Eligibility - Current and Retroactive 510-03-25-10

(New 7/1/2014 ML #3404)

View Archives

 

 

(N.D.A.C. Section 75-02-02.1-10)

 

1. Current eligibility may be established from the first day of the month in which the signed application was received.

2. Retroactive eligibility may be established for as many as three calendar months prior to the month in which the signed application was received. Eligibility can be established if all factors of eligibility are met during each month of retroactive benefits. If a previous application has been taken and denied in the same month, eligibility for that entire month may be established based on the current application. Retroactive eligibility may be established even if there is no eligibility in the month of application.

Note: This provision does not apply to individuals eligible only under the Adult Expansion Group for the months of October, November, or December 2013.

All case records shall be documented to reflect eligibility or ineligibility for each individual month assistance is requested prior to and through the month in which the application is processed.

 

Services received by individuals eligible under the Adult Expansion Group will be covered as ‘fee for service’ by the participating insurance carrier for all months prior to and including the month the eligibility determination is entered into the eligibility system. Coverage of services under the insurance plan will begin the 1st day of the month following the month the eligibility determination is entered into the eligibility system.

3. An individual determined eligible for part of a month is eligible for the entire calendar month unless a specific factor prevents eligibility during part of that month. Examples of specific factors include:

1. An individual is born in the month, in which case the date of birth is the first date of eligibility;
2. An individual enters the state, in which case the earliest date of eligibility is the date the individual entered the state unless still receiving Medicaid benefits from another state. Information regarding the date Medicaid benefits from the other state are no longer available should be established in order to determine the beginning date of eligibility in North Dakota; or
3. An individual is discharged from a public institution, in which case the earliest date of eligibility is the date of discharge.

4. A child cannot be eligible for Medicaid for the same period of time the child is covered under the Healthy Steps Program.

5. For an ongoing Medicaid case, coverage may be added retroactively up to 12 months for a non-covered household member, provided the individual lived in the household during the months requested.

Note: Coverage under the Adult Expansion Group cannot begin prior to January 1, 2014.