Section .0100 – Coverage Groups

Link to law: http://reports.oah.state.nc.us/ncac/title 10a - health and human services/chapter 21 - medical assistance administration/subchapter b/subchapter b rules.html
Published: 2015

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subchapter 21B – eligibility determination

 

SECTION .0100 – COVERAGE GROUPS

 

10A NCAC 21B .0101       MANDATORY (TRANSFERRED TO 10A nCAC 23D

.0101)

10A ncac 21B .0102       OPTIONAL

(TRANSFERRED TO 10A NCAC 23D .0102)

 

SECTION .0200 ‑ APPLICATION PROCESS

 

10A NCAC 21B .0201       ACCEPTANCE OF APPLICATION (TRANSFERRED

TO 10A NCAC 23C .0101)

 

10A NCAC 21B .0202       face-to-face INTERVIEW (TRANSFERRED TO

10A NCAC 23C .0102)

 

10A NCAC 21B .0203       APPLICATION PROCESSING STANDARDS

(TRANSFERRED TO 10A NCAC 23C .0201)

 

10A NCAC 21B .0204       EFFECTIVE DATE OF ASSISTANCE

(a)  The first month of Medicaid coverage shall be:

(1)           The month of application, or for SSI

recipients, the month of application for SSI; or

(2)           As much as three months prior to the month

of application when the client received medical services covered by the program

and was eligible during the month or months of medical need; or

(3)           If the client applies prior to meeting a

non‑financial requirement, no earlier than the calendar month in which

all non‑financial requirements are met.

(b)  Assistance shall be authorized beginning on the first

day of the month except when:

(1)           The client's income exceeds the income

level and he must spenddown the excess income for medical care.  The assistance

shall be authorized on the day his incurred medical care costs equal the amount

of the excess income.

(2)           For groups identified in Rule .0311,

Sub-item (3)(a) of this Subchapter, the client shall be authorized on the day

the reserves are reduced, or incurred medical care costs equal the amount of

the excess income, whichever occurs later.

(c)  Medicaid coverage shall end on the last day of the last

month of eligibility except for those individuals eligible for emergency

conditions only as described in 10A NCAC 23E .0102.  The last month of

eligibility shall be:

(1)           The month in which timely notice of

termination expires; or

(2)           The month in which adequate notice of

termination expires.

 

History Note:        Authority

G.S. 108A‑54; 42 C.F.R. 435.914; 42 C.F.R. 435.919; Alexander v. Bruton

Consent Order dismissed Effective February 1, 2002;

Eff. September 1, 1984;

Amended Eff. January 1, 1995; October 1, 1991; August 1,

1990;

Temporary Amendment Eff. March 1, 2003;

Amended Eff. August 1, 2004.

 

10A NCAC 21B .0205       RECOMMENDATION FOR DISPOSITION

(TRANSFERRED TO 10A NCAC 23C .0103)

 

10A NCAC 21B .0206       DISPOSITION (TRANSFERRED TO 10A NCAC 23C

.0104)

 

10A NCAC 21B .0207       REFERRALS at a face-to-face interview

(TRANSFERRED TO 10A NCAC 23C .0105)

 

10A NCAC 21B .0208       MANDATORY USE OF OUTREACH LOCATIONS

(TRANSFERRED TO 10A NCAC 23C .0106)

 

10A NCAC 21B .0209       hours for accepting financial and

medical assistance applications (TRANSFERRED TO 10A ncac 23c .0107)

 

SECTION .0300 ‑ CONDITIONS FOR ELIGIBILITY

 

10A NCAC 21B .0301       AGE (TRANSFERRED TO 10A NCAC 23E .0101)

 

10A NCAC 21B .0302       UNITED STATES CITIZEN (TRANSFERRED TO

10A NCAC 23E .0102)

 

10A NCAC 21B .0303       RESIDENCE (TRANSFERRED TO 10A NCAC 23E

.0103)

 

10A NCAC 21B .0304       DEPRIVATION (TRANSFERRED TO 10A NCAC 23E

.0104)

 

10A NCAC 21B .0305       DISABILITY (TRANSFERRED TO 10A NCAC 23E

.0105)

 

10A NCAC 21B .0306       BLINDNESS (TRANSFERRED TO 10A NCAC 23E

.0106)

 

10A NCAC 21B .0307       CARETAKER RELATIVE (TRANSFERRED TO 10A

nCAC 23E .0107)

 

10a NCAC 21B .0308       INMATE OF PUBLIC INSTITUTION OR PRIVATE

PSYCHIATRIC HOSPITAL (TRANSFERRED TO 10A nCAC 23E .0108)

 

10A NCAC 21B .0309       APPLYING FOR ALL BENEFITS AND ANNUITIES

(TRANSFERRED TO 10A NCAC 23E .0201)

 

10A NCAC 21B .0310       RESERVE (TRANSFERRED TO 10A NCAC 23E

.0202)

 

10A NCAC 21B .0311       TRANSFER OF RESOURCES

In accordance with 42 U.S.C. 1396p(c), an individual who

transfers resources and receives compensation that is less than the fair market

value shall be ineligible to receive nursing facility services or in-home health

services and supplies, as follows:

(1)           As provided for by P.L. 100‑360, Section

303(g) amended by P.L. 100‑485, Section 608(d)(16)(D), the provisions of

42 U.S.C. 1396p(c) shall be effective for all transfers of resources, including

transfers of tenancy-in-common interest in real property, when requesting

nursing facility services, for a level of care in a medical institution

equivalent to that of a nursing facility services, or for home and

community-based services, except transfers between spouses, occurring on or

after July 1, 1988.  The provisions of 42 U.S.C. 1396p(c) shall be effective

for transfers between spouses, occurring on or after October 1, 1989.

(2)           As allowed under 42 U.S.C. 1396p(c)(2)(D), the

provisions of 42 U.S.C. 1396p(c) for ineligibility for nursing services due to

transfer of resources shall not be applied:

(a)           To individuals who transferred resources

after July 1, 1988 and before March 15, 1989 and were found eligible prior to

March 15, 1989;

(b)           When it is determined by the agency's

judgment that the applicant or recipient is a victim of fraud and did not take

the action with the intent of becoming eligible for Medicaid.

(3)           In accordance with

42 USC 1396p(c), an Aged, Blind, or Disabled individual (42 CFR 435.120) or

Qualified Medicare Beneficiary as described in (1905(p)(1) in a private living

arrangement who transfers resources and receives compensation that is less than

fair market value shall be ineligible to receive in-home health services and

supplies (1905(a)(7) and 1905(a)(24) of the Social Security Act in accordance

with this item.  These provisions do not apply to optional State Supplements

(42 CFR 435.130).  The provisions of 42 USC 1396p(c) shall be effective for all

transfers occurring on or after February 1, 2003.  As allowed under 42 USC

1396p(c), the provisions for ineligibility for these services due to transfer

of resources shall not be applied;

(a)           to the individuals who referenced in this

Paragraph transferred resources prior to February 1, 2003, and were found

eligible either before or after February 1, 2003;

(b)           when it is determined by the agency's

judgment that the applicant/recipient is a victim of fraud.

 

History Note:        Authority G.S. 108A‑54; 108A‑58;

P.L. 100‑360; P.L. 100‑485; 42 U.S.C. 1396p(c); 42 C.F.R. 435.121;

42 C.F.R. 435.840; 42 C.F.R. 435.841; 42 C.F.R. 435.845; S.L. 2002-126;

Eff. September 1, 1984;

Amended Eff. December 1, 1991; August 1, 1990;

Temporary Amendment Eff. April 21, 2003; March 1, 2003;

Amended Eff. August 1, 2004.

 

10A NCAC 21B .0312       INCOME (TRANSFERRED TO 10A NCAC 23E

.0203)

 

10A NCAC 21B .0313       PERSONAL NEEDS ALLOWANCE (TRANSFERRED TO

10A nCAC 23E .0204)

 

SECTION .0400 ‑ BUDGETING PRINCIPALS

 

10A NCAC 21B .0401       BUDGET UNIT MEMBERSHIP (TRANSFERRED TO

10A NCAC 23E .0205)

 

10A NCAC 21B .0402       FINANCIAL RESPONSIBILITY AND DEEMING

(TRANSFERRED TO 10A NCAC 23E .0206)

 

10A NCAC 21B .0403       RESERVE (TRANSFERRED TO 10A NCAC 23E

.0207)

 

10A NCAC 21B .0404       INCOME (TRANSFERRED TO 10A NCAC 23E

.0208)

 

10A NCAC 21B .0405       CERTIFICATION AND AUTHORIZATION

(TRANSFERRED TO 10A NCAC 23G .0101)

 

10A NCAC 21B .0406       DEDUCTIBLE (TRANSFERRED TO 10A NCAC 23E

.0209)

 

10a NCAC 21B .0407       PATIENT LIABILITY (TRANSFERRED TO 10A

NCAC 23E .0210)

 

10A NCAC 21B .0408       CLASSIFICATION (TRANSFERRED TO 10A NCAC

23D .0201)

 

10A NCAC 21B .0409       CHANGE IN SITUATION (TRANSFERRED TO 10A

nCAC 23G .0304)

 

10A NCAC 21B .0410       ALIEN SPONSOR DEEMING (TRANSFERRED TO

10A NCAC 23E .0211)

 

SECTION .0500 ‑ REDETERMINATION

 

10A NCAC 21B .0501       TIME AND CONTENT (TRANSFERRED TO 10A

NCAC 23G .0301)

 

10A NCAC 21B .0502       INTERVIEW (TRANSFERRED TO 10A NCAC 23G

.0302)

 

10a NCAC 21B .0503       RECOMMENDATION (TRANSFERRED TO 10A NCAC

23G .0303)