Sec. 10.18.05.04. Changes in Eligibility and Disenrollment

A. A recipient shall notify the Department within 10 business days of a change in:

(1) Availability of third-party payment for services covered under MADAP;

(2) Gross household income; or

(3) Address.

B. If a change reported in §A of this regulation results in a recipient no longer qualifying for MADAP, the Department shall:

(1) Determine the recipient ineligible for MADAP; and

(2) Disenroll the recipient.

C. The notice of intended action, which notifies the recipient of the disenrollment, shall:

(1) Be mailed to the recipient at least 15 business days before the effective date of disenrollment;

(2) Include an explanation of the action;

(3) Cite the regulation supporting the action; and

(4) Explain the right of the recipient to request reconsideration or an appeal of the decision.

D. If the recipient is determined to be ineligible before the next verification of eligibility is due to be submitted to the Department because of a change in eligibility, the disenrollment shall be the earlier of:

(1) The date on which the recipient’s next verification of eligibility is due to be submitted to the Department; or

(2) The first day of the month that is at least 15 calendar days after the date of the notice of ineligibility for MADAP benefits.

E. If the recipient’s Medical Assistance coverage is pending or active, the recipient shall be disenrolled, as determined by the Department.