10-144-332 Me. Code R. § 2-8

Current through 2024-51, December 18, 2024

Section 144-332-2-8 - GOOD CAUSE

I. Applicant/Participant Rights

A. Every Medicaid or CHIP applicant or recipient may claim good cause for refusing to cooperate with TPL, medical support, or cooperating with the Department's establishment of medical support from the non-custodial parent. When the individual claims good cause, sanctions are not implemented unless it is finally determined that good cause does not exist.

B. Applicants receive an explanation of cooperation requirements, sanctions, and the right to claim good cause. The Department may attempt to establish paternity and collect medical support in cases where there is no risk to the individual or children.

C. If good cause is not granted, the individual is given the opportunity to withdraw from the benefit or provide additional information to substantiate the claim. If good cause is granted, no referral is made.

II. Acceptable Reasons for Good Cause

Good cause for not cooperating with TPL, medical support, or establishment of medical support from the non-custodial parent may be claimed by the individual if the individual can demonstrate that -

A. cooperation may reasonably be anticipated to result in physical or emotional harm to the child or physical or emotional harm to the caretaker relative which would hinder the ability to care for the child,

B. legal proceedings for adoption of the child are pending before a court or the individual has been working with a social agency to decide whether to relinquish the child for adoption, or

C. the child was conceived as the result of rape or incest.

III. Verification of Good Cause

Documents from court records, law enforcement agencies, medical sources, social service agencies and any other legal document may be used to substantiate rape, adoption and physical or emotional harm to the child or caretaker relative. If such documents are unavailable, information may be secured from other sources familiar with the claims of the individual. The Department should assist the individual in obtaining the required evidence, but no contact with collateral sources will be made without the individual's knowledge and consent.

If the individual thinks that attempts to establish paternity or collect support would pose a risk to the individual or children, the individual must provide evidence to substantiate the claim of good cause not to cooperate.

The Department may make contact with the absent parent or putative father only if it is essential to the claim for good cause. The Department shall not make contact until the applicant or recipient has the opportunity to -

A. present additional evidence or information which makes contact with the absent parent or putative father unnecessary;

B. withdraw the application for assistance, or have the case closed; and

C. have the good cause claim denied.

IV. Good Cause Determinations

A. The Department determines whether an applicant's request for good cause is approved or denied. This decision, and the reason for the decision, are documented by the Department and provided to the individual in writing.

B. If good cause is not granted and the individual continues to refuse to cooperate, sanctions are applied to the individual, and the TPL unit and DSER proceed to establish medical support from the non-custodial parent without the individual's cooperation.

10-144 C.M.R. ch. 332, § 2-8