Applicant's and Recipient's Responsibility 510-05-20-15

(Revised 2/04 ML #2900)

(N.D.A.C. Section 75-02-02.1-12.1)

Applicants for and recipients of Medicaid benefits must provide the information necessary to determine if a health plan is cost-effective.

Recipients with a health plan the Department has determined is cost-effective must cooperate with all of the conditions or requirements of the health plan. Applicants and recipients must take any optional coverage provided through the plan when it is cost-effective to do so. Failure to cooperate with plan requirements, or to select cost-effective options of the plan, will:

Result in termination of payments for the health plan premiums; and
Result in nonpayment for services, by Medicaid, which the health plan would pay, or would have paid, had the recipient conformed to the requirements of the health plan.