Need 510-03-35-35

(Revised 2/1/2024 ML #3805)

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

    1. There is no client share (recipient liability); or

    2. When the applicant or recipient has incurred or may incur medical expenses for which the applicant or recipient is responsible (after any third party payments) that equal or exceed the client share.

  1. If an individual does not utilize Medicaid for seven months, their eligibility will be ended.
  2. 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.