5006-2        ADEQUATE NOTICE

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

Adequate notice means:

1. The notice is issued by the caseworker or by the Eligibility Information System ( EIS Eligibility Information System ); and
    

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

3. The notice gives the Medical Assistance Manual section or the state regulations citation that supports the action.  This is not required if there is no change in benefits.  A manual section or state regulation citation is required in all other circumstances.

Adequate notice must be mailed or given 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.
    

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. The person's whereabouts are unknown and agency mail to that person has been returned by the post office.
    

9. 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.
    

10. A Family 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 should be sent the day the adverse decision is made.