210.19 Termination of MEAD SR 05-22, 05/05 (AAM-A)

Employment

Terminate MEAD eligibility if the individual becomes unemployed due to:

. voluntarily quitting or losing employment without good cause (see Section 210.05, Good Cause for Loss of Employment);

. deciding not to seek employment or return to work; or

. terminating employment to seek medical treatment which will not enable the individual to become re-employed.

MEAD eligibility automatically terminates:

. at the end of the first six-month extension; or

. if eligible for one additional six-month extension, at the completion of the second extension.

Terminate MEAD if an individual has 3 consecutive occurrences of becoming employed during the 5th month of an extension.

Premiums

Non-payment of premiums for 2 consecutive months without good cause (see Section 210.15, Good Cause for Non-Payment of MEAD Premiums), as determined by NHHKC, will result in termination of MEAD.

NHHKC notifies the MEAD liaison at New HEIGHTS that the case must close for non-payment of premiums. The MEAD liaison closes the case and notifies the Family Services Specialist of the closing action.

MEAD coverage may be reinstated during the advance notice period following termination due to non-payment of premiums when:

. the participant furnishes proof of payment in full for the past due premiums or proof that a payment plan for past due premiums has been established; or

. it has been redetermined by NHHKC staff that there is good cause for non-payment and the participant has exhausted all available resources with which to pay past due premiums.

Non-payment of premiums for 3 consecutive months with good cause (see Section 210.15, Good Cause for Non-Payment of MEAD Premiums), as determined by NHHKC, will result in termination of MEAD, unless a payment plan for past due premiums is established. If good cause exists for non-payment of premiums, a payment plan may be arranged between the client and NHHKC.

The option of a payment plan is available to clients only once in a 2-year period.

Administrative Appeals

Upon receiving a request for an administrative appeal on the basis of MEAD closing due to non-payment of premiums, notify NHHKC so that a pre-hearing conference can be arranged between their representative and the client.

If the issue is not resolved at the pre-hearing conference, notify NHHKC of the date and time of the administrative appeal.

NHHKC represents DHHS at the administrative appeal.