Page 12

1. Discontinuation – EOHHS sends an “Ineligible for Medicaid Notice”, stating that Medicaid eligibility has been terminated for adults in the household due to the failure to enroll in the RIte Share-approved plan. Anyone in the household subject to the notice may reapply (for inactive cases) or request reinstatement (for active Medicaid cases) if: a. they choose to comply with RIte Share; b. an exemption from participation is granted; or c. the individual no longer has access to the ESI. B. The “Ineligible for Medicaid Notice” shall include a statement indicating that any affected Medicaid-eligible individuals in the household have the right to appeal and to request a hearing to contest the change in eligibility and the enrollment decision. 3.19 Disenrollment from RIte Share-Approved Plan A. Pursuant to Part 30-00-3 of this Title, RIte Share members who are voluntarily or involuntarily disenrolled from an approved ESI plan must report the change in enrollment status to EOHHS in no more than ten (10) days from the date the disenrollment action occurs. The type of disenrollment will determine EOHHS’s action as follows: 1. Voluntary disenrollment – Medicaid-eligible RIte Share members age nineteen (19) or older who voluntarily disenroll from an approved ESI will be terminated for coverage based on the failure to meet the non-financial cooperation requirements set forth in this Part. Voluntary disenrollment includes, but is not limited to, instances in which a RIte Share member: a. Requests that the employer drop coverage or cease enrollment for the entire family or a Medicaid-eligible individual in the family; b. Fails to meet the requirements established by the employer to maintain enrollment in the approved plan such as, submit required documentation or forms. c. Engages in unlawful or fraudulent acts, such as submitting false claims that violate the terms for continuing enrollment in the ESI plan. Please refer to § 3.6 of this Part. 2. Involuntary disenrollment – Involuntary disenrollment includes the loss of access to ESI as a result of change in employment, termination of coverage by the employer for an entire class of workers, death, separation, divorce, disability of the policy holder, or any other factors that