DATE: AUGUST 26, 2002
Change No: 12-03
Effective: October 1, 2002
As part of an ongoing effort to increase access to services, the Centers for Medicare and Medicaid Services (CMS) is encouraging states to use written forms and materials that are easily understandable to the public. The Division of Medical Assistance is leading a work group to begin redesigning forms to make them more "consumer friendly" and to make more information available in Spanish. This work group includes county staff from Edgecombe, Johnston, Mecklenburg, Robeson and Sampson Counties, along with state staff from DSS to represent all assistance programs. The first two forms the work group reviewed were the DSS-8109, Notice of Denial and the DSS-8110, Notice Of Termination Or Modification Of Public Assistance.
The work group has revised and renamed the manual DSS-8109, Notice Of Denial, to the DSS-8109/DSS-8109S, Your Application For Benefits Is Being Denied Or Withdrawn. The format of the automated DSS-8109A will be revised later as funding becomes available to make EIS changes.
a. Due to enhancements in EIS, the DSS-8109A is now available as an automated notice for application withdrawals in all aid program/categories.
b. Unless overridden, EIS will automatically send the DSS-8109A, Notice Of Withdrawal, whenever an application is withdrawn.
The work group has revised and renamed the manual DSS-8110, Notice Of Termination Or Modification Of Public Assistance (Timely) to the DSS-8110/DSS-8110S, Your Benefits Are Changing. The format of the automated DSS-8110A will be revised later as funding becomes available to make EIS changes.
When a recipient’s benefits are terminated or reduced, he has the right to continued benefits if he requests a hearing during the 10-day timely notice period. If the hearing is requested timely, benefits can continue until the first appeal decision for all appeals that do not involve disability. For appeals involving disability, the recipient has the right to continued benefits until the state hearing decision or until all rights to a SSA appeal have been exhausted.
Apply these changes to all applications taken on or after October 1, 2002. Apply to all re-enrollments begun on or after October 1, 2002.
Use your existing supply of the manual DSS-8110 (English version) before ordering the new form. The new printed version of the DSS-8110 will not be issued until the current supply is exhausted. Make the following pen and ink changes to the existing form to comply with current policy regarding the continuation of Medicaid benefits.
The paragraph should now read:
“If the change is for Work First Assistance, Refugee Assistance, Medicaid, or Special Assistance; and if you ask for a hearing on or before the date the change will be made, your benefits will continue until the first hearing decision is made, unless you waive this right. Continuation of benefits Does Not apply to North Carolina Health Choice.”
The paragraph should now read:
“If you do not waive the right to have your benefits continued and the hearing shows that the changes were correct, you may have to repay the benefits you received while waiting for the hearing decision.”
Insert: MA-3430, Figures 1A, 1B, 2A, 2B, 3A, 3B and 4, effective 10/01/02.
Online Manual: Entire section revised.
Remove: MA-5000, Figures and Instructions for the DSS-8108, DSS-8110, DSS-8158 and DSS-8191W.
Insert: Nothing to insert.
If you have any questions regarding this information, please contact your Medicaid Program Representative.
[This policy material was researched and written by Vanessa Broadhurst, Policy Consultant, Medicaid Eligibility Unit.]
MA-3430, Fig. 1A, DSS-8108
MA-3430, Fig. 1B, DSS-8108 (Spanish)
MA-3430, Fig. 2A, DSS-8109
MA-3430, Fig. 2B, DSS-8109 (Spanish)
MA-3430, Fig. 2 Instructions
MA-3430, Fig. 3A, DSS8-8110
MA-3430, Fig. 3B, DSS-8110 (Spanish)
MA-3430, Fig 3 Instructions
MA-3430, Fig 4, DSS-1473
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.