Authority: IC 12-13-2-3; IC 12-13-5-3

Affected: IC 12-15

Sec. 1. (a) An applicant for or recipient of Medicaid will have the opportunity to claim good cause for refusing to cooperate as required by 42 CFR 433.147.

(b) Prior to requiring cooperation under 42 CFR 433.147, the DFR will notify the applicant or recipient of the right to claim good cause as an exception to the cooperation requirement and of all the requirements applicable to a good cause determination as follows:

1. (1) The notice will be in writing, with a copy furnished to the applicant or recipient.
2. (2) An acknowledgment that the applicant or recipient received the notice will be signed and dated by the caseworker and the applicant or recipient, and the acknowledgment will be placed in the case file.

(c) An applicant for or recipient of Medicaid who refuses to cooperate and who claims to have good cause for refusing to cooperate has the burden of establishing the existence of a good cause circumstance. The applicant or recipient will be required to:

1. (1) specify the circumstances as described in section 3 of this rule that the applicant or recipient believes provide sufficient good cause for not cooperating;
2. (2) corroborate the good cause circumstances in accordance with section 4 of this rule; and
3. (3) if requested, provide sufficient information to permit an investigation pursuant to section 4 of this rule.

(d) If the requirements of subsection (c) are not met, the DFR shall, on that basis, determine that good cause does not exist.

(Division of Family Resources; 470 IAC 2.1-4-1; filed Jun 4, 1985, 2:37 p.m.: 8 IR 1298, eff Jul 1, 1985 [IC 4-22-2-5 suspends the effectiveness of a rule document for thirty (30) days after filing with the secretary of state. LSA Document #85-29 was filed Jun 4, 1985.]; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR- 470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA; readopted filed Nov 13, 2019, 11:56 a.m.: 20191211-IR-470190490RFA; filed Aug 28, 2023, 9:55 a.m.: 20230927-IR-470230215FRA)