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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL D-215.3 Denial/Termination Assistance is denied or terminated when: ● eligibility criteria is not met; and/or ● child is receiving cash assistance; and/or ● information essential for determining eligibility was requested in writing is not provided by the required date. ● the agency fails to provide the child’s current status as requested on the monthly report. Notify the applying agency of the denial/termination and the reason with the Notice of Decision, Form 2447-EM (page 3) Thirteen (13) days adverse action notice is required; unless the responsible agency reports the child is no longer under their supervision or the child has been moved to an ineligible placement. If the child may be eligible for medical assistance under a different category of Medicaid or Nevada Check Up, inform the agency of the child’s potential eligibility and attach the appropriate application to the Notice of Decision. D-215.4 Reporting Requirements Public agencies are required to report the status of children receiving Medicaid or for whom a Medicaid application has been submitted to the Division by the 10th of each month. D-220 MEDICAID ELIGIBILITY FOR TITLE IV-E ELIGIBLE FOSTER CHILDREN AT RITE OF PASSAGE Medicaid coverage may be provided for children residing at Rite of Passage facilities in Nevada and receiving Title IV-E foster care payments from another state. If an agency fails to respond to the monthly report by the end of the month it is due, the eligibility worker will terminate the case(s).

D-220.1 Application Rite of Passage staff must: • complete and sign Form 2447-EM, Medicaid Application for Children in the Custody of a Public Agency; and • provide all of the information required for an eligibility determination. Division of Welfare and Supportive Services D-215.3 Medical Assistance Manual SPECIALIZED GROUPS-APPLICATION PROCESSING 17 Jan 01 MTL 01/17 DENIAL/TERMINATION