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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-2260

FINANCIAL ELIGIBILITY REGULATIONS-PLA

REVISED 12/10/2025 - CHANGE NO. 11-25

I. FINANCIAL AND RESOURCE RESPONSIBILITY FOR ALL M-AABD and MQB COVERAGE GROUPS

This section provides the policy rules for determining responsibility for individual and couple applicants and beneficiaries when they live in a private living arrangement. In addition, this section provides instructions for how and when to "deem" income and resources from a financially responsible spouse or parent(s) to the spouse or child a/b. Because of a court decision, Division of Health Benefits (DHB) can no longer employ income deeming methodology in MQB eligibility determinations. Accordingly, this section provides instructions on how to use family size budgeting in MQB cases.

II. FINANCIAL RESPONSIBILITY

A. Spouse-for-spouse financial responsibility exists for a spouse who:

1. Is legally married to the a/b,

2. Does not receive SSI, Work First, or CAP and

3. Lives in, or is temporarily absent from the home, or

4. Has lived apart for less than one month.

a. Financial responsibility ceases at the beginning of the 2nd month.

b. Beginning with the 2nd month, budget them as separate individuals.

B. Parent-for-child financial responsibility exists for a child who:

1. Is under the age of 18,

2. Lives in or is temporarily absent from the home,

3. Has never been married,

4. Has never served in the military,

5. Has not been legally emancipated,

6. Does not receive SSI, Work First, CAP, or IAS, and

7. Is the natural or adopted child of an adult a/b or of an adult a/b’s spouse;

UNLESS