Need 510-03-35-35

(Revised 5/1/2025 ML #3918)

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(N.D.A.C. Section 75-02-02.1-11)

 

Need is a factor of eligibility. Need in this sense is not to be confused with the necessity for a particular medical service.

 

1. Need is automatically established for individuals who are determined to be categorically needy eligible under ACA Medicaid.

    

2. For a medically needy applicant or recipient, need is established when:

   1. The individual has applied for Medicaid.

   2. There is no client share; or

   3. The individual has incurred or may incur medical expenses which the individual is responsible for after any third-party payments that equal or exceed client share.

       

3. If an individual does not utilize Medicaid for six months, their eligibility will end the following month.

    

4. Individuals may request their Medicaid coverage be terminated in writing or verbally. A verbal request must be recorded in the case file narrative and reflected on the closing notice. Follow policy at 510-03-25-25 notice requirements to determine proper closing time frame.