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Title 8: Medicaid Page 19 Iowa Department of Health and Human Services Employees’ Manual Chapter A: Administration Department Responsibilities Revised January 13, 2023 Notification Notification Legal reference: 42 CFR 435.912, 42 CFR 435.917, Iowa Code Section 249A.4, 441 IAC 7.7(1) and 76.16(1) Give members adequate notice of any action taken that affects the member’s eligibility. See When Notice Is Required. Every notice the Department issues must be “adequate.” Some notices must also be timely. Adequate notice can be given no later than the date benefits would have been received. “Adequate notice” means a written notice of decision sent to the member that specifies: ▪ The action taken and the reasons for it. ▪ The effective date. ▪ The Employees’ Manual chapter number and subheading describing the policy basis for the action. ▪ The rule or law reference, when the notice of decision relates to a negative action. ▪ The client’s right to request a fair hearing. ▪ How assistance may be continued when a hearing is requested (if applicable). “Timely notice” means a written notice given at least ten calendar days before the effective date of adverse action, except in cases of probable fraud (which require notice of five calendar days). The timely notice period extends from the day after a notice is issued to the effective date of action. A timely notice period must be at least ten calendar days. When Notice Is Required Legal reference: 42 CFR 431.213, 435.912, and 435.917, 441 IAC 7.7(17A), 7.7(1), 7.7(6), and 76.16.(1) Issue an adequate notice whenever you take action on a case: ▪ An application is approved, rejected, or withdrawn. ▪ Medicaid is canceled. This includes cancellation due to termination of SSI payments or termination of foster care or subsidized adoption payments. ▪ Medicaid is reinstated or reinstatement is denied. See 8-G, Reinstatement. ▪ A change in a member’s circumstances affects eligibility, including increase, reduction, suspension, or cancellation of benefits. The notice must also be timely to take adverse action on a case, such as when Medicaid is canceled, suspended, or reduced, except as noted under When Timely Notice Is Not Required. Send a Notice of Decision or a Notice of Action for an application only when a final decision of eligibility has been made. When determining eligibility under more than one coverage group, you do not need to send a Notice of Decision or a Notice of Action for each coverage group considered.