Section 75-02-02.1-08 - Medicaid unit1. For individuals not subject to MAGI-based methodology, a Medicaid unit may be one individual, a married couple, or a family with children under twenty-one years of age or, if blind or disabled child, under age eighteen, whose income and assets are considered in determining eligibility for any member of that unit, without regard to whether the members of the unit all physically reside in the same location. An applicant or recipient who is also a caretaker of children under twenty-one years of age may select the children who will be included in the Medicaid unit. Anyone whose needs are included in the unit for any month is subject to all Medicaid requirements which may affect the unit. The financial responsibility of relatives must be considered with respect to all members of the assistance unit.2. For individuals subject to a MAGI-based methodology, a Medicaid unit is determined by the individual's tax filing status as well as the individual's relationship to those with whom the individual lives. Each individual will have his or her own Medicaid unit determined as follows:
a. If the individual is a tax filer, and is not also claimed as a dependent by someone else, the individual's Medicaid unit consists of the individual, the individual's spouse, if living with the individual, and anyone the individual or his or her spouse claims as a dependent, plus a dependent's spouse that lives with them, and any unborn children of a pregnant woman who is included in the unit.b. If the individual is claimed as a tax dependent by another, even if the individual files his or her own tax return, and does not meet any of the following exceptions, that individual's Medicaid unit is the same as the household that claims the individual as a dependent, plus the individual's spouse that lives with them and any unborn children of a pregnant woman who is included in the unit: (1) The individual is claimed as a dependent by someone other than a spouse, or a natural, adopted, or stepparent;(2) The individual is under nineteen years old and is living with both parents but the parents are not filing a joint return; or(3) The individual is under nineteen years old and will be claimed as a dependent by a noncustodial parent.c. If the individual is not a tax filer, is not expected to be claimed as a dependent by another, or meets one of the conditions set forth in paragraphs 1, 2, or 3 of subdivision b, the individual is subject to the nonfiler rules. A nonfiler individual's Medicaid unit is the individual, and, if living with the individual, the individual's spouse; natural, adopted, or stepchildren under nineteen years old; natural, adopted, or stepparents; or natural, adopted, or step-siblings under nineteen years old, plus any of their spouses that live with them, and any unborn children of a pregnant woman who is in the household. 3. Individuals may not be opted out of a Medicaid household unit determined under subsection 2.4. To determine medically needy eligibility for pregnant women, children aged to nineteen, or parent or caretaker relatives, income budgeting will be based on non-MAGI income methodology with the exclusion of assets.N.D. Admin Code 75-02-02.1-08
Amended by Administrative Rules Supplement 2014-353, July 2014, effective January 1, 2014. .Amended byAdministrative Rules Supplement 375, January 2020, effective1/1/2020General Authority: NDCC 50-06-16, 50-24.1-04
Law Implemented: NDCC 50-24.1-01, 50-24.1-37; 42 USC 1396a(e)