(Revised 10/1/13 ML #3390)
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(N.D.A.C. 75-02-02.1-41.2(5) & (6))
When an individual is added to a MAGI household, a new application for that individual is processed. This may affect the established household.
The following applies to individuals who applied for and were found eligible for Medicaid benefits to start prior to January 1, 2014, and to individuals who are subject to the non-MAGI methodologies. This does not apply to individuals subject to MAGI methodologies. For treatment of income under MAGI methodologies, see MAGI Income Methodologies 510-05-85-13.
- Budgeting procedures used when adding individuals to an eligible unit. Individuals may be added to an eligible unit up to one year prior to the current month, provided the individual meets all eligibility criteria for Medicaid, the eligible unit was eligible in all of the months in which eligibility for the individual is established, and the individual was in the unit in the months with respect to which eligibility for that individual is sought. Client share (recipient liability) will be based on the unit's actual income and circumstances when adding each individual for retroactive periods. Client share must be based on the unit's income and circumstances from the base month, plus the best estimate of each individual's income and circumstances when adding each individual to the current or next month.
Client share for other individuals in the Medicaid unit who were medically needy eligible may increase or decrease with the addition of the new member. Any client share, or lack of, applied to previously paid claims will not be adjusted; however, the new client share will be applied to any claims billed in the future.
Other individuals in the Medicaid unit who were previously determined to be poverty level eligible remain poverty level eligible, regardless of any income change, when adding an individual to the unit.
- Budgeting procedures when deleting individuals from a case. When a member of an existing unit is expected to leave the unit during the benefit month, that person may remain as a member of the unit until the end of the benefit month.
