reglab/statecodes huggingface dataset:
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 5 - CITIZENSHIP/ALIEN STATUS AND IDENTITY › Section 477-5-003 - MEDICAID FOR CERTAIN CHILDREN AND PREGNANT WOMEN

Current through June 17, 2024
A child or pregnant woman may be eligible if he or she is a Nebraska
	 resident and is lawfully present in the United States. A child or pregnant
	 woman is considered lawfully present if he or she is:
(A) A qualified non-citizen as defined in
  section 431 of the Personal Responsibility and Work Opportunity Reconciliation
  Act (PRWORA) (8 U.S.C. §
										1641) ;
(B) A non-citizen in nonimmigrant status who
  has not violated the terms of the status under which he or she was admitted or
  to which he or she has changed after admission;
(C) A non-citizen who has been paroled into
  the United States pursuant to section 212(d)(5) of the Immigration and
  Nationality Act (INA) (8
  U.S.C. §
										1182(d)(5))
  for less than one year, except for a non-citizen paroled for prosecution,
  deferred inspection, or pending removal proceedings;
(D) A non-citizen who belongs to one of the
  following classes:
(i) Non-citizens currently
  in temporary resident status, pursuant to section 210 or 245A of the
  Immigration and Nationality Act (INA) (8 U.S.C. §§
											1160 or
  1255a, respectively);
(ii) Non-citizens currently under temporary
  protected status, pursuant to section 244 of the Immigration and Nationality
  Act (INA) (8 U.S.C. §
											1254a) , and pending applicants for temporary
  protected status who have been granted employment authorization;
(iii) Non-citizens who have been granted
  employment authorization under
  8 CFR
  274 a.12(c)(9), (10), (16), (18), (20), (22),
  or (24);
(iv) Family Unity
  beneficiaries pursuant to
  section
  301 of Pub.L.
				101-649, as amended;
(v)
  Non-citizens currently under Deferred Enforced Departure (DED), pursuant to a
  decision made by the President;
(vi) Non-citizens currently in deferred
  action status, not including Deferred Action for Childhood Arrival (DACA);
  or
(vii) Non-citizens whose visa
  petition has been approved and who have a pending application for adjustment of
  status;
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 5 - CITIZENSHIP/ALIEN STATUS AND IDENTITY › Section 477-5-005 - VERIFICATION OF CITIZENSHIP AND NON-CITIZEN STATUS

Current through June 17, 2024
When an applicant or clients states one or more of the unit members is
	 a non-citizen, the applicant or client is required to present verification for
	 each non-citizen member. The non-citizen status must be verified using the
	 Federal Data Services hub. If the hub is not available to verify citizenship
	 and non-citizen status, the Systematic Alien Verification for Entitlements
	 Program System of Records (SAVE), or receipt of Supplemental Security Income
	 (SSI), Social Security Disability Insurance (SSDI), or Medicare is sufficient
	 proof of citizenship or lawfully admitted non-citizen status.
005.01
FAILURE TO
  COOPERATE.
If the applicant or client fails to cooperate in
  providing documentation, the applicant or client is ineligible.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 5 - CITIZENSHIP/ALIEN STATUS AND IDENTITY › Section 477-5-006 - REASONABLE OPPORTUNITY PERIOD

Current through June 17, 2024
Applicants or clients who attest to being United States citizens or
	 eligible non-citizens, and meet all other eligibility requirements must be
	 given a reasonable opportunity to present satisfactory documentation of
	 citizenship or non-citizen status. Medical benefits must not be denied,
	 delayed, reduced, or terminated during the reasonable opportunity period. If
	 the Department has requested verification, such as an out-of-state birth
	 certificate, benefits will not be denied or terminated while awaiting receipt.
	 Once an individual has declared himself or herself a United States citizen or
	 eligible non-citizen and has provided all other information to determine
	 eligibility, benefits must be provided.
006.01
DURATION OF REASONABLE
  OPPORTUNITY.
A 90-day timeframe is given to verify an individual's
  attested citizenship or satisfactory non-citizen status if the Department or
  applicant or client cannot provide verification. A notice will be sent to
  inform the applicant or client of the reasonable opportunity period. The
  reasonable opportunity period extends 90 days from the date on which the notice
  is received by the applicant or client, which means five days after the date of
  the notice unless the applicant or client shows he or she did not receive the
  notice within the five-day period. If citizenship or immigration status has not
  been verified by the end of the reasonable opportunity period, Medicaid
  benefits will be terminated. If the individual appeals the case closure, the
  Medicaid case is not subject to reinstatement pending the outcome of a fair
  hearing. The reasonable opportunity period encompasses all aspects of the
  process to verify citizenship or immigration status, including not only time
  for an individual to provide documentation but also time for the Department to
  resolve inconsistencies or conclude the electronic verification
  process.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 5 - CITIZENSHIP/ALIEN STATUS AND IDENTITY › Section 477-5-007 - REPATRIATION PROGRAM

Current through June 17, 2024
The Repatriation Program provides temporary assistance, care, and
	 treatment for up to 90 days for United States citizens or dependents of United
	 States citizens who have returned from foreign countries. To qualify for
	 repatriation assistance, the individual must be returned from a foreign country
	 because he or she is destitute or ill or because of war, threat of war, or a
	 similar crisis. A request must be made by the State Department to the United
	 States Department of Health and Human Services to receive the individual in the
	 United States and to provide the necessary care, treatment, and assistance. The
	 assistance may include reception service, food, shelter, clothing, and
	 transportation. It may also include payment for special services such as
	 medical and psychiatric care. Any assistance provided through General
	 Assistance or Emergency Assistance may be reimbursed through federal funds.
	 Central Office will contact the appropriate local office on all arriving cases.
	 If it appears the individual is eligible for another form of assistance, a
	 referral must be made or an application for categorical assistance must be
	 completed.
007.01
ELIGIBILITY PERIOD.
Assistance may be provided for up
  to 90 days from the date the individual arrives in the United States. If the
  individual needs assistance beyond 90 days and is not eligible for Retirement,
  Survivors, and Disability Insurance (RSDI), Supplemental Security Income (SSI),
  or categorical assistance, the local office shall contact Central
  Office.
007.02
MEDICAL
  PAYMENTS.
All payments for medical care must be made at rates no
  higher than those paid by Medicaid.
007.03
REPAYMENT.
The individual is required to sign an agreement to repay the cost of the
  assistance provided.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 6 - STATE RESIDENCY › Section 477-6-001 - RESIDENCE

Current through June 17, 2024
To be eligible for assistance, an applicant/client must be a Nebraska
	 resident. A resident is an individual living in the state voluntarily with the
	 intent of making Nebraska his/her home. Residence starts with the month the
	 applicant/client moves into the state, even if the applicant/client received
	 categorical assistance in another state.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 6 - STATE RESIDENCY › Section 477-6-002 - RESIDENCE OF APPLICANTS ENTERING THE STATE INTO A LICENSED HOME

Current through June 17, 2024
The intent of an applicant to establish Nebraska residence must be
	 investigated if the applicant comes into the state and immediately enters a
	 home licensed by the Nebraska Department of Health and Human Services, Division
	 of Public Health (nursing home or alternate care facility).
To determine the applicant's intent to establish residence in Nebraska,
	 the applicant's purpose for entering the state must be considered.
The applicant is a Nebraska resident if his/her purpose for entering
	 the state was because s/he
1. Desired
  to be near to close friends or relatives in the state;
2. Previously resided in the state;
  or
3. Has other contacts in the
  state.
If none of these conditions exist, the applicant's intent to establish
	 residence shall be evaluated by the Department. If the applicant states that
	 s/he plans to establish residence, but the situation seems to indicate
	 otherwise, other factors are reviewed, including when the applicant entered the
	 state, whether the applicant maintains a residence or owns property (including
	 real and/or personal property) in another state, and the place of residence of
	 the applicant's spouse and other immediate family members, if any.
Relevant factors to take into consideration include if the applicant
	 was eligible for Medicaid in the state in which s/he previously resided, how
	 the applicant was referred to the facility in Nebraska, and where the applicant
	 would reside if s/he moved out of the facility in Nebraska, and any other
	 related factors.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 6 - STATE RESIDENCY › Section 477-6-003 - NON-INSTITUTIONALIZED APPLICANTS/CLIENTS

Current through June 17, 2024
003.01
Age 21 and
  Over
: For applicants/clients who are not residing in an
  institution and who are not capable of indicating intent, the state of
  residence is the state where the applicant/client is living.
003.02 If an applicant/client is under age
  twenty-one (21), not emancipated or married, and not Title IV-E eligible, the
  state of residence is the state where the individual resides, including.
1. With or without a fixed address;
  or
2. The state of residency of the
  parent or caretaker.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 6 - STATE RESIDENCY › Section 477-6-004 - INSTITUTIONALIZED APPLICANTS/CLIENTS

Current through June 17, 2024
004.01
Institutionalized
  Applicants/Clients
: The state where the institution is located is
  an institutionalized applicant/client's state of residence unless it is
  determined that the applicant/client is a resident of another state, according
  to the following: For any institutionalized applicant/client who is twenty (20)
  years old or younger, or who is twenty-one (21) years old or older and became
  incapable of indicating intent before reaching twenty-one (21) years old, the
  state of residence is
1. That of his/her
  parent(s) or his/her legal guardian at the time of placement, or
2. That of his/her parent(s) or his/her legal
  guardian if the applicant/client is institutionalized in that state.
For any institutionalized applicant/client who became incapable of
	 indicating intent at or after reaching twenty-one (21) years old, the state of
	 residence is the state in which the applicant/client is physically present
	 except where another state makes a placement.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 6 - STATE RESIDENCY › Section 477-6-005 - ABSENCE

Current through June 17, 2024
005.01
Absence From the
  State
:
The Department may not deny assistance because an individual has not
	 resided in the state for a specified period.
005.02
Temporary
  Absence
: The Department may not deny or terminate eligibility due
  to an applicant/client's temporary absence from the state, if the
  applicant/client intends to return. A temporary absence is ninety (90) days or
  less, except in extraordinary circumstances.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 7 - AGE AND DATE OF BIRTH › Section 477-7-001 - AGE REQUIREMENT/AGE LIMIT

Current through June 17, 2024
To be eligible for Medicaid or 599 CHIP, an applicant/client must meet
	 the age requirements for the applicable Medicaid category.
1. For age requirements for Children's
  Medicaid, see 477 NAC 19-003.01 and 477 NAC;
2. For 599 CHIP, see 477 NAC
  19-004.04;
3. For Former Ward, see
  477 NAC 19-005.02;
4. For Former
  Foster Care, see 477 NAC
  27-007;
5. For Aged, Blind, and Disabled (ABD), see
  477 NAC 27-001.01 and 477 NAC
  24-001.07A;
6. For Women's Cancer Program, see 477 NAC
  27-004.02; and
7. For Medically
  Needy see 477 NAC 27-005.02 and 477 NAC 27-005.02A.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 7 - AGE AND DATE OF BIRTH › Section 477-7-003 - VERIFICATION OF AGE

Current through June 17, 2024
If age is a factor for eligibility, an applicant's/client's age must be
	 verified, see Appendix 477-000-004 for the Verification Plan.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 8 - SOCIAL SECURITY NUMBER › Section 477-8-001 - REQUIREMENT OF A SOCIAL SECURITY NUMBER

Current through June 17, 2024
Each applicant for or recipient of Medicaid is required, as a condition
	 of eligibility, to
1. Furnish his/her
  Social Security number (SSN); or
2.
  Apply for an SSN with the Social Security Administration (SSA), if one has not
  been issued or is not known.
The SSN, in conjunction with other information, provides evidence of
	 identity of the individual.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 8 - SOCIAL SECURITY NUMBER › Section 477-8-002 - EXCEPTION TO REQUIREMENT OF AN SSN

Current through June 17, 2024
If an applicant/client refuses to obtain an SSN for a well-established
	 religious objection, the Department may assign the individual a unique Medicaid
	 identification number as an alternative.
002.01 Well-Established Religious Objection
An individual
1. Is a member
  of a recognized religious group or division of the group; and
2. Adheres to the tenets or teachings of the
  group or division of the group, and for that reason is conscientiously opposed
  to applying for or using a national identification number.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 8 - SOCIAL SECURITY NUMBER › Section 477-8-003 - APPLICATION FOR AN SSN

Current through June 17, 2024
An applicant who has not previously applied for an SSN shall be given
	 ninety (90) days from the date of application to verify that he/she has
	 submitted an application with the SSA. An applicant shall not be eligible after
	 the ninety (90) - day period unless verification of the application is
	 received.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 8 - SOCIAL SECURITY NUMBER › Section 477-8-004 - ASSISTANCE PENDING VERIFICATION

Current through June 17, 2024
After the applicant/client has been referred to SSA, if s/he is
	 otherwise eligible, assistance shall not be delayed, denied, or discontinued
	 pending the verification or assignment of an SSN.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 9 - NOTIFICATION › Section 477-9-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
These regulations govern the services provided under Nebraska's
	 Medicaid program as defined by the Medical Assistance Act, Nebraska Revised
	 Statute §
									68-901 et seq.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 9 - NOTIFICATION › Section 477-9-002 - TYPES OF NOTICES

Current through June 17, 2024
002.01
ADEQUATE NOTICE.
An adequate notice must include a
  statement of what action is intended, the reason for the intended action, and
  the specific supporting manual reference or the change in federal or state law
  that requires the action. An adequate notice must be sent no later than the
  effective date of the action.
002.02
TIMELY
  NOTICE.
A timely notice must be sent by the Department to the
  applicant, client, or his or her authorized representative at least ten
  calendar days before the date the action becomes effective, which is always the
  first day of the month.
002.03
ADEQUATE AND TIMELY NOTICE.
In cases of intended
  adverse action the client must be given both adequate and timely notice.
  Adverse action includes action to discontinue, terminate, suspend, or reduce
  assistance; to change the manner or form of assistance; or to change service
  provision to a more restrictive method.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 9 - NOTIFICATION › Section 477-9-003 - SITUATIONS REQUIRING ADEQUATE NOTICE ONLY

Current through June 17, 2024
In the following situations, timely notice does not apply, however,
	 adequate notice must be sent no later than the effective date of action:
(A) The Department has factual information
  confirming the death of the client;
(B) The Department receives a written and
  signed statement from the client:
(i) Stating
  that assistance is no longer required; or
(ii) Giving information that requires
  termination or reduction of assistance, and indicating, in writing, that the
  client understands the consequence of supplying the information;
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 9 - NOTIFICATION › Section 477-9-004 - WAIVER OF NOTICE

Current through June 17, 2024
If a client agrees to waive his or her right to a timely notice in
	 situations requiring timely notice, a statement signed by the client must be
	 obtained and filed in the case record.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 9 - NOTIFICATION › Section 477-9-005 - FRAUD CASES

Current through June 17, 2024
At least five days' advance written notice must be given if:
(A) The Department has facts indicating that
  action should be taken to discontinue, terminate, or reduce assistance because
  of probable fraud by the client; and
(B) The facts have been verified when
  possible through collateral sources.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 10 - FAIR HEARING PROCESSES › Section 477-10-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
These regulations govern the services provided under Nebraska's
	 Medicaid program as defined by the Medical Assistance Act, Nebraska Revised
	 Statute §
									68-901 et seq.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 10 - FAIR HEARING PROCESSES › Section 477-10-002 - RIGHT TO FAIR HEARING

Current through June 17, 2024
Every applicant or client has the right to appeal any action, inaction,
	 or failure to act with reasonable promptness by requesting a fair
	 hearing.
002.01
REASONS
  FOR APPEAL.
The applicant or client may appeal because:
(A) His or her application is
  denied;
(B) His or her application
  is not acted on with reasonable promptness;
(C) His or her Medicaid is
  suspended;
(D) His or her services
  are reduced;
(E) His or her
  Medicaid case is closed;
(F) His or
  her services are changed to be more restrictive; or
(G) He or she thinks the Department's action
  was erroneous.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 10 - FAIR HEARING PROCESSES › Section 477-10-004 - MAINTAINING SERVICES

Current through June 17, 2024
If an applicant or client submits a request for a fair hearing before
	 the effective date on the Notice of Action, the applicant or client is presumed
	 to have requested the continued receipt of any ongoing assistance pending the
	 appeal decision, unless the applicant or client otherwise
	 indicates.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 10 - FAIR HEARING PROCESSES › Section 477-10-005 - REINSTATING SERVICES

Current through June 17, 2024
The agency allows for the reinstatement and the receipt of any ongoing
	 assistance pending the appeal decision when timely notice is not given and a
	 fair hearing is requested within 10 days from the date the individual receives
	 the Notice of Action, which is considered to be five days after the date on the
	 notice.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 11 - LIVING ARRANGEMENTS › Section 477-11-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
The regulations govern the services provided under the Medical
	 Assistance Act, Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 68 901
	 et seq.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 11 - LIVING ARRANGEMENTS › Section 477-11-002 - DEFINITIONS

Current through June 17, 2024
The following definitions are used in the administration of
	 Medicaid:
002.01
INPATIENT.
A patient who has been admitted to a
  medical institution on the recommendation of a physician or dentist and is
  receiving room, board, and professional services in the institution on a
  continuous 24 hour-a-day basis.
002.02
INSTITUTION.
An establishment which furnishes, in single or multiple facilities, food and
  shelter to four or more persons unrelated to the proprietor and, in addition,
  provides some treatment or services which meet some need beyond the basic
  provision of food and shelter.
002.03
INSTITUTION FOR MENTAL
  DISEASE (IMD).
An institution of more than 16 beds which is
  primarily engaged in providing diagnosis, treatment, or care of persons with
  mental diseases. Such care includes medical attention, nursing care, and
  related services. Whether an institution is an institution for mental diseases
  is determined by its overall character as that of a facility established and
  maintained primarily for the care and treatment of individuals with mental
  diseases, whether or not it is licensed as such.
002.04
LEVEL OF
  CARE.
A category of living arrangement. Levels of care funded by
  Medicaid include nursing facility (NF), intermediate care facility for
  individuals with developmental disabilities (ICF/DD), acute hospital, and
  institution for mental disease (IMD).
002.05
MEDICAL
  INSTITUTION.
An institution which is organized to provide medical
  care, including nursing and convalescent care, and has the necessary
  professional personnel, equipment, and facilities to manage the medical,
  nursing, and other health needs of patients on a continuing basis in accordance
  with accepted standards. The institution must be authorized under state law to
  provide medical care.
002.06
PUBLIC INSTITUTION.
An institution which is the
  responsibility of a governmental unit, or over which a governmental unit
  exercises administrative control.
002.07
PUBLICLY OPERATED
  COMMUNITY RESIDENCE.
A publicly operated residence to serve no
  more than 16 residents and provide some services beyond food and shelter, such
  as social services, help with personal living activities, or training in
  socialization or life skills. Occasional or incidental medical or remedial care
  may also be provided.
002.07(A)
EXCEPTIONS.
The following facilities are not
  considered publicly operated community residences, even if their accommodations
  are for 16 or fewer residents:
(i) Residential
  facilities adjacent to any large institution or multi-purposes
  complex;
(ii) Education or
  vocational training institutions;
(iii) Correctional or holding facilities for
  individuals whose personal freedom is restricted because of a court sentence,
  holding, or pending disposition; and
(iv) Medical treatment facilities such as
  hospitals and skilled nursing facilities.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 11 - LIVING ARRANGEMENTS › Section 477-11-003 - LIVING ARRANGEMENTS

Current through June 17, 2024
003.01
ELIGIBLE LIVING ARRANGEMENTS.
An applicant or client
  is eligible regardless of his or her living arrangement.
003.01(A)
INSTITUTIONALIZED
  INDIVIDUALS.
An inmate of a public institution, as defined by 42
  Code of Federal Regulations (CFR) 435.1009, who meets inpatient status in a
  medical institution, as defined by
  42 CFR
  435.1010, and who is otherwise eligible may
  only receive payment for services received during his or her inpatient stay
  over 24 hours.
003.01(A)(i)
EXCEPTION.
This does not apply to infants or young
  children who reside with their mother at the Nebraska Correctional Center for
  Women.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 11 - LIVING ARRANGEMENTS › Section 477-11-004 - ABSENCE

Current through June 17, 2024
004.01
ABSENCE BECAUSE OF
  SCHOOLING.
The child's absence from home for the purpose of
  attending school does not affect eligibility.
004.02
TEMPORARY ABSENCE FROM THE
  HOME.
A child is still considered part of the household while he
  or she is out of the home for a visit not to exceed three months. A child is
  still considered part of the original household while he or she is on summer
  visitation.
004.03
TEMPORARY ABSENCE DUE TO EMERGENCY SITUATIONS.
In
  emergency situations which deprive a child of the care of a parent relative,
  guardian, or conservator, temporary plans may be made to care for the child in
  the home of an individual or institution acting in the place of the caretaker.
  The unit may continue to receive assistance for the period of the emergency or
  the time actually required to make new arrangements for care, but the
  assistance must not continue beyond three months.
004.04
CONVALESCENT
  LEAVE.
Eligibility for individuals on convalescent leave or visit
  from public medical institutions is determined in accordance with the
  applicable program standards. Eligibility is based on an individual's living
  situation and needs while on leave.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-001 - ASSIGNMENT OF THIRD PARTY RESOURCES

Current through June 17, 2024
See 471 NAC 3-004.
The assignment of third-party resources gives the Department the right
	 to pursue and receive payments from any third party liable to pay for the cost
	 of medical care and services for the client or for any other household member,
	 and which otherwise would be covered by Medicaid. The assignment of the rights
	 to third party medical payments is effective with the date of Medicaid
	 eligibility.
For Medicaid cases with a share of cost, the assignment becomes
	 effective the first day of the month when the case status changes to "Share of
	 Cost Met."
For third party payments received directly see Appendix
	 477-000-015.
12-001.01
Third-Party Payments Not Assigned
: The following
  third-party payments are not subject to the automatic assignment provision:
1. Medicare benefits; and
2. Payments from income-producing policies
  that subsidize the client's income while s/he is hospitalized or receiving
  care, regardless of the type of medical service being provided.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-002 - CLIENT COOPERATION

Current through June 17, 2024
12-002.01
Client Cooperation
  Required
: As a condition of eligibility, a client must cooperate
  in obtaining third-party resources unless s/he has good cause for
  noncooperation. Cooperation includes any or all of the following:
1. Providing complete information regarding
  the extent of third-party resources that s/he or any other household member has
  or may have. This includes coverage provided by a person not in the household
  or by an agency;
2. Providing any
  additional information or signing claim forms that may be necessary for
  identification and collection of potential third-party payments;
3. Appearing as a witness in a court or
  another proceeding, if necessary;
4. Notifying the Department of any action
  s/he is initiating to recover money from a liable third-party for medical care
  or services. This includes the identity of the third-party, as well as the
  entire amount of any settlement, court award, or judgment;
5. Reimbursing the Department or paying to
  the provider any payments received directly from a third-party for any services
  payable by Medicaid; and
6. Taking
  any other reasonable steps to secure payments Noncooperation by the client is
  failure or refusal by the client to fulfill these requirements. Pregnant women
  are not exempt from these requirements.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-003 - OPPORTUNITY TO CLAIM GOOD CAUSE

Current through June 17, 2024
12-003.01
Notification of
  Right
: The client must be notified of the right to claim good
  cause for noncooperation at the time of application, renewal, and whenever
  cooperation becomes an issue.
12-003.02
Good Cause
  Exemption
: See 466 NAC 3-003.
12-003.03
Delay Pending
  Determination
: The Department must not deny, delay, or discontinue
  Medicaid pending a determination of good cause if the client has complied with
  the requirements of providing acceptable evidence or other necessary
  information.
12-003.04
Review of Good Cause
: At the time of each eligibility
  renewal, a good cause claim must be reviewed based on a circumstance that is
  subject to change. If circumstances remain the same, no action is required. A
  new determination is necessary if circumstances have changed. If good cause no
  longer exists, the requirement to cooperate must be enforced.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-004 - SANCTION FOR REFUSAL TO COOPERATE

Current through June 17, 2024
If the client fails or refuses to cooperate and there is no good cause
	 shown, the appropriate sanction must be applied. If the reason for
	 noncooperation is the client's failure or refusal to provide information about
	 or obtain third-party resources, the client is ineligible. Eligibility of
	 dependent child(ren) is not affected. Ineligibility continues for the client
	 until s/he cooperates or cooperation is no longer an issue.
12-004.01
Pregnant Women and
  Noncooperation
: If a pregnant woman refuses to cooperate in
  obtaining third-party resources and there is no good cause claim or
  determination, the appropriate sanction is applied.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-005 - THIRD-PARTY RESOURCES RECEIVED DIRECTLY

Current through June 17, 2024
If a client receives a third-party resource directly and the medical
	 expense for which the third-party resource is intended is payable by Medicaid,
	 the payment is considered unearned income for Non-MAGI based categories unless
	 reimbursed by the client. If the third-party resource exceeds Medicaid rates,
	 the excess is considered unearned income for Non-MAGI based categories unless
	 paid out on other medical services or supplies. Regardless of the existence of
	 a good cause claim, any third-party resource received directly by the client
	 must be reimbursed. See Appendix 477-000-01
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-006 - RECOUPMENT OF THIRD-PARTY RESOURCES

Current through June 17, 2024
1. In order to
  claim reimbursement for benefits paid by Medicaid that should have been paid by
  a third-party resource, the Department must send a letter informing the client
  that s/he must reimburse the Department or the provider. The client is allowed
  ten (10) days from the date of notification to reimburse the medical payment.
  For an applicant, the Department must not delay determination of eligibility
  pending the applicant's reimbursement. At the time the application is approved,
  the client must be notified of the number of days left in which to reimburse
  the payment;
2. If the client
  tenders the third-Party Resource within the ten (10) days, no further action is
  taken; or
3. If the client fails or
  refuses to refund the third-party resource within the ten (10) days, the entire
  amount is considered unearned income in the first month possible, taking into
  account adequate and timely notice. Any balance remaining is considered a
  resource in the following month.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-007 - WILLFULLY WITHHELD INFORMATION

Current through June 17, 2024
When evidence reasonably establishes a client willfully withheld
	 information regarding a third-party resource that resulted in an overpayment of
	 Medicaid expenditures, the case must be referred to the Special Investigation
	 Unit (SIU).
Once a case has been referred to SIU, no further action shall be taken
	 with regard to the prosecution of the suspected fraud, except in accordance
	 with instructions or approval by SIU. However, normal case actions must be
	 completed, which include applying the appropriate sanction.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-008 - TERMINATION OF ASSIGNMENT

Current through June 17, 2024
When a client is removed from the household, the assignment provision
	 is terminated. The client's rights to any further third-party resources are
	 automatically restored effective with the date of ineligibility. However, the
	 assignment remains in effect for the time period during which the client was
	 receiving Medicaid.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-009 - HEALTH INSURANCE

Current through June 17, 2024
12-009.01
Cooperation in Obtaining Health Insurance
: A client
  shall enroll in an available health plan if the Department has determined that
  it is cost effective and the client is able to enroll on his/her own behalf. In
  those circumstances, the Department pays the premiums, deductibles,
  coinsurance, and other cost-sharing obligations for this insurance. See
  Appendix 477-000-016.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-010 - COOPERATION WITH CHILD SUPPORT ENFORCEMENT (CSE) UNIT

Current through June 17, 2024
Child Support Enforcement Services are provided to a child eighteen
	 (18) years old or younger who has a noncustodial parent(s). See Appendix
	 477-000-005.
CSE services are not provided for
1. An unborn child;
2. A child who is receiving Home and
  Community-Based Services in the home of both parents; or
3. An emancipated minor.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-011 - DUTIES OF THE CLIENT

Current through June 17, 2024
The parent/needy caretaker relative, relative payee, guardian,
	 conservator, or the minor parent of the child for whom aid is claimed is
	 required to cooperate with CSE (unless good cause for refusing to do so is
	 shown).
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-012 - OPPORTUNITY TO CLAIM GOOD CAUSE

Current through June 17, 2024
12-012.01
Notification of Right
: The client must be notified at
  the time of application and whenever cooperation becomes an issue of the right
  to claim good cause as an exception to the cooperation requirement. The client
  must be given
1. A verbal explanation of good
  cause, and
2. The opportunity to
  ask questions.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-013 - SANCTIONS FOR REFUSAL TO COOPERATE

Current through June 17, 2024
Upon receiving notification from the CSE Unit that an individual
	 refused to cooperate, the individual is no longer eligible for Medicaid. The
	 sanctioned individual remains in the household as financially
	 responsible.
12-013.01
Exceptions for Sanctions for Refusal to Cooperate:
1. If an individual is age 18 or younger,
  Medicaid cannot be closed until the end of his/her initial six months of
  continuous eligibility.
2. If a
  minor parent is in the household of his/her active Medicaid parent(s), the
  minor's parent is responsible for cooperating in obtaining support for the
  minor's child. The minor's active Medicaid parent(s) is sanctioned if s/he or
  the minor does not cooperate.
3. No
  sanction is imposed for non-cooperation of a pregnant woman.
4. No sanction is imposed if at the time
  non-cooperation began, a child was not in the household of the active Medicaid
  parent(s).
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 12 - THIRD-PARTY RESOURCES AND CHILD SUPPORT ENFORCEMENT › Section 477-12-014 - OTHER RELATED ELIGIBILITY REQUIREMENTS

Current through June 17, 2024
12-014.01
Receipt of Other Assistance
: An individual who
  receives Medicaid may not at the same time receive a payment of another type of
  categorical assistance administered by the Department. This does not preclude a
  Medicaid client from being the payee for a grant made on behalf of a child in
  the individual's care. Assistance from a source other than the Department may
  be used to supplement but not duplicate assistance for a particular
  need.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 13 - MEDICAID BENEFITS PROVIDED IN ERROR › Section 477-13-001 - MEDICAID BENEFITS PROVIDED IN ERROR

Current through June 17, 2024
If a client has received Medicaid benefits through misrepresentation or
	 fraud, including because of erroneously reported income, changes in income, or
	 changes in private health insurance premiums, the client is required to repay
	 those benefits.
001.01 Fraud or Abuse
If there is reason to believe that a client has defrauded or abused the
	 Medicaid program, the Department shall refer the case to the Special
	 Investigation Unit (SIU to conduct a full investigation of the claim. Once a
	 case has been referred to SIU, no additional action shall be taken with regard
	 to the prosecution of the suspected fraud, except in accordance with
	 instructions or approval by SIU.
001.02 Repayment of Medicaid Benefits
  Provided in Error
A client who has received Medicaid benefits for which s/he was not
	 eligible due to an error by the Department may choose to make restitution to
	 the Department.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 14 - DEFINITIONS PERTAINING TO MAGI-BASED PROGRAMS › Section 477-14-001 - HOUSEHOLD SIZE FOR A TAX FILER

Current through June 17, 2024
The individual expected to file a tax return plus all persons whom the
	 individual expects to claim as a tax dependent. See Appendix 477-000-006 on how
	 to construct a Medicaid household.
Note: If an individual does not intend to file an income tax return or
	 intend to be claimed as a dependent, non-filer rules apply. If the tax payer
	 cannot reasonably establish that another individual is a tax dependent of the
	 taxpayer for the tax year in which Medicaid is sought, the inclusion of such
	 individual in the household of the tax payer is determined by using non-filer
	 rules.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 14 - DEFINITIONS PERTAINING TO MAGI-BASED PROGRAMS › Section 477-14-002 - MARRIED COUPLES

Current through June 17, 2024
In the case of married couples living together or filing jointly, each
	 spouse will be included in the household of the other spouse, regardless of
	 whether they expect to file a joint tax return or whether one spouse expects to
	 be claimed as a tax dependent by the other spouse.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 14 - DEFINITIONS PERTAINING TO MAGI-BASED PROGRAMS › Section 477-14-003 - INDIVIDUAL CLAIMED AS A TAX DEPENDENT

Current through June 17, 2024
In the case of an individual who expects to be claimed as a tax
	 dependent by a tax filer for the taxable year of an eligibility determination,
	 the household is the household of the tax filer claiming such individual as a
	 tax dependent, except when:
1. The
  individual expects to be claimed as a tax dependent of someone other than a
  spouse or a biological, adopted, or step parent;
2. The individual under the age 19, a full
  time student in secondary school and will graduate before age 19, who expects
  to be claimed by one parent as a tax dependent and are living with both
  parents, but the parents are not expected to file a joint return.
3. Individuals under age 19, a full time
  student in secondary school and will graduate before age 19, who expect to be
  claimed as a tax dependent by a non-custodial parent.
a. To be considered a non-custodial parent, a
  court order, binding separation, divorce or custody agreement establishing
  custody must exist.
b. If no such
  order exists, or in the event of a shared custody agreement the custodial
  parent is the parent with whom the child spends most nights.
Note: If a tax dependent meets an exception see household size for a
	 non-tax filer at 477 NAC
	 14-004.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 14 - DEFINITIONS PERTAINING TO MAGI-BASED PROGRAMS › Section 477-14-004 - HOUSEHOLD SIZE FOR A NON-TAX FILER

Current through June 17, 2024
The individual and, if living with the individual:
1. The individual's spouse,
2. The individual's natural, adopted and step
  children under age 19.
3. In the
  case of individuals under age 19, the individual's natural, adopted and step
  parents and natural, adoptive and step siblings under age 19.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 14 - DEFINITIONS PERTAINING TO MAGI-BASED PROGRAMS › Section 477-14-005 - FAMILY SIZE USING MODIFIED ADJUSTED GROSS INCOME METHODOLOGY (MAGI)

Current through June 17, 2024
Means the number of persons counted as members of an individual's
	 household. When determining the family size of other individuals, who have a
	 pregnant woman in their household, the family size is counted as the pregnant
	 woman plus the number of children she is expected to deliver.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 15 - HOUSEHOLD OR UNIT SIZE FOR MAGI-BASED PROGRAMS › Section 477-15-002 - MARRIED COUPLES

Current through June 17, 2024
In the case of married couples living together or filing jointly, each
	 spouse will be included in the household of the other spouse, regardless of
	 whether they expect to file a joint tax return or whether one spouse expects to
	 be claimed as a tax dependent by the other spouse
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 15 - HOUSEHOLD OR UNIT SIZE FOR MAGI-BASED PROGRAMS › Section 477-15-003 - INDIVIDUAL CLAIMED AS A TAX DEPENDENT

Current through June 17, 2024
In the case of an individual who expects to be claimed as a tax
	 dependent by a tax filer for the taxable year of an eligibility determination,
	 the household is the household of the tax filer claiming the individual as a
	 tax dependent, except when
1. The
  individual expects to be claimed as a tax dependent of someone other than a
  spouse or a biological, adopted, or step parent;
2. The individual is under nineteen (19)
  years old, expects to be claimed by one (1) parent as a tax dependent, and is
  living with both parents, but the parents are not expected to file a joint
  return.
3. The individual is under
  nineteen (19) years old and expects to be claimed as a tax dependent by a
  non-custodial parent.
a. To be considered a
  non-custodial parent, a court order, binding separation, divorce, or custody
  agreement establishing custody must exist.
b. If no court order exists, or in the event
  of a shared custody agreement, the custodial parent is the parent with whom the
  child spends most nights.
c. In the
  event of a joint custody arrangement, the child's household includes the
  individuals listed at 477 NAC
  15-005 that reside in either
  household.
If a tax dependent meets an exception, see Household Size for a Non-Tax
	 Filer at 477 NAC
	 15-005.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 15 - HOUSEHOLD OR UNIT SIZE FOR MAGI-BASED PROGRAMS › Section 477-15-004 - CHILDREN WHO EXPECT TO FILE BUT DO NOT EXPECT TO BE CLAIMED

Current through June 17, 2024
When a child under nineteen (19) years old resides with his/her
	 parent(s) and expects to file a tax return, but does not expect to be claimed
	 as a tax dependent by his/her parents(s), non-filer rules shall be applied when
	 constructing the child's household size.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 15 - HOUSEHOLD OR UNIT SIZE FOR MAGI-BASED PROGRAMS › Section 477-15-005 - HOUSEHOLD SIZE FOR A NON-TAX FILER

Current through June 17, 2024
The individual and, if living with the individual,
1. The individual's spouse;
2. The individual's natural, adopted, and
  step children under nineteen (19) years old; and
3. In the case of individuals under nineteen
  (19) years old, the individual's natural, adopted, and step parents, and
  natural, adoptive, and step siblings under nineteen (19) years.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 15 - HOUSEHOLD OR UNIT SIZE FOR MAGI-BASED PROGRAMS › Section 477-15-006 - FAMILY SIZE USING MODIFIED ADJUSTED GROSS INCOME METHODOLOGY (MAGI)

Current through June 17, 2024
The number of persons counted as members of an applicant's/client's
	 household. When determining the family size of other individuals who have a
	 pregnant woman in their household, the family size is counted as the pregnant
	 woman plus the number of children she is expected to deliver.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 17 - RESOURCES FOR MAGI-BASED PROGRAMS › Section 477-17-001 - RESOURCES USING MAGI-BASED METHODOLOGY

Current through June 17, 2024
In the case of applicants/clients whose financial eligibility for
	 Medicaid is determined using MAGI-based methodologies, the Department shall not
	 apply any asset or resource test.