B-2200, Conflict of Interest

Revision 09-4; Effective December 1, 2009

An eligibility specialist has an obligation to avoid even the appearance of impropriety or conflict of interest when determining Medicaid eligibility. The eligibility specialist must not work on or review an ongoing case nor assist an applicant or recipient to receive benefits if the applicant or recipient is a relative (by blood or marriage), roommate, dating companion, supervisor or someone under the specialist's supervision. The specialist may not determine their eligibility for Medicaid. The specialist may provide anyone with an application for Medicaid and may inform anyone how and where to apply. The specialist may help anyone gather documents to verify eligibility and need for Medicaid, but must not take any other role in determining eligibility.

The specialist must consult with the supervisor if the applicant or recipient is a friend or acquaintance. Generally, the specialist should not work on cases or applications involving these individuals, but the degree and nature of the relationship should be taken into account.