(Revised 10/1/13 ML #3390)
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(N.D.A.C. Section 75-02-02.1-10)
- Current eligibility may be established from the first day of the month in which the signed application was received, or in the case of an application received through the Low Income Subsidy file of the Medicare Savings Program, the date the Social Security Administration received the Low Income Subsidy application. This provision does not apply to Qualified Medicare Beneficiaries. Eligibility for those applying under the Adult Expansion Group received between October 1, 2013 and December 31, 2013 will be determined for coverage to begin January 1, 2014.
- 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. This provision does not apply to individuals eligible only under the Adult Expansion group for the months of October, November, or December 2013 or to Qualified Medicare Beneficiaries.
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.
Applications for MAGI households received in January, February or March, 2014 that request prior month coverage for October, November or December will have their prior month eligibility processed under non-MAGI rules.
Retroactive eligibility for the expansion group will be covered as fee for service by the participating insurance carrier. Individuals eligible only under the adult expansion group do not have eligibility for October, November, or December, 2013.
- 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:
- An individual is born in the month, in which case the date of birth is the first date of eligibility;
- 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
- An individual is discharged from a public institution, in which case the earliest date of eligibility is the date of discharge.
- Eligibility for Qualified Medicare Beneficiaries begins in the month following the month in which the eligibility determination is made (e.g. the application is received on March 29, eligibility is determined in April, the first month of QMB eligibility is May)
- An individual cannot be eligible as a Qualifying Individual and be eligible under any other Medicaid coverage for the same period of time
- A child cannot be eligible for Medicaid for the same period of time the child is covered under the Healthy Steps Program.
- For an ongoing medical case, coverage may be added retroactively up to 12 months for a non-covered household member. This provision does not apply to Qualified Medicare Beneficiaries.
- The individual must have lived in the household during the months requested.
- This includes adding SLMB coverage to an individual’s ongoing Medicaid-only case, or adding Medicaid coverage to an individual’s ongoing SLMB case.
