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UPDATED: JUNE 2010

487

OTHER ELIGIBILITY REQUIREMENTS

DECISION AND NOTIFICATION

made. (See CATEGORICAL FACTORS SSI-RELATED DISABILITY) If the eligibility determination process for a disabled applicant takes more than 90 days, on or before the 90th day, the A/R is sent a written statement stating the reasons for the delay. When the applicant is eligible under a different category, Medicaid is authorized for the interim period.

Each applicant for Medicaid is notified in writing of the local district's decision regarding his/her application. In the written notification, the applicant is informed of: the action taken, the effective date of the action, the specific reason(s) for the action whether positive or negative, including supporting regulations or laws; his/her right to a conference with a representative of the district; and of his/her right to a fair hearing including the method by which s/he may obtain a hearing. The applicant is also advised that s/he may be represented at any conference or fair hearing by someone such as legal counsel, or by a relative, friend or other person and of the availability of community legal services (Legal Aid), if any. A fair hearing request may be made on the basis of: denial of assistance; failure to determine the applicant's eligibility within the time period specified; inadequacy of the amount or manner of assistance; discontinuance or reduction of coverage or assistance; objection to State policy as it affects the applicant; or any other grounds affecting the applicant’s entitlement to assistance. If a recipient requests a fair hearing within the time period specified in the notice, Medicaid is continued unchanged until a decision is issued on the Fair Hearing.

A separate Medicaid eligibility determination is completed for every TA case closed or denied where the A/R also applied for or was in receipt of Medicaid, except for cases when the reason for closing or denying TA is also a valid reason for closing or denying Medicaid. In all situations, the client is advised in a separate statement of the status of his/her Medicaid eligibility.

This section describes decision and notification in detail. It is organized as follows:

Acceptance; Denial; Withdrawal; and Discontinuance or reduction.

(MRG)