Eligibility Criteria 400-29-35-05

(Revised 5/1/05 ML #2969)

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IM 5094

 

(NDAC 75-02-10-05)

 

 

A person may receive necessary benefits under this chapter if the person meets all of the requirements of this section.

  1. An applicant or recipient must be a  resident of this state;

  2. An applicant or recipient must be:

  1. Sixty-five years of age or older;
  2. Eighteen years of age or older and disabled or blind; or
  3. Considered disabled under the Workers with Disabilities program.

  1. An applicant or recipient must have applied for and been found eligible for Medicaid benefits (Service Chapter 501-05), with the following exceptions:

  1. All income, including SSI income, will be counted.
  2. SSI resource ineligibility - if an applicant or recipient chooses to maintain an asset level that causes that person to be ineligible for Supplemental Security Income (SSI) benefits, eligibility for BCAP will end, and no benefits will be made on behalf of that person until eligibility for SSI benefits is re-established. This exception exists only if the applicant or recipient is able to change the assets to become eligible for SSI benefits.
  3. Disqualifying Transfer of Income and Assets. A person is ineligible for benefits if the person or the spouse of the person disposed of assets or income for less than fair market value during the look-back period of thirty-six months for the purpose of qualifying for benefits (see section 400-29-35-15, "Disqualifying Transfer ").

  1. Apply for and receive benefits through the Medicare Savings Programs under Qualified Medicare Beneficiaries (OMB), or specified Low-income Medicare Beneficiaries (SLMB). The Medicare Savings Programs are available to assist with Medicare costs for people with limited income and assets.

  2. An applicant or recipient must meet functional assessment criteria in accordance with the North Dakota Administrative Code Chapter 75-02-10-10, is not severely impaired in any of the activities of daily living of toileting, transferring to or from a bed or chair, or eating, is in need of a structured or supervised environment, and is impaired in three of the four instrumental activates of daily living. The functional assessment is required before the Department will pay for room and board in a licensed basic care facility. The functional assessment is completed by the Home and Community Based Services Division located at the County Social Service Board. A "Transmittal Between Units " form is used to request a functional assessment on an applicant or recipient.  For a resident of the State Hospital discharged to a Basic Care facility and who is a BCAP applicant, the initial functional assessment done by the State Hospital social worker must be used.

  3. An applicant or recipient must receive and meet the criteria established under the personal care service assessment in order for the basic care facility to receive the personal care service payments. The assessment is completed by the Home and Community Based Services or Developmental Disability Services case manager.