Need 510-05-35-35

(Revised 11/1/06 ML #3047)

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(N.D.A.C. Section 75-02-02.1-11)

 

Need is a factor of eligibility. Need in this sense is not to be confused with the necessity for a particular medical service.

1. Need is established for individuals who are determined to be categorically needy, optionally categorically needy, or poverty level eligible.

2. For a medically needy applicant or recipient, need is established when there is no recipient liability or when the applicant or recipient has incurred medical expenses for which the applicant or recipient is responsible (after any third party payments) that equal or exceed the recipient liability. If there is no need, there is no eligibility, and the application must be denied or the case must be closed.

3. When financially eligible individuals (individuals in subsection 1 or those in subsection 2 with no recipient liability) are not utilizing the program, assistance may be terminated if a written request is obtained from the recipient. An oral request will also suffice if recorded in the case file narrative and reflected on the closing notice, which must be mailed to the recipient.