N.D. Admin. Code 75-02-02.1-14.1

Current through Supplement No. 395, January, 2025

Section 75-02-02.1-14.1 - Eligibility for medically frail Medicaid expansion enrollees

1. For the purpose of this section, "medically frail" means an individual who is eligible for or enrolled with Medicaid expansion and has been deemed to meet the status of medically frail which upon a review and determination may include an individual with any of the following: serious or complex medical conditions; disabling mental disorders; chronic substance use disorders; or physical, intellectual, or developmental disability that significantly impairs one's ability to perform one or more activities of daily living.

2. A Medicaid expansion enrollee interested in applying for a medically frail determination shall complete a self-assessment and return the completed form to the department.

3. In any instance in which a determination is to be made as to whether any individual is medically frail, documentation that validates the diagnosis or medical condition along with any other supporting documentation must be submitted to the department. The self-assessment form and documentation submitted shall be reviewed by a medical professional with professional training and pertinent experience, and who shall determine if the applicant meets medically frail eligibility requirements.

4. If the Medicaid expansion enrollee is approved for eligibility as medically frail, the enrollee may choose coverage through a managed care organization or through the Medicaid state plan services, except for individuals ages nineteen and twenty as their coverage will be determined under the Medicaid state plan services.

5. Coverage of an enrollee as medically frail may begin no earlier than the first of the month in which the self-assessment was received by the department.

N.D. Admin Code 75-02-02.1-14.1

Adopted by Administrative Rules Supplement 2014-353, July 2014, effective January 1, 2014. .

Amended by Administrative Rules Supplement 368, April 2018, effective 4/1/2018.

Amended by Administrative Rules Supplement 2021-383, January 2022, effective 1/1/2022.

General Authority: NDCC 50-06-16, 50-24.1-04

Law Implemented: NDCC 50-24.1-01, 50-24.1-37; 42 CFR 440.315(f)