OBSOLETE POLICY CHIP MANUAL |
Effective Date: October 1, 2011
The agency must provide all applicants and recipients with a written notice of:
the decision on an application or review;
any action to terminate, discontinue, or suspend a client's medical assistance;
any action that changes the form or amount of benefits;
any request for information or verifications needed to determine eligibility.
Notice to Approve or Increase Benefits
The eligibility agency must notify a client whenever it approves an application or renews eligibility at review for medical assistance benefits. The agency must notify the client of any positive action affecting the form or amount of benefits, such as a decrease in premium.
A notice to approve or renew eligibility, or increase benefits must include the following information:
What action the agency is taking, i.e., approval of an application or review, or a change to a different medical program that allows a client to receive more medical services.
Who the action affects, and any differences in how each person is affected. If an action affects everyone in the household in the same way, the notice does not have to name each person separately or explain the effect more than once.
The date such action is effective.
Notices to approve or renew eligibility, or improve benefits do not have to be sent 10-days before the effective date.
Adverse Action Notices
The eligibility agency must notify the client of any action that denies, reduces, or ends medical assistance benefits. The agency must notify the client of the action taken on an application or eligibility review, an increase in premium, or any other adverse change affecting the client's eligibility.
An adverse action notice must include the following information:
What action the agency is taking, i.e., denial of an application; requirement to pay a premium and the amount; change to a different medical program that has less medical services available; termination of eligibility.
Who the action affects, and any differences in how each person is affected. If an action affects everyone in the household in the same way, the notice does not have to name each person separately or explain the effect more than once.
The date such action is effective.
The reason for the action.
The policy citation, or the federal or state law or regulation that supports the action.
An explanation of the client's right to a fair hearing.
The eligibility agency must send adverse action notices in accordance with the advance notice requirements in Sections 803-1.
Requesting Information or Verification
When the eligibility agency needs forms, information or verification from the client to determine eligibility, the agency must send a written request to the client. The request must say what is required and the due date for providing the requested information, form or verification. The notice must tell the client he may ask for more time to respond and may ask the agency to help obtain information or verification if the client cannot get it.
For policy about verifications, see sections 701-2 (applications), 704 (reviews), 705 (verifications), and 804 (changes).
The eligibility agency must inform clients of the right to ask for a fair hearing if the client disagrees with an agency action, or does not make a timely decision on an application. Clients must be informed at application and any time the eligibility agency takes an action affecting the client's eligibility.
The notices sent to clients must explain:
how the client can ask for a hearing,
how long the client has to ask for a hearing,
how a recipient may receive continued benefits while the hearing takes place, and
that the client may represent himself, or have a family member, friend, representative or attorney represent him.