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)
