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For reductions, denials, or terminations, the notice contains reasons for the action, with any supporting regulations. It also specifies fair hearing rights and the circumstances under which SeniorCare benefits will be continued if a hearing is requested. SeniorCare members will be notified of an adverse action at least 10 days prior to the effective date of the adverse action, except under certain circumstances. Timely notice requirements do not apply when: 1. A prescription drug billing must be reversed due to an incorrect billing, and that reversal results in a benefit or service change. 2. A member chooses to withdraw from the program. 3. A member requests to establish a new benefit period and eligibility for the previous benefit period is terminated (see SECTION 33.11 RE-APPLICATION). 4. A member is an inmate of a public institution. 5. A member passes away. This page last updated in Release Number: 26-03 Release Date: 08/12/2026 Effective Date: 08/12/2026 33.14 SeniorCare Appeals 33.14.1 SeniorCare Appeals Introduction SeniorCare applicants, members or representatives may file an appeal by writing to the Division of Hearings and Appeals (DHA) when one of the following occurs and the action is not the result of a general program policy change: 1. An application is denied, or the person is denied the right to apply. 2. An application is not acted upon within thirty calendar days. 3. A member believes that the benefits they received, or the initial eligibility date of program benefits were not properly determined. 4. Program benefits are reduced, discontinued, suspended, or terminated. An appeal may result in a hearing. 33.14.2 Requesting a Hearing The SeniorCare applicant or member, or their representative, may request a hearing. The request for a hearing must be made in writing to the DHA within 45 days from the effective date of the adverse action. Benefits will be continued only if the individual requests a hearing prior to the effective date of the adverse action. Hearings may be requested by writing to: Wisconsin Department of Administration Division of Hearings and Appeals PO Box 7875 Madison, WI 53707-7875