802-1        ADEQUATE NOTICE

Each applicant or recipient must be provided adequate notice of any action taken by DPA on an application for assistance or as a result of a change or redetermination.

Adequate notice means:

1) The notice is issued by DPADivision of Public Assistance; and

2) The notice contains the reason(s) for the action; and

3) The notice gives the specific federal or state regulation citation that supports the action. This is not required if there is no change in benefits. A federal or state regulation citation is required in all other circumstances.

Adequate notice must be sent to an applicant or recipient no later than the date of action for the situations listed below:

1)  Finding of eligibility

2)  Issuance of retroactive benefits

3)  Denial of an application for assistance

4)  Factual information confirms the death of a recipient

5)  Clear written statement signed by recipient is received reporting that the recipient no longer wishes assistance or giving information which the recipient knows will result in the termination or reduction of his or her assistance

Note:

After the date of adverse action the client must provide a written and signed request for closure of their Medicaid benefits. This is only necessary if the client requests closure in the same month, after the date of adverse action.

6)  A recipient adult or child has been committed or admitted to an institution in which residents are ineligible for Medicaid

7)  A recipient adult or child has been placed in skilled nursing care, intermediate care, or long-term hospitalization

8)  A recipient adult or child has been accepted for assistance in a new jurisdiction and that fact has been established by the jurisdiction previously providing assistance

9)  A MAGIModified Adjusted Gross Income Medicaid child is removed from the home as a result of a judicial determination or voluntarily placed in foster care by his or her legal guardian

For the situations listed above, date of action means:

1)  For applications, no later than the workday following the day on which a decision of eligibility or ineligibility was first made; or

2)  For all other actions, no later than the day upon which the recipient normally expects to receive his next coupon or card. This is a maximum. Normally, adverse notice must be sent the day the adverse decision is made.