Notice of Decision 400-29-25

(Revised 11/1/10 ML #3238)

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(NDAC 75-02-10-07)

 

  1. Applications - A decision as to eligibility of an application will be made within forty-five days, or within ninety days in disability cases, from the date of the application, except in unusual circumstances.
  2. Redetermination - A decision as to eligibility on a redetermination will be made within thirty days.
  3. Immediately upon an eligibility determination, whether eligibility can be found, ineligibility can be found, or eligibility cannot be determined, applicants/recipients must be notified by the county agency. A notice must be sent 10 days in advance of any decision terminating or reducing benefits under this chapter.
  4. A 10-day advance notice is required to be sent to a recipient informing them of their next month's recipient responsibility. A 10-day advance notice is required before increasing the next month's recipient responsibility.

When reworking a month based on new or changed information, 10-day advance notice or adequate notice does not apply. Basic Care policy states all available income must be counted with no exceptions. If information is received that changes the recipient responsibility, the month must be reworked to account for the new information.

  1. A notice must be timely or adequate.
  2. A 10-day advance of adequate notice is not required in the following instances, but the county is still required to inform the recipient of the action taken if:
  1.  County has factual information confirming the death of the recipient;
  2. The recipient no longer meets the criteria to be in a basic care facility;
  3. The county has received in writing the recipient's decision to terminate services;
  4. The recipient is placed in a nursing care facility, moved to a different basic care facility,  or returns home;
  5. State or federal government initiates a mass change which uniformly affects all applicants, recipients, and households;
  6. The recipient enters a public institution, occupants of which are not Medicaid eligible;
  7. The recipient's whereabouts are unknown and mail directed to the recipient is returned by the post office indicating no known forwarding address; or
  8. There is factual information that responsibility for providing assistance has been accepted by another state or jurisdiction.
  1. Errors made by public officials and delays caused by the action of public officials do not create eligibility and may not form the basis for the award of any benefit to any adversely affected applicant or recipient who would not otherwise be eligible to receive that benefit.
  2. A separate notice must be sent each month unless there is no change in the recipient responsibility.
  3. Two notices are sent to the basic care facility address; one for the recipient and one for the facility. The Notice of Action goes to the recipient. The Monthly Budget information goes to the basic care facility which is notification to the facility on how much to collect and for what items.