R9-22-307. Approval or Denial of Eligibility

A. Approval. If the applicant meets all the eligibility requirements and conditions of eligibility of this Article, the Administration or its designee shall approve the application and provide the applicant with an approval notice. The approval notice shall contain: 1. The name of each approved applicant, 2. The effective date of eligibility for each approved applicant, 3. The reason and the legal citations if a member is approved for only emergency medical services, and 4. The applicant’s right to appeal the decision. B. Denial. If an applicant fails to meet the eligibility requirements or conditions of eligibility of this Article, the Administration or its designee shall deny the application and provide the applicant with a denial notice. The denial notice shall contain: 1. The name of each ineligible applicant, 2. The specific reason why the applicant is ineligible, 3. The income and resource calculations for the applicant compared to the income or resource standards for eligibility when the reason for the denial is due to the applicant’s income or resources exceeding the applicable standard, 4. The legal citations supporting the reason for the ineligibility, 5. The location where the applicant can review the legal citations, 6. The date of the application being denied; and 7. The applicant’s right to appeal the decision and request a hearing.