Basic Factors of Eligibility 510-05-35

Medicaid Unit 510-05-35-05

(Revised 8/1/2025 ML 3854)

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(N.D.A.C. Section 75-02-02.1-08)

1. A Medicaid unit may be one individual, a married couple, or a family with children under twenty-one years of age, or if blind or disabled under age eighteen, whose income and assets are considered in determining eligibility for any member of that unit, without regard to whether the members of the unit all physically reside in the same location.

2. An applicant or recipient who is the caretaker of a blind or disabled child under eighteen years of age may select any of their non-blind or disabled children to be included in the Medicaid unit. Anyone whose needs are included in the unit for any month is subject to all Medicaid requirements which may affect the unit. The financial responsibility of relatives must be considered with respect to all members of the assistance unit.

When a child is included in the Medicaid unit eligibility is pursued for the child unless:

1. The child is eligible under the Healthy Steps Program;
2. The child is an ineligible noncitizen or the child's US citizenship has not been verified;
3. The child is ineligible due to no medical need (client share (recipient liability) exceeds need);
4. The child is receiving services in a Psychiatric Residential Treatment Facility (PRTF), or the state hospital, the Prairie at St. John's center, the Stadter Psychiatric Center, or any other institution for mental disease (IMD), and has not obtained certification of need for services in that facility; or
5. The child's identity has not been verified.
6. The child is eligible under ACA Medicaid

When a caretaker chooses not to include a child in the Medicaid unit, the child is not included in the unit for any other purpose (e.g. in the budget, in the asset test, or to create eligibility for a caretaker).