Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 332 - MAINECARE ELIGIBILITY MANUAL
Part 2 - BASIC ELIGIBILITY CRITERIA
Section 144-332-2-15 - NOTICES

Universal Citation: 10 ME Code Rules ยง 144-332-2-15

Current through 2024-38, September 18, 2024

Individuals are notified in writing as soon as eligibility is determined. If some of the individuals applying for MaineCare are eligible and some are not, the notice must specify who is and who is not eligible and the reasons for each individual's ineligibility.

I. Individuals whose eligibility begins after the month of application must be sent a denial notice for the month(s) of ineligibility.

II. All individuals who apply for Medicaid must be notified of their eligibility for retroactive coverage. Such notification must indicate the months of eligibility or ineligibility.

III. When an individual is determined to be ineligible, the notification contains-

A. a statement that the application has been denied,

B. the specific reason(s) for the denial,

C. the manual citations which support the decisions, and

D. an explanation of the individual's right to request a hearing.

IV. In situations when the intended action is to discontinue eligibility or to reduce services, timely and adequate notice must be given to the recipient.

A. "Timely" means that the notice must be mailed 15 days before the intended change would be effective (ten days for notice plus five days for mail).

Timely actions resulting from computer matching mass changes, such as annual cost of living adjustments to Social Security and other Federal benefit updates require an advance notice of 30 days prior to the effective date of the action.

The only situations in which the timely notice guarantee is not required are as follows:

1. Factual information is received confirming the death of the recipient;

2. A written statement that assistance is no longer wanted is received by the Department. Such statement must be signed by the recipient or the recipient's representative;

3. The recipient has been committed to a public institution (See Section 9 of this Part.);

4. The recipient's cost of care changes (See Part 12, Sections 4.3.4; Part 13, Section 6; and Part 14, Section 6.2.);

5. The recipient's whereabouts are unknown and Departmental mail directed to the recipient has been returned;

6. An applicant for MaineCare has been covered temporarily due to the Department's failure to determine eligibility within the 45-day time limit and is later found to be ineligible; or

7. Documentation is obtained that the individual is currently receiving Medicaid in another state.

B. "Adequate" means a written notice which includes a statement of-
1. the action the Department intends to take;

2. the reasons for the intended action;

3. the regulations supporting such action;

4. an explanation of the rights to request a hearing; and

5. a statement explaining that if a hearing is requested within the notice period, the intended action will not become effective until after a hearing Decision is rendered.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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