reglab/statecodes huggingface dataset:
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-21 - Continuous eligibility for pregnant women and newborns

Current through Supplement No. 393, July, 2024
When a pregnant woman, whose pregnancy has been confirmed,
				  becomes eligible for Medicaid, she continues eligible, without regard to any
				  increase in income of the Medicaid unit, while pregnant, for twelve months
				  beginning on the last day of pregnancy, and through the end of the month in
				  which the twelve-month period ends. A child born to a woman who is eligible on
				  the day of the child's birth is eligible and continues to be eligible for
				  Medicaid, without regard to the child's income or assets, for twelve months
				  beginning on the day of birth, and through the end of the month in which the
				  twelve-month period ends.
General Authority:
NDCC 50-06-16,
					 50-24.1-04
Law Implemented:
NDCC
					 50-24.1-01
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-22 - Medicare savings programs

Current through Supplement No. 393, July, 2024
1. Qualified
				Medicare beneficiaries are entitled only to Medicare cost-sharing benefits
				described in subsection 19 of section
				75-02-02.1-01, beginning in the
				month following the month in which the individual is determined
				eligible.
2. Special low-income
				Medicare beneficiaries are entitled only to Medicare cost-sharing benefits
				described in paragraph 2 of subdivision a of subsection 19 of section
				75-02-02.1-01. Eligibility may be
				established for as many as three calendar months prior to the month in which
				the application was received.
3.
				Qualifying individuals are entitled only to Medicare cost-sharing benefits
				described in paragraph 2 of subdivision a of subsection 19 of section
				75-02-02.1-01. Eligibility may be
				established for as many as three calendar months prior to the month in which
				the application was received unless the individual was in receipt of any other
				Medicaid benefits for the same period. Eligibility shall be established on a
				first-come, first-served basis to the extent of funding allocated for coverage
				of this group under section 1933 of the Act [42 U.S.C. 1396u-3]
				.
4. Individuals eligible for the
				Medicare part B immunosuppressive drug benefit are entitled to coverage for the
				Medicare part B immunosuppressive drug benefit only. To be eligible, the
				individual is required to have Medicare coverage under Medicare end stage renal
				disease and this benefit ends thirty-six months after a successful
				transplant.
5. All medically needy
				technical eligibility factors apply to the Medicare savings programs except as
				identified in this section.
6. No
				individual may be found eligible for the Medicare savings programs unless the
				total value of all nonexcluded assets does not exceed:
a. For periods of eligibility prior to
				January 1, 2010:
(1) Four thousand dollars for
				a one-person unit; or
(2) Six
				thousand dollars for a two-person unit.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-23 - Eligibility of qualified disabled and working individuals

Current through Supplement No. 393, July, 2024
1. Qualified disabled and working individuals
				are entitled only to medicare cost-sharing benefits described in paragraph 1 of
				subdivision a of subsection 19 of section
				75-02-02.1-01.
2. No person may be found to be a qualified
				disabled and working individual unless the total value of all assets not
				described in subsection 4 does not exceed:
a.
				Four thousand dollars for a one-person unit; or
b. Six thousand dollars for a two-person
				unit.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-24 - Spousal impoverishment prevention

Current through Supplement No. 393, July, 2024
1. For purposes of
				this section:
a. "Community spouse" means the
				spouse of an institutionalized spouse or the spouse of a home and
				community-based services spouse.
b.
				"Family member" means only minor or dependent children, dependent parents, or
				dependent siblings of the institutionalized spouse, home and community-based
				services spouse, or community spouse who are residing with the community
				spouse. For purposes of applying this definition, a family member is dependent
				only if that family member is, and may properly be, claimed as a dependent on
				the federal income tax return filed by the institutionalized spouse or home and
				community-based services spouse, or the community spouse, or filed jointly by
				both.
c. "Home and community-based
				services spouse" means an individual who:
(1)
				Requires care of the type provided in a nursing facility, but chooses to
				receive home and community-based services in the community; and
(2) Is married to a spouse who resides in the
				community at least one day of each month.
d. "Institutionalized spouse" means an
				individual who:
(1) Requires care in a medical
				institution, a nursing facility, a swing bed, or the state hospital and, at the
				beginning of the individual's institutionalization, was likely to be in the
				facility for at least thirty consecutive days even though the individual does
				not actually remain in the facility for thirty consecutive days; and
(2) Is married to a spouse who resides in the
				community at least one day of each month.
e. "Monthly maintenance needs allowance"
				means for a community spouse, the greater of the amount authorized by the
				legislative assembly per month or the minimum amount permitted under section
				1924(d)(3) of the Act [
				42
				U.S.C. 1396r-5(d)(3) ], as
				adjusted pursuant to section 1924(g) of the Act [
				42
				U.S.C. 1396r-5(g)
				].
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-24.1 - Breast and cervical cancer early detection program

Current through Supplement No. 393, July, 2024
The breast and cervical cancer early detection group consists
				  of individuals under age sixty-five who:
1. Are uninsured and not otherwise eligible
				for Medicaid;
2. Have been screened
				for breast and cervical cancer under the centers for disease control and
				prevention's national breast and cervical cancer early detection program and
				have been found to require treatment for breast cancer, cervical cancer, or a
				precancerous condition relating to breast cancer or cervical cancer;
3. Meet the requirements of section
				75-02-02.1-16, relating to residence, section 75-02-02.1-18, relating to
				citizenship, and section 75-02-02.1-19, relating to inmates of public
				institutions; and
4. Become
				eligible on the first day of the later of the month of diagnosis or the first
				month of retroactive eligibility, as provided in section 75-02-02.1-10, and
				continue to be eligible until they no longer require treatment for breast or
				cervical cancer or a precancerous condition or no longer meet the requirements
				of this subsection.
General Authority:
NDCC 50-06-16,
					 50-24.1-04
Law Implemented:
NDCC
					 50-24.1-17
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-24.2 - Eligibility for workers with disabilities

Current through Supplement No. 393, July, 2024
1. An individual
				shall be enrolled as a member of the workers with disabilities coverage if that
				individual:
a. Is gainfully
				employed;
b. Is at least sixteen,
				but less than sixty-five, years of age;
c. Is disabled as determined by the social
				security administration or the state review team;
d. Meets the requirements of this section;
				and
e. Is not in receipt of any
				other Medicaid benefits under this chapter other than coverage as a qualified
				Medicare beneficiary or a special low-income Medicare beneficiary.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-24.3 - Eligibility for children with disabilities

Current through Supplement No. 393, July, 2024
1. A child must be
				enrolled as a member of the children with disabilities coverage if that child:
a. Is under age nineteen, including the month
				the child turns age nineteen;
b. Is
				disabled;
c. Meets the requirements
				of this section; and
d. Is not in
				receipt of any other Medicaid benefits under this chapter.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-24.4 - Hospital presumptive eligibility

Current through Supplement No. 393, July, 2024
1. For purposes of
				this section, "qualified hospital" means a hospital or hospital-owned physician
				practice or clinic that:
a. Is a Medicaid
				provider;
b. Notifies the
				department of its election to make presumptive eligibility determinations;
				and
c. Has been approved by the
				department to make presumptive eligibility determinations under this
				section.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-25 - Asset considerations

Current through Supplement No. 393, July, 2024
Except as otherwise provided in this chapter, this section
				  applies to all aged, blind, and disabled applicants and recipients of
				  medicaid.
1. All actually available
				assets must be considered in establishing eligibility for medicaid. Assets are
				actually available when at the disposal of an applicant, recipient, or
				responsible relative; when the applicant, recipient, or responsible relative
				has a legal interest in a liquidated sum and has the legal ability to make the
				sum available for support, maintenance, or medical care; or when the applicant,
				recipient, or responsible relative has the lawful power to make the asset
				available, or to cause the asset to be made available. This subsection does not
				supersede other provisions of this chapter which describe or require specific
				treatment of assets, or which describe specific circumstances which require a
				particular treatment of assets.
2.
				The financial responsibility of any individual for any applicant or recipient
				of medicaid is limited to the responsibility of spouse for spouse and parents
				for a disabled child under age eighteen. Such responsibility is imposed upon
				applicants or recipients as a condition of eligibility for medicaid. Except as
				otherwise provided in this section, the assets of the spouse and parents are
				considered available to an applicant or recipient, even if those assets are not
				actually contributed. For purposes of this subsection, biological and adoptive
				parents, but not stepparents, are treated as parents.
3. It is presumed that all spousal assets are
				actually available. In order to rebut this presumption, the applicant or
				recipient must demonstrate that the spousal assets are unavailable despite
				reasonable and diligent efforts to access such assets. No applicant or
				recipient who has a statutory or common-law cause of action for support out of
				the assets of a spouse, but who has failed to diligently pursue that cause of
				action, may rebut the presumption. Any applicant or recipient who documents any
				of the following circumstances will have rebutted the presumption without
				further proof:
a. A court order, entered
				following a contested case, determines the amounts of support that a spouse
				must pay to the applicant or recipient;
b. The spouse from whom support could
				ordinarily be sought, and the property of such spouse, is outside the
				jurisdiction of the courts of the United States or any of the United
				States;
c.The applicant or recipient
				has been subject to marital separation, with or without court order, and the
				parties have not separated for the purpose of securing medicaid benefits; or
d. In cases where section
				75-02-02.1-24 applies, the assets
				are those properly treated as belonging to the community spouse.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-26 - Asset limits

Current through Supplement No. 393, July, 2024
In all instances, including determinations of equity,
				  property must be realistically evaluated in accord with current fair market
				  value. No one subject to an asset limit may be found eligible for medicaid
				  unless the combined equity value of the medicaid unit's assets of whatever
				  nature, not excluded pursuant to section
				  75-02-02.1-28 or section
				  75-02-02.1-28.1, do not
				  exceed:
1. For individuals who seek
				benefits as members of the categorically needy or medically needy aged, blind,
				and disabled groups:
a. Three thousand
				dollars for a one-person unit;
b.
				Six thousand dollars for a two-person unit; and
c. An additional amount of twenty-five
				dollars for each member of the unit in excess of two;
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-28 - Excluded assets

Current through Supplement No. 393, July, 2024
Except as provided in section 75-02-02.1-28.1, the following
				  types of assets will be excluded in determining if the available assets of an
				  applicant or recipient exceed asset limits:
1. The home occupied by the Medicaid unit,
				including trailer homes being used as living quarters.
2. Personal effects, wearing apparel,
				household goods, and furniture.
3.
				One motor vehicle.
4. Indian trust
				or restricted lands and the proceeds from the sale thereof, so long as those
				proceeds are impressed with the original trust.
5. Indian per capita funds and judgment funds
				awarded by either the Indian claims commission or the court of claims after
				October 19, 1973, interest and investment income accrued on such Indian per
				capita or judgment funds while held in trust, and purchases made using interest
				or investment income accrued on such funds while held in trust. The funds must
				be identifiable and distinguishable from other funds. Commingling of per capita
				funds, judgment funds, and interest and investment income earned on those
				funds, with other funds, results in loss of the exemption.
6.
a. In
				determining the eligibility of an individual with respect to skilled nursing
				services, swing-bed, or home and community-based benefits, the individual will
				be ineligible for those Medicaid benefits if the individual's equity interest
				in the individual's home exceeds five hundred thousand dollars.
b. The dollar amount specified in this
				subsection will be increased, beginning with 2011, from year to year based on
				the percentage increase in the consumer price index for all urban consumers,
				all items, United States city average, rounded to the nearest one thousand
				dollars.
c. This subsection does
				not apply to an individual whose spouse, or child who is under age twenty-one
				or is blind or disabled, lawfully resides in the individual's home.
d. This subsection may not be construed as
				preventing an individual from using a reverse mortgage or home equity loan to
				reduce the individual's total equity interest in the home.
e. This subsection applies only to
				individuals who made application for Medicaid with respect to skilled nursing
				facility services, swing-bed, or home and community-based benefits on or after
				January 1, 2006.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-28.1 - Excluded assets for Medicare savings programs, qualified disabled and working individuals, and spousal impoverishment prevention

Current through Supplement No. 393, July, 2024
1. An asset may be
				excluded for purposes of Medicare savings programs, qualified disabled and
				working individuals, and spousal impoverishment prevention only if this section
				provides for the exclusion. An asset may be excluded under this section only if
				the asset is identified.
2. The
				assets described in subsections 2 through 5 and subsections 8, 9, and 11
				through 27 of section
				75-02-02.1-28 are
				excluded.
3. A residence occupied
				by the individual, the individual's spouse, or the individual's dependent
				relative is excluded for Medicare savings programs and qualified disabled and
				working individuals. A residence occupied by the community spouse is excluded
				for spousal impoverishment prevention cases. The residence may include a mobile
				home suitable for use, and being used, as a principal place of residence. The
				residence remains excluded during temporary absence of the individual from the
				residence so long as the individual intends to return. Renting or leasing part
				of the residence to a third party does not affect this definition. For purposes
				of this subsection:
a. "Dependent" means an
				individual who relies on another for medical, financial, and other forms of
				support, provided that an individual is financially dependent only when another
				individual may lawfully claim the financially dependent individual as a
				dependent for federal income tax purposes;
b. "Relative" means the parent, child,
				stepparent, stepchild, grandparent, grandchild, brother, sister, stepbrother,
				stepsister, aunt, uncle, niece, nephew, or first cousin, whether by birth or
				adoption, and whether by whole or half-blood, of the individual or the
				individual's current or former spouse; and
c. "Residence" includes all contiguous lands,
				including mineral interests, upon which it is located.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-30 - Contractual rights to receive money payments

Current through Supplement No. 393, July, 2024
1. An applicant or recipient may own
				contractual rights to receive money payments. Such contractual rights are
				available assets subject to the asset limits. If the applicant or recipient has
				sold property and received in return a promise of payments of money at a later
				date, usually to be made periodically, and an attendant promise to return the
				property if the payments are not made, the arrangement is usually called a
				"contract for deed". The essential feature of such a contract is the right to
				receive future payments, usually coupled with a right to get the property back
				if the payments are not made. Contractual rights to receive money payments also
				arise out of other types of transactions. The valuable contract document may be
				called a promissory note, accounts receivable, annuity, mortgage, or by some
				other name.
2. There is a
				presumption that the holder's interest in contractual rights to receive money
				payments is saleable without working an undue hardship. This presumption may be
				rebutted by evidence demonstrating that the contractual rights are not saleable
				without working an undue hardship.
General Authority:
NDCC
					 50-06-16,
					 50-24.1-04
Law Implemented:
NDCC
					 50-24.1-02
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-31.1 - Trusts established by applicants, recipients, or their spouses after August 10, 1993

Current through Supplement No. 393, July, 2024
1. For purposes of
				determining an individual's eligibility under this chapter, subject to
				subsection 4, this section applies to a trust established by the individual
				after August 10, 1993. Subsections 1, 2, and 3 of section
				75-02-02.1-31
				apply to this section.
2.
a. For purposes of this subsection, an
				individual shall be considered to have established a trust if assets of the
				individual were used, by someone with lawful authority over those assets, to
				form all or part of the corpus of the trust and if any of the following
				individuals established that trust other than by will:
(1) The individual;
(2) The individual's spouse;
(3) A person, including a court or
				administrative body, with legal authority to act in place of or on behalf of
				the individual or the individual's spouse; or
(4) A person, including any court or
				administrative body, acting at the direction or upon the request of the
				individual or the individual's spouse.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-32 - Valuation of assets

Current through Supplement No. 393, July, 2024
It is not always possible to determine the value of assets
				  with absolute certainty, but it is necessary to determine a value in order to
				  determine eligibility. The valuation must be based on reasonably reliable
				  information. It is the responsibility of the applicant or recipient, or the
				  persons acting on behalf of the applicant or recipient, to furnish reasonably
				  reliable information. Because an applicant or recipient may not be
				  knowledgeable of asset values, and particularly because that person may have a
				  strong interest in the establishment of a particular value, whether or not that
				  value is accurate, some verification of value must be obtained. If a valuation
				  from a source offered by an applicant or recipient is greatly different from
				  generally available or published sources, the applicant or recipient must
				  provide a convincing explanation for the differences particularly if the
				  applicant or recipient may be able to influence the person providing the
				  valuation. If reasonably reliable information concerning the value of assets is
				  not made available, eligibility may not be determined. Useful sources of
				  verification include:
1. With respect
				to liquid assets: reliable account records.
2. With respect to personal property other
				than liquid assets:
a. Publicly traded
				stocks, bonds, and securities: stockbrokers.
b. Autos, trucks, mobile homes, boats, farm
				equipment, or any other property listed in published valuation guides accepted
				in the trade: the valuation guide.
c. With respect to harvested grains or
				produce: grain buyers, grain elevator operators, produce buyers; and, for crops
				grown on contract: the contract.
d.
				With respect to stock in corporations not publicly traded: appraisers,
				accountants.
e. With respect to
				other personal property: dealers and buyers of that property.
f. With respect to a life insurance policy:
				the life insurance company.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-33.1

Current through Supplement No. 393, July, 2024
General Authority:
NDCC 50-06-16,
					 50-24.1-04
Law Implemented:
NDCC 50-24.1-02;
					 42 USC
					 1396p(c)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-33.2 - Disqualifying transfers made on or after February 8, 2006

Current through Supplement No. 393, July, 2024
1. This section applies to transfers of
				income or assets made on or after February 8, 2006.
2. Except as provided in subsections 7 and
				16, an individual is ineligible for skilled nursing care, swing-bed, or home
				and community-based benefits if the individual or the individual's spouse
				disposes of assets or income for less than fair market value on or after the
				look-back date. The look-back date is a date that is sixty months before the
				first date on which the individual is both receiving skilled nursing care,
				swing-bed, or home and community-based services and has applied for benefits
				under this chapter, without regard to the action taken on the
				application.
3. An applicant,
				recipient, or anyone acting on behalf of an applicant or recipient, has a duty
				to disclose any transfer of any asset or income made by or on behalf of the
				applicant or recipient, or the spouse of the applicant or recipient, for less
				than full fair market value:
a. When making an
				application;
b. When completing a
				redetermination; and
c. If made
				after eligibility has been established, by the end of the month in which the
				transfer was made.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-34 - Income considerations

Current through Supplement No. 393, July, 2024
1. All
				income that is actually available shall be considered. Income is actually
				available when it is at the disposal of an applicant, recipient, or responsible
				relative; when the applicant, recipient, or responsible relative has a legal
				interest in a liquidated sum and has the legal ability to make the sum
				available for support, maintenance, or medical care; or when the applicant,
				recipient, or responsible relative has the lawful power to make the income
				available or to cause the income to be made available. Income shall be
				reasonably evaluated. This subsection does not supersede other provisions of
				this chapter which describe or require specific treatment of income, or which
				describe specific circumstances which require a particular treatment of
				income.
2. The financial
				responsibility of any individual for any applicant or recipient of medicaid
				will be limited to the responsibility of spouse for spouse and parents for a
				child under age twenty-one. Such responsibility is imposed as a condition of
				eligibility for medicaid. Except as otherwise provided in this section, the
				income of the spouse and parents is considered available to the applicant or
				recipient, even if that income is not actually contributed. Biological and
				adoptive parents, and stepparents, are treated as parents.
3. All spousal income is considered actually
				available unless:
a. A court order, entered
				following a contested case, determines the amounts of support that a spouse
				must pay to the applicant or recipient;
b. The spouse from whom support could
				ordinarily be sought, and the property of such spouse, is outside the
				jurisdiction of the courts of the United States or any of the United States;
				or
c. The applicant or recipient is
				subject to marital separation, with or without court order, and there has been
				no collusion between the applicant or recipient and that person's spouse to
				render the applicant or family member eligible for medicaid.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-34.1 - MAGI-based methodology

Current through Supplement No. 393, July, 2024
Effective for the benefit month of January 2014, the
				  following MAGI-based methodology will be used in determining income eligibility
				  for medicaid.
1. Income is based on
				household composition.
2. Monthly
				income is used prospectively for new applications; annualized income is used
				for ongoing cases.
3. Current,
				point in time income is used; however, reasonable expected changes in income
				must be included.
4. A tax
				dependent child's income does not count in a taxpayer parent's or caretaker
				relative's household if the child is not required to file a tax return. The
				child's needs are included in the taxpayer's household.
a. If the taxpayer parent or taxpayer
				caretaker relative is in the child's medicaid household, the child's income
				does not count in the child's household, either.
b. If the taxpayer parent or taxpayer
				caretaker relative is not in the child's medicaid household, the child's income
				counts in the child's household.
c.
				If the child is not required to file a tax return, however, files a return to
				get a refund of taxes withheld, the child's income is not counted.
d. If the child is required to file a tax
				return, the child's income is counted in all of the households in which the
				child is included.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-34.2 - Income conversion for individuals subject to a MAGI-based methodology

Current through Supplement No. 393, July, 2024
1. For purposes of this section, "biweekly"
				means every two weeks.
2. Income
				received either weekly or biweekly must be converted to monthly income in
				determining the household's countable income under MAGI-based methodology.
				Income must be received each week for those paid weekly, or every other week
				for those paid biweekly, for income to be converted.
3. Income conversion is not done for the
				three month prior period. Actual income received in those months is counted in
				determining eligibility.
General Authority:
NDCC
					 50-06-16,
					 50-24.1-04
Law Implemented:
NDCC
					 50-24.1-37;
					 42 U.S.C.
					 1396
					 a(e)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-37 - Unearned income

Current through Supplement No. 393, July, 2024
Unearned income is income that is not earned income. Unearned
				  income received in a fixed amount each month shall be applied in the month in
				  which it is normally received. The following income rules apply to individuals
				  not subject to a MAGI-based methodology:
1. Recurring unearned lump sum payments
				received after application for medicaid shall be prorated over the number of
				months the payment is intended to cover. When a payment is received and
				prorated in an ongoing case, or after a period of medicaid eligibility or
				eligibility for the children's health insurance program as provided in chapter
				75-02-02.2, and the case is closed and then reopened during the prorated
				period, or within the following proration period, the lump sum payment
				proration must continue. All other recurring unearned lump sum payments
				received before application for medicaid or for the children's health insurance
				program as provided in 75-02-02.2 are considered income in the month received
				and are not prorated.
2. All
				nonrecurring unearned lump sum payments, except health or long-term care
				insurance payments, veterans administration aid and attendance, veterans
				administration reimbursements for unusual medical expenses, and veterans
				administration homebound benefits intended for medical expenses shall be
				considered as income in the month received and assets thereafter.
3. One-twelfth of annual conservation reserve
				program payments, less expenses, such as seeding and spraying, necessary to
				maintain the conservation reserve program land in accordance with that
				program's requirements, is unearned income in each month.
General Authority:
NDCC
					 50-06-16,
					 50-24.1-04
Law Implemented:
NDCC
					 50-24.1-02,
					 50-24.1-37;
					 42 USC
					 1396 a(e)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-37.1 - Unearned income for individuals subject to a MAGI-based methodology

Current through Supplement No. 393, July, 2024
Unearned income is income that is not earned income. Unearned
				  income received in a fixed amount each month shall be applied in the month in
				  which it is normally received. Effective January 1, 2014, individuals subject
				  to a MAGI-based methodology will have income treated as follows:
1. Recurring unearned lump sum payments
				received after application for medicaid shall be prorated over the number of
				months the payment is intended to cover. When a payment is received and
				prorated in an ongoing case, or after a period of medicaid eligibility or
				eligibility for the children's health insurance program as provided in chapter
				75-02-02.2, and the case is closed and then reopened during the prorated
				period, or within the following proration period, the lump sum payment
				proration must continue. All other recurring unearned lump sum payments
				received before application for medicaid or for the children's health insurance
				program as provided in 75-02-02.2 are considered income in the month received
				and are not prorated.
2. All
				nonrecurring unearned lump sum payments, except health or long-term care
				insurance payments, veterans administration aid and attendance, veterans
				administration reimbursements for unusual medical expenses, and veterans
				administration homebound benefits intended for medical expenses shall be
				considered as income in the month received and assets thereafter.
3. Net taxable conservation reserve program
				(CRP) income is considered income and prorated over the year.
General Authority:
NDCC
					 50-06-16,
					 50-24.1-04
Law Implemented:
NDCC
					 50-24.1-02,
					 50-24.1-37;
					 42 USC
					 1396 a(e)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-38.1 - Post-eligibility treatment of income

Current through Supplement No. 393, July, 2024
Except in determining eligibility for workers with
				  disabilities or children with disabilities, this section prescribes specific
				  financial requirements for determining the treatment of income and application
				  of income to the cost of care for an individual screened as requiring nursing
				  care services who resides in a nursing facility, the state hospital, an
				  institution for mental disease, a psychiatric residential treatment facility,
				  or an intermediate care facility for individuals with intellectual
				  disabilities, or who receives swing-bed care in a hospital.
1. The following types of income may be
				disregarded in determining medicaid eligibility:
a. Occasional small gifts;
b. For so long as
				38 U.S.C.
				5503 remains effective, ninety dollars of
				veterans administration improved pensions paid to a veteran, or a surviving
				spouse of a veteran, who has neither spouse nor child, and who resides in a
				medicaid-approved nursing facility;
c. Payments to certain United States citizens
				of Japanese ancestry, resident Japanese aliens, and eligible Aleuts made under
				the Wartime Relocation of Civilians Reparations Act [50 U.S.C. App. 1989 et
				seq.];
d. Agent orange
				payments;
e. German reparation
				payments made to survivors of the holocaust, and reparation payments made under
				sections 500 through 506 of the Austrian General Social Insurance
				Act;
f. Netherlands reparation
				payments based on Nazi, but not Japanese, persecution during World War II [
				Pub. L.
				103-286;
				42 U.S.C.
				1437 a, note];
g. Radiation Exposure Compensation Act [ Pub.
				L. 101 -426; 42 U.S.C.
				2210, note];
h. Interest or dividend income from liquid
				assets; and
i. From annual
				countable gross rental income, an amount equal to real estate taxes for rental
				property that the recipient is responsible for paying on that
				property.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-38.3 - Disregarded income for certain individuals subject to a MAGI-based methodology

Current through Supplement No. 393, July, 2024
This section applies to an individual residing in the
				  individual's own home or in a specialized facility, workers with disabilities
				  coverage, children with disabilities coverage, and to the medicare savings
				  programs, but does not apply to an individual receiving nursing care services
				  in a nursing facility, the state hospital, an institution for mental disease, a
				  psychiatric residential treatment facility, an intermediate care facility for
				  individuals with intellectual disabilities, or receiving swing-bed care in a
				  hospital. Effective January 1, 2014, the above-identified individuals subject
				  to a MAGI-based methodology are allowed the following income disregards:
1. Nontaxable income other than:
a. Nontaxable foreign earned
				income;
b. Nontaxable interest;
				and
c. The nontaxable portion of
				social security benefits.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-38.4 - Earned income for individuals subject to a MAGI-based methodology

Current through Supplement No. 393, July, 2024
Earned income is income that is currently received as wages,
				  salaries, commissions, or profits from activities in which an individual or
				  family is engaged through either employment or self-employment. Income is
				  "earned" only if the individual or family contributes an appreciable amount of
				  personal involvement and effort. Earned income shall be applied in the month in
				  which it is normally received. Effective January 1, 2014, individuals subject
				  to a MAGI-based methodology will have income treated as follows:
1. If earnings from more than one month are
				received in a single payment, the payment must be divided by the number of
				months in which the income was earned, and the resulting monthly amounts shall
				be attributed to each of the months with respect to which the earnings were
				received.
2. Net earnings or losses
				from self-employment as considered for income tax purposes are counted for
				modified adjusted gross income households.
General Authority:
NDCC
					 50-06-16,
					 50-24.1-04
Law Implemented:
NDCC
					 50-24.1-37;
					 42 USC
					 1396 a(e)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-39 - Income deductions

Current through Supplement No. 393, July, 2024
This section applies to an individual residing in the
				  individual's own home or in a specialized facility, workers with disabilities
				  coverage, children with disabilities coverage, and to the medicare savings
				  programs, but does not apply to an individual receiving nursing care services
				  in a nursing facility, the state hospital, an institution for mental disease, a
				  psychiatric residential treatment facility, an intermediate care facility for
				  individuals with intellectual disabilities, or receiving swing-bed care in a
				  hospital. No deduction not described in subsections 1 through 14 may be allowed
				  in determining medicaid eligibility. For individuals not subject to a
				  MAGI-based methodology, the following deductions apply:
1. Except in determining eligibility for the
				medicare savings programs, the cost of premiums for health insurance may be
				deducted from income in the month the premium is paid or prorated and deducted
				from income in the months for which the premium affords coverage. In
				determining eligibility for the workers with disabilities coverage, the workers
				with disabilities enrollment fee and premiums are not deducted. In determining
				eligibility for the children with disabilities coverage, the children with
				disabilities premiums are not deducted. For purposes of this subsection,
				"premiums for health insurance" include payments made for insurance, health
				care plans, or nonprofit health service plan contracts which provide benefits
				for hospital, surgical, and medical care, but do not include payments made for
				coverage which is:
a. Limited to disability
				or income protection coverage;
b.
				Automobile medical payment coverage;
c. Supplemental to liability
				insurance;
d. Designed solely to
				provide payments on a per diem basis, daily indemnity, or nonexpense-incurred
				basis; or
e. Credit accident and
				health insurance.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-39.1 - Income deductions for individuals subject to a MAGI-based methodology

Current through Supplement No. 393, July, 2024
This section applies to an individual residing in the
				  individual's own home or in a specialized facility, workers with disabilities
				  coverage, children with disabilities coverage, and to the medicare savings
				  programs. This section does not apply to an individual receiving nursing care
				  services in a nursing facility, the state hospital, an institution for mental
				  disease, a psychiatric residential treatment facility, an intermediate care
				  facility for individuals with intellectual disabilities, or receiving swing-bed
				  care in a hospital. Effective January 1, 2014. individuals subject to a
				  MAGI-based methodology are allowed a standard deduction of five percent of the
				  one hundred percent of poverty level applicable to the size of the individual's
				  medicaid unit.
General Authority:
NDCC
					 50-06-16,
					 50-24.1-04
Law Implemented:
NDCC
					 50-24.1-37;
					 42 USC
					 1396 a(e)
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-40 - Income levels

Current through Supplement No. 393, July, 2024
1. Levels of income
				for maintenance shall be used as a basis for establishing financial eligibility
				for Medicaid. The income levels applicable to individuals and units are:
a. Categorically needy income levels.
(1) Family coverage income levels established
				in the Medicaid state plan are applied to the family coverage group. The family
				size is increased for each unborn child when determining the appropriate family
				size.
(2) Except for individuals
				subject to the nursing care income level, the income level for categorically
				needy aged, blind, or disabled recipients is that which establishes
				supplemental security income eligibility.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-41 - Deeming of income

Current through Supplement No. 393, July, 2024
Excess income is the amount of net income remaining after
				  allowing the appropriate disregards, deductions, and medicaid income
				  level.
1. Twenty-five percent of the
				excess income of an ineligible medicaid unit shall be deemed available during
				any full calendar month an eligible member of the medicaid unit receives
				services in a specialized facility.
2. No income may be deemed to a supplemental
				security income recipient in a specialized facility or receiving home and
				community-based services as such a recipient's maintenance needs are met by the
				supplemental security income grant.
3. If subdivision a or b applies, the excess
				income of an individual in nursing care, an intermediate care facility for
				individuals with intellectual disabilities, the state hospital, or the Anne
				Carlsen facility, receiving swing bed care in a hospital or receiving home and
				community-based services may be deemed to the individual's legal dependents to
				bring their income up to the appropriate medically needy income level.
a. The legal dependents who are also eligible
				for medicaid do not receive a temporary assistance for needy families payment
				or supplemental security income. In these circumstances, income may be deemed
				only to the extent it raises the legal dependents' income to the appropriate
				medically needy income level.
b.
				The legal dependents are ineligible for medicaid or choose not to be covered by
				medicaid. In these circumstances, income may be deemed only to the extent it
				raises the legal dependents' net income to the appropriate community spouse or
				family member income level.
(1) Income of the
				institutionalized or home and community-based spouse may be deemed to an
				ineligible community spouse only to the extent that income is made available to
				the community spouse.
(2) Excess
				income shall be deemed to family members in spousal impoverishment cases, up to
				the family members' income level.
North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-41.1 - Recipient liability

Current through Supplement No. 393, July, 2024
Recipient liability is the amount of monthly net income
				  remaining after all appropriate deductions, disregards, and Medicaid income
				  levels have been allowed. All such income must be considered to be available
				  for the payment of medical services provided to the eligible individual or
				  family.
The following deductions apply to all individuals :
1. Up to fifteen dollars per month of
				expenses for necessary medical or remedial care, incurred by a member of the
				Medicaid unit or spouse or child for whom that member is legally responsible,
				in a month prior to the month for which eligibility is being determined, may be
				subtracted from recipient liability other than recipient liability created as a
				result of medical care payments, to determine remaining recipient liability,
				provided that:
a. The expense was incurred in
				any month during which the individual who received the medical or remedial care
				was not a Medicaid recipient or the expense was incurred in a month the
				individual was a Medicaid recipient, but for a medical or remedial service not
				covered by Medicaid;
b. The expense
				was not previously applied in determining eligibility for, or the amount of,
				Medicaid benefits for any Medicaid recipient;
c. The medical or remedial care was provided
				by a medical practitioner licensed to furnish the care;
d. The expense is not subject to payment by
				any third party, including Medicaid and Medicare;
e. The expense was not incurred for swing-bed
				services provided in a hospital, nursing facility services, or home and
				community-based services during a period of ineligibility determined under
				section 75-02-02.1-33.1;
f. Each
				expense claimed for subtraction is documented by the applicant or recipient in
				a manner which describes the service, the date of the service, the amount of
				the cost incurred, the amount of the cost remaining unpaid, the amount of the
				cost previously applied in determining Medicaid benefits for any Medicaid
				recipient, and the name of the service provider; and
g. The Medicaid unit is still obligated to
				pay the provider of the medical or remedial service.