October 4, 2004

(Recipient name)
(Recipient address)
(Rec. City/State/Zip)

CONTINUATION OF MEDICAID BENEFITS

On September 20, 2004, the North Dakota Department of Human Services notified you that unless Congress acted, your Medicaid coverage under the Qualifying Individual coverage group would end September 30, 2004.  Thankfully, Congress has extended funding for this Medicare Part B premium assistance program through November 20, 2004. 

You do not need to take any action.  This letter is to notify you that the Medicaid coverage for your Medicare Part B premium will continue. 

If you have any questions about this program and your coverage, please contact me

(Eligibility worker name)
(County Social Service Office)
(County phone #)