C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 431—STATE ORGANIZATION AND GENERAL ADMINISTRATION › Subpart E—Fair Hearings for Applicants and Beneficiaries

42 C.F.R. § 431.230

Maintaining services

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(a) If the agency sends the 10-day or 5-day notice as required under § 431.211 or § 431.214 of this subpart, and the beneficiary requests a hearing before the date of action, the agency may not terminate or reduce services until a decision is rendered after the hearing unless—

(1) It is determined at the hearing that the sole issue is one of Federal or State law or policy; and

(2) The agency promptly informs the beneficiary in writing that services are to be terminated or reduced pending the hearing decision.

(b) If the agency's action is sustained by the hearing decision, the agency may institute recovery procedures against the applicant or beneficiary to recoup the cost of any services furnished the beneficiary, to the extent they were furnished solely by reason of this section.

[44 FR 17932, Mar. 29, 1979, as amended at 45 FR 24882, Apr. 11, 1980; 78 FR 42302, July 15, 2013]
Notes of Decisions
Cited in 21 cases (2 in the last 5 years), 1979–2025 · leading case: Hamby v. Neel, 368 F.3d 549 (6th Cir. 2004).
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Hamby v. Neel, 368 F.3d 549 (6th Cir. 2004). · cites it 2× “42 C.F.R. §§ 431.230 (a) and insurance denial letter must be submitted with the application, 431.”
Daniels v. Wadley, 926 F. Supp. 1305 (M.D. Tenn. 1996). · cites it 2× “These proposed modifications shall include: (1) a mechanism for ensuring that all enrollees who would be entitled to predeprivation hearings under the Medicaid Act, 42 C.F.R. § 431.230 , are entitled to a predeprivation hearing under TennCare; (2) a method for ensuring that such…”
Shakhnes Ex Rel. Shakhnes v. Eggleston, 740 F. Supp. 2d 602 (S.D.N.Y. 2010). “” 42 C.F.R. § 431.230 (a). This regulation also fleshes out the statutory right to a fair hearing found in 42 U.”
Frank v. Kizer, 213 Cal. App. 3d 919 (Cal. Ct. App. 1989). · cites it 2× “( 42 C.F.R. § 431.230 (a).) I The Department contends that despite the plain language of the regulations, the 10-day notice is not required in all cases—specifically, when acute-level care is no longer medically necessary—nor must the state continue to pay for covered services…”
Rosen v. Tennessee Comm'r of Fin. & Admin., 280 F. Supp. 2d 743 (M.D. Tenn. 2002). · cites it 2× “42 C.F.R. §§ 431.230 (a) and 431.232(d). This Circuit and other courts have ruled, persons who receive benefits under the Medicaid Act are entitled to the continued receipt of Medicaid benefits pending a final determination of ineligibility.”
Centennial Spring Health Care Ctr. v. Commonwealth, 541 A.2d 806 (Pa. Commw. Ct. 1988). · cites it 2× “On the basis of this assertion, Petitioners conclude that recoupment should be made from the actual recipients of the services, and they cite as controlling a federal regulation allowing for recoupment from an applicant or recipient which regulation they contend conflicts with…”
Soltesz v. Ohio Dept. of Job & Fam. Servs., 2020 Ohio 365 (Ohio Ct. App. 2020). “] The Trial Court abused its discretion to the prejudice of the Appellant, when it dismissed the administrative appeal, where the partial record certified to the Trial Court proves that the Appellant's right to continue to receive benefits should be continued through the date of…”
Mowbray v. Kozlowski, 724 F. Supp. 404 (W.D. Va. 1989). “42 C.F.R. § 431.230 (a)(1) allows the discontinuance of services to an individual whose appeal concerns only an issue of state or federal law, and § 431.”
Olson v. Wing, 281 F. Supp. 2d 476 (E.D.N.Y 2003). “See 42 C.F.R. § 431.230 (b); N.Y. Soc. Serv. L.”
JULIA M. v. Scott, 498 F. Supp. 2d 1245 (W.D. Mo. 2007). · cites it 3× “42 C.F.R. § 431.230 . And finally, “[t]he agency must (a) Furnish Medicaid promptly to recipients without any delay caused by the agency’s administrative procedures; [and] (b) Continue to furnish Medicaid regularly to all eligible individuals until they *1248 are found to be…”
French v. Dep't of Child. & Families, 920 So. 2d 671 (Fla. 5th DCA 2006). “See 42 C.F.R. § 431.230 (a). If DCF had continued paying Gail French for personal care assistance during the pen-dency of the administrative action, there would have been no need for retroactive corrective payments in the first place.”
Moffitt v. Austin, 600 F. Supp. 295 (W.D. Ky. 1984). “42 CFR 431.230. Hearings must be at a reasonable time, date, and place, by one or more impartial officials or other individuals who have not been directly involved in the initial determi *299 nation of the action.”
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— 42 C.F.R. § 431.230(a) — 1 case
Soltesz v. Ohio Dept. of Job & Fam. Servs., 2020 Ohio 365 (Ohio Ct. App. 2020). “] The Trial Court abused its discretion to the prejudice of the Appellant, when it dismissed the administrative appeal, where the partial record certified to the Trial Court proves that the Appellant's right to continue to receive benefits should be continued through the date of…”
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