DHHS - Medicaid Policy Manual
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All Medicaid Programs

Obsolete Policy

 

Obsolete 0114 - 227-6 Sanctions for Non-Cooperation

End Date:  December 31, 2013

 

No Previous Policy

 

 

If an applicant/recipient who must cooperate refuses to cooperate with Medical Support Enforcement requirements and does not claim good cause, he or she is not eligible for Medicaid coverage.  Code the case for the non-cooperating person. Determine eligibility and authorize coverage for the other household members.

 

There are two times when you might sanction a client:

  1. When an applicant refuses to complete the ORS/CSS application forms and does not want to claim good cause.

  1. If the applicant does not want to claim good cause, apply the sanction.

  2. If the applicant claims good cause, a sanction cannot be applied until a determination is made regarding the good cause claim. (227-4)

  3. If the initial claim of good cause is denied, and the client still refuses to complete the ORS/CSS application, apply the sanction.

  4. This does not require notification from ORS.

  1. When ORS notifies you that a recipient who completed the ORS/CSS application  initially, or who has been cooperating, but is now refusing to cooperate.

  1. Give the recipient the opportunity to claim good cause before applying the sanction. (227-4)

  2. If the recipient claims good cause, the sanction cannot be applied until a determination is made regarding the good cause claim.

  3. If the recipient does not want to claim good cause and does not want to cooperate after being notified about the non-cooperation issue or if the good cause claim is denied, apply the sanction

Additional Information

 

  1. Do not sanction the dependent child(ren) in the household when a parent refuses to cooperate.  Do not sanction a dependent child who is not a minor parent and who does not live with an adult caretaker relative if he or she refuses to cooperate.  If a dependent child is emancipated and is a minor parent, sanction the child if he or she refuses to cooperate with Medical Support Enforcement requirements for his/her own child.

 

  1. When a sanctioned client makes the decision to cooperate sometime after the first of the month, the Medicaid coverage will become effective the first day of the same month.