Budgeting Procedures When Adding and Deleting Individuals 510-03-90-30

(Revised 5/1/2017 ML #3498)

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(N.D.A.C. 75-02-02.1-41.2(5) & (6))

When an individual is added to an ACA Medicaid Household , a review must be completed to process eligibility for the individual.

Individuals may be added to an eligible unit up to one year prior to the current month, provided The individual meets all eligibility criteria for Medicaid; The eligible unit was eligible in all of the months in which eligibility for the individual is established; and The individual was in the unit in the months with respect to which eligibility for that individual is sought.

Note: Individuals eligible under the Adult Expansion Group only, cannot be added as eligible prior to January 1, 2014.

When an individual is added to an eligible household and requests eligibility for a retroactive period, the addition of the member will NOT affect the eligibility for anyone already eligible for any prior month(s) or the current month. However, eligibility may change for future months provided the appropriate notice requirements can be met.

Note : Eligibility for individuals within a Continuous Eligibility Period would not be changed.

Client share (recipient liability) will be based on the unit's actual income and circumstances when adding each individual for retroactive periods. Client share must be based on the unit's income and circumstances from the base month, plus the best estimate of each individual's income and circumstances when adding each individual to the current or next month.

Client share for other individuals in the ACA Medicaid Household who were medically needy eligible may increase or decrease with the addition of the new member. Any client share, or lack of, applied to previously paid claims will be adjusted.

Other individuals in the ACA Medicaid Household who were previously determined to be poverty level eligible remain poverty level eligible, regardless of any income change, when adding an individual to the unit.

Budgeting procedures when deleting individuals from a case.

When a member of an existing unit is expected to leave the unit during the benefit month, that person may remain as a member of the unit until the end of the benefit month.

Refer to Manual Section 510-03-53-20 for policy regarding deleting individuals who are Continuously Eligible and move out of the ACA Medicaid Household.