North Dakota Administrative Code

Repealed effective January 1, 2025.

1. An applicant or recipient must be a United States citizen or an alien lawfully admitted for permanent residence. Acceptable documents to establish United States citizenship and naturalized citizen status are defined in 42 CFR 435.407. 2. For purposes of qualifying as a United …

1. Incarceration status is not a condition of Medicaid eligibility and does not make an individual ineligible. An individual who is an inmate of a public institution who meets all eligibility factors for Medicaid is eligible. Medicaid eligibility for individuals who are inmates o…

1. Parents and caretaker relatives, and their spouses, who meet the medically needy technical requirements and the requirements of this section are eligible under the parent and caretaker relative group. 2. Parents and caretaker relatives eligible under the parent and caretaker r…

1. 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. 2. An institution for mental disease consists of more than sixteen beds. 3. Fede…

Families that cease to be eligible under the parent and caretaker relative group and who meet the requirements of this section may continue to be eligible for Medicaid benefits without making further application for Medicaid. 1. Families that include at least one individual who w…

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 mo…

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…

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 valu…

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 a minor or dependent child, dependent parent, or dependent sibling of the institutiona…

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 br…

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 r…

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 …

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 depart…

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 dispo…

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 …

Repealed effective April 1, 2012.

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.…

working individuals, and spousal impoverishment prevention. 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 ex…

1. Ownership of real or personal property or liquid assets can take various forms. The first basic consideration is the distinction between real and personal property. Real property relates to land and those things, such as houses, barns, and office buildings, which are more or l…

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, usua…

Repealed pursuant to North Dakota Century Code section 28-32-18.1, effective July 16, 2003.

1. A trust is an arrangement whereby a person known as the "grantor" or "trustor" gives assets to another person known as the "trustee" with instructions to use the assets for the benefit of a third person known as the "beneficiary". The assets placed in trust are called the "pri…

August 10, 1993. 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.…

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, …

Repealed effective February 1, 1996.

Repealed effective January 1, 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 s…

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 l…

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 …

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 weekl…

methodology. 1. For purposes of this section, "reasonable compatibility" refers to an allowable difference or discrepancy between the income reported by an applicant or recipient and the income reported by an electronic data source. 2. The department may request additional inform…

Repealed effective December 1, 1991.

Repealed effective July 1, 2003.

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 unearne…

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 follow…

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 …

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 nur…

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 serv…

methodology. 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 nurs…

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 …

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 serv…

1. The department shall use levels of income for maintenance 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 Medic…

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 me…

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…

1. Definitions. For purposes of this section: a. "Base month" means the calendar month prior to the processing month. 93 b. "Benefit month" means the calendar month for which eligibility and recipient liability is being computed. c. "Best estimate" means an income, expense, or ci…

No individual may be determined to be ineligible for Medicaid for any month if, had the approved state plan for medical assistance in effect on January 1, 1972, been in effect in such month, that individual would be eligible. The following income and resource standards were a par…

1. For purposes of determining an individual's eligibility under this chapter, if payment is made by the individual to the individual's attorney-in-fact for services or assistance furnished to the individual by the attorney-in-fact, the department may not treat the services or as…

1. Children ages birth through eighteen years of age are eligible for plan coverage provided all other eligibility criteria are met. Coverage for children who are eighteen years of age will continue through the last day of the month in which the child turns nineteen years of age.…

As used in this chapter, unless the context or subject matter otherwise requires: 1. "Case manager" means the individual who coordinates and leads the person-centered planning process, and who provides each target population member with information about and assistance in accessi…