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(a) If a beneficiary does not cure the deficit hours as described in He-W 837.08(a), the department shall suspend the beneficiary’s eligibility effective the first of the month following the one-month opportunity to cure, subject to appeal pursuant to He-W 837.17.
(b) Prior to suspension, the department shall provide, at a minimum, a ten-day written notice to the beneficiary that his or her medicaid eligibility shall be suspended due to noncompliance, and shall include all applicable notice requirements found in 42 CFR 431, Subpart E, and appeal rights pursuant to He-W 837.17.
(c) The suspension shall remain in effect until the beneficiary reactivates eligibility prior to redetermination by:
(1) Satisfying within a single calendar month the deficit hours from the noncompliant month or by satisfying within a single calendar month the deficit hours from the cure month, whichever is less;
(2) Demonstrating within a single calendar month enough good cause hours pursuant to He-W 837.10 and He-W 837.11 to fully cover the number of deficit hours;
(3) Demonstrating within a single calendar month a combination of community engagement hours and good cause hours sufficient to fully cover the number of deficit hours;
(4) Providing documentation of an exemption pursuant to He-W 837.04; or
(5) Becoming eligible for medicaid under an eligibility category that is not subject to the community engagement requirement.
(d) Reactivation shall be effective:
(1) On the date that the deficit hours are reported to the department;
(2) On the date the department receives the required attestation or third party certification or documentation to establish good cause or an exemption; or
(3) On the date that the beneficiary was admitted to the hospital where the beneficiary was found to have good cause pursuant to He-W 837.10(a)(8) or an exemption under He-W 837.03, and has good cause or an exemption within 30 calendar days of the date of their hospital discharge.
(e) Upon reactivation in (d) above, a beneficiary’s obligation to meet the community engagement requirement shall begin on the first full month following the month in which the beneficiary’s eligibility is reactivated.
(f) After suspension, a beneficiary shall not be required to complete a new medicaid application if she or he has met one of the requirements of (c) above.
Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.10)