4.5 Notices

4.5.1 Notice Requirements
4.5.2 Application Notice

4.5.2.1 Notice of Approval
4.5.2.2 Notice of Denial

4.5.3 Notice of Adverse Action

4.5.3.1 Adequate Notice of Adverse Action
4.5.3.2 Timely Notice of Adverse Action

4.5.4 Notice of Positive Action

4.5.1 Notice Requirements

All applicants and members must be provided timely and adequate written notice of any decision affecting their eligibility, including an approval, denial, or termination of eligibility, or a change in benefits. Applicants and members must receive written notice of:

The decision on an application or renewal
Any action to discontinue a member’s eligibility or benefits
Any action that changes the amount of benefits

4.5.2 Application Notice

Any SSI parent who applies for CTS must be provided notice about the status of his or her application (approved, denied, or pending the receipt of additional information), in writing, within 30 days of application for benefits

4.5.2.1 Notice of Approval

Any notice of approval of CTS eligibility must include:

The effective date of eligibility
The circumstances under which the individual must report, and procedures for reporting, any changes that may affect the individual's eligibility
Basic information on the benefit amount and which individuals are eligible
An explanation of the right to a fair hearing and how to request one

4.5.2.2 Notice of Denial

Any notice of denial of CTS eligibility for an individual or the household must include:

The month(s) which were denied and in which individuals were determined ineligible
The reason(s) for the denial, including citations of the law or policy that supports the action
An explanation of the right to a fair hearing and how to request one
The telephone number and the name and address of the agency to contact for more information

4.5.3 Notice of Adverse Action

An adverse action is when the IM agency makes a change that will stop or reduce benefits. Members have the right to adequate and timely notice of an adverse action.

4.5.3.1 Adequate Notice of Adverse Action

To be considered adequate, an adverse action notice must include the following:

A statement describing the intended action
The reason(s) for the intended action, including a citation of the law, regulation, rule, or policy that supports or requires the action
An explanation of the right to a fair hearing and how to request one
A statement on the availability of free legal representation
A statement that if a hearing is requested before the action's effective date, benefits will continue until the hearing decision is made
The latest date a member can appeal
A statement that the member may have to repay any benefits continued during the appeal if the hearing decision isn't in their favor, or they abandon or withdraw the hearing request
The telephone number and the name and address of the agency to contact for more information

4.5.3.2 Timely Notice of Adverse Action

To be considered timely, a notice of an adverse action must be mailed or sent electronically at least 10 days before the effective date of any intended adverse action, unless one or more of the following circumstances apply:

Factual information confirms a recipient or payee's death, and there's no relative to take his/her place as primary person
A clear, written statement initiated and signed by the member is submitted stating they no longer wish to receive benefits
The member is receiving SSI benefits from another state

4.5.4 Notice of Positive Action

A positive action is when the IM agency makes a change that will begin eligibility for someone or increase their benefits. Members have the right to adequate notice of a positive action.

To be considered adequate, a positive notice must include the following:

A statement describing the intended action
Basic information on the benefit amount and which individuals are eligible
An explanation of the right to a fair hearing and how to request one
A statement on the availability of free legal representation
The telephone number and the name and address of the agency to contact for more information

This page last updated in Release Number: 22-01
Release Date: 04/04/2022
Effective Date: 04/04/2022