Medicaid Policy                                                                 

 

 

811-1 Due Process

 

Effective Date:  January 1, 2025

 

No Previous Policy

 

Due process is the legal requirement to maintain coverage when there is insufficient time to give proper notice to a member when the agency is making a decision affecting their eligibility on a medical assistance program (811).  If the agency does not have time to send proper notice, the agency must extend eligibility into the following month.  This is referred to as a ‘Due Process’ month.

1. A Due Process Month is required in the following situations:

1. At Review when:

1. 1. 1. The Member submits their review forms or attempts to complete the review before the end of the review month, and the agency does not have time to complete the redetermination and send proper notice of an adverse action. This occurs when:

1. 1. 1. 1. Verification is requested and the due date is after 10-day notice.

1. 1. 1. 2. The member provides verification but the agency cannot complete the review and notify the member of an adverse action before 10-day notice.

• • • • • Do not issue an additional due process month if requested verification from the review are not received before the end of the due process month. If verification is received within the three months following a due process month the date all verification is received is a new application date (707).

1. 1. 2. The renewal determination is being made after 10-day notice, even if the member is being renewed on the same program.

1. 1. 3. The review is submitted after 10-day notice but before the end of the month.

2. At change report when:

1. 1. 1. The member submits all requested verification, and the agency does not have time to send proper notice of an adverse action.

1. 1. 2. Verification is submitted by the end of the due process month and the agency does not have time to send proper notice of an adverse action.

1. 1. 1. 1. If requested verification from a change report is not received in the month following a due process month, the member must reapply for benefits (707).

1. 1. 3. A program was terminated with proper notice, and verification is then received before the effective coverage end date that resolves the ineligible reason but results in a new ineligible reason and there is insufficient time to give proper notice.

1. 1. 1. 1. Do not give a due process month if proper notice was given and the ineligible reason is not resolved before the effective coverage end date.

3. When a member ages off of their current program; and

1. 1. 1. A decision about a member’s ongoing eligibility has not yet been made and there is insufficient time to give proper notice.

4. When the time limit is exhausted on a time-limited program follow the review section above.

5. When the member is no longer eligible for Transitional prior to the end of the time limit but the member’s eligibility under other programs has not yet been determined and there is insufficient time to give proper notice.

6. When the member requests additional time to submit requested verification before the due date and the new due date is after 10-day notice. See 731.

2. The agency must give an additional due process month in the following situations:

• When proper notice cannot be given before the end of the due process month;

• When additional verification is requested and is due after 10-day notice of the due process month.

3. A Due Process month may be removed if proper notice can be given.

4. Do not remove a Due Process month if proper notice cannot be given, unless the member is moving to a better program.

Example: 

Michelle submits her review on April 23^rd of the review month.  The worker approves a due process month for May and sends a verification checklist giving Michelle until May 8^th to submit the check stubs. Michelle submits the check stubs on May 7^th which are processed before 10-day notice.  

• A 2^nd due process month is not needed and the new certification period will start June 1^st.

Same scenario: check stubs were submitted timely, but the case was not worked until May 23^rd.

• A 2^nd due process month must be issued, the new certification period will start July 1^st.

Same scenario: check stubs were submitted untimely, and the case was not worked until May 23^rd

• A 2^nd due process month must be issued, the new certification period will start July 1^st.

Example: 

John reports a job on October 26^th.   The worker sends a verification checklist requesting income verification and giving John until November 6^th to submit the requested verification.  John submits the verification on November 23^rd. 

• If no adverse action: re-open program effective December 1^st. 
• If an adverse action: re-open the program and approve a due process month. The effective date of the change is January 1^st.

Similar scenario but income verification is submitted timely, and the case is not worked until November 21^st.  

• If no adverse action: re-open program effective December 1^st.
• If an adverse action: re-open the program and approve a due process month. The effective date of the change is January 1^st.