Medical Assistance
2.1.1.2.5 Periodic Data Matching
Periodic Data Matching (PDM) is a process that uses electronic data sources to identify Medical Assistance for Families with Children and Adults (MA-FCA) enrollees who may no longer meet eligibility criteria for the program.
Enrollees in MA-FCA are subject to data matching using electronic data sources at least once during an enrollee’s 12-month period of eligibility.
The electronic data sources used for periodic data matching provide information about an enrollee’s or household member’s income, Medicare Part A enrollment, or death.
Notification of Discrepant Information
Discrepant information is electronic data that is not consistent with the case information attested to by the enrollee. An enrollee will receive a discrepancy notice only when the information from an electronic data source indicates the enrollee may no longer qualify for the program in which he or she is currently enrolled.
An enrollee must respond to the discrepancy notice within 30 days from the date on the notice by mail, in person, or by calling the agency. An enrollee may respond to the discrepancy notice by submitting a response form with confirmed or corrected information. An enrollee who confirms the information on the form is correct must not be required to provide paper verification to resolve the discrepancy.
Extension to Resolve a Discrepancy
An extension of time beyond the 30-day period is available when an enrollee is cooperating with the agency but unable to provide the information needed to resolve a discrepancy before the date of closure. An extension may be granted only upon enrollee request. There is no limit to the number of extensions an enrollee may be granted, if the enrollee is cooperating with the PDM process.
Resolving a PDM discrepancy
Income discrepancy
An income-related PDM discrepancy is considered resolved when the agency receives an attestation of current household income from the MA enrollee. No verification is required if the enrollee’s attested income is the same as the income listed on the discrepancy notice.
Medicare Part A discrepancy
A Medicare Part A discrepancy is considered resolved when an enrollee confirms having Medicare Part A or attests that he or she does not have Medicare Part A. If an enrollee disputes having Medicare, the agency must check any other available data sources about Medicare enrollment, and if necessary, refer the enrollee to the Social Security Administration (SSA) to update his or her records. The agency cannot require an enrollee to contact SSA before resolving the discrepancy.
Death discrepancy
A death discrepancy is considered resolved when the death is either confirmed or denied by the household. If an enrollee denies the death discrepancy, the agency must resolve the discrepancy and refer the enrollee to SSA to correct his or her records. The agency cannot require an enrollee to contact SSA before resolving the discrepancy.
An enrollee may report changes during the process of resolving their PDM discrepancies. See MHCP Changes in Circumstances for more information.
Failure to Resolve a PDM Discrepancy
An MA enrollee must cooperate with the PDM process as a condition of eligibility. Enrollees who fail to resolve a PDM discrepancy or request an extension within 30 days of the notice are no longer eligible for MA. The enrollee is not eligible for MA, MinnesotaCare, advanced premium tax credits (APTC) or cost-sharing reductions (CSR) until the enrollee resolves all outstanding discrepancies. An enrollee with an outstanding discrepancy may be eligible to purchase a qualified health plan without a subsidy if he or she meets the eligibility criteria.
An MA enrollee whose eligibility ended due to failure to resolve a PDM discrepancy must resolve the outstanding discrepancy to qualify for MA again. Once the person resolves the outstanding discrepancy, the earliest the person can be eligible for MA is the first day of the month in which the person cooperated with the agency to resolve the PDM discrepancy or reapplied.
Legal Citations
Minnesota Statutes, section 256B.0561