Current through 2024-38, September 18, 2024
I.
Applicant/Participant Rights
A. Every Medicaid
or CHIP applicant or recipient may claim good cause for refusing to cooperate
with TPL, medical support, or cooperating with the Department's establishment
of medical support from the non-custodial parent. When the individual claims
good cause, sanctions are not implemented unless it is finally determined that
good cause does not exist.
B.
Applicants receive an explanation of cooperation requirements, sanctions, and
the right to claim good cause. The Department may attempt to establish
paternity and collect medical support in cases where there is no risk to the
individual or children.
C. If good
cause is not granted, the individual is given the opportunity to withdraw from
the benefit or provide additional information to substantiate the claim. If
good cause is granted, no referral is made.
II. Acceptable Reasons for Good Cause
Good cause for not cooperating with TPL, medical support,
or establishment of medical support from the non-custodial parent may be
claimed by the individual if the individual can demonstrate that-
A. cooperation may reasonably be anticipated
to result in physical or emotional harm to the child or physical or emotional
harm to the caretaker relative which would hinder the ability to care for the
child,
B. legal proceedings for
adoption of the child are pending before a court or the individual has been
working with a social agency to decide whether to relinquish the child for
adoption, or
C. the child was
conceived as the result of rape or incest.
III. Verification of Good Cause
Documents from court records, law enforcement agencies,
medical sources, social service agencies and any other legal document may be
used to substantiate rape, adoption and physical or emotional harm to the child
or caretaker relative. If such documents are unavailable, information may be
secured from other sources familiar with the claims of the individual. The
Department should assist the individual in obtaining the required evidence, but
no contact with collateral sources will be made without the individual's
knowledge and consent.
If the individual thinks that attempts to establish
paternity or collect support would pose a risk to the individual or children,
the individual must provide evidence to substantiate the claim of good cause
not to cooperate.
The Department may make contact with the absent parent or
putative father only if it is essential to the claim for good cause. The
Department shall not make contact until the applicant or recipient has the
opportunity to-
A. present additional
evidence or information which makes contact with the absent parent or putative
father unnecessary;
B. withdraw the
application for assistance, or have the case closed; and
C. have the good cause claim
denied.
IV. Good Cause
Determinations
A. The Department determines
whether an applicant's request for good cause is approved or denied. This
decision, and the reason for the decision, are documented by the Department and
provided to the individual in writing.
B. If good cause is not granted and the
individual continues to refuse to cooperate, sanctions are applied to the
individual, and the TPL unit and DSER proceed to establish medical support from
the non-custodial parent without the individual's cooperation.
