1310 Prudent Person - The
local worker shall use the prudent person concept in administering the
medical assistance programs. The phrase, "prudent person" applies
to the particular situation that indicates further verification of information
is needed. It also applies to the reasonableness of judgments made by
an individual in a given situation based on that individual's experience
and knowledge of the program.
It is the responsibility of staff to be prudent when the circumstances
of a particular case indicate the need for further inquiry. Additional
substantiation or verification should be obtained whenever the information
provided by the applicant or recipient is incomplete, unclear, or contradictory.
Circumstances that require a more thorough analysis of a case include:
Real or personal property holdings
that are very near or equal to the resource limitation.
An individual who is living at a
higher standard of living than known resources or income would permit.
An individual who appears to qualify
for potential resources such as Social Security, unemployment benefits,
veterans' benefits, medical insurance, etc.
An individual who appears to be
confused.
An individual who has a history
of providing conflicting or incomplete information.
Documents (birth certificates, Social Security cards, etc.) that appear to have been altered.