Eligibility Criteria for Nursing Home Residents 400-29-35-10

(Revised 5/1/05 ML #2969)

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An individual may receive benefits under this chapter if the individual:

  1. Meets eligibility criteria established under Section 400-29-35-05 of this chapter;

  2. Has resided in a nursing facility for at least six months;

  1. Was ineligible for Medicaid upon admittance to the nursing facility; and
  2. Subsequently denied nursing facility level of care; or
  3. Eligible for Medicaid but no longer meets nursing facility level of care criteria.

  1. During the first six months in a nursing facility, an individual may be eligible if:

  1. The individual’s spouse is admitted to the nursing facility at a nursing level of care; and
  2. There is not a basic care provider in the same city or town as the nursing facility.

  1. Meets functional assessment criteria established in the North Dakota Administrative Code Chapter 75-02-10-06. The functional assessment is required before the Department will pay for room and board in a licensed basic care facility.

The request for all functional assessments will only come from the state office in these situations (even if a nursing home is already a basic care provider).

  1. A recipient must receive a 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 case manager or the Developmental Disability Services case manager.