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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL D-530 Division of Welfare and Supportive Services CHANGES Medical Assistance Manual TERMINATIONS FOR MEDICAID 24 Jan 25 MTL 02/24 When a recipient can no longer meet the requirements of one of the eligible categories or has failed to cooperate in providing information, the case must be closed. When posting a termination, two future months must be posted in order to ensure closure in the MMIS system.

Note: Regardless of changes in income, pregnant women remain eligible through the post-partum period and Nevada Check Up eligible children remain eligible through the 12-month eligibility period.

If the customer cooperates prior to the effective date of termination, reinstate the case and evaluate medical eligibility.

D-530.1 Non-Payment of Nevada Check Up Premiums

When a household is 60 days, or two full months past due, the case will be terminated. A non-payment of premium task will be created in AMPS and must be acted on for the future month. Case workers will be notified with a task in the system when non-payment has occurred.

Once a termination for non-payment of premium has occurred, the household must serve a 90 day sit-out period. If payment is received within the 90 days, DHCFP will notify DWSS, and the child/ren will be enrolled beginning the next administrative month. If payment is received after the 90-day period, a new application is required.

If a child is terminated due to non-payment of premium, the time spent serving the sit-out is not included in the child/ren’s 12 months continuous eligibility. A full 12 months of coverage (less the time spent serving the sit-out) will be granted; however, in the Instance of a sit-out, the coverage will not be continuous. Case workers must adjust the annual re- determination due date, to ensure that a full 12 months of coverage is provided and that an annual re-determination is completed by the 12th month of coverage.

If all other eligibility criteria is met and the 90 day sit-out has been served, a child/ren cannot be denied eligibility, even if a past due balance exists. The child/ren will be enrolled and any outstanding debt will be managed by DHCFP.

D-530.2 Adverse Action

When assistance is terminated, a Notice of Decision (NOD) must be sent to both the customer and the representative/legal guardian a minimum of 13 days before the proposed action is effective. When counting the 13 days, weekends and holidays must be included; however, if this date falls on a Friday, weekend or holiday, the action must be taken the prior workday. To meet the advance notice requirements, the action to reduce or terminate benefits must be taken (posted) in the computer at least 14 days prior to the last day of the month, to ensure the computer-generated Notice of Adverse Action (NOAA) is mailed on time. If case circumstances require posting as late as the 13th day of the adverse action notice period, local print must be done to meet advance notice requirements.