North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-02 - Economic Assistance › Chapter 75-02-02.1 - Eligibility for Medicaid › Section 75-02-02.1-05 - Coverage groups

Current through Supplement No. 393, July, 2024
Within the limits of legislative appropriation, the
				  department may provide benefits to coverage groups described in the approved
				  Medicaid state plan in effect at the time those benefits are sought. These
				  coverage groups do not define eligibility for benefits. Any individual who is
				  within a coverage group must also demonstrate that all other eligibility
				  criteria are met.
1. The categorically
				needy coverage group includes:
a. Children for
				whom adoption assistance maintenance payments are made under title
				IV-E;
b. Children for whom foster
				care maintenance payments are made under title IV-E;
c. Children who are living in North Dakota
				and are receiving title IV-E adoption assistance payments from another
				state;
d. Children in a foster care
				placement in North Dakota and receiving a title IV-E foster care payment from
				another state;
e. Caretakers of
				deprived children who meet the parent and caretaker relative eligibility
				criteria;
f. Families who were
				eligible under the family coverage group in at least three of the six months
				immediately preceding the month in which the family became ineligible because
				of the caretaker relative's earned income or because a member of the unit has a
				reduction in the time-limited earned income disregard;
g. Families who were eligible under the
				family coverage group in at least three of the six months immediately preceding
				the month in which they became ineligible as a result, wholly or partly, of the
				collection or increased collection of child or spousal support continue
				eligible for Medicaid for four calendar months;
h. Pregnant women who meet the nonfinancial
				requirements with modified adjusted gross income at or below the modified
				adjusted gross income level for pregnant women;
i. Eligible pregnant women who applied for
				and were eligible for Medicaid as categorically needy during pregnancy continue
				to be eligible for twelve months beginning on the last day of the pregnancy,
				and through the end of the month in which the twelve-month period
				ends;
j. Children born to the
				categorically needy eligible pregnant women who applied for and were found
				eligible for Medicaid on or before the day of the child's birth, for twelve
				months beginning on the day of the child's birth and through the end of the
				month in which the twelve-month period ends;
k. Children up to age nineteen who meet the
				nonfinancial Medicaid requirements with modified adjusted gross income at or
				below the modified adjusted gross income level for that child's age;
l. Adults between the ages of nineteen and
				sixty-four, inclusive, who meet the nonfinancial Medicaid requirements:
(1) Who are not eligible under subdivisions e
				through k above; or
(2) Who are not
				eligible for supplemental security income, unless they fail the medically needy
				asset test; or
(3) Whose modified
				adjusted gross income is at or below the established modified adjusted gross
				income level for this group;
m. Former foster care children through the
				month they turn twenty-six years of age, who were enrolled in Medicaid and were
				in foster care when they turned eighteen years old, provided they are not
				eligible under any of the categorically eligible groups other than the group
				identified in subdivision l.
n.
				Aged, blind, or disabled individuals who are receiving supplemental security
				income payments or who appear on the state data exchange as zero payment as a
				result of supplemental security income's recovery of an overpayment or who are
				suspended because the individuals do not have a protective payee, provided that
				the more restrictive Medicaid criteria is met; and
o. Individuals who meet the more restrictive
				requirements of the Medicaid program and qualify for supplemental security
				income benefits under section 1619(a) or 1619(b) of the Act [42 U.S.C.
				1382h(a) or
				1382h(b)]
				.