435.557(a), reliable information available to the State includes, but is not limited to, adjudicated claims and encounter data as relevant to the individual for the preceding 12 months (as applicable). However, States may not have these data available, or there may be a lag in receipt of such data. In the absence of reliable information available to the State, States must seek additional information to verify qualification for the short-term hardship exception. 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 (for example, from a provider, a medical bill or admission or discharge paperwork) if documentation is reasonably available, or other information, as required at § 435.557(b)(2) if no documentation exists or is reasonably available. The State must ensure that the eligibility record includes sufficient information to substantiate the State's eligibility determination for the short-term hardship exception.