State Residence 510-05-35-85

(Revised 01/03 ML #2833)

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(N.D.A.C. Section 75-02-02.1-16)

A resident of the state is a person who is living in the state voluntarily and not for a temporary purpose. Temporary absences from the state with subsequent returns to the state, or intent to return when the purpose of the absence has been accomplished, do not interrupt continuity of residence. Residence is retained until abandoned or established in another state.

1. For persons entering the state, the earliest date of eligibility is the date of entry. Residence may not be established for persons who are receiving Medicaid benefits or claiming residence from another state.

2. Individuals under age twenty-one.

• For any individual under age twenty-one who is living independently from his parents or who is married and capable of indicating intent, the state of residence is the state where the individual is living with the intention to remain there permanently or for an indefinite period.
• For any individual who is receiving foster care or adoption assistance payments, under title IV-E, from another state and is living in North Dakota, North Dakota is the state of residence for Medicaid purposes.
• For any individual under age twenty-one not residing in an institution, whose Medicaid eligibility is based on blindness or disability, the state of residence is the state in which the individual is living.
•  For any other non-institutionalized individual under age twenty-one, the state of residence is the state in which the caretaker is a resident. Children coming to North Dakota to receive an education, special training, or services in the Anne Carlson School, maternity homes, vocational training centers, etc. are normally regarded as living temporarily in the state if their intent is to return to their home state upon completion of the service for which they came. Likewise, children placed by out-of-state courts into homes of relatives or foster parents in North Dakota are generally considered to be living in the state for a temporary purpose. Such children, therefore, remain legal residents of their states of origin. Similarly, residents of North Dakota who leave the state temporarily to pursue educational goals (including any child participating in Job Corps) or other specialized services (including children placed by state courts into homes of out-of-state relatives or foster parents) do not lose residence in the state.
• For any institutionalized individual, under age twenty-one, who is neither married nor living independently, residence is that of the parents or legal guardian at the time of placement. Only if the parental rights have been terminated, and a guardian or custodian appointed, may the residence of the guardian or custodian be used. If the individual has been abandoned by his parents and does not have a guardian, the individual is a resident of the state in which he lives.

3. Individuals age twenty-one and over:

• For any individual not residing in an institution, the state of residence is the state where the individual is living with the intention to remain there permanently or for an indefinite period or is entering the state with a job commitment or seeking employment.

Migrants and seasonal farm workers may choose to retain residence in their home state, and can still be eligible for Medicaid in the state in which they are employed or seeking employment.

2. For an institutionalized individual who became incapable of indicating intent before age twenty-one, the state of residence is that of the parent or guardian making application, at the time of placement or, if the individual is institutionalized in that state, at the time of application. If the individual has no guardian, the application is not made by either parent, and the placement was not made by another state, the state of residence is the state in which the individual is physically present.
3. For any other institutionalized individual, the state of residence is the state where the individual is living with the intention to remain there permanently or for an indefinite period.

4. A "person incapable of indicating intent" means one who:

1. Has an intelligence quotient of forty-nine or less, or a mental age of seven or less, based upon tests acceptable to the Division of Mental Health of the Department of Human Services;
2. Has been found by a court of competent jurisdiction to be an incapacitated person as defined in subsection 2 of North Dakota Century Code section 30.1-26-01;
3. Has been found by a court of competent jurisdiction to be legally incompetent; or
4. Is found incapable of indicating intent based on medical documentation obtained from a physician or surgeon, clinical psychologist, or other person licensed by the state in the field of mental retardation.

5. Individuals placed in out-of-state institutions by a state agency retain residence in that state regardless of the individual's indicated intent or ability to indicate intent. State residence ends, however, when the competent individual leaves the facility in which the individual was placed by the state. Providing information about another state's Medicaid program or about the availability of health care services and facilities in another state, or assisting an individual in locating an institution in another state, does not constitute a state placement.

State agencies include human service centers, the Division of Juvenile Services, special education, county social service offices, the Department of Human Services, and the Health Department. Tribal entities and hospital social workers or other staff are not state agencies.

6. For any individual receiving a state supplemental payment, the state of residence is the state making the payment.

7. For any individual on whose behalf payments for regular foster care are made, the state of residence is the state making the payment.

8. If an interstate reciprocal residency agreement has been entered into between this state and another state pursuant to 42 CFR 435.403(k), the state of residence of an affected individual is the state determined under that agreement.

North Dakota has an interstate reciprocal residency agreement with ten states. The agreement provides that individuals of any age institutionalized in one of these states are considered a resident of the state in which they are institutionalized.

The states with whom we have the agreement are:

North Dakota also has a specific agreement with the State of Minnesota. The agreement states that individuals who enter a nursing facility remain a resident of the state they were a resident of prior to admission into the nursing facility for 24  months following admission, and if the individual has a community spouse, they continue to be a resident of the state the community spouse lives in beyond the 24 month time limit. This agreement terminates at the point the individual is discharged from a nursing facility unless the individual is being transferred to a different nursing facility.

9. When two or more states cannot agree which state is the individual's state of residence, the state of residence is the state in which the individual is physically present.

10. North Dakota residents will be provided Medicaid outside the state when:

1. It is a general practice for residents of a particular locality to use medical resources outside the state;
2. The availability of medical resources requires an individual to use medical facilities outside the state for short or long periods. Prior approval from the Medical Services Division must be obtained when an individual is being referred for out-of-state medical services.

Transportation for approved out-of-state medical services will be arranged jointly by the individual and the county agency.

3. Persons are absent from the state for a limited period of time to receive special services or training;
4. It is an emergency situation; and
5. Services are received during an eligible period but prior to application.