Appeal Process For Changes To Medicaid Benefits

The act requires the department of health care policy and financing (department) to give a medicaid recipient at least a 10-day advance notice if medical assistance benefits are being suspended, terminated, or modified (intended action), unless certain conditions are met.

The act extends the time for appeal to 60 days after the date of the notice. If the recipient files an appeal prior to the effective date of the intended action, the recipient's medical assistance benefits will continue unchanged until the completion of the appeal process. If authorized under federal law, the department may permit a recipient's medical benefits to continue even though the appeal is filed after the effective date of the intended action. The department shall promulgate rules, consistent with federal law, that prescribe the circumstances under which the benefits may continue.

The act permits an applicant or recipient to request the county or service delivery agency dispute resolution process either prior to appeal to the department or as part of the filing of the appeal. If the dispute is resolved, the county or service delivery agency will inform the applicant or recipient of the process for the dismissal of the state-level appeal.

Except as provided in the act, the act requires the person or persons involved in making the decision relating to the intended action to be available for cross-examination if requested by the appellant.

The act appropriates $2,500 to the department to implement the act, which money may be used for Medicaid management information system maintenance and projects. In addition, the department anticipates receiving $22,500 in federal funds for Medicaid management information system maintenance and projects to implement the act.

(Note: This summary applies to this bill as enacted.)