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When a customer is no longer eligible for a Medical Assistance (MA) program, benefits must be stopped.
Eligibility is stopped when:
The customer or representative does not provide proof needed to determine eligibility, does not cooperate in resolving discrepancies, or provides inconsistent or unclear information;
The customer no longer meets a requirement for the current MA program;
The customer dies (MA1502G);
The customer asks for MA benefits to be stopped (MA1502BB); or
Agency mail is returned by the post office as undeliverable, and the customer cannot be located to determine residency (MA1502Q).
When benefits for a customer with a Special Treatment Trust (MA803A) are stopped for any reason, the AHCCCS Division of Business and Finance (DBF) must be notified. See Notifying DBF of Events Affecting a Special Treatment Trust for instructions.
Information may be provided before the date that MA benefits stop that could change the decision to stop benefits. In this case, the customer’s eligibility is re-evaluated. See the following table for examples:
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MA is stopping because… |
And before the MA benefit end date… |
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Proof was not provided |
The proof requested is received. |
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The customer did not meet an MA requirement |
A change is reported showing that the customer meets the requirement. |
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The customer asked that MA benefits be stopped |
The customer contacts the Benefits and Eligibility Specialist and asks for MA benefits to continue. |
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Returned mail was received from the Post Office |
The customer contacts the Benefits and Eligibility Specialist and provides current address information. |
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Term |
Definition |
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Discontinuance |
A customer’s MA benefits are stopped. |
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Program |
Legal Authorities |
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All Programs except KidsCare |
42 CFR 435.916(c), (d) and (f) |
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KidsCare |
42 CFR 457.343 |