A timely and adequate Advance Notice is required prior to taking any of the following actions:
When authorizing each month of monthly Categorically Needy Nonmoney Payment (NMP) Spend-Down. The notice will indicate the spend-down amount and the beginning and ending date of eligibility.
Decreasing or discontinuing MA.
NOTE: If an individual requests benefits be terminated or reports a move out of state, but does not provide a
signed statement or Voluntary Withdrawal form (PA 1829), advanced notice must be given.
Example A: Steven calls the Statewide Customer Service Center and requests closure of their MA benefits. There is no written request of the closure. The worker will close Steven’s MA with a 15-day Advance Notice to Discontinue using reason code “063 – Voluntary Withdrawal.”
Example B: Sally calls and requests closure of MA benefits for their child Eva, as Sally’s ex-spouse will now be providing full medical coverage for Eva. Sally would like their own medical coverage to remain open. There is no written request of the closure. The worker will close Eva’s MA with a 15-day Advance Notice to Discontinue using reason code “063 – Voluntary Withdrawal.”
Example C: Pauline calls the CAO and reports that their household have relocated to New Jersey. There is no written request of the closure. The worker will close Pauline’s MA with a 15-day Advance Notice to Discontinue using reason code “064 – Permanent Move Out of State.”
If a signed statement or PA 1829 is provided, confirming notice can be given. See Section 377.4, Confirming Notice.
Discontinuing Medical Assistance for a child who reaches the age limit.
Discontinuing Medical Assistance at the end of the postpartum period for the mother.
Discontinuing a budget which is actively transferred from one county to another.
NOTE: The Advance Notice is sent by the county that the individuals are leaving.
In addition to the information listed in Section 377.1 which is contained on all notices, the Advance Notice will contain:
An explanation of the reason for the action, and the basis on which the decision was made.
The availability of continuing benefits if an action is appealed.
An explanation that the Department will no longer pay the health insurance premium for an individual enrolled in the HIPP Program or Medicare Premium (Buy-In) when MA benefits are discontinued. See Section 338.22, Health Insurance Premium Payment (HIPP) Program.
An explanation that eligibility for services under the Medical Assistance Transportation Program (MATP) will end on the date the MA ends.
NOTE: A Late/Incomplete Notice does not serve as advance notice for those MA budgets enrolled in Semi-Annual Reporting (SAR). For any changes or closings resulting from SAR, an advance notice is required for MA.
A budget closed with an Advance Notice will be closed effective the 15th day from the processing date of the transaction.
Example: The CAO processes the closure of an MA budget on May 1st. The closure date is May 16th.
The CAO will not use the Advance Notice as the first notice to the recipient that has a scheduled appointment or is to provide information to the CAO. The Advance Notice is used only after the recipient has failed to keep the scheduled appointment or failed to provide information within an established time period.
Updated February 22, 2021, Replacing August 28, 2020