Adult Medicaid Manual MA-2420 NOTICE AND HEARINGS PROCESS

II. POLICY PRINCIPLES

A. An a/r has the right to a written notice when:

1. An inquiry about Medicaid is made. Use the DMA-5095/DMA-5095S, Medicaid/Work First Notice of Inquiry, for inquiry documentation.

2. An application is approved or benefits are continued. Use the automated DSS-8108A/DSS-8108S, Notice of Benefits, or use the manual DMA-5002/DMA-5002S, Approval Notice.

Caseworkers must manually add the following sentence to the DMA-5002 approval notices that do not contain information about Medicare Part D: “If you receive Medicare, Medicare is responsible for your prescriptions.”

When approving Medicaid for Family Planning services, add the following sentence to the DMA-5002/DMA5002S, Approval Notice, if it does not contain the information: “Your partner may be potentially eligible also.”

3. An application is denied or withdrawn. Use the automated or the manual DSS-8109/DSS-8109S, Notice of Benefits Denied or Withdrawn, to notify the applicant of the denial/withdrawal.

4. Benefits are changed, reduced, or terminated. Use the automated or the manual DSS-8110/DSS-8110S, Notice of Change in Benefits, to notify the recipient of both timely and adequate changes or terminations. For Medicare recipients, manually add the following sentence to the manual DSS-8110 that does not contain information about Medicare Part D: “Now that you are enrolled/receiving Medicare, Medicaid will not pay your prescriptions. Medicare is responsible for your prescriptions.”

B. An a/r has the right to appeal an action if he disagrees with the county dss' decision.

C. In certain situations, an a/r has the right to have his benefits continued until a hearing decision is rendered.

D. A local hearing must be held at the county dss for all appeals, except for those involving a determination of disability. For appeals involving disability issues, including terminations at the end of ex parte reviews when the recipient claims he is still disabled, request a state hearing.

REVISED 10/01/11 – CHANGE NO. 18-11

(II.)

E. An a/r has a right to a State hearing if he disagrees with the county dss local appeal decision, or if the appeal involves a determination of disability. The right to a state hearing includes instances where presumptive SSI benefits have ended, no disability determination has been made and an ex parte review determines that the individual is not eligible in any other aid program category.