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A. If an applicant was receiving Medicaid in another state prior to moving to NC, the local agency is responsible for contacting the prior state to:

1. Notify the state of the applicant’s move to NC, and

2. Request verification from the other state or send a DHB-5097/5097sp to the applicant to provide proof that the Medicaid eligibility in the other state was terminated.

The local agency may verbally contact the other state agency to verify Medicaid eligibility. The local agency must document in NC FAST the contact person’s name, title, and phone number.

3. Follow-up with the out-of-state agency at least every 2 weeks until a response is received either verbally or written. If not verified by the 45/90 day, or after 2 requests, whichever is later, deny the application. Document in NC FAST all attempts to contact the out of state agency as well as the response received.

4. The local agency may obtain any information on resources such as bank accounts, stocks, bonds, promissory notes, former homesite, etc., that will aid in determining eligibility in NC.

B. Medical Bills

1. If the applicant has outstanding medical bills in NC in the same month the applicant received Medicaid in the other state, verify whether the other state’s Medicaid program will cover bill(s) incurred in NC.

• Some Medicaid programs in other states are similar to NC. They only cover out-of-state services if it is an emergency, or the service was prior approved.

2. If the applicant has a bill in NC that will NOT be covered by the other state, authorize Medicaid in NC if otherwise eligible for that month.

C. If the other state will pay the NC claims:

1. Contact the medical provider(s) and verify whether they are enrolled or are willing to enroll with the other state.

2. If providers are not willing to enroll and file claims with the other state, authorize NC Medicaid, if otherwise eligible.

3. If providers are willing to enroll and bill the other state, there is no need for NC coverage for that month(s).