North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 45 - GENERAL PROCEDURES FOR PUBLIC HEALTH PROGRAMS › Subchapter A - PAYMENT PROGRAMS › Section .0200 - ELIGIBILITY DETERMINATIONS › Section 45A .0202 - DETERMINATION OF FINANCIAL ELIGIBILITY

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A
				  patient must meet the financial eligibility requirements of this Subchapter to
				  be eligible for benefits provided by the payment programs. Financial
				  eligibility shall be determined by the NC Division of Public Health Purchase of
				  Medical Care Services Unit through application of income scales that reflect
				  federal poverty levels. The income scales can be found at
				  http://www.ncdhhs.gov/control/pomcs/pomcs.htm. The definition of annual net
				  family income in Rule .0203 of this Section and the definitions of family in
				  Rule .0204 of this Section shall be used in applying the income scales, except
				  as provided in Paragraph (c) of this Rule.
(b) A person is financially eligible for
				  services under the Sickle Cell Program if the annual net family income is at or
				  below the federal poverty level in effect on July 1, the beginning of each
				  fiscal year.
(c) A person is
				  financially eligible for the HIV Medications Program if the gross family income
				  is at or below 300 percent of the federal poverty level in effect on July 1,
				  the beginning of each fiscal year, with the following exceptions:
(1) If a waiting list develops, priority for
				  enrollment into the HIV Medications Program shall be given to those whose net
				  family income is at or below 125 percent of the federal poverty level, and
				  second priority to those individuals with income above 125 percent and at or
				  below 250 percent of federal poverty guidelines; and
(2) If the HIV Medications Program's
				  financial eligibility level is changed, all clients enrolled in the HIV
				  Medications Program during the most recent year or at the time the eligibility
				  level is changed shall be eligible to continue to be enrolled in and served by
				  the HIV Medications Program even if the clients' financial status exceeds the
				  newly-established eligibility level. The eligibility of these clients shall
				  remain in force until:
(A) they no longer
				  qualify for the HIV Medications Program other than for financial
				  reasons;
(B) they no longer require
				  the services of the HIV Medications Program;
(C) their income increases such that they
				  have an income that exceeds the level under which they originally qualified for
				  and enrolled into the HIV Medications Program; or
(D) they fail to comply with the rules of the
				  HIV Medications Program.
(3) If an individual is determined to be
				  financially eligible, pursuant to Rule .0203 of this Section, if the
				  application for financial eligibility was received by the Department in the
				  fourth quarter of the fiscal year, the individual shall remain financially
				  eligible for benefits until the end of the next fiscal year unless there is a
				  change in the individual's family size pursuant to Rule .0204 of this Section
				  or family financial resources or expenses during that period pursuant to Rule
				  .0203 of this Section.
The HIV Medications Program shall provide notice of changes
					 to the financial eligibility or other eligibility requirements to interested
					 parties within North Carolina's HIV community (e.g., persons living with HIV
					 disease, their families and caregivers, advocates and service providers,
					 relevant local and state agencies) via electronic or print mechanisms.