NC S1320

Establishes a permanent appeals process for Medicaid applicants and recipients to challenge Department determinations to deny, terminate, suspend, or reduce covered services.

Requires the Department to provide written notice at least 10 days before an adverse determination takes effect, including explanation of the action, applicable regulations, appeal rights, and contact information for Legal Aid services.

Allows applicants or recipients to request a hearing before an administrative law judge within 30 days of notice; services continue at prior levels until the hearing is completed if timely appeal is filed.

Directs the Office of Administrative Hearings to schedule contested Medicaid cases within 45 days and allows simplified procedures; requires the Mediation Network to offer mediation within 5 days of appeal request.

Establishes burden of proof standards: petitioner bears burden when requesting a benefit; agency bears burden when appealing a reduction, termination, or suspension of previously granted benefits.