Revision 25-2; Effective March 31, 2025
Case Action | Date Form Is Mailed or Given to Applicant or Recipient | Effective Date to be Entered on Form 2065-A, Notification of Community Care Services |
---|---|---|
If application is denied, includes when the applicant is denied for one service that was requested but granted another service: | Within two business days of denial. | Not applicable for denials. |
If application is certified: | Within two business days of certification. | The effective date is the date on Form 2064, Eligibility Worksheet, or the negotiated date. The effective date for Primary Home Care (PHC), Community Attendant Services (CAS) and Title XIX Day Activity and Health Services (DAHS) cases is not applicable. Check the pending box to show eligibility is contingent on medical approval. For Residential Care (RC) cases where the applicant is determined eligible for Emergency Care, enter the date the applicant was determined eligible. |
If a verbal referral is necessary or priority status is added: | Within two business days of certification. | The date is negotiated with the provider for PHC, Family Care (FC) and CAS. |
If there is:
| Within two business days of the decision. | The date the action is completed is the date the change goes into effect. |
If there is an increase in units: | Within two business days of the decision. | The date must be seven calendar days or earlier if negotiated after the date on Form 2101, Authorization for Community Care Services |
If services are decreased or terminated because:
| Within two business days of the learned denial date | The last day of the final month of CAS eligibility as determined by the Medicaid for the Elderly and People with Disabilities (MEPD) staff. |
| Not applicable. | No notice is sent in this situation. |
| 12 calendar days before the case is closed. | 12 calendar days following the date Form 2065-A is mailed.* |
| Before the date of action. | Services continue only through the termination date of the categorical recipient group, even if appealed. |
| 12 calendar days before the case is closed and only at annual review. | 12 calendar days following the date Form 2065-A is mailed.* |
| Within two business days of the date information that a nursing facility stay is permanent or notification of the effective date. | The date the recipient entered the facility. |
| Within two business days of the date information is received. | The date CCSE staff become aware of the action. Services are not reinstated before the outcome of the appeal hearing. |
| Within two business days of the date information is received. | The last date of eligibility for Medicaid. |
| Not applicable. | Not applicable. |
If services are decreased or terminated for any reason not given above: | at least 12 calendar days before services are decreased or terminated. | 12 calendar days following the date Form 2065-A is mailed *, unless the recipient:
In some cases, the recipient might request a specific effective date. |
*For decreases if the last day of any period is a Saturday, Sunday, or a legal holiday, the period is extended to include the next day that is not a Saturday, Sunday, or a legal holiday. Skeleton crew days are not legal holidays. Legal holidays are days when the agency is closed.
Refer to the instructions for Form 2065-A for the procedures to follow when a recipient requests a hearing in writing or in person.
Notes:
- For terminations, the effective date on Form 2065-A must be the same as the End Date on Form 2101.
- Do not send Form 2065-A when a recipient’s forwarding address is unknown, such as situations when the post office sends notification that the recipient left no forwarding address.
- Send Form 2065-A when a recipient is transferring from one service to another, whether or not the change is considered positive or negative.