B-9100, General Information for Denials and Terminations

Revision 24-4; Effective Dec. 1, 2024

Although often used interchangeably, denials and terminations are different types of adverse case actions.

A denial refers to a determination of ineligibility for Medicaid benefits that a person is not currently receiving. A denial action may occur when processing an application, a request for a new type of benefit, or a program transfer request.

A termination refers to a determination of ineligibility for ongoing Medicaid benefits that a person is currently receiving. A termination action may occur when processing a renewal or redetermination based on a change in circumstances .

Unless otherwise specified, the policy in the following sections applies to both denials and terminations.