Application and Decision 510-05-25

 

Application and Redetermination 510-05-25-05

(Revised 1/1/10 ML #3205)

IM 5068

View Archives

 

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

 

 

  1. Application.

  1. All individuals wishing to make application for Medicaid must have the opportunity to do so, without delay.

  2. A relative or other interested party may file an application in behalf of a deceased individual to cover medical costs incurred prior to the deceased individual's death.

  3. An application is a request for assistance on:

  1. SFN 405, "Application for Economic Assistance Programs";

  2. SFN 502, "Application for HealthCare Coverage for Children, Families, and Pregnant Women";

  3. SFN 641, "Title IV-E/Title XIX Application-Foster Care";

  4. SFN 1803, "Subsidized Adoption Agreement";

  5. SFN 958, "Health Care Application for the Elderly and Disabled";

  6. The Department’s system generated "Statement of Facts";

  7. The Department's online "Application for Economic Assistance Programs";

  8. The Low Income Subsidy file from SSA;

  9. If within one calendar month of when an applicant's Medicaid case was closed, one of the prescribed redetermination forms (see subsection 2(b); or

  10. Applications provided by disproportionate share hospitals or federally qualified health centers are SFN 405 with "HOSPITAL" stamped on the front page.

  1. A prescribed application form must be signed by the applicant, an authorized representative or, if the applicant is incompetent or incapacitated, someone acting responsibly for the applicant.

  2. The date of application is the date an application, signed by an appropriate person, is received at a county agency, the Medical Services Division, a disproportionate share hospital, or a federally qualified health center. The date received must be documented.

  3. An application is required to initially apply for Medicaid, to re-apply after a Medicaid application was denied, to re-apply after a Medicaid case has closed, or to open a new Medicaid case for a child who has been adopted through the state subsidized adoption program.

  4. A recipient may choose to have a face-to-face or telephone interview when applying for Medicaid; however, none are required in order to apply for assistance.

  5. Information concerning eligibility requirements, available services, and the rights and responsibilities of applicants and recipients must be furnished to all who require it.

  1. Redetermination.

  1. A recipient has the same responsibility to furnish information during a redetermination as an applicant has during an application.

  2. A redetermination must be completed at least annually using the Department's:

  1. System generated "Monthly Report";

  2. System generated "Redetermination of Eligibility;"

  3. SFN 407, "Redetermination for Healthcare Coverage";

  4. SFN 642, "Title IV-E/Title XIX Redetermination-Foster Care" for children in Foster Care;

  5. SFN 856, "Adoption Subsidy Agreement - Annual Review" for subsidized adoption; or

  6. One of the previously identified applications completed to apply for another program.

In circumstances where a desk review is appropriate, such as when adding a child, or adding Medicare Savings Programs coverage, to an existing case in which the county agency has all information needed to complete a redetermination, eligibility may be established without a redetermination form. In unique circumstances, when the county agency has all information needed to complete a redetermination, and circumstances prevent a recipient or their representative from timely returning the redetermination form, continued eligibility may be established without a completed form.

  1. A redetermination must be completed within thirty days after a county agency has received information indicating a possible change in eligibility status, when eligibility is lost under a category (e.g. Transitional Medicaid Benefits), or when adding an individual to an existing Medicaid case. When the county agency has all information needed to redetermine eligibility based on a change in circumstances, a redetermination form does not have to be completed. When additional information is needed one of the forms identified in b. must be used.

  2. A redetermination, using one of the forms identified in b, is required to open a new Medicaid case for recipients (other than children who are adopted through the state subsidized adoption program, which requires an application) who move from an existing case to their own case (e.g. an 18 year old caretaker moves to her own case; a disabled child turns age 18; or a child goes into foster care).

  3. A recipient may choose to have a face-to-face or telephone interview for their redetermination; however, none are required in order to complete a redetermination.