Explorer/State Machine Docs/Eligibility

Eligibility State Machine

Domain: eligibility · API spec: eligibility-openapi.yaml

Determination

States

State	Description	SLA clock
in_progress	Eligibility determination underway; awaiting program-level decisions	running
completed	All program decisions resolved; eligibility determination finalized	stopped
withdrawn	Determination closed because the associated application was withdrawn	stopped

Actions

Action	Actors	Transition	Steps
flag-expedited API → System flags a Determination as qualifying for expedited SNAP processing	System	no state change	Record that the household qualifies for expedited SNAP processing `sets expeditedFlagged` Emit eligibility.application.expedited — Intake stores the flag; Workflow switches the intake task to the expedited SLA track (7 CFR § 273.2(i))
complete API → System marks a Determination as complete after all program Decisions are resolved	System	in_progress→completed	Emit eligibility.application.determination_completed — signals all program Decisions are resolved; Intake subscribes to close the application
withdraw API → System withdraws a Determination when the associated application is withdrawn	System	in_progress→withdrawn	Emit eligibility.determination.withdrawn

Event Subscriptions

Event	Emitted by	Handler steps
`intake.application.submitted`	Intake/Application	Create a Determination for the submitted application
`intake.application.review_completed`	Intake/Application	Call the final determination adapter for each remaining pending Decision (42 CFR § 435.912)
`eligibility.application.decision_completed`	Eligibility/Decision	If `$pendingDecision is null`: Complete the Determination when all program Decisions are resolved
`intake.application.withdrawn`	Intake/Application	If `id is set`: Withdraw the Determination; already-resolved Decisions are preserved as the audit record

Decision

States

State	Description	SLA clock
pending	Program eligibility decision awaiting automatic or caseworker review	running
approved	Member approved for the program based on eligibility criteria	stopped
denied	Member denied for the program based on eligibility criteria	stopped
ineligible	Member found categorically ineligible for the program	stopped

Actions

Action	Actors	Transition	Steps
approve API → System approves a Decision after automatic or caseworker review	System	pending→approved	Record when the Decision was finalized `sets decidedAt` Record whether the Decision was reached automatically or by a caseworker `sets path` Emit eligibility.application.decision_completed — Intake records the outcome per member; Determination checks if all Decisions are resolved
deny API → System denies a Decision based on failing eligibility criteria	System	pending→denied	`sets decidedAt` `sets path` Store the machine-readable denial reason; required for the Notice of Action and appeal basis (7 CFR § 273.2(h), 42 CFR § 435.917) `sets denialReasonCode` Emit eligibility.application.decision_completed
mark-ineligible API → System marks a Decision as categorically ineligible	System	pending→ineligible	`sets decidedAt` `sets path` Store the categorical ineligibility reason code (e.g., citizenship bar for SNAP, age limit for TANF) `sets denialReasonCode` Emit eligibility.application.decision_completed

Event Subscriptions

Event	Emitted by	Handler steps
`eligibility.decision.created`	unknown	Match on `$object.program`: When `snap`: Call the SNAP expedited screening adapter; if criteria are met, the adapter triggers flag-expedited on the Determination (7 CFR § 273.2(i)) When `medicaid`: Initiate async data exchange for Medicaid ex parte — MAGI income check (FDSH FTI) and existing enrollment check (FDSH Medicare/VCI) (42 CFR § 435.940, 42 CFR § 435.916)
`data_exchange.call.completed`	unknown	Call the Medicaid ex parte adapter when all data exchange results for a Decision are in; adapter triggers approve, deny, or mark-ineligible (42 CFR § 435.911)