315.09 Denial or Termination of Assistance (MAM)

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Deny or terminate medical assistance for all adults in the assistance group if any individual in the assistance group who is potentially eligible for other income or benefits fails or refuses to:

. apply or complete the application process for the other income or benefit(s);

. provide information or verification to obtain the other income or benefit(s);

. cooperate with the eligibility-determining agencies or individual(s) responsible for the other income or benefit(s);

. meet the application timeframes described in Section 315.03, Application Requirements for Developing Potential Sources of Income, or set by the eligibility-determining agencies or individuals responsible for the other income or benefit(s);

. accept the other income or benefit(s), if found eligible; or

. pursue all appeal options up to, but not including, court action, if found ineligible for the income or benefit due to medical reasons.

Exceptions:

. 12 Month EMA cannot be terminated for refusal or failure to apply for potential benefits. See Section 167.05, Ineligibility Reasons, for valid termination reasons.

. Women who are pregnant or are within the 60-day post-partum medical coverage period cannot be terminated from medical assistance for failure or refusal to obtain third party medical coverage or cooperate with DCSS.

References: He-W 652.07, 42 CFR 435.608, 45 CFR 233.20(a)(3)(ix)