Page 14

14

To be eligible for the In-Home (SAIH) Program, an applicant/ beneficiary (a/b) must meet all other Basic Special Assistance eligibility requirements, except the requirement to reside in an SA facility.

There are also other eligibility requirements that are unique to the SAIH Program that do not apply to SA Basic a/bs. This section provides the policies and procedures that are specific to SAIH and which differ from the eligibility policies and procedures in the Special Assistance Manual for a/b’s residing in SA facilities.

For all other situations that are not covered in this manual, follow the instructions in the Special Assistance Manual.

Special instructions for SAIH applications for individuals receiving Department of Health and Human Services (DHHS) Supported Housing Slots through the Transitions to Community Living can be found in DAAS Administrative Letter 13-07 Instructions for Special Assistance In-Home Approvals for Individuals with Verified Supported Housing Slots.

The SAIH option is only available for SAA or SAD. SCD beneficiaries are not eligible for SAIH payments.

I. SAIH AND MEDICAID

A. SAIH Beneficiaries Are Automatically Eligible for Medicaid

Based on legislative action established by the NC General Assembly

effective January 1, 2023, SAIH automatically qualifies an SAIH

beneficiary for Medicaid for non-SSI recipients.

Always remember to explain retroactive Medicaid to SAIH applicants and

discuss if there is a need for retroactive Medicaid benefits. If the applicant

does not request Medicaid that is retroactive to the SAIH application

month, document in the SAIH case file that retroactive Medicaid was

offered and the reason that no retroactive application was taken.

Also explain to SAIH applicants that when the applicant accepts Medicaid,

they assign their right to third party insurance benefits to the state. Inform

the applicant that it is a misdemeanor to fail to disclose the identity of any

person or organization against which they have the right to recovery of

medical expenses paid by Medicaid.

SA-5200 I.