Title: Par
Author: Michele Gee
Last saved by: raddington
Company: DHS

Bismarck, North Dakota	MANUAL LETTER #3194	October 1, 2009

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

Groups Covered Under Medicaid 510-05-30-05.  

Changed subsections (4)(e), (4)(g) and (4)(h) to remove the aged , blind and disabled requirements from the eligibility criteria for the Medicare Savings Programs (QMB, SLMB, and QI-1).  Federal Statutes do not include this requirement, and although most Medicare recipients are aged or disabled, some Medicare recipients with renal failure are not. 

4.	The poverty level group includes:
e.	Qualified Medicare Beneficiaries (QMB), who are ~~aged, blind, or disabled individuals~~ entitled to Medicare part A benefits, and who meet the medically needy nonfinancial criteria, have assets no greater than twice the SSI resource standards, and have income at or below one hundred percent of the poverty level. Effective January 1, 1991 (90% of the poverty level from April 1, 1990, through December 31, 1990).
g.	Special Low-Income Medicare Beneficiaries (SLMB), who are ~~aged, blind, or disabled individuals~~ entitled to Medicare Part A benefits, who meet the medically needy nonfinancial criteria, have assets no greater than twice the SSI resource standards, and have income above one hundred percent of the poverty level but not in excess of one hundred twenty percent of the poverty level. Effective January 1, 1993.
h.	Qualifying Individuals (QI-1), who are ~~aged, blind, or disabled individuals~~ entitled to Medicare Part A benefits, who meet the medically needy nonfinancial criteria, have assets no greater than twice the SSI resource standards, have income above 120% of the poverty level, but not in excess of 135% of the poverty level, and are not eligible for Medicaid under any other provision. Effective January 1, 1998.
 
Age and Identity 510-05-35-40

Subsection 5(b) was changed to clarify that a newborn stays continuously eligible until their first birthday without verification of identity regardless of living arrangement.  The first and second level of verifications charts have been amended to recognize the change in policy mandated by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). This act amended the Deficit Reduction Act of 2005’s identity verification requirements by adding a document from a federally recognized Indian tribe to the first level of acceptable verifications.  

b.	Newborn children: A child, born to a woman who has applied for and been determined Medicaid eligible and is in receipt of Medicaid when the child is born, may be eligible without verifying identity for up to one year. ~~as long as the Mother is eligible or would remain eligible if she were pregnant and as long as the child remains in the Mother's household.~~  Identity verification for the child must be supplied at the next redetermination of eligibility that occurs in or after the month of the child’s first birthday. This provision also applies in instances where labor and delivery services were furnished prior to the date of the Medicaid application and covered based on retroactive eligibility.
This exception applies to all children whose birth is covered by Medicaid, including those under the emergency services only provisions.   ~~as long as the child remains in the Mother's household.~~

Primary Verifications of Identity
(Level One)
These Documents Verify both Citizenship and Identity: | Explanatory Information:

US Passport

•	Issued by the Department of State
•	Does not have to be currently valid, as long as it was issued without limitation; (any passport issued with a limitation cannot be used to verify citizenship, but CAN be used to verify identity)
•	Through 1980, spouses and children were often included on one passport; after that each person is issued his own passport.

Certificate of Naturalization (DHS/INS Forms N-550 or N-570) | •	Department of Homeland Security or Immigration and Naturalization Service (INS) issues for naturalization.
Certificate of US Citizenship (DHS/INS Forms N-560 or N-561) | •	Department of Homeland Security or INS issues certificates of citizenship to individuals who derive citizenship through a parent.

Tribal Enrollment Card
Certificate of Degree of Indian Blood
Or other documents issued by a federally recognized Indian tribe that evidences membership or enrollment with such tribe

•	A Document issued by a federally recognized Indian tribe evidencing membership or enrollment or affiliation with, such tribe

d.	Secondary verifications of identity may be accepted if primary verifications are not provided. Verification documents must be presented in their official and original form as received from the issuing agencies.  Photocopies or notarized copies are not acceptable.  Once an original document is presented, a photocopy must be made and maintained in the case file.
 
Secondary Verifications of Identity
(Level 2)
Acceptable Verifications: | Explanatory Information:

~~Certificate of Degree of Indian Blood, or other U. S. American Indian / Alaska Native tribal document~~

~~•~~	~~Must include a photograph of the applicant or recipient; or~~
~~•~~	~~Have other personal identifying information for the individual such as name, age, sex, race, height, weight, or eye color~~

Driver's license issued by a state or territory
(DO NOT accept Canadian driver's license)

•	Must include a photograph of the applicant or recipient: or
•	Have other personal identifying information for the individual such as name, age, sex, race, height, weight, or eye color

Identification card issued by a US Federal, State or local government with the same information as a driver's license. | •	DO NOT accept a voter's registration card
School ID card | •	Must include a photograph of the applicant or recipient
U. S. military ID card or draft record |
Military dependent's identification card |
U. S. Coast Guard Merchant Mariner card |

Citizenship and Alienage 510-05-35-45
Subsection 3 and the first level of verifications chart have been amended to recognize the change in policy mandated by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).  This act amended the Deficit Reduction Act of 2005’s citizenship verification requirements by exempting any child born to a Mother eligible for Medicaid at the time of the child’s birth from the requirements and adds a document from a federally recognized Indian tribe to the first level of acceptable verifications. 
3.	Newborn children. A child, born to a woman who has applied for and been determined Medicaid eligible and is in receipt of Medicaid when the child is born, may be eligible without verifying citizenship. ~~for up to one year as long as the Mother is eligible or would remain eligible if she were pregnant and as long as the child remains in the Mother's household. Citizenship verification for the child must be~~ ~~supplied at the next redetermination of eligibility.~~ This provision also applies in instances where labor and delivery services were furnished prior to the date of the Medicaid application and covered based on retroactive eligibility.
This provision applies to all children whose Mother is eligible for Medicaid at the time of their birth, including those under the emergency services only provisions. 
Children who are born to a woman who is not eligible for regular Medicaid must comply with the verification requirements if Medicaid is requested.   
5.	Acceptable documentation for US citizens and naturalized citizens.
a.	There are three documents that may be accepted as proof of both citizenship and identity because each contains a photograph of the individual named in the document and either the US or a state government has established the citizenship and identity of the individual.  These three documents are considered to be the primary (Level 1) and preferred verification documents.
 
Primary Verifications
(Level 1)
These Documents Verify both Citizenship and Identity: | Explanatory Information:

US Passport

•	Issued by the Department of State
•	Does not have to be currently valid, as long as it was issued without limitation; (any passport issued with a limitation cannot be used to verify citizenship, but CAN be used to verify identity)
•	Through 1980, spouses and children were often included on one passport; after that each person is issued his own passport.

Certificate of Naturalization (DHS/INS Forms N-550 or N-570) | •	Department of Homeland Security or Immigration and Naturalization Service (INS) issues for naturalization.
Certificate of US Citizenship (DHS/INS Forms N-560 or N-561) | •	Department of Homeland Security or INS issues certificates of citizenship to individuals who derive citizenship through a parent.

Tribal Enrollment Card
Certificate of Degree of Indian Blood
Or other documents issued by a federally recognized Indian tribe that evidences membership or enrollment with such tribe

•	A Document issued by a federally recognized Indian tribe evidencing membership or enrollment or affiliation with, such tribe

Continuous Eligibility Periods 510-05-53-15

Added a clarification at subsection 5(e) addressing loss of contact when the child’s whereabouts are unknown.

5.	A continuous eligibility period must be ended earlier than redetermination for any of the following reasons:
a.	The recipient turns age 19;
b.	The recipient loses state residency;
c.	The recipient requests that their coverage end;
d.	The recipient dies; or
e.	The agency has lost contact with the ~~recipient.~~  family and the child’s whereabouts are unknown.

Asset Considerations for the Medicare Savings Programs 
510-05-60-15
Added verbiage to subsection 3 to clarify that parental assets are considered in determining a child’s eligibility for the Medicare Savings Programs except in those situations where the child lives apart from the parents.
Medically needy asset considerations, valuation of assets, and forms of asset ownership apply to Medicare Savings Programs eligibility determinations except:
1.	Half of a liquid asset held in common with another QMB, SLMB, or QI is presumed available;
2.	Assets owned by a child, under age twenty-one, in the unit are  not considered available in determining eligibility for the child's parent, except that all liquid assets held in common by the child and the parent are considered available to the parent; and
3.	Assets owned by a parent or spouse who is not residing with an applicant or recipient for a part of a month are not considered available for that month unless the assets are liquid assets held in common.  This provision does not apply to situations where either the parent, spouse, or child is away from the home for a full calendar month for the purposes of work or school.

Disqualifying Transfer Provisions 510-05-80-10
A link has been created from the first paragraph of this section to the definitions subsection that defines ‘nursing care services’ to aid in the clarification of which services are affected by disqualifying transfers.
1.	An individual is ineligible for nursing care services if the individual or the spouse of the individual disposes of assets or income for less than fair market value on or after the look-back date. (Transfers by a parent do not affect a child’s coverage of nursing facility services and vice versa.)

Life Expectancy Table 510-05-100-75
The table at subsection 2, effective February 8, 2006 has been updated to coincide with a new Federal table.

Par. 2.  Effective Date -- This manual letter is effective for the benefit month of October 2009.

Carol K. Olson, Executive Director	Manual Letter # 3194
North Dakota Department of Human Services	Page  of  Pages