Page 52

51 Effective Date: July 1, 2009

Approval Date: contains information on their rights for an Administrative Hearing. Clients can call the Office of Administrative Hearings (OAH) to set up a hearing, or they may contact MPA staff directly and request a hearing. OAH notifies the client and the agency’s Administrative Hearing Coordinator of the request. If the enrollee requests an Administrative Hearing prior to their disenrollment, the enrollee will receive continued benefits pending the outcome of the Administrative Hearing. The Coordinator prepares the case and sets up a pre-hearing conference as a way to settle the dispute or collect information. Cases that are not resolved in the pre-hearing conference proceed to an Administrative Hearing. The Administrative Law Judge conducts the hearing. The Judge’s decision is mailed to the client and the Administrative Hearing Coordinator. Either party may appeal the decision for additional review and to the courts, if need be.

8.8. The State assures that it has made the following findings with respect to the payment aspects of its plan: (Section 2103(e)) 8.8.1.

No Federal funds will be used toward State matching requirements. (Section 2105(c)(4)) (42CFR 457.220) 8.8.2.

No cost-sharing (including premiums, deductibles, copays, coinsurance and all other types) will be used toward state matching requirements. (Section 2105(c)(5) (42CFR 457.224) (Previously 8.4.5) 8.8.3.

No funds under this Title will be used for coverage if a private insurer would have been obligated to provide such assistance except for a provision limiting this obligation because the child is eligible under the this Title. (Section 2105(c)(6)(A)) (42CFR 457.626(a)(1)) 8.8.4.

Income and resource standards and methodologies for determining Medicaid eligibility are not more restrictive than those applied as of June 1, 1997. (Section 2105(d)(1) (42CFR 457.622(b)(5)) 8.8.5.

No funds provided under this title or coverage funded by this title will include coverage of abortion except if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest. (Section 2105)(c)(7)(B)) (42CFR 457.475)

8.8.6.

No funds provided under this title will be used to pay for any abortion or to assist in the purchase, in whole or in part, for coverage that includes abortion (except as described above). (Section 2105)(c)(7)(A)) (42CFR 457.475)