Application and Decision 510-05-25
Application and Redetermination 510-05-25-05
(Revised 2/04 ML #2900)
(N.D.A.C. Section 75-02-02.1-02)
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Application.
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All individuals wishing to make application for Medicaid must have the opportunity to do so, without delay.
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A relative or other interested party may file an application in behalf of a deceased individual to cover medical costs incurred prior to the deceased individual's death.
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An application is a request for assistance on SFN 405, "Application for Medicaid, Temporary Assistance for Needy Families (TANF), Food Stamps, and Child Care Assistance"; SFN 502, "Application for HealthCare Coverage for Children, Families, and Pregnant Women"; SFN 641, "Title IV-E/Title XIX Application-Foster Care"; SFN 854, "Adoption Subsidy Application"; or the Department’s system generated "Statement of Facts." Applications provided by disproportionate share hospitals or federally qualified health centers are SFN 405 with "HOSPITAL" stamped on the front page.
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A prescribed application form must be signed by the applicant, an authorized representative or, if the applicant is incompetent or incapacitated, someone acting responsibly for the applicant.
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The date of application is the date an application, signed by an appropriate person, is received at a county agency, the Medical Services Division, a disproportionate share hospital, or a federally qualified health center. The date received must be documented.
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A recipient may choose to have a face-to-face or telephone interview when applying for Medicaid; however, none are required in order to apply for assistance.
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Information concerning eligibility requirements, available services, and the rights and responsibilities of applicants and recipients must be furnished to all who require it.
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A recipient has the same responsibility to furnish information during a redetermination as an applicant has during an application.
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A redetermination must be completed at least annually using the Department's system generated "Monthly Report" or "Redetermination of Eligibility;" SFN 407, "Redetermination of Eligibility for Medicaid"; SFN 642, "Title IV-E/Title XIX Redetermination-Foster Care" for children in Foster Care; SFN 856, "Adoption Subsidy Agreement - Annual Review" for subsidized adoption; or one of the previously identified applications completed to apply for another program.
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A redetermination must also be completed within thirty days after a county agency has received information indicating a possible change in eligibility status, or when eligibility is lost under a category (e.g. Transitional Medicaid Benefits). When the county agency has all information needed to redetermine eligibility based on a change in circumstances, a redetermination form does not have to be completed. When additional information is needed one of the forms identified in b. must be used.
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A recipient may choose to have a face-to-face or telephone interview for their redetermination; however, none are required in order to complete a redetermination.