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Medicaid termination or reduction notice
Medicaid coverage notice
What federal rules say a medicaid termination or reduction notice must contain, and how a beneficiary can keep their coverage while they disagree.
Required parts of the notice
| Part | What the law says | Citation |
|---|---|---|
| What will happen, and when What the agency is going to do, and the exact date it takes effect. | “A statement of what action the agency, skilled nursing facility, or nursing facility intends to take and the effective date of such action” | 42 CFR 431.210(a) ↗ |
| The specific reasons The specific reason for the decision about you, not a general category. | “A clear statement of the specific reasons supporting the intended action” | 42 CFR 431.210(b) ↗ |
| The rule they relied on The specific regulation or law that supports the decision. | “The specific regulations that support, or the change in Federal or State law that requires, the action” | 42 CFR 431.210(c) ↗ |
| Your right to a hearing That you have the right to ask for a hearing, and how. | “The individual's right to request a local evidentiary hearing if one is available, or a State agency hearing” | 42 CFR 431.210(d) ↗ |
| How to keep coverage during an appeal When your coverage continues if you ask for a hearing. | “An explanation of the circumstances under which Medicaid is continued if a hearing is requested” | 42 CFR 431.210(e) ↗ |
The deadline that keeps your coverage
42 CFR 431.230(a)
“the beneficiary requests a hearing before the date of action, the agency may not terminate or reduce services until a decision is rendered after the hearing”
If you ask for a hearing before the date of action, federal rules keep your services in place until the hearing decision, with narrow exceptions. Your state may set an earlier date in the letter; if it does, use the earlier one.
Before this date, request a fair hearing and say you want your coverage to continue.
Sources
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