Eligibility Appeals Sample Clauses

Eligibility Appeals. The Department of Economic Security has an Office of Appeals, which hears eligibility appeals for eligibility determinations made by DES employees. Eligibility appeals for eligibility determinations made by AHCCCS employees are heard by a separate agency, the Office of Administrative Hearings (OAH). Other than the two different offices the eligibility appeals process are essentially the same. Any differences are noted below. If a Childless Adult loses eligibility for any reason, they have 30 calendar days from the date the decision notice is mailed to request an appeal of the decision. A request for appeal can be submitted either verbally or in writing. The member may request to withdraw the hearing request at any time. Benefits will continue if the request for appeal is received within 10 calendar days from the date the decision notice is mailed. Benefits will not be continued if the action appealed is due solely to a change required by a change in federal or state law. Within 7 days from receipt of the appeal request at DES and within 10 days at AHCCCS, the DES or AHCCCS eligibility office schedules a pre-hearing conference and sends copies of the budget calculations, income screens, notices, and case notes to the member. The conference may be conducted by telephone at the request of the member. Within 10 calendar days of receipt of the appeal request, a DES or AHCCCS supervisor reviews the results of the pre-hearing conference and documents in the appeal packet the accuracy of the eligibility decision. When the pre-hearing conference may result in an informal resolution of the dispute at DES, a request to withdraw from the appeal is sent to the member. An informal resolution may happen when the decision is discussed with the member directly and the member agrees that the agency made the correct decision. A request to withdraw from the appeal is not sent to the member when the decision requires correction. When the review of the circumstances indicates that the case needs correction, DES sends the Request to Xxxxxx and Xxxxxx (FAA-1389A) form to the Office of Appeals. The case is not corrected until a response is received from the Office of Appeals or the Office of Administrative Hearings that indicates that the matter was vacated and remanded to the local office for correction. At AHCCCS, when the pre-hearing conference may result in an informal resolution of the dispute, a request to withdraw from the appeal is sent to the member. If a correction is ne...
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Eligibility Appeals. If an individual appeals his or her eligibility determination and needs access to FTI, the Marketplace, state Medicaid agency, or state CHIP agency will collect a handwritten signature (either an original or a copy) from the adult application filer to authorize the disclosure. If an application includes more than one tax household, or if the individual needs access to data regarding income from title II benefits obtained from SSA via the hub or the number of quarters of coverage obtained from SSA via the hub, the Marketplace, state Medicaid agency, or state CHIP agency will collect handwritten signatures from every adult listed on the application to authorize the disclosure. These signatures can be mailed or uploaded to the Marketplace, state Medicaid agency, or state CHIP agency, and the Marketplace, state Medicaid agency, or state CHIP agency may also elect to receive them via facsimile. We are working with our Federal partners to develop appropriate authorizing language to pair with the signature or signatures, and will share this with states in the future.
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Related to Eligibility Appeals

  • Benefit Eligibility For purposes of the Benefit Plan entitlement, common-law and same sex relationships will apply as defined.

  • Eligibility and Enrollment 2.3.1 The State of Georgia has the sole authority for determining eligibility for the Medicaid program and whether Medicaid beneficiaries are eligible for Enrollment in GF. DCH or its Agent will determine eligibility for PeachCare for Kids and will collect applicable premiums. DCH or its agent will continue responsibility for the electronic eligibility verification system (EVS).

  • Eligibility Determination The State or its designee will make eligibility determinations for each of the HHSC HMO Programs.

  • Eligibility for Benefits A member will not be eligible to receive Long Term Disability benefits until their Income Protection benefits have expired.

  • Eligibility It will notify the Issuer and the Servicer promptly if it no longer meets the eligibility requirements in Section 5.1.

  • Special Eligibility The following employees also receive an Employer Contribution:

  • ELIGIBILITY TO BID 2.1 The bidder must be 18 years old and above, sound mind and not declared as bankrupt.

  • General Eligibility 1. Except as provided in #2 below, a teacher who received an evaluation rating of ineffective or improvement necessary in the prior school year is not eligible for any salary increase and remains at their prior year salary.

  • Eligibility to Participate An employee eligible to participate in the State Employee Group Insurance Program, as described in Sections 2A and 2B, may participate in open enrollment. In addition, a person in the following categories may, as allowed in section 5D1 above, make certain changes: (1) a former employee or dependent on continuation coverage, as described in Section 2D, may change plans or add coverage for health and/or dental plans on the same basis as active employees; and (2) an early retiree, prior to becoming eligible for Medicare, may change health and/or dental plans as agreed to for active employees, but may not add dependent coverage.

  • Eligibility and Participation An individual is deemed an “Eligible Employee” and, therefore, eligible to participate in the Plan if he or she is a member of the Company’s Management Team at the time of such individual’s termination of employment with the Company, and such employment terminates due to an event which constitutes a Qualifying Termination.

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