A completed Notice to Applicant will be sent to the applicant or recipient when:
55 Pa. Code § 125.24(c) 55 Pa. Code § 125.84(e)
An application is approved.
An application is denied.
An application is withdrawn.
A newborn or another person is added to the applicant/recipient group.
The individual’s request to change wording in the case record is denied.
The individual’s request for a medical transportation allowance is approved or denied.
A change in benefits.
When an application is approved, the Notice to Applicant will show the following information (along with the information in Section 377):
The effective date of eligibility for MA coverage.
The amount of the patient pay liability and the name of the provider(s) who are to be paid by the recipient.
The Notice to Applicant can be used to tell an applicant whether he or she is eligible for retroactive MA and the amount of the person’s patient pay liability, if any. If the applicant is applying for both continuing and retroactive MA, the CAO will separate notices.
When an application is denied, the notice will give the following information:
The reason the application was denied.
The facts and figures that were used to make the decision.
A list of items that were needed for proof but were not turned in.
A notice is issued at renewal for MA benefits, regardless of whether there is a change in eligibility.
Exception: A notice is not sent when Long-Term Care facility or Home and Community-Based Services benefits are renewed unless there is a change in eligibility or cost of care.
If the recipient is not eligible or benefits will be changed, the CAO will send an advance notice.
If the recipient is eligible for increased benefits, the CAO will send a confirming notice.
Updated August 20, 2020, Replacing September 24, 2018