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2232.10.00 EXCEPTIONS TO TIMELY NOTICE (MED)

The following situations do not require timely notice, but do require notice to be sent no later than the effective date of action:2

• The DFR has information confirming the death of a recipient. • The DFR has received a voluntary withdrawal of assistance or reduction of coverage (See 2250.00.00 for written/verbal voluntary withdrawal policies). • The DFR has verified that the recipient has been accepted for assistance in a new • jurisdiction (county, state, territory, or commonwealth); or • Recipient has been admitted to an institution where he is ineligible under current plan for further services (For example, member has been admitted to a facility which requires suspension of current coverage).

2235.00.00 CHANGES IN CATEGORY OF ASSISTANCE (CLEVIDENCE RULING) (MED)

When a Medicaid member loses eligibility under their current category of assistance, eligibility under all potential categories must be explored. If the case record contains information that a member is potentially eligible in another category, a new pending category will be formed by the Eligibility System according to the member’s recorded information reflected in their case file and the Medicaid categorical hierarchy (see IHCPPM 2035.30.00).

If there is no information indicating possible eligibility under another category, Medicaid is to be discontinued. If the member is found to be ineligible in the newly formed category, Medicaid is to be discontinued. When eligibility is to be discontinued, a discontinuance notice is mailed to the member, which contains a list of all applicable categorical groups. If the client supplies information indicating potential eligibility under another categorical group prior to the member’s effective date of discontinuance, Medicaid eligibility must be reinstated while eligibility under the new potential category is being determined.

When a change is reported that results in a potential new Medicaid category, Medicaid benefits continue without interruption. If the person is required to pay a CHIP or MEDWorks premium, continued eligibility is conditional upon the first day of the first month the premium categorical coverage begins. Whenever there is an adverse action, members must be given timely notice before the effect of the adverse action takes place. Please, refer to IHCPPM 2232.00.00. MEDICAID MUST NOT BE INTERRUPTED WHILE A DETERMINATION IS BEING MADE CONCERNING THE MEMBER’S ELIGIBILITY IN THE NEW CATEGORY.

If an individual self-attests to being pregnant (refer to IHCPPM 2426.00.00), then eligibility may be considered under that category. For ongoing members (including those authorized conditionally), once pregnancy is reported there should be no closure for income considerations until after the end of the postpartum period.