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North Carolina Department of Health and Human Services North Carolina Medicaid Division of Health Benefits AGED, BLIND AND DISABLED MEDICAID MANUAL MA-2220

STATE RESIDENCY

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REVISED 05/30/2023 – CHANGE NO. 09-23

Current Change Notice: 09-23 • Section II., Policy Principle: o Clarifies applicants/beneficiaries’ (a/b) to provide one (1) proof of state residency. This includes the revision of DHB-5097, Request for Information form which that the language Please note: You may need to provide up to two forms of verification for Proof of State Residency was removed. o Obsolete the DMA-5153, North Carolina Residency Applicant Declaration form and removed from the online form library. This form is no longer required due to the applicant is only required to provide one (1) proof of residence. o Moved Temporary Absence section from section III. to II. This provides instructions to the caseworker before denying or terminating an a/b Medicaid eligibility when temporarily absent. Also included, the beneficiary may be temporarily absent but returning to NC in less than 12 months. o Added Moved to Another State section to provide instructions for the caseworker. • Section IV. Residency Verification add: o Added a Homeless section pertaining to the local agency may accept self-attest from the a/b when they declare homeless. o A written declaration from a person who has a social, family, or economic relationship with the applicant and who has personal knowledge of the applicant's intent to live in North Carolina permanently may be accepted as proof of state residency. Obsolete DMA-5152 and revised to DHB-5152, North Carolina Residency Declaration. o Updated language pertaining to the local agency may deny eligibility on the 45th/90th day if there is substantial evidence showing that the documentation is false. • Section V. Individual Moving to NC was Previously Eligible in Another State o Request verification from the other state or send a DHB-5097 to the applicant to provide proof that the Medicaid eligibility in the other state was terminated. The caseworker may verbally contact the other state agency to verify Medicaid eligibility. The caseworker must document in the NC FAST the contact person’s name, title, and phone number. o Provide clarification and instructions when the applicant becomes eligible for NC Medicaid.

I. RESIDENCY REQUIREMENT

To receive Medicaid in North Carolina (NC), an applicant/beneficiary (a/b) must be a North Carolina resident and meet financial and non-financial requirements. This section outlines the specific requirements and how state residence is verified. In order to meet NC Medicaid residency requirements, an individual must:

A. Be physically present in NC and have the intent to reside here, or