§ 25.5-4-104 — State medical assistance program - single state agency

(1)
The state department, by rules, shall establish a program of medical assistance to
provide necessary medical care for the categorically needy. The state department
is designated as the single state agency to administer the medical assistance
program in accordance with Title XIX of the federal Social Security Act and this
article 4 and articles 5 and 6 of this title 25.5. The program is not required to
furnish to members under sixty-five years of age the benefits that are provided to
members sixty-five years of age and over under Title XVIII of the federal Social
Security Act, but the medical assistance program must otherwise be uniform to
the extent required by Title XIX of the federal Social Security Act.

(2) The state department may review any decision of a county department
and may consider any application upon which a decision has not been made by the
county department within a reasonable time to determine the propriety of the
action or failure to take timely action on an application for medical assistance. The
state department shall conduct any additional investigation the state department
deems necessary. After giving the county department an opportunity to rebut the
state department's findings or conclusions that the action or delay in taking action
was a violation of or contrary to state department rules, the state department shall
make a decision whether to grant medical benefits and the amount of medical
benefits pursuant to this article 4 and articles 5 and 6 of this title 25.5 and the rules
of the state department. Applicants or members affected by the state department's
decisions, upon request, must be given reasonable notice and opportunity for a fair
hearing by the state department.

Legislative History

Source: L. 2006: Entire article added with relocations, p. 1819, � 7, effective July 1. L. 2024: Entire section amended, (SB 24-176), ch. 152, p. 622, � 19, effective August 7.