Title: Par
Author: Curtis Volesky
Last saved by: raddington
Company: NDDHS

Bismarck, North Dakota	MANUAL LETTER #3021	April 1, 2006

Par. 1.  Material Transmitted and Purpose --Transmitted with this Manual Letter are changes to Service Chapter 510-05, Medicaid Eligibility Factors.

510-05-20-20.  Cost-effectiveness Determination 
Subsection 5 has been updated to remove the reference to drug coverage because Medicaid is no longer responsible for drug coverage for Medicare beneficiaries.
5.	The following health plans are usually not considered to be cost-effective.
a.	Medicare supplement policies for individuals with routine medical needs (the exceptions are ~~policies with drug coverage or~~ recipients with higher medical needs and the recipient's covered costs exceed the premium);

510-05-25-20.  Medicaid Brochures
This section has been updated to identify that the new application form guidebook will take the place of the individual brochures.  If an application is provided without the guidebook, the appropriate brochures must be provided.
~~1.~~	All applicants for Medicaid must be provided the “Application for Assistance Guidebook” or, in place of the guide book:
1. ~~a.~~A brochure entitled "Medicaid" (376kb pdf) (05-100-15) outlining the services available under the Medicaid Program;
2. ~~b.~~ A brochure entitled "Your Civil Rights" (152kb pdf) (05-100-20); ~~and~~
3. ~~c.~~ A notice entitled "Notice of Privacy Practices" (18 kb pdf) (DN 900 which is available in E-Forms~~.~~);
4. ~~2.~~ All households with individuals of childbearing age must be made aware of the opportunity they have to receive family planning services and must be given a brochure entitled "Family Planning-Choosing Your Family Size," or "Family Planning Program" (05-100-25)~~.~~ ;
5. ~~3.~~ All households with individuals under the age of twenty-one must be made aware of the availability of "North Dakota Health Tracks" (early and periodic screening, diagnosis and treatment services) and be given the brochure entitled "ND Health Tracks" (05-100-30)~~.~~ ; and
6. ~~4.~~ All households with pregnant, breast feeding or postpartum women, or children under age five, must be made aware of the availability of the WIC (Women, Infants, and Children) Program, and must be provided a "WIC" outreach brochure (05-100-35).  
~~5.  Acknowledgment that the applicant received such information is contained on the application form.~~

510-05-30-05.  Groups Covered Under Medicaid
This subdivision has been updated to reflect a previous change allowing pregnancy to be medically confirmed.
3.	The medically needy group includes:
c.	Pregnant women whose pregnancy has been medically ~~verified~~ confirmed and who qualify on the basis of financial eligibility.

510-05-35-15.  Caretaker Relatives
Subsection 6 has been added to clarify that a caretaker can not become eligible based on having a child in their care if they have opted out all of their own children who are living with them.
6.	A child other than a natural or adoptive child cannot create eligibility for a caretaker when a natural or adoptive child under age 21, or 18 if blind or disabled, resides in the home of the caretaker. 

510-05-35-80.  Social Security Numbers
Language has been added to clarify that neither Transitional nor Extended Medicaid Benefits can be terminated for no SSN. 
1.	A valid social security number (SSN), or verification of application for SSN, must be furnished as a condition of eligibility, for each individual for whom Medicaid benefits are sought except a newborn child for the first sixty days, beginning on the date of birth and for the remaining days of the month in which the sixtieth day falls, an individual who is currently eligible for Transitional or Extended Medicaid Benefits, and an illegal alien seeking emergency services. (see 05-35-70 for a description of emergency services.)

510-05-35-85.  State Residence
Subsection 2(d) has been rewritten to clarify that a child’s residence follows that of the parent.  If living with another caretaker, residence follows that of the caretaker only if the child is living there on a permanent basis.  Language was also changed in subsection 3(a) to clarify that residency for migrants is also based on where they are residing, not just where they are employed.
2.	Individuals under age twenty-one.
d.	For any other non-institutionalized individual under age twenty-one, the state of residence is the state in which the parent is a resident, or if the child is residing with another caretaker on other than a temporary basis, the state in which the caretaker is a resident. A child is normally considered to be living in the state temporarily if: 
i.	The child comes to North Dakota to live with relatives through a private arrangement;
ii.	The child ~~who~~ comes to North Dakota to receive an education, special training, or services in the Anne Carlson School, maternity homes, vocational training centers, etc. ~~is normally regarded as living temporarily in the state~~ if the intent is to return to the child’s home state upon completion of the education or service~~.~~; 
~~iii.~~	~~A~~ The child is placed by an out-of-state court into the home of relatives or foster parents in North Dakota on other than a permanent basis; or ~~is living in the state for a temporary purpose and remains a legal resident of the state of origin. A resident of North Dakota who leaves the state temporarily to pursue educational goals (including any~~ 
iv.	The child entered the state to participate~~ing~~ in Job Corps~~)~~ or other specialized services (including a child  placed by a ~~state~~ court into the home of ~~out-of-state~~ relatives or foster parents in North Dakota) ~~does not lose residence in the state~~.

3.	Individuals age twenty-one and over:
a.	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.
The state of residence, for Medicaid purposes, of migrants and seasonal farm workers is the state in which they are living due to ~~employed~~ employment or seeking employment.

510-05-35-90.  Application for Other Benefits 
Subsection 2 has been reorganized and language has been added to clarify that although individuals could apply for early retirement benefits (beginning at age 62) or widows benefits (beginning at age 60) they are not required to apply for these earned rights benefits prior to the individuals full retirement age if the individual is still employed.  Receipt of these benefits prior to full retirement age creates a permanently reduced benefit, and is offset by earnings. 
1.	As a condition of eligibility, applicants and recipients must take all necessary steps to obtain any annuities, pensions, retirement, and disability benefits, to which they are entitled, unless they can show good cause for not doing so. Annuities, pensions, retirement, and disability benefits include, but are not limited to, veterans' compensation and pensions; old age, survivors, and disability insurance benefits; railroad retirement benefits; and unemployment compensation.
Good cause under this section exists if:
a.	The recipient is a pregnant woman or a newborn who is within the 60 days of free Medicaid; 
b.	The recipient is eligible for Transitional or Extended Medicaid Benefits; 
c.	Receipt of the annuity, pension, retirement, or disability benefit would result in a loss of health insurance coverage; or 
d.	An employed or self-employed individual who has not met their full retirement age chooses not to apply for Social Security early retirement or widows benefits. 

Good cause must be documented in the case file.

510-05-35-100.  Blindness and Disability
A change was made to subsection 4 to clarify that SSA will not make a disability determination when someone is within six months of their full retirement age.  Full retirement age for individuals born after 1939 is after age 65.  Language was also changed in subsection 5 to more closely follow the State Review Team process. 
4.	The county agency will need to obtain and submit medical and social information to the State Review Team for their evaluation if: ~~If~~
a.	~~t~~The applicant is requesting assistance for a month prior to the SSI application;~~,~~ 
b.	~~if t~~The applicant is not eligible for SSI because of the SSI income and resource levels;~~,~~
c.	~~if t~~The applicant refuses to apply for SSI;~~,~~ 
d.	~~if t~~The applicant is not eligible for SSA disability due to not being insured;, 
e.	~~if t~~The applicant is applying for Workers with Disabilities coverage and is not eligible for SSA disability due to substantial gainful activity;~~,~~ 
f.	The applicant has applied for SSA disability and a determination is not made within 45 days of the Medicaid application; or 
g.	~~t~~The applicant is within six months of reaching full retirement age ~~65~~, ~~the county agency will need to obtain and submit medical and social information to the State Review Team for their evaluation~~.  
The medical and social information is generally submitted along with SFN 451, "Eligibility Report on Disability/Incapacity" (05-100-40), and if the individual is applying for Workers with Disabilities coverage, SFN 228, "Workers with Disability Report Part II" (05-100-41).  

5.	The state agency may not make an independent determination of disability if the Social Security Administration has made a disability determination or will make a disability determination within ninety days after the date of application for Medicaid.

When a Medicaid application, based on disability, is pending for 45 days, the SFN 451 or the SFN 228 must be sent to the State Review Team. The State Review Team will ~~contact the Social Security Disability Determination Services Unit (DDS) to obtain medical/social information.  If the information needed to make a disability determination is not available from DDS, the State Review Team will~~ request the medical information from the applicant.  A copy of the request will be sent to the county agency ~~which will need to obtain the medical/social information~~. A decision regarding disability will then be made within the 90 day time period if the Social Security Disability Determination Services Unit (DDS) has not made a decision. However, once DDS eventually makes a disability determination, Medicaid must follow that decision.

510-05-57-10.  Individuals Covered (Workers with Disabilities)
Subsection 3 was changed to clarify that an individual who is SSI eligible, but not Medicaid eligible (i.e. excess countable assets), could pursue coverage through Workers with Disabilities.
3.	An SSI recipient, or an individual who is eligible as a 1619a or 1619b, is not eligible under this coverage~~, as~~ if ~~they are~~ categorically eligible for Medicaid.  

510-05-70-30.  Excluded Assets 
The example in subsection 3(b) was simplified for clarification.   
3.	Any prepayments or deposits, regardless of ownership, which total $5000 or less, which are designated by an applicant or recipient for ~~their~~ the applicant’s or recipient’s burial. An applicant or recipient designates a prepayment or deposit for his or her burial by providing funds that are used for that purpose.
b.	Any funds, insurance or other property given to another person or entity in contemplation that its value will be used to meet the burial needs of the applicant or recipient must be considered towards the burial exclusion.  This includes any funds set aside in a separate account or used to purchase insurance or any other burial product.  Any amount in excess of the $5000 burial exclusion is a countable asset if the fund, insurance, or other property has a cash value, fair market value, or surrender value.
Example:  ~~An individual with no burial plan living in a nursing facility gives his daughter $3945 per month for five months, and asks that the money be used for his funeral.  His daughter purchases a $20,000 single premium life insurance policy that designates a funeral home as beneficiary, to the extent necessary to pay for the individual’s funeral and burial expenses, with the individual’s children named as contingent beneficiaries.  The individual applies for Medicaid in the fifth month.  The insurance policy has a surrender value of $17,500 in the month of application.  The policy is intended for the individual’s burial, so $5000 of the value of the policy is excluded.  The remaining $12,500 of the value of the policy is an asset held in trust, and is considered to be available to the individual (05-70-50 Trusts).  To the extent that the $19,725 paid to the daughter is neither excluded nor available under 05-70-50, a disqualifying transfer has occurred ($19,725 - $5000 (burial set-aside) - $12,500 (countable asset) = $2225 transfer).~~ A Medicaid recipient with an insurance policy that is designated for burial previously transferred ownership of the policy to his daughter.  The policy has a current cost basis of $5400 and cash surrender value (CSV) of $7500.  The insurance policy is considered to be transferred in trust to meet the burial needs of the recipient.  $5000 is excluded under the burial exclusion and the additional $400 in cost basis is a countable asset to the recipient ($5400 - $5000 = $400).  The extra $2100 in cash surrender value is earnings and is excluded ($7500 CSV - $5400 cost basis = $2100 earnings). 

510-05-70-45.  Annuities
Language was added to subsection 4 to clarify a good faith effort to sell an annuity.  Language was also changed in subsection 6 to clarify the payment amount of a community spouse annuity.
   
4.	The value of a countable annuity is:
a.	If the annuity may be surrendered to its issuing entity for a refund or payment of a specified amount or provides an available lump-sum settlement option, an amount equal to the total available proceeds from that refund, surrender, or settlement;
b.	If the annuity may be assigned, an amount equal to its value as a contractual right to receive money payments; and
c.	If the annuity may not be surrendered or assigned, an amount equal to the highest amount offered by a buyer ready and able to complete the purchase of the right to receive a stream of income consisting of the payments yet to come due under the terms of the annuity.  The owner of an annuity may demonstrate a good faith effort to sell the annuity or the right to receive the payments from the annuity by making an offer to sell to the regular market for such property.  
i.	"Receivables" are the legal right to be paid money due under the terms of a contract. The income stream produced by an annuity is such a receivable. Any person may purchase the right to this income stream.
ii.	A "factor" is someone who buys receivables at a discount.
iii.	The "factors' market" is one place that an annuity's income stream may be sold. Companies and individuals nationwide will pay a lump sum in return for the right to receive the remaining annuity payments. This income stream may be sold regardless of whether the annuity is irrevocable or not assignable. Several offers must be sought in order to establish the fair market value of the annuity.

A good faith effort to sell must include an honest effort to sell the annuity that is reasonably calculated to induce a willing buyer to believe the annuity offered for sale is actually for sale at a reasonable price.  An offer to sell an annuity or its payments includes making an offer in writing and submitting it to potential purchasers.  The offer must include, at a minimum: 

i.	A statement that the annuity owner is willing to take all necessary steps to sell the annuity or relinquish the payments under it in exchange for a lump sum payment including but not limited to providing an irrevocable power of attorney, change of beneficiary, payee, or address;  

ii.	A statement of the amount of payments;

iii.	A description of the term of the payments (how long they will last); and

iv.	The name, address, and telephone number of a person who will answer inquiries and receive offers.

6.	An annuity purchased for a community spouse in which a payment option was selected before August 1, 2005 is not countable as an available asset for purposes of making an assessment or determining eligibility but any payment derived from that annuity is income, if:
a.	The annuity is irrevocable and cannot be assigned to another person;
b.	The issuing entity is an insurance company or other commercial company that sells annuities as part of the normal course of business;
c.	The annuity provides for level monthly payments;
d.	The annuity will return the full purchase price and interest within the purchaser's life expectancy; and
e.	Unless specifically ordered otherwise by a court of competent jurisdiction acting to increase the amount of spousal support paid on behalf of a community spouse by an institutionalized spouse or a home and community based services (HCBS) spouse~~:~~, the monthly payments from the annuity 
~~i.~~	~~For eligibility periods before August 1, 2005, the monthly payments from the annuity do not exceed $2267; and~~
~~ii.~~	~~For eligibility periods on or after August 1, 2005,~~ the monthly payments from the annuity do not exceed $2488 effective January 2006 ($2378 effective August 2005).

510-05-70-60.  Valuation of Assets 
4.	Divided or partial interests. Divided or partial interests include assets held by the applicant or recipients, jointly or in common with persons who are not in the Medicaid unit; assets where the applicant or recipient or other persons within the Medicaid unit own only a partial share of what is usually regarded as the entire asset; and interests where the applicant or recipient owns only a life estate or remainder interest in the asset.
c.	Life estates and remainder interests.
i.	The life estate and remainder interest table must be used to determine the value of a life estate or remainder interest. In order to use the table, it is necessary to first know the age of the life tenant or, if there ~~are~~ is more than one life tenant~~s~~, the age of the youngest life tenant; and the market value of the property which is subject to the life estate or remainder interest. The value of a life estate is found by selecting the appropriate age in the table and multiplying the corresponding life estate decimal fraction times the market value of the property. The value of a remainder interest is found by selecting the appropriate age of the life tenant in the table and multiplying the corresponding remainder interest decimal fraction times the fair market value of the property. Refer to 05-100-80 for the Life Estate table.
ii.	The life estate and remainder interest tables are based on the anticipated lifetimes of individuals of a given age according to statistical tables of probability. If the life tenant suffers from a condition likely to cause death at an unusually early age, the value of the life estate decreases and the value of the remainder interest increases. An individual who requires long-term care, who suffers from a condition that is anticipated to require long-term care within twelve months, or who has been diagnosed with a disease or condition likely to reduce the individual's life expectancy is presumed to suffer from a condition likely to cause death at an unusually early age, and may not rely upon statistical tables of probability applicable to the general population to establish the value of a life estate or remainder interest. If an individual is presumed to suffer from a condition likely to cause death at an unusually early age, an applicant or recipient whose eligibility depends upon establishing the value of a life estate or remainder interest must provide a reliable medical statement that estimates the remaining duration of life in years. The estimated remaining duration of life may be used, in conjunction with a life expectancy table, to determine the comparable age for application of the life estate and remainder interest table. Refer to 05-100-75 for the life expectancy table.
iii.	In most situations, the act of establishing a life estate interest in property is transferring a partial interest, a remainder interest, in property to someone else, while retaining (or giving another) the life estate interest.  When transferring a remainder interest, part of the value of the property is also transferred.  The value transferred is established by multiplying the value of the property at the time of transfer by the appropriate value in the remainder interest column of the life estate and remainder interest table.  Equity in the property must also be considered when determining the amount of the transfer.  If there is a loan against the property that is assumed by the remaindermen as part of the transfer, then the amount of the loan is considered compensation received.  If the life tenant retains the loan obligation, the full value of the remainder interest is the amount transferred.

Example:  A 75-year-old transfers a remainder interest in property, valued at $80,000, to his children.  He has a $20,000 mortgage on the property, which he is still obligated to pay.  Using the table, the value of the remainder interest is $35,888.25 ($80,000 x .47851 = $35,888.25) and is the value of what he transferred away.  He still owns the life estate interest, which has a value of $44,111.75, but he only has $24,111.75 in equity ($44,111.75 - $20,000 loan).  If the children who received the remainder interest also assumed the mortgage, the children actually are giving compensation, so the uncompensated amount of the transfer is only $15,888.25 ($35,888.25 - $20,000 loan = $15,888.25).

510-05-75-15.  Communal Colonies
This is a new section to address the treatment of assets and income for applicants and recipients who live in communal colonies.  This policy must be followed for all determinations following the effective date.

Individuals who live communally (i.e. Hutterites, Mennonites, Amish, etc.) may or may not have a collective ownership of property and income.  In determining eligibility, it will first be necessary to determine whether collective ownership of assets and income exists.  If it does not, medically needy policy applies to individuals and families, as it does for any other individual or family.  

If the commune has collective ownership, also determine whether the commune is self-employed.  Most communal colonies are self-employed in agricultural or manufacturing and are incorporated, or set up as a large partnership.  Occasionally, some colonies are not self-employed, but may be working under contract for wages.

1.	Assets.  When colonies have a collective ownership in assets, no individual ownership rights remain, and the assets of the colony are not considered available.   

Any personal assets owned by an applicant or recipient that are not owned collectively, and are not otherwise exempt or excluded, are countable, and the medically needy asset limits apply.

2.	Income.  Most colonies have collective ownership of income, which is often generated from their self-employment venture.  When colonies have a collective ownership in income, a share attributable to each individual or family must be determined.  Countable income is established as follows:

a.	If the colony is self-employed, from the colony’s corporate or partnership tax return. 
i.	From the total gross income, subtract any cost of goods for resale, repair, or replacement, to arrive at the colony’s adjusted gross income; and

ii.	Divide the total amount of adjusted gross income by the number of members in the colony to establish each individual’s share of income.  Multiply this amount by the number of individuals in the Medicaid unit to determine the unit’s share.  If the tax return represents an entire year of the business operation, one twelfth of the unit’s share is the monthly income; and    

iii.	Apply the medically needy self-employment income disregards described in 05-85-20; and  

Example:  There are 124 members in a colony that is engaged in farming.  A family of six in the colony applies for Medicaid.  The corporate tax return indicates $4,922,603 in adjusted gross earnings.  Divide $4,922,603 by 124 members to arrive at each individual’s share of $39,698.41.  Multiply $39,698.41 by six to arrive at the unit’s share of $238,190.46.  The self-employment disregard for farming is 75%, which gives the family $59,547.62 in countable annual income.  Divide by 12 to determine the Medicaid unit’s monthly income of $4,962.30.  

iv.	Identify the income as belonging only to the adults in the Medicaid unit, or older children who are actively engaged in the operation and are not students, and allow the appropriate earned income deductions for those individuals who are actively engaged in the operation.  If no individuals in the Medicaid unit are actively engaged in the business, such as an aged or disabled individual, the income is considered to be unearned income; or

Example:  An aged individual from a colony engaged in farming applies for Medicaid.  The corporate tax return indicates $4,922,603 in adjusted gross earnings, which is divided by the 124 members in the colony to arrive at each individual’s share of $39,698.41.  Because there is only one individual in the unit, the unit’s share is $39,698.41.  The self-employment disregard for farming is 75%, which gives the individual $9,924.60 in countable annual income.  Divide by 12 to determine the Medicaid unit’s monthly income of $827.05.  The income is shown as unearned income because the aged person is no longer actively engaged in the business.

b.	If the colony is not self-employed, but is working under contract for wages:

i.	Divide the total contract income by the number of members in the colony to establish each individual’s share of income.  Multiply this amount by the number in the Medicaid unit to determine the unit’s share; and  
ii.	Identify the income as belonging only to the adults in the Medicaid unit, or older children who are actively engaged in the operation and are not students, and allow the appropriate earned income deductions for those individuals who are actively engaged in the operation. If no individuals in the Medicaid unit are actually engaged in the business, such as an aged or disabled individual, the income is considered to be unearned income; and  

c.	For members who have other earned or unearned income, the income counts as income of the individual who receives it and the medically needy policies apply to the income.  Income is counted for the individual, even if the income has been given to the colony.  

3.	Adding or deleting individuals.  
a.	Changes in the unit’s share of income must be changed when adding or deleting members to the unit and is based on the number of individuals in the unit.  The share is not changed when adding an unborn child until the child is born.

Example:  The individual share of income established for a colony, based on the colony’s self-employment, is $350 per individual per month.  A family within the colony consists of 5 individuals so the Medicaid unit’s total monthly income is $1,750 (5 x $350). A child is born and added to the unit, so now the unit consists of 6 individuals, and monthly income is $2,100 (6 x $350).  If the unit had instead lost a member and reduced in size to 4, the income would have decreased to $1,400 (4 x $350).

b.	The individual’s share of income, which is based on the number of members in the colony, is normally determined when calculating annual income from self-employment for self-employed colonies, or for a new contract period for colonies working under a contract for wages.  The number of members in the colony does not need to be changed in between these calculations, or when adding or deleting a member from the household.  However, if the colony reports a change in the number of members, the individual share must be recalculated based on the new information.

Example 1:  The individual share of income has been established for a colony at $350 per individual per month.  This amount was originally calculated based on the number of members in the colony and the colony’s self-employment income.  A child is born to a family.  A new calculation does not have to be made because there may now be more members in the colony, but the $350 per person per month continues to be used as the individual share of income.

Example 2:  The individual share of income has been established for a colony at $350 per individual per month, and was based on 124 members. A child is born to a family and reported.  At the same time, new information is provided that the colony now has 118 members because a different family left the colony, and one member died.  A new calculation must be made because a change in the actual membership number has been confirmed by the colony.  The new individual share has now increased to $367.80 per person per month.

510-05-80-25.  Exceptions to Disqualifying Transfer Provision 
Subsection 5 was updated to reflect previous changes made to the treatment of annuities for community spouses and to accommodate the increase in the allowed annuity payment.  The example in subsection 6 was corrected to better explain the policy.

5.	A transfer is not disqualifying to the extent that the asset was used to acquire an annuity ~~that is owned by~~ for a community spouse if the annuity meets the requirements in subsections 6 or 7 of 05-70-45. 
~~a.~~	~~The annuity is irrevocable and cannot be assigned to another person;~~
~~b.~~	~~The annuity is purchased from an insurance company or other commercial company that sells annuities as part of the normal course of business;~~
~~c.~~	~~The annuity provides for level monthly payments;~~
~~d.~~	~~The annuity will return the full purchase price and interest within a reasonable estimate of the purchaser's life expectancy; and~~
~~e.~~	~~The monthly payments from the annuity do not exceed $2267 unless specifically ordered otherwise by a court of competent jurisdiction acting to increase the amount of spousal support paid on behalf of a community spouse by an institutionalized spouse or a home and community based services spouse.~~
6.	A transfer to meet the burial needs of an individual is not disqualifying to the extent the asset transferred meets the burial exclusion and to the extent the asset is considered available to the individual.
Example:  ~~A Medicaid recipient without any other burial plan purchases a burial insurance policy for $10,000 and transfers ownership to someone outside of the Medicaid unit. The policy has a cash surrender value of $7500. The insurance policy is considered to be transferred in trust to meet the burial needs of the individual, so the $7500 cash surrender value is considered available to the individual, of which $3000 is excluded for burial ($4500 is a countable asset). The remaining $2500 of the amount that was transferred ($10,000 - $7500 = $2500) is a disqualifying transfer~~

510-05-85-05.  Income Considerations 
Language was added to subsection 2 to incorporate existing policy and to clarify that a stepparent’s income is used to determine a child’s eligibility when the stepparent is the only caretaker, and the child is making the stepparent eligible, and when budgeting Transitional Medicaid Benefits. 
2.	The financial responsibility of any individual for any applicant or recipient of Medicaid will be limited to the responsibility of spouse for spouse and parents for children under age twenty-one. Such responsibility is imposed as a condition of eligibility for Medicaid. Except as otherwise provided in this section, the income of the spouse and parents is considered available even if that income is not actually contributed. Natural and adoptive parents, but not stepparents, are treated as parents (exceptions to counting a stepparent’s income applies when the stepparent is the only eligible caretaker and is eligible for Medicaid because of the child, as described in 05-35-20(2) or when budgeting for Transitional Medicaid Benefits as described in 05-50-05(7)).  

510-05-85-25.  Post Eligibility Treatment of Income 
Language was changed in subsection 1(h) to clarify that interest and dividend income is only disregarded if from liquid assets. 

This section prescribes specific financial requirements for determining the treatment of income and application of income to the cost of care for individuals screened as requiring nursing care services who are residing in nursing facilities, the state hospital, the Anne Carlsen facility, the Prairie at St. John's center, the Stadter Psychiatric Center, intermediate care facilities for the mentally retarded (ICF-MR), and individuals receiving swing bed care in hospitals.
1.	The following types of income may be disregarded in determining Medicaid eligibility:
h.	Interest or dividend income from liquid assets.

510-05-85-30.  Disregarded Income 
A new subsection was added to disregard reimbursements of Medicare Part D premiums, copayments, and deductibles made by prescription drug plans.
44.	Medicare Part D premiums, copayments, and deductibles refunded by prescription drug plans.

510-05-85-40.  Income Levels
This section is updated with the new family member and poverty level income levels. 
2.	Medically needy income levels.  
d.	Family member income level. The income level for each ineligible family member in a spousal impoverishment case is ~~$534~~ $550 effective April ~~2005~~ 2006 (~~$521~~ $534 effective April ~~2004~~ 2005).
3.	Poverty income levels.
a.	Qualified Medicare Beneficiaries…

Number of Persons | Monthly Income Level
1 | $ ~~798~~ 817
2 | ~~1070~~ 1100
3 | ~~1341~~ 1384
4 | ~~1613~~ 1667
5 | ~~1885~~ 1950
6 | ~~2156~~ 2234
7 | ~~2428~~ 2517
8 | ~~2700~~ 2800
Effective April 1, ~~2005~~ 2006
For each person in the Medicaid unit above eight, add $~~272~~ 284 to the monthly amount.

b.	Specified Low-Income Medicare Beneficiaries.
Number of Persons | Monthly Income Levels
1 | $ ~~957~~ 980
2 | ~~1283~~ 1320
3 | ~~1609~~ 1660
4 | ~~1935~~ 2000
5 | ~~2261~~ 2340
6 | ~~2587~~ 2680
7 | ~~2913~~ 3020
8 | ~~3239~~ 3360
Effective April 1, ~~2005~~ 2006
For each person in the Medicaid unit above eight, add $~~326~~ 340 to the monthly amount.

c.	Pregnant women and children under age six. 
Number of Persons | Monthly Income Level
1 | $~~1061~~ 1087
2 | ~~1422~~ 1463
3 | ~~1784~~ 1840
4 | ~~2145~~ 2217
5 | ~~2506~~ 2594
6 | ~~2868~~ 2971
7 | ~~3229~~ 3348
8 | ~~3590~~ 3724
Effective April 1, ~~2005~~ 2006
 
For each person in the Medicaid unit above eight, add $~~362~~ 377 to the monthly amount.

d.	Qualifying Individuals.
Number of Persons | Monthly Income Level
1 | $ ~~1077~~ 1103
2 | ~~1444~~ 1485
3 | ~~1811~~ 1868
4 | ~~2177~~ 2250
5 | ~~2544~~ 2633
6 | ~~2911~~ 3015
7 | ~~3278~~ 3398
8 | ~~3644~~ 3780
Effective April 1, ~~2005~~ 2006
For each person in the Medicaid unit above eight, add $~~367~~ 383 to the monthly amount.

e.	Transitional Medicaid Benefits.
Number of Persons | Monthly Income Level
1 | $~~1476~~ 1511
2 | ~~1978~~ 2035
3 | ~~2481~~2560
4 | ~~2984~~ 3084
5 | ~~3486~~ 3608
6 | ~~3989~~ 4132
7 | ~~4491~~ 4656
8 | ~~4994~~ 5180
Effective April 1, ~~2005~~ 2006
For each person in the Medicaid unit above eight, add $~~503~~ 525 to the monthly amount.

f.	Workers with Disabilities.
Number of Persons | Monthly Income Level
1 | $~~1794~~ 1837
2 | ~~2405~~ 2475
3 | ~~3016~~ 3112
4 | ~~3628~~ 3750
5 | ~~4239~~ 4387
6 | ~~4850~~ 5025
7 | ~~5461~~ 5662
8 | ~~6073~~ 6300
Effective April 1, ~~2005~~ 2006
For each person in the Medicaid unit above eight, add $~~611~~ 637 to the monthly amount.

Other Sections Changed
This manual letter includes several other typographical corrections that are not identified above.

Par. 2.  Effective Date  -- This manual letter is effective for the benefit month of April 2006.

Carol K. Olson, Executive Director		Manual Letter #3021
North Dakota Department of Human Services	Page  of  Pages