1. (1) The eligibility agency shall notify an applicant or member in writing of the eligibility decision made on the application or the recertification.
2. (2) The eligibility agency shall end an individual's enrollment upon member request or upon discovery that the individual is no longer eligible.
3. (3) The eligibility agency shall end an individual's enrollment if the individual fails to complete the periodic review process on time.

4. (4) The eligibility agency shall notify an member in writing at least ten days before the effective date of an action adversely affecting the member's eligibility. The notice must include:

   1. (a) the action to be taken;
   2. (b) the reason for the action;
   3. (c) the regulations or policy that support an adverse action;
   4. (d) the applicant's or member's right to a hearing;
   5. (e) how an applicant or member may request a hearing; and
   6. (f) the applicant or member's right to represent himself, or use legal counsel, a friend, relative, or other spokesperson.

5. (5) The eligibility agency need not give 10-day notice of termination if:

   1. (a) the member is deceased;
   2. (b) the member moves out-of-state and is not expected to return; or
   3. (c) the member enters a public institution or institution for mental disease.

KEY: CHIP, Medicaid, PCN, UPP

Date of Last Change: July 1, 2024

Notice of Continuation: January 16, 2026

Authorizing, and Implemented or Interpreted Law: 26B-3-108; 26B-1-213