Application 400-29-20

(Revised 5/1/05 ML #2969)

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IM 5094

 

(NDAC 75-02-10-03)

 

 

  1. All individuals wishing to make application for benefits must have the opportunity to do so.

  2. An application is a request made by a person desiring benefits, or by a proper person seeking such benefits on behalf of another person, to a county agency. 

  3. An application consists of an application for Medicaid benefits and an application for services received in a licensed basic care facility, which includes a functional assessment.

  1. An application for the Medicaid and Basic Care Assistance Program on SFN 405, "Application for Assistance." A copy of the application is available as an E-form. This application process is completed by the county agency eligibility worker.
  2. An "Application for Services" which includes a completed functional assessment and may require a Personal Care Services Assessment, as described in Service Chapter 670-10 for Expanded SPED Program. This process is completed by the Home and Community Based Service Case Manager or Developmental Disability Services case manager.

  1. Application forms must be signed by the applicant, a proper person, or the applicant's court appointed guardian if the applicant has been adjudged incompetent by the court.

  2. Information concerning eligibility requirements, available services, and the rights and responsibilities of applicants and recipients must be furnished to all who require it.

  3. The date of the application is the date the application, signed by an appropriate person, is received by the county social service board.

  4. If a person is already receiving Medicaid benefits, a completed redetermination of eligibility is used to determine eligibility for the Basic Care Assistance Program.