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UPDATED: JANUARY 2011
490
OTHER ELIGIBILITY REQUIREMENTS DECISION AND NOTIFICATION
DENIAL
Description: A denial is a determination that an applicant is not eligible for Medicaid. Policy: When an application for Medicaid is denied, a written notification is sent to the applicant.
References: SSL Sect. 366
366-a
Dept. Reg. 358-3.3
358-4.1
360-2.3
360-2.4
360-2.5
360-2.8
360-2.9
ADMs 10 OHIP/ADM-4
04 OMM/ADM-6
97 OMM/ADM-2
96 ADM-15
89 ADM-21
87 ADM-4
INFs
10 OHIP/INF-1
GIS
10 MA/015
Interpretation: An application for requested Medicaid coverage may be denied because the applicant is ineligible or because the applicant's eligibility cannot be determined due to his/her failure to cooperate in establishing eligibility.
When a decision is reached, a letter is sent to the applicant, including a copy of the budget, when applicable, informing him/her of the reason for the denial and of his/her right to: a conference with a representative of the local district; and a fair hearing as outlined in OTHER ELIGIBILITY REQUIREMENTS DECISION AND NOTIFICATION. A copy of the notice is also sent to the Medical provider (e.g., nursing home and hospital) as appropriate.
(MRG)