HAR §17-1713.1-4. Notice content

(a) A notice of approved eligibility includes, but is not limited to: (1) The basis and effective date of eligibility; (2) The circumstances and procedures under which reporting is required; (3) If applicable, the amount of medical expenses which must be incurred to establish eligibility for medically needy spenddown; (4) Information on the level of benefits and services approved, including, any premiums, enrollment fees and cost sharing; and (5) Information on administrative appeal rights as described in chapter 17-1703.1 to appeal eligibility or approved level of benefits and services. (b) A notice to deny or take other action affecting an individual’s eligibility or level of benefits and services, based on the individual’s household income at or below the applicable MAGI standard shall contain information on the basis for eligibility other than the MAGI standard and how to request a determination on a MAGI-excepted basis. [Eff 09/30/13] (Auth: HRS §346-14; 42 C.F.R. §§431.210, 435.917) (Imp: HRS §346-14; 42 C.F.R. §§431.210, 435.917)