Following successful program authorization and creation (or reuse) of an integrated case then Program Group logic is used on the IC to determine the set of eligible programs and the clients who will be in receipt of these programs. Rules logic determines whether to create a new product delivery case, or reuse an existing product delivery case, as well as determine the post processing required in various situations. This logic only applies within an insurance affordability IC, and not across integrated cases of this type.
When creating a new product delivery case, a check is performed to determine whether a product delivery of that type already exists on the integrated case. If there is, the existing product delivery can be reused; if not, then a new product delivery is created. If a member is eligible on a product delivery but was previously an eligible member on a different PD type, then additional updates must be made to the PD the member is leaving, before adding as member to the new PD. And as the number of insurance assistance PDs is dependent on the number of tax households within the overall household, this further complicates the program group logic.
Changes in circumstances will cause the existing PDs to be reassessed. Cases may no longer be relevant for ongoing case management. Federal guidance has talked about the "churn" to describe a situation where household income fluctuates - a Medicaid-eligible household has an increase in income that exceeds the Medicaid standard so the household now qualifies for insurance assistance. The HCR solution caters for this churn whereby the insurance assistance PD would be created, however we didn't implement functionality to close the Medicaid PD; a future decrease in household income might result in Medicaid eligibility again. We are considering a separate case closure process which would check for cases where certification periods for all members has ended and closing automatically or notifying a case worker to close.