WELFARE - MEDICAL ASSISTANCE (MEDICAID);

You asked what is considered proper notice when the Department of Social Services (DSS) intends to terminate a client’s Medicaid coverage. You asked this in light of a constituent who received a termination notice postmarked one day before the termination date.

Federal law generally governs how states run their Medicaid programs, including due process requirements. Federal regulations require “timely and adequate” notice of any intended adverse actions, including terminations, discontinuations, or suspensions of Medicaid eligibility. Timely is defined as 10 days before the intended action, although the notice can be provided later in certain circumstances (42 CFR §§ 435. 919 and 431. 211).

DSS regulations require the department to mail or give adequate notice at least 10 days before intended adverse actions, including benefit terminations (DSS Uniform Policy Manual, § 1570. 10). (Along with this notice, DSS sends a separate notice informing the client of his right to request a department fair hearing if he disagrees with the intended actions and the timeframe for doing so. Generally, the action is stopped until after the hearing and a DSS hearing officer has rendered his decision. )

We spoke with Larry Carlson of DSS. He believes that the notice you refer to was a second notice that the department sent, perhaps because there was no response to the first one.

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