Page 43

UPDATED: JUNE 2010

493

OTHER ELIGIBILITY REQUIREMENTS DECISION AND NOTIFICATION

DISCONTINUANCE OR REDUCTION

Description: A discontinuance of Medicaid is a termination of all benefits under the program. The reduction of Medicaid is a change of benefit coverage from more extensive coverage to less extensive coverage or to an increase in the recipient’s liability, i.e., a change from Community Coverage with Community-Based Long-Term Care to Community Coverage without Long-Term Care, or a change from full coverage to a spenddown.

Policy: A determination by the district to discontinue or reduce a recipient's Medicaid coverage is communicated to the recipient in a letter of intent to discontinue or reduce Medicaid. Generally, the notice is sent at least ten days in advance of the proposed action. Under certain circumstances, it is not necessary to send a notice of intent ten days in advance of the action. (See OTHER ELIGIBILITY REQUIREMENTS DECISION AND NOTIFICATION) Where the A/R is in receipt of both Medicaid and Public Assistance, any notice to discontinue or reduce Temporary Assistance also includes a statement advising the client of the status of his/her Medicaid eligibility.

References: SSL Sect. 366

366-a

Dept. Reg. 358-3.3

358-4.1

360-2.3

360-2.6

360-2.7

360-2.8

360-2.9

ADMs 04 OMM/ADM-6

97 OMM/ADM-2

89 ADM-21

83 ADM-27

81 ADM-55

80 ADM-19

Interpretation: A Medicaid case is discontinued because of the recipient's ineligibility for continued assistance, failure to cooperate, permanent removal from the district or other factors which affect continued eligibility. Generally, a letter of notification (MRG)