TITLE 1: GOVERNMENT
DIVISION 2: EXECUTIVE BRANCH
§ 20195. Coverage and Eligibility and Method of Processing Applications and Determining Eligibility. The Commonwealth Medicaid Agency shall process applications and makes determinations of Medicaid eligibility as follows: (a) Each applicant will be required to submit an application for medical assistance and to submit required supporting documents. (b) Eligibility determination must be made within 60 days from the date the application is submitted to the Commonwealth Medicaid Agency. (c) Eligibility coverage may begin as much as three months prior to the submission date of application if the Commonwealth Medicaid Agency determines that the applicant is eligible during that period. (d) Eligibility coverage will be for up to one year. (e) Changes of circumstances must be reported by the beneficiary and redeterminations made by the Commonwealth Medicaid Agency. Beneficiaries are required to re-apply and be redetermined annually. (f) The Commonwealth Medicaid Agency shall issue written denial letters for all ineligible applicants and terminated beneficiary(ies) and the Medicaid program shall establish an appeal process for any denial. (g) As a condition of eligibility, each legally able applicant and recipient will be required to assign his or her rights for release of information from agencies, providers, and other organizations to the Commonwealth Medicaid Agency for the purposes of making eligibility determination and for care coordination and evaluation of quality of services by providers. Refusal to assign rights to the Commonwealth Medicaid Agency will result in the denial or termination of eligibility. (h) Supplemental Security Income recipients are considered eligible upon filing an application for Medicaid. Annual reapplication and redetermination may not be required for Supplemental Security Income recipients. Continued receipt of Supplemental Security Income benefits, as verified by the Social Security Administration, is sufficient to maintain eligibility. Source: PL 21-28, § 2 (May 22, 2020). Commission Comment: The Commission numbered this section pursuant to 1 CMC § 3806(a).