(a) The agency must issue and publicize its hearing procedures.
(b) The agency must, at the time specified in paragraph (c) of this section, inform every applicant or beneficiary in writing—
(1) Of his or her right to a fair hearing and right to request an expedited fair hearing;
(2) Of the method by which he may obtain a hearing;
(3) That he may represent himself or use legal counsel, a relative, a friend, or other spokesman; and
(4) Of the time frames in which the agency must take final administrative action, in accordance with § 431.244(f).
(c) The agency must provide the information required in paragraph (b) of this section—(1) At the time that the individual applies for Medicaid;
(2) At the time the agency denies an individual's claim for eligibility, benefits or services; or denies a request for exemption from mandatory enrollment in an Alternative Benefit Plan; or takes other action, as defined at § 431.201; or whenever a hearing is otherwise required in accordance with § 431.220(a);
(3) At the time a skilled nursing facility or a nursing facility notifies a resident in accordance with § 483.15 of this chapter that he or she is to be transferred or discharged; and
(4) At the time an individual receives an adverse determination by the State with regard to the preadmission screening and annual resident review requirements of section 1919(e)(7) of the Act.
(d) If, in accordance with § 431.10(c)(1)(ii), the agency has delegated authority to the Exchange or Exchange appeals entity to conduct the fair hearing, the agency must inform the individual in writing that—
(1) He or she has the right to have his or her hearing before the agency, instead of the Exchange or the Exchange appeals entity; and
(2) The method by which the individual may make such election;
(e) The information required under this subpart must be accessible to individuals who are limited English proficient and to individuals with disabilities, consistent with § 435.905(b) of this chapter, and may be provided in electronic format in accordance with § 435.918 of this chapter.
[44 FR 17932, Mar. 29, 1979, as amended at 57 FR 56505, Nov. 30, 1992; 58 FR 25784, Apr. 28, 1993; 78 FR 42301, July 15, 2013; 81 FR 68847, Oct. 4, 2016; 81 FR 86448, Nov. 30, 2016]
Notes of Decisions
K.W. Ex Rel. D.W. v. Armstrong, 789 F.3d 962 (9th Cir. 2015).
· cites it 6× “§ 1396a(a)(3); 42 C.F.R. § 431.206 , or deprive a participant of property under the Due Process Clause, U.”
Davis v. Shah, 821 F.3d 231 (2d Cir. 2016).
· cites it 2× “See 42 C.F.R. §§ 431.206 (b), (c); id. § 431.”
Henry Pashby v. Albert Delia, 709 F.3d 307 (4th Cir. 2013).
· cites it 2× “Those regulations state that, “[a]t the time of any action affecting [a Medicaid recipient’s] claim,” 42 C.F.R. § 431.206 (c)(2), the state agency must inform each beneficiary in writing “[o]f his right to a hearing,” “[o]f the method by which he may obtain a hearing,” and…”
Samele v. Zucker, 324 F. Supp. 3d 313 (E.D.N.Y 2018).
· cites it 4× “§ 1396a(a)(3)-(4) ; 42 C.F.R. §§ 431.206 (b)-(c), 431.210, 431.”
Soskin v. Reinertson, 353 F.3d 1242 (10th Cir. 2004).
· cites it 2× “The Medicaid Act’s implementing regulations set forth requirements for notice related to the right to appeal and the reasons for termination.”
Grier v. Goetz, 402 F. Supp. 2d 876 (M.D. Tenn. 2005).
· cites it 5× “42 C.F.R. § 431.206 (c)(2). “Action means a termination, suspension, or reduction of Medicaid eligibility or covered services.”
NB Ex Rel. Peacock v. Dist. of Columbia, 682 F.3d 77 (D.C. Cir. 2012).
“Such notice must contain a statement of what action the state intends to take, the reasons for that action, the specific regulations supporting the action, the individual’s right to a hearing, and an explanation of the circumstances under which coverage will be continued if a…”
Nb v. Dist. of Columbia, 34 F. Supp. 3d 146 (D.D.C. 2014).
· cites it 4× “” 42 C.F.R. § 431.206 (b), (c)(2). Such notice must contain a statement of what action the state intends to take, the reasons for that action, the specific regulations supporting the action, the individual’s *149 right to request a hearing, and an explanation of the…”
Susan J. v. Riley, 254 F.R.D. 439 (M.D. Ala. 2008).
· cites it 3× “§ 1396a(a)(3) and the due process clause of the Fourteenth Amendment.”
King Ex Rel. King v. Sullivan, 776 F. Supp. 645 (D.R.I. 1991).
· cites it 2× “§ 1396a(a)(3) and 42 C.F.R. § 431.206 . In connection with all eight general claims, Plaintiffs also aver separate violations of their civil rights under 42 U.”
Philadelphia Welfare Rights Org. v. O'Bannon, 517 F. Supp. 501 (E.D. Pa. 1981).
· cites it 3× “Plaintiffs contend that this cut-off date discourages recipients from appealing the termination and that this absolute termination date violates recipients’ rights to a fair hearing before termination and, in so doing, this mandatory cut-off date violates federal regulations 42…”
— 42 C.F.R. § 431.206(b) — 1 case
— 42 C.F.R. § 431.206(b)(2) — 1 case
— 42 C.F.R. § 431.206(c) — 1 case
— 42 C.F.R. § 431.206(c)(1) — 1 case
— 42 C.F.R. § 431.206(c)(2) — 1 case
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