10-144-332 Me. Code R. § 5-9
Individuals will be notified in writing as soon as eligibility is determined. If some of the individuals applying for medical coverage are eligible and some are not, the notice must specify who is or is not eligible and the reasons for each individual's ineligibility.
Individuals whose eligibility begins after the month of application must be sent a denial notice for the month(s) of ineligibility.
When an individual is determined to be ineligible, the notification will contain a statement that the application has been denied, the specific reason(s) for the denial, the manual citations which support the decisions, and an explanation of the individual's right to request a hearing.
In situations when the intended action is to discontinue eligibility or to reduce services, timely and adequate notice must be given to the recipient. However, coverage will not be continued beyond the enrollment period pending a hearing decision.
"Timely" means that the notice must be mailed 15 days before the intended change would be effective (ten days for notice plus five days for mail).
"Adequate" means a written notice which includes a statement of the action the Department intends to take, the reasons for the intended action, the regulations supporting such action, and an explanation of the rights to request a hearing.
If an application is denied for MAGI- Related Medicaid or CHIP, notification will be given that other coverage may be available if the household has large medical bills or a child has a disabling condition. The application will be transferred to the SBM.
Before MaineCare or CHIP coverage is ended or denied, it must be determined that the individual is not eligible under any coverage group.
If coverage under CHIP is ended for a reason other than that the enrollment period has ended, the individual will be given adequate and timely notice.
10-144 C.M.R. ch. 332, § 5-9