Cal. Code Regs. Tit. 22, § 50179 - [Operative until 10/1/2024] Notice of Action-Medi-Cal-Only Determinations or Redeterminations
(a) County
departments shall notify beneficiaries in writing of their Medi-Cal-only
eligibility or ineligibility, and of any changes made in their eligibility
status or share of cost. This notification shall be called the "Notice of
Action."
(b) The Notice of Action
shall be on a form prescribed by the Department and shall include the name and
telephone number of the eligibility worker who completed the eligibility
determination, and the date the form was completed. A copy of the Notice of
Action shall be placed in the case file.
(c) The Notice of Action shall include the
following:
(1) The approval, denial or
discontinuance of eligibility, the recision of a denial or discontinuance, or
the change in the share of cost and the effective date of the action.
(2) The amount of the share of cost, if any,
and the amount of the net nonexempt income used to determine the share of
cost.
(3) The reason an action is
being taken and the law or regulation that requires the action, if the action
is a denial, discontinuance or increase in share of cost.
(4) The right to request a State hearing if
dissatisfied with:
(A) Any action or inaction
by the county department that affects the applicant's or beneficiary's Medi-Cal
eligibility or share of cost, except as limited in Section
50951(a).
(B) Any action taken by, or on behalf of, the
Department that affects the applicant's or beneficiary's Medi-Cal
benefits.
(5) The
procedures for requesting a State hearing and the time limits within which a
state hearing must be requested.
(6) The circumstances under which aid will be
continued if a hearing is requested.
(7) A statement, when appropriate, regarding
the information or action necessary to reestablish eligibility or determine a
correct share of cost.
(d) The Notice of Action shall be mailed for:
(1) Adverse actions, at least 10 calendar
days prior to the first of the month in which the action becomes effective,
excluding the date of mailing.
(2)
Discontinuances or increases in the share of cost which are not adverse
actions, in sufficient time to reach the beneficiary by the effective date of
the action.
(3) All other
instances, no later than the date the county department takes the
action.
(e) Duplicate
Notices of Action shall be mailed to the administrator of the long-term care
facility in which the applicant or beneficiary resides, if the applicant or
beneficiary or person acting on their behalf has made such a request.
(f) Conditional notices, which advise
applicants or beneficiaries that eligibility will be denied or discontinued
unless specified actions are taken by the applicants or beneficiaries, shall
not be considered to meet the Notice of Action requirements of (a).
Notes
2. Amendment of subsection (c)(1), repealer of subsections (c)(4)-(c)(7), and subsection renumbering filed 9-10-97; operative 10-10-97 (Register 97, No. 37).
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code. Reference: Sections 10950, 10951, 11002, 11004, 11052, 11055, 14000, 14005, 14016, 14016.2, 14023, 14023.7 and 14124.90 Welfare and Institutions Code.
2. Amendment of subsection (c)(1), repealer of subsections (c)(4)-(c)(7), and subsection renumbering filed 9-10-97; operative 10-10-97 (Register 97, No. 37).
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