Montana Administrative Code

37.82.1006 MEDICAID FOR WORKERS WITH DISABILITIES: RESOURCES An individual is eligible in regard to resources if the individual's resources, including any resources of relatives deemed to be available to the individual pursuant to the supplemental security income (SSI) regulation…

37.82.1007 MEDICAID FOR WORKERS WITH DISABILITIES: COST SHARE FEES Except as provided in (2) below, an otherwise eligible individual must make a monthly cost share fee in accordance with the table in (3) below, as a condition of eligibility for benefits under the Medicaid for Wor…

37.82.101 MEDICAL ASSISTANCE, PURPOSE, AND INCORPORATION OF POLICY MANUALS Subject to applicable state and federal laws, regulations and rules, the Montana Medicaid program pays for covered medically necessary services for persons determined eligible by the department or its agen…

37.82.102 MEDICAL ASSISTANCE, DEFINITIONS "AABD" means aid to the aged, blind, and disabled under Title XVI of the Social Security Act. "AB" means Aid to the Blind under Title X of the Social Security Act. "AFDC" means Aid to Families with Dependent Children under Title IV-A of t…

37.82.1101 INDIVIDUALS COVERED, NON-INSTITUTIONALIZED MEDICALLY NEEDY Medicaid under this subchapter will be provided to the following individuals who would be receiving FAIM financial assistance if their income had not exceeded the income standards found in ARM 37.78.420 provide…

37.82.1102 NON-FINANCIAL REQUIREMENTS, NON- INSTITUTIONALIZED MEDICALLY NEEDY Except as provided in (2) , for groups covered under ARM 37.82.1101 (1) , the AFDC nonfinancial requirements which are set forth in ARM 46.10.301 through 46.10.307, 46.10.320 and 46.10.321 will be used …

37.82.1106 MEDICALLY NEEDY INCOME STANDARDS To be eligible for medically needy assistance, SSI and family-related institutionalized and non-institutionalized recipients must meet: non-financial criteria of ARM 37.82.1102 ; resource criteria of ARM 37.82.1110 ; and income criteria…

37.82.1107 INCOME ELIGIBILITY, NONINSTITUTIONALIZED MEDICALLY NEEDY Medically needy income eligibility fornon-institutionalized and family-related personswill be computed using a one month prospective budget period. For groups covered under ARM 37.82.1101 (1)(a) through (1)(e), m…

37.82.1110 RESOURCE STANDARDS, NON-INSTITUTIONALIZED MEDICALLY NEEDY Except as provided in (2) for households receiving assistance in the FAIM project, the medically needy resource limitations are: For households receiving assistance in the FAIM project, the medically needy resou…

37.82.1111 THREE MONTH RETROACTIVE COVERAGE, NON-INSTITUTIONALIZED MEDICALLY NEEDY The retroactive period may include any or all of the three months immediately preceding the month of application. To be eligible for retroactive medically needy coverage, during each month of the r…

37.82.1116 RESOURCE EXCLUSIONS: MEDICALLY NEEDY COVERAGE FOR NONINSTITUTIONALIZED INDIVIDUALS, COUPLES, AND FAMILIES In determining eligibility for noninstitutionalized medically needy individuals, couples, and families under the family Medicaid and aged, blind, and disabled Medi…

37.82.1301 DEFINITIONS RELATING TO INSTITUTIONAL STATUS As used in this subchapter: "Active treatment in institutions for the mentally retarded" requires the following: The individual's regular participation, in accordance with an individual plan of care, in professionally develo…

37.82.1305 GROUPS COVERED, AFDC-RELATED INSTITUTIONALIZED INDIVIDUALS Medicaid will be provided to the following AFDC-related institutionalized individuals under the heading categorically needy: Individuals under age 21 in intermediate care facilities, including in intermediate c…

37.82.1306 GROUPS COVERED, SSI-RELATED INSTITUTIONALIZED INDIVIDUALS Medicaid will be provided to the following SSI-related institutionalized individuals under the heading categorically needy: Individuals receiving SSI on the basis of the SSI income standard for institutionalized…

37.82.1310 NON-FINANCIAL REQUIREMENTS, AFDC-RELATED INSTITUTIONALIZED INDIVIDUALS Individuals under age 19 who continue to receive AFDC even though they are in a medical institution or intermediate care facility are presumed to have met the non-financial requirements for medicaid…

37.82.1311 NON-FINANCIAL REQUIREMENTS, SSI-RELATED INSTITUTIONALIZED INDIVIDUALS Individuals receiving SSI on the basis of the SSI income standard for institutionalized individuals are presumed to have met the nonfinancial requirements for medicaid eligibility. For individuals in…

37.82.1312 FINANCIAL REQUIREMENTS, AFDC-RELATED INSTITUTIONALIZED INDIVIDUALS Individuals under age 19 who continue to receive AFDC even though they are in a medical institution or intermediate care facility are presumed to have met the financial requirements for medicaid eligibi…

37.82.1313 FINANCIAL REQUIREMENTS, SSI-RELATED INSTITUTIONALIZED INDIVIDUALS Individuals receiving SSI on the basis of the SSI income standard for institutionalized individuals are presumed to have met the financial requirements for medicaid eligibility. For individuals in medica…

37.82.1320 POST-ELIGIBILITY APPLICATION OF PATIENT INCOME TO COST OF CARE After the nonfinancial and resource eligibility criteria are met, the income of individuals in a residential medical institution will be applied toward the cost of care as provided in this section. This pro…

37.82.1321 PROHIBITED COVERAGE Medicaid will not be provided to: an individual who is an inmate of a public institution; an individual who is a patient under age 65 in an institution for tuberculosis or mental disease except as an inpatient receiving active treatment in a psychia…

37.82.1322 RESOURCE EXCLUSIONS: FAMILY MEDICAID AND AGED, BLIND, AND DISABLED MEDICAID FOR INSTITUTIONALIZED CATEGORICALLY NEEDY AND MEDICALLY NEEDY INDIVIDUALS, COUPLES, AND FAMILIES In determining eligibility for categorically needy and medically needy institutionalized individ…

37.82.1330 INSTITUTIONALIZED SPOUSE, DEFINITIONS The following definitions apply with respect to ARM 37.82.1320, 37.82.1321, 37.82.1330, 37.82.1331, and 37.82.1336 through 37.82.1338. "Community spouse" is the member of the married couple who continues to reside in the community …

37.82.1331 INSTITUTIONALIZED SPOUSE, RESOURCE ASSESSMENTS A resource assessment is available to any married individual who: entered a medical institution on or after October 1, 1989; is likely to remain in the institution for at least 30 consecutive days; and has a spouse who con…

37.82.1336 INSTITUTIONALIZED SPOUSE, RESOURCE ELIGIBILITY DETERMINATION The institutionalized spouse is resource eligible when the institutionalized spouse and community spouse's combined countable resources are less than or equal to the community spouse's resource allowance in (…

37.82.1337 INSTITUTIONALIZED SPOUSE, RECEIPT OF ADDITIONAL RESOURCES When additional resources are received by an institutionalized spouse after the initial eligibility determination and receipt of such resources would cause ineligibility for the institutionalized spouse, the res…

37.82.1338 INSTITUTIONALIZED SPOUSE, TRANSFER OF RESOURCES TO COMMUNITY SPOUSE Within 90 days of the initial eligibility determination or court order, or within any time period specifically required under the court order, an institutionalized spouse must irrevocably transfer reso…

37.82.201 APPLICATION Opportunity to apply: Any individual wishing to do so will be afforded the opportunity to apply for medicaid without delay. Written application and place of application: The application must be submitted in writing: on the form and in the manner prescribed b…

37.82.204 DETERMINATION OF ELIGIBILITY Timely determination of eligibility: Aid will be furnished in a timely manner to eligible persons and will conform to the following time standards: 90 days for applicants on the basis of disability; and 45 days for all other applicants. Thes…

37.82.205 REDETERMINATION OF ELIGIBILITY Periodic redetermination of eligibility: where an individual has been determined eligible, eligibility will be reconsidered or redetermined: at the time required when the department has information obtained previously about anticipated cha…

37.82.206 FURNISHING ASSISTANCE The department will: furnish medicaid in a timely manner to recipients, as required by ARM 37.82.204(1) (a) , without any delay caused by the agency's administrative procedures; continue to furnish medicaid regularly to all eligible individuals; ma…

37.82.207 RECIPIENT OVERPAYMENTS The department shall take reasonable and appropriate actions to recover each recipient overpayment, as defined in ARM 37.82.102, of medicaid benefits when the recipient overpayment is the result of the recipient's intentional or unintentional act …

37.82.301 MAGI AS THE MEASURE OF INCOME Effective January 1, 2014, except for members receiving aged, blind, or disabled benefits or benefits based on participation in a Medicaid home and community-based services waiver, a person's income must be determined in accordance with 42 …

37.82.401 CITIZENSHIP AND ALIENAGE As a condition of eligibility for Medicaid, an otherwise eligible individual must be either: a citizen of the United States; or a qualified alien as defined in ARM 37.78.220 lawfully admitted for permanent residence or who entered the U.S. after…

37.82.402 RESIDENCY For purposes of this rule, a person is considered incapable of indicating intent if: his I.Q. is 49 or less or he has a mental age of seven or less, based on standardized tests; he has been judged legally incompetent; or documentation acceptable to the departm…

37.82.406 APPLICANT'S CHOICE OF CATEGORY A person who is eligible for more than one category of Medicaid eligibility will have eligibility determined for the category the person selects. A person who is eligible for Medicaid as a qualified Medicare beneficiary and under another M…

37.82.407 LIMITATION ON THE FINANCIAL RESPONSIBILITY OF RELATIVES The income and resources of the following relatives are considered available to an individual in determining the individual's eligibility for Aged Blind Disabled (ABD) Medicaid: the spouse of the individual, except…

37.82.415 APPLICATION FOR OTHER BENEFITS As a condition of eligibility, applicants and recipients must make every effort to obtain any benefits to which they are entitled, unless they can show good cause for not doing so. These benefits include, but are not limited to, veteran's …

37.82.416 ASSIGNMENT OF RIGHTS TO BENEFITS, COOPERATION WITH CHILD SUPPORT SERVICES REQUIREMENTS As a condition of eligibility for Medicaid, each legally able applicant and recipient must assign his rights to medical support or other third party payments to the department and mus…

37.82.417 TRANSFER OF RESOURCES The following definitions apply to this subchapter: "Fair market value" means the amount of compensation at which property would change hands between a willing buyer and an unrelated seller, neither being under compulsion to buy or sell and both ha…

37.82.418 BONA FIDE EFFORT TO SELL NON-HOME REAL PROPERTY (REPEALED) Authorizing statute(s): 53-6-113, MCA Implementing statute(s): 53-6-131, 53-6-141, 53-6-142, MCA History: NEW, 1989 MAR p. 882, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 476; EMERG, REP, 2003 MAR p. 652, Eff. 4…

37.82.422 CONDITIONAL MEDICAL ASSISTANCE, DEFINITIONS Definitions for the purposes of conditional medical assistance include: "Nonliquid resource" is personal property which is not cash and which cannot be converted to cash within 20 workdays. "Liquid resource" is property which …

37.82.423 CONDITIONAL MEDICAL ASSISTANCE, ELIGIBILITY Medicaid applicants may qualify for assistance conditioned on the sale, at current market value, of excess nonliquid resources. To be eligible for conditional assistance an applicant must: be categorically eligible by reason o…

37.82.424 HEALTH PLAN PREMIUM PAYMENTS "Group health plan" means any plan of an employer or any plan to which an employer contributes including a self-insured plan to provide health care, directly or otherwise, to the employer's employees, former employees, or the families of suc…

37.82.430 COBRA CONTINUATION BENEFICIARIES, APPLICATION, AND ELIGIBILITY FOR MEDICAID A person is a COBRA continuation beneficiary eligible for Medicaid, if: the person meets the nonfinancial criteria in (2) of this rule; the person has countable resources which do not exceed twi…

37.82.431 MEDICAID ESTATE RECOVERIES, WAIVER OF RECOVERY BASED UPON UNDUE HARDSHIP The department shall waive, in whole or in part, its claim under 53-6-167 , MCA, if the applicant demonstrates that recovery would result in an undue hardship to the applicant as provided in this r…

37.82.435 MEDICAID REAL PROPERTY LIEN, NOTICE AND RIGHT TO HEARING At least 30 days prior to filing a lien under 53-6-171, MCA upon real property of a Medicaid applicant or recipient, the department must provide the applicant or recipient notice of its determination that applican…

37.82.436 MEDICAID REAL PROPERTY LIEN, WAIVER OF LIEN RECOVERY BASED UPON UNDUE HARDSHIP The department shall waive, in whole or in part, its recovery upon a lien under 53-6-171 through 53-6-188 , MCA, if the applicant demonstrates that recovery would result in an undue hardship …

37.82.437 MEDICAID REAL PROPERTY LIEN, SPOUSE'S LIMITED RECOVERY EXEMPTION The department shall provide to the recipient's surviving spouse an exemption from recovery on a lien under 53-6-171 , MCA to the extent and under the conditions specified in 53-6-182 , MCA, according to t…

37.82.438 MEDICAID REAL PROPERTY LIEN, RELEASE OF LIEN AFTER RECIPIENT'S RETURN HOME If a recipient upon whose real property the department has imposed a lien under 53-6-171 , MCA has been discharged from the facility and has returned home, the department shall upon written reque…

37.82.701 GROUPS COVERED, NONINSTITUTIONALIZED FAMILIES AND CHILDREN Medicaid will be provided to: Individuals under age 19 who currently reside in Montana and are receiving foster care, guardianship, or adoption assistance under Title IV-E of the Social Security Act, whether or …