Continuing Benefits While Appeal is Pending

If benefits are being terminated or reduced, the applicant/recipient may request that benefits continue while the appeal is pending. A request for continuation of benefits must be made within ten days following issuance of the notice. See 42 C.F.R. § 431.231(c)(2). Allowance should be made in the event the Applicant’s reports late receipt of notification due to mail processing time. If the Applicant provides the envelope in which the notice was received, allow 12 days from the U.S. Postal Service date stamp to determine if benefits are to be continued. If the Applicant cannot provide the envelope in which the notice was received, allow 14 days from the date on the notice to determine if benefits are to be continued. In the event the 14th day is a weekend or holiday, allow until the close of business on the first workday following the 14th day. ABD Manual, Appendix B-2.

The Department must reinstate and continue services until a decision is rendered after a hearing if action is taken without providing the required advance notice. 42 C.F.R. § 431.231(c)(1). The Department must continue to furnish Medicaid regularly to all eligible individuals until they are found to be ineligible. 42 C.F.R. § 435.930(b).

If benefits are continued and the individual loses the appeal, the Department may take action to recover the overpayment. 42 C.F.R. § 431.230(b).