477 Neb. Admin. Code, ch. 3, § 004

Current through September 17, 2024

Section 477-3-004 - APPLICANT AND CLIENT RESPONSIBILITIES

Each applicant or client is required to:

(A) Provide complete and accurate information. State and federal law provides penalties that may include a fine, imprisonment, or both, for persons found guilty of making false statements or failing to report promptly any changes in their circumstances to obtain assistance or services for which they are not eligible;

(B) Report a change in circumstances no later than 10 days following the change. This includes information regarding:

(i) Change or receipt of a resource including cash, stocks, bonds, or a motor vehicle. Changes in resources do not apply to clients whose eligibility is determined using modified adjusted gross income (MAGI)-based methodology;

(ii) Change in unit composition, such as the addition, loss of, or temporary absence of a unit member;

(iii) Change in residence;

(iv) Living arrangement;

(v) Disability status;

(vi) New employment;

(vii) Termination of employment; or

(viii) Change in the amount of monthly income, including:

(1) All changes in unearned income; and

(2) Changes in the source of employment, in the wage rate, or in employment status, such as part-time to full-time or full-time to part-time.

(a) For reporting purposes, full-time employment is considered at least 30 hours per week. The client must report new employment within 10 days of receipt of the first paycheck, and a change in wage rate or hours within 10 days of the change. To avoid adverse action, a client must prove good cause for any failure to report a change to the Department within 10 days. Unconfirmed statements do not constitute good cause;

(C) Present his or her Medicaid card to providers;

(D) Inform the medical provider and the Department of any third-party resources which may be liable for his or her medical expenses, in whole or in part, and cooperate in obtaining these third-party resources;

(E) Enroll in a health plan and maintain enrollment if:

(i) One is available to the client;

(ii) The client is able to enroll on his or her own behalf; and

(iii) The Department has determined enrollment in the plan to be cost effective;

(F) Reimburse to the Department or pay to the provider any third-party resources received directly for services payable by Medicaid;

(G) Pay any unauthorized medical expenses;

(H) Pay any required medical copayment;

(I) Meet the requirements of Managed Care, if applicable; and

(J) Cooperate with state and federal quality control.

477 Neb. Admin. Code, ch. 3, § 004

Amended effective 7/29/2020

Amended effective 9/17/2024