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UPDATED: JANUARY 2012
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OTHER ELIGIBILITY REQUIREMENTS
DISTRICT OF FISCAL RESPONSIBILITY (DFR)
Infants Residing with Incarcerated Mothers
The DFR for an infant residing with an incarcerated mother is the mother’s district of legal residence prior to incarceration.
Children Eligible for Continuous Medicaid Coverage
A child who has lost eligibility, but is in a period of continuous coverage, who moves to another district will not have his/her coverage transitioned to the new district of residence. Continuous coverage will be provided by the former district of residence.
If a child turns age 19 during a period of continuous eligibility, the guarantee of continuous eligibility will end as of the last day of the month of the child’s nineteenth birthday. However, if the child is receiving medically necessary inpatient services at that time, Medicaid coverage continues through the end of the hospitalization.
Disposition: When the district of fiscal responsibility for the A/R has been established, that district authorizes Medicaid, if the A/R is otherwise eligible.
If a dispute based on residency occurs between local districts for an otherwise eligible A/R, either district may request a fair hearing to determine the district of fiscal responsibility. The district where the A/R is found provides Medicaid until the fair hearing decision is rendered. The district found to be responsible, if necessary, reimburses the district that assumed responsibility for the A/R prior to the fair hearing decision.
Generally, a person cannot gain residence in a district while receiving care in a Title XIX facility or a public institution.
When a pregnant woman is determined presumptively eligible for Medicaid, the district she states is her residence is fiscally responsible for care provided during the period of presumptive eligibility. Her documented district of residence may be different when a full eligibility determination is completed.
(MRG)