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Bismarck, North Dakota	MANUAL LETTER #3205	January 1, 2010

Par. 1.	Material Transmitted and Purpose – Transmitted with this Manual Letter are changes to Service Chapter 510-05 Medicaid Eligibility Factors.  New language is in red and underlined and old language has been struck through.

Home and Community Based Services (HCBS) 510-05-15-05
Subsection 4 was changed to set a minimum age for the Aged and Disabled waiver to age 18.
4.	Medicaid Waiver for Home and Community Based Services: Services are provided to individuals at least 18 years of age, who meet the disability criteria of the Social Security Administration, or are at least 65 years of age who are screened as requiring care in a nursing facility, but choose to receive services in the community. As of April 1, 2007, this waiver merged the Waiver for the Aged or Disabled (which began October 1, 1983) and the Waiver for the Traumatic Brain Injured (which began in 1994).

Application and Redetermination 510-05-25-05
Subsection 1(c) is updated to include the new SFN 958 “Health Care Application for the Elderly and Disabled” (which will be available in early 2010); to treat the records sent with the Low Income Subsidy file from SSA as applications for Medicaid and Medicare Savings Programs as required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA); and to accept SFN 1803 “Subsidized Adoption Agreement”, rather than SFN 854 “Title IV-E Adoption Subsidy Certification”, as an approved application for Medicaid.  The online “Application for Economic Assistance Programs”, (which should be available by February 2010), is also added to the list of acceptable forms. Sections 1(c) and 2(b) were rearranged to show the various forms in a ‘list’ format.
1.	Application.
~~c.~~	~~An application is a request for assistance on SFN 405, "Application for Economic Assistance Programs"; SFN 502, "Application for HealthCare Coverage for Children, Families, and Pregnant Women"; SFN 641, "Title IV-E/Title XIX Application-Foster Care";SFN 1803 “Subsidized Adoption Agreement” SFN 854, "Adoption Subsidy Application"; SFN 958 “Health Care Application for the Elderly and Disabled”; the Department’s system generated "Statement of Facts"; the Department’s online “Application for Economic Assistance Programs”; the Low Income Subsidy file from SSA, or if within one calendar month of when an applicant's Medicaid case was closed, one of the prescribed redetermination forms (see subsection 2(b). Applications provided by disproportionate share hospitals or federally qualified health centers are SFN 405 with "HOSPITAL" stamped on the front page.~~
c.	An application is a request for assistance on:
i.	SFN 405, "Application for Economic Assistance Programs"; 
ii.	SFN 502, "Application for HealthCare Coverage for Children, Families, and Pregnant Women"; 
iii.	SFN 641, "Title IV-E/Title XIX Application-Foster Care"; 
iv.	SFN 1803 “Subsidized Adoption Agreement” ~~SFN 854, "Adoption Subsidy Application~~"; 
v.	SFN 958 “Health Care Application for the Elderly and Disabled”; 
vi.	The Department’s system generated "Statement of Facts"; 
vii.	The Department’s online “Application for Economic Assistance Programs”; 
viii.	The Low Income Subsidy file from SSA; ~~or~~ 
ix.	If within one calendar month of when an applicant's Medicaid case was closed, one of the prescribed redetermination forms (see subsection 2(b))~~.~~; or 
x.	Applications provided by disproportionate share hospitals or federally qualified health centers are SFN 405 with "HOSPITAL" stamped on the front page.

2.	Redetermination.
b.	A redetermination must be completed at least annually using the Department’s:
i.	System generated “Monthly Report”;
ii.	System generated “Redetermination of Eliigibility”;
iii.	SFN 407, “Redetermination for Healthcare Coverage”;
iv.	SFN 642, “Title IV-E/Title XIX Redetermination – Foster Care” for Children in Foster Care;
v.	SFN 856, “Adoption Subsidy Agreement – Annual Review” for subsidized adoption; or
vi.	One of the previously identified applications completed to apply for another program. 
In circumstances where a desk review is appropriate, such as when adding a child, or adding Medicare Savings Programs coverage, to an existing case in which the county agency has all information needed to complete a redetermination, eligibility may be established without a redetermination form. In unique circumstances, when the county agency has all information needed to complete a redetermination, and circumstances prevent a recipient or their representative from timely returning the redetermination form, continued eligibility may be established without a completed form.

Eligibility - Current and Retroactive 510-05-25-10 
Subsection one has been changed to incorporate the requirements as set forth by the Medicare Improvements for Patients and Providers Act of 2008, which makes it mandatory to accept data from the Social Security Low Income Subsidy application file as an application request for the Medicare Savings Programs.

1.	Current eligibility may be established from the first day of the month in which the signed application was received, or in the case of ~~the Medicare Savings Program~~ an application received through the Low Income Subsidy file, the date the Social Security Administration received the Low Income Subsidy application. This provision does not apply to Qualified Medicare Beneficiaries.

Groups Covered Under Medicaid 510-05-30-05
This section has been changed to incorporate the requirements as set forth by the Medicare Improvements for Patients and Providers Act of 2008, which changes the asset limits for the Medicare Savings Programs to be the same as those for the Medicare Part D Low Income Subsidy.

4.	The poverty level group includes:
e.	Qualified Medicare Beneficiaries (QMB), who are entitled to Medicare part A benefits, and who meet the medically needy nonfinancial criteria, have assets no greater than ~~twice the SSI resource standards~~ the limit established for the Medicare Part D Low Income Subsidy, 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 entitled to Medicare Part A benefits, who meet the medically needy nonfinancial criteria, have assets no greater than ~~twice the SSI resource standards~~ the limit established for the Medicare Part D Low Income Subsidy, 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 entitled to Medicare Part A benefits, who meet the medically needy nonfinancial criteria, have assets no greater than ~~twice the SSI resource standards~~  the limit established for the Medicare Part D Low Income Subsidy, 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
This section has been amended to recognize the change in policy mandated by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) which excludes newborn children born to women who were Medicaid eligible at the time of the child’s birth from the identity verification requirements.

Primary Verifications Table
(Level 1)

US Passport
or US Passport Card Issued since 2007

•	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.
•	The passport card is for frequent travelers by land or sea between the US and Canada, Mexico, the Caribbean and Bermuda.

5.	Identity must be established and documented as provided in this section.
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.  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 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 here on a temporary basis and who is not eligible for Medicaid or emergency medical services must comply with the verification requirements if Medicaid is requested.

Citizenship and Alienage 510-05-35-45
Primary Verifications Table
(Level 1)

US Passport
or US Passport Card Issued since 2007

•	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.
•	The passport card is for frequent travelers by land or sea between the US and Canada, Mexico, the Caribbean and Bermuda.

Social Security Numbers 510-05-35-80
Subsection1 is modified to clarify that once a newborn is one year of age, the SSN is required, and subsection 6 added to clarify that while verification of application for a SSN is allowable to put someone on Medicaid, the worker is still to follow up and obtain the individual’s actual 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 the following individuals do not have to provide a SSN, or verification of application for SSN:
a.	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, or if the newborn is continuously eligible, for the remaining days of the newborn's first eligibility period; 
b.	An individual who is currently eligible for Transitional or Extended Medicaid Benefits; and
c.	An illegal alien seeking emergency services. (see 05-35-70 for a description of emergency services.)

When the exempt period ends, a social security number or verification of application for SSN must be provided to continue Medicaid coverage.
Members of the Medicaid unit who are not seeking benefits may voluntarily provide their SSN; however, they are not required to do so.
2.	Persons who do not have a number must be referred to the Social Security Administration to apply for one. The county agency may assist the applicant as needed.
3.	A copy of the enumeration at birth form (SSA 2853) that is completed at the hospital, or any other receipt from the Social Security Administration is adequate verification of application for SSN.
4.	The Medicaid household must be informed, at the time of application and yearly thereafter, that the agency will use the SSN in the administration of the Medicaid Program. The SSN will be used to verify income and asset information from the Social Security Administration, Internal Revenue Service, Job Service, Unemployment Compensation, Food Stamp Program, TANF Program, Child Support Enforcement, State Motor Vehicle, Department of Vital Statistics and other states.
The informing requirement is met by the appropriate language found on the Application for Assistance and the Redetermination of Eligibility.
5.	Social Security numbers are electronically verified through the NUMIDENT system for all recipients. When a number is reported as not valid, the recipient must provide their valid SSN in order to continue eligible for Medicaid.
6.	Except for recipients excused in Subsection 1, recipients who provide verification of application for a SSN must provide a SSN by the next redetermination. If a child is within a continuous eligibility (CE) period when the case redetermination is being completed, and the SSN is not provided, the child is eligible through the end of the current CE period; however, the child’s SSN must be provided for eligibility to continue past the end of that CE period.

Inmates of Public Institutions 510-05-35-95

Subsections 1 and 2 of this section have been reorganized to clarify who is an inmate of a public institution.

1.	For purposes of this section:
a.	"Individual on conditional release" means an individual who is away from the institution, for trial placement in another setting or for other approved leave, but who is not discharged. An individual on "definite leave" from the state hospital is an individual on conditional release.
b.	"Inmate of a public institution" means a person who has been sentenced, placed, committed, admitted, or otherwise required or allowed to live in the institution, and who has not subsequently been unconditionally released or discharged from the institution. 

	An individual is not considered an inmate if:
i.	The individual is attending school at the North Dakota School for the Blind in Grand Forks, or North Dakota School for the Deaf in Devils Lake;
ii.	The individual is in a public institution for a temporary period pending other arrangements appropriate to the individual's needs (i.e., Juvenile Detention Center, Fargo); or 
iii.	The individual is over age sixty-five and a patient in the state hospital.
c.	"Unconditionally released" means released, discharged, or otherwise allowed or required to leave the institution under circumstances where a return to the institution cannot be required by the operator of the institution.
Examples of public institutions include but are not limited to: State Hospital, School for the Blind, School for the Deaf, State Developmental Center at Grafton, Veterans Administration Hospitals, North Dakota Veteran’s Home, North Dakota Youth Correctional Center, North Dakota State Penitentiary, and city, county, or tribal jails.
2.	An inmate of a public institution is not eligible for Medicaid unless:

a.  ~~b.~~	The eligible individual is residing in the ICF/MR at the State Developmental Center, or is in long term care in the North Dakota Veteran’s Home;
b.  ~~e.~~	The individual is under age twenty-one, in the state hospital receiving inpatient psychiatric services, and who meets the certificate of need for admission. A person who attains age twenty-one while receiving treatment, and who continues to receive treatment as an inpatient, may continue to be eligible through the month the individual attains the age of twenty-two~~.~~; or 
c.   ~~f.~~	The individual is under the age of 19 and is determined to be continuously eligible for Medicaid.  While the individual remains eligible for Medicaid no medical services will be covered during the stay in the public institution.
3.	Individuals who are committed under the penal system to a public institution are not eligible for Medicaid even though they may be receiving care in a medical facility. Inmate status at a penal facility (correctional) begins at the time of confinement.

Residence in the institution is terminated by parole, discharge, release on bond, or whenever the individual is allowed to return and reside in their home. A transfer from a penal facility to the state hospital or another facility, for evaluation or treatment does not terminate inmate status.

Individuals Covered (Children with Disabilities) 
510-05-58-10
This section is being updated to include the policy that individuals that are Categorically Eligible for Medicaid cannot be eligible under the Children with Disabilities coverage.
1.	An individual may be enrolled under the Children with Disabilities coverage if he or she:
a.	Is under age 19 (including month individual turns age 19);
b.	Is disabled; and
c.	Except for Qualified Medicare Beneficiary or Special Low-income Medicare Beneficiary coverage, is not in receipt of any other Medicaid benefits under this chapter.
2.	The Social Security Administration may refuse to determine disability for a new applicant when the family has excess assets or income.  In these situations, the State Review Team will make a medical determination of disability.  This disability determination is valid for all Medicaid coverages; however, these individuals will likely remain eligible for Medicaid under the Children with Disabilities coverage.  
3.	Applicants or recipients who are eligible under this coverage, but who may also be eligible as medically needy, may choose which coverage they want, and will likely be based on which is more cost-effective for them.  Once a recipient has been authorized as eligible for a current or past benefit month under one coverage, and the eligibility cannot be unauthorized, the recipient cannot switch coverages for that benefit month.   A recipient can switch between coverages prospectively.
4.	A SSI recipient, or an individual who is eligible as a 1619a or 1619b, is not eligible under this coverage if categorically eligible for Medicaid.  

Individuals Covered and Benefits 510-05-60-10
This section has been changed to incorporate the requirements as set forth by the Medicare Improvements for Patients and Providers Act of 2008, which makes it mandatory to accept data from the Social Security Low Income Subsidy application file as an application request for the Medicare Savings Programs.
 
1.	Qualified Medicare Beneficiaries are entitled only to Medicare cost sharing benefits beginning in the month following the month in which the eligibility determination is made (i.e. the application is received on March 29, eligibility is determined in April, the first month of QMB eligibility is May).
2.	Specified Low-Income Medicare Beneficiaries are entitled only to payment of their Medicare Part B premium. Eligibility may be established for as many as three calendar months prior to the month in which the application was received or the date the Social Security Administration received the Low Income Subsidy application.
3.	Qualifying Individuals are entitled only to payment of their Medicare Part B premium. Eligibility may be established for as many as three calendar months prior to the month in which the application was received or the date the Social Security Administration received the Low Income Subsidy application. A redetermination of eligibility is required in December of each year to establish continued eligibility for the coming year.

Asset Limits for the Medicare Savings Program 510-05-60-20
This section has been changed to incorporate the requirements as set forth by the Medicare Improvements for Patients and Providers Act of 2008, which changes the asset limits for the Medicare Savings Programs to be the same as those for the Medicare Part D Low Income Subsidy.

No person may be found eligible for the Medicare Savings Programs unless the total value of all non-excluded assets does not exceed~~:~~ the limit established for the Medicare Part D Low Income Subsidy.  This amount changes annually.  Effective with the benefit month of January 2010, the limits are:
~~1.~~	~~Four thousand dollars for a one-person unit; or~~
~~2.~~	~~Six thousand dollars for a two-person unit.~~
1.	$6,600 for a one-person unit ($4,000 in 2009); or
2.	$9,910 for a two-person unit ($6,000 in 2009)

Excluded Assets 510-05-70-30
The example at Subsection 3(b) has been corrected.
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 $6000 burial exclusion is a countable asset if the fund, insurance, or other property has a cash value, fair market value, or surrender value.
Example:  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 $6400 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. $6000 is excluded under the burial exclusion and the additional $400 in cost basis is a countable asset to the recipient ($6400 - $6000 = $400). The extra ~~$2100~~ $1100 in cash surrender value is earnings and is excluded ($7500 CSV - $6400 cost basis = $1100 earnings).

Annuities Purchased Before August 1, 2005 510-05-70-45-20
Subsection 2(c)(v) is updated for the 2009 amounts.
c.	The annuity meets all of the following conditions:
i.	The annuity is irrevocable and cannot be assigned to another person;
ii.	The issuing entity is an insurance company or other commercial company that sells annuities as part of the normal course of business;
iii.	The annuity provides for level monthly payments;
iv.	The annuity will return the full purchase price and interest within the purchaser's life expectancy; and
v.	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 do not exceed ~~$2610~~ $2739 effective January ~~2008~~ 2009 (~~$2541~~ $2610 for ~~2007~~ 2008).

Post Eligibility Treatment of Income 510-05-85-25
This section has been changed to include the increase in the income level for residents in an Intermediate Care Facility for the Mentally Retarded (ICF-MR) to $85 effective January 1, 2010.
3.	In establishing the application of income to the cost of care, the following deductions are allowed in the following order:
a.	The ~~nursing care income level;~~ appropriate nursing care or ICF-MR income level; 

Disregarded Income 510-05-85-30
Subsection 1 has been changed to include the payments made by the Department in connection with the State Long Term Care Subsidy Program as disregarded income for the Medicaid program.

The following types of income must be disregarded in determining Medicaid eligibility:
1.	Money payments made by the Department, another state, or tribal entities in connection with the State LTC Subsidy program, foster care, subsidized guardianship, or the subsidized adoption program (This does not include Casey family, or other private foster care payments);

Income Levels 510-05-85-40
Subsection 2 has been changed to include the increase in the income level for residents in an Intermediate Care Facility for the Mentally Retarded (ICF-MR) to $85 effective January 1, 2010.  
2.	Medically needy income levels.
b.	Nursing care income level. The nursing care income level is fifty dollars per month and must be applied to residents receiving psychiatric or nursing care services in nursing facilities, ~~intermediate care facilities for the mentally retarded (ICF-MR),~~ the state hospital, the Prairie Psychiatric Center, the Stadter Psychiatric Center, a Psychiatric Residential Treatment Facility (PRTF), the Anne Carlsen facility, or receiving swing bed care in a hospital.
c.	ICF-MR income level.  The income level for a resident of an Intermediate Care Facility for the Mentally Retarded (ICF-MR) is $85 effective January 1, 2010.
d.	Community spouse income level. The income level for a community spouse who is eligible for Medicaid is subject to the categorically needy, medically needy, or poverty level income levels. The level for an ineligible community spouse is $2267, or a higher amount if ordered by a court or hearing officer.
e.	Family member income level. The income level for each ineligible family member in a spousal impoverishment case is $607 effective April 2009 ($584 effective April 2008).

Determining the Appropriate Income Level in Special Circumstances 510-05-85-45
Subsection 4 has been updated to reflect the change in the income level for a resident of an Intermediate Care Facility for the Mentally Retarded (ICF-MR) effective January 1, 2010.  
4.	During a month in which an individual with eligible family members in the home enters or leaves a Psychiatric Residential Treatment Facility (PRTF), an Intermediate Care Facility for the Mentally Retarded (ICF-MR),  or a nursing facility to return home, or elects to receive HCBS or terminates that election, the individual will be included in the family unit in the home for the purpose of determining the family size and the appropriate medically needy income level. Individuals in a Psychiatric Residential Treatment Facility (PRTF), an Intermediate Care Facility for the Mentally Retarded (ICF-MR), or a nursing facility will be allowed ~~fifty dollars~~ the appropriate nursing care or Intermediate Care Facility for the Mentally Retarded (ICF-MR) income level to meet their maintenance needs during all full calendar months in which the individual resides in the facility. Recipients of HCBS will be allowed the medically needy income level for one during all full calendar months in which the individual receives HCBS. In determining eligibility for Workers with Disabilities and Children with Disabilities coverages, individuals in a nursing facility, or in receipt of HCBS, will be allowed the appropriate Workers with Disabilities or Children with Disabilities level for one during all full calendar months in which the individual resides in the facility.  

Budgeting Procedures for SSI Recipients 510-05-90-45
Subsection 2 has been updated with a link to “Related Programs” (510-05-95) which describes the State LTC Subsidy Program which starts January 1, 2010.
2.	SSI recipients residing in a nursing facility, an intermediate care facility for the mentally retarded (ICF-MR), the state hospital, the Anne Carlsen facility, the Prairie Psychiatric Center, the Stadter Psychiatric Center, a Psychiatric Residential Treatment Facility (PRTF), or receiving swing bed care in a hospital: The SSI recipient is allowed the nursing care income level.  Also see State LTC Subsidy Program 510-05-95-45. 
Parental and spousal income is not considered available to the recipient.  
Individuals between the ages of 21 and 65 are not eligible for Medicaid in the state hospital.

Budget Procedures for Medically Needy and Poverty Level 510-05-90-55 
This section has been changed to include the increase in the income level for residents in an Intermediate Care Facility for the Mentally Retarded (ICF-MR) to $85 effective January 1, 2010.
2.	Recipients residing in a nursing facility, ~~an intermediate care facility for the mentally retarded (ICF-MR),~~ the state hospital, the Anne Carlsen facility, the Prairie Psychiatric Center, the Stadter Psychiatric Center, a Psychiatric Residential Treatment Facility (PRTF), or receiving swing bed care in a hospital: The recipient is allowed the $50 nursing care income level.
Recipients residing in an intermediate care facility for the mentally retarded (ICF-MR): The recipient is allowed the $85 ICF-MR income level.
For a single individual under age 21, or if blind or disabled under age 18, parental income is not considered available during any full calendar month the recipient is in the facility. Likewise, for a married recipient, income of the spouse is not considered available during any full calendar month, or when the community spouse is ineligible for Medicaid (spousal impoverishment case), during any full or partial month.
If the individual has no source of income, and is ineligible for SSI, the income of the spouse or parents may be deemed in the amount of $50 (or $85 if the individual is in an ICF-MR) to meet the maintenance needs of the individual.
Individuals between the ages of 21 and 65 are not eligible for Medicaid in the state hospital.

Budgeting Procedures for Continuous Eligibility for Children under Age 19 510-05-90-75 
This section has been changed to include the increase in the income level for residents in an Intermediate Care Facility for the Mentally Retarded (ICF-MR) to $85 effective January 1, 2010.
2.	For a continuously eligible child residing in a nursing facility, ~~an intermediate care facility for the mentally retarded (ICF-MR),~~ the state hospital, the Anne Carlsen facility, the Prairie Psychiatric Center, the Stadter Psychiatric Center, a Psychiatric Residential Treatment Facility (PRTF), or receiving swing bed care in a hospital: the recipient is allowed the $50 nursing care income level and excess income becomes recipient liability.
Recipients residing in an intermediate care facility for the mentally retarded (ICF-MR): The recipient is allowed the $85 ICF-MR income level.
For a single individual under age 19, parental income is not considered available during any full calendar month the recipient is in the facility.
If the individual has no source of income, and is ineligible for SSI, the income of the parents may be deemed in the amount of $50, (or $85, if the individual is in an ICF-MR) to meet the maintenance needs of the individual.
NOTE:  The premium calculation for Children/Workers with Disabilities is still required.

State LTC Subsidy Program 510-05-95-45   
This is a new section that describes the State LTC Subsidy Program.  (Effective January 1, 2010).
 
The State LTC (Long-Term Care) Subsidy Program is a state funded program that provides additional income to qualifying Medicaid recipients who are subject to Post Eligibility Treatment of Income budgeting.  The state subsidy provides funds to help meet current maintenance needs of recipients.  This program began January 1, 2010.

1.	To qualify, an individual must:

a.	Be a Medicaid recipient;

b.	Be a SSI recipient who receives a SSI payment of $30 per month or less;

c.	Reside in a nursing facility, the state hospital, the Anne Carlsen Center; Prairie at St. John’s Center; the Stadter Center; a Psychiatric Residential Treatment Facility (PRTF); an Intermediate Care Facility for the Mentally Retarded (ICF-MR); or receive swing bed care in a hospital;

d.	Have total income, between SSI and any other source, of less than $50 per month; and

e.	Be expected to reside in the facility for the entire calendar month.

2.	Determining the amount of the subsidy payment:

a.	The subsidy payment is the difference between the $30 SSI payment level and $50, less any other income available to the recipient.  The maximum subsidy cannot exceed $20 per month.

b.	If a recipient receives less than $30 in SSI benefits due to a SSI overpayment, because SSI benefits have not yet been paid, because of other income received by the recipient, because the SSI recipient is eligible under 1619(b), or for any other reason, the subsidy does not increase due to the lower SSI payment.  For subsidy calculation purposes, the SSI benefit is calculated at $30, even if the amount actually paid is less than that amount.

When a child who is a SSI recipient chooses to be eligible for Medicaid under a children and family eligibility category instead of as a disabled child, the child can still qualify for the subsidy.  

c.	Subsidy payments may be established for the processing month and prospective months if the recipient is anticipated to be in the facility for the entire month for which the subsidy is determined.  Subsidy payments are not established for retroactive months.

d.	When a recipient’s budget, including a retroactive budget in which a subsidy payment was previously established, is reworked for a month and results in an underpayment, the recipient will receive a supplement for the month.  If a reworked budget results in an overpayment for the month, the overpayment will be disregarded.

e.	Subsidy payments, including underpayments, are automatically calculated when Medicaid eligibility is authorized.

3.	Paying the subsidy 

a.	There is no minimum payment amount required, however, if a payment amount is less than $10, the payment will be held until the total of the payment plus any subsequent payments total or exceed $10.  If the payment amount plus any subsequent payment amounts do not exceed $10 after three months, the payment will be paid regardless of the amount.

b.	Payments will be paid by check to the recipient.  A recipient may request a direct deposit of the payment by providing bank routing and account numbers to the county agency.  Questions related to checks or direct deposits should be directed to the Fiscal Administration Unit.

c.	Subsidy payments are issued on a weekly basis to accommodate new approvals and supplemental payments.  Checks are normally mailed on Fridays and direct deposits are normally processed on Thursday nights.

4.	Subsidy payment determinations are not appealable.

5.	There is no estate recovery for subsidy payments.

Par. 2.  Effective Date -- This manual letter is effective for the benefit month of January 2010.

Carol K. Olson, Executive Director		Manual Letter #3205
North Dakota Department of Human Services	Page  of  Pages