N.D. Admin. Code 75-02-02.1-24.3

Current through Supplement No. 395, January, 2025

Section 75-02-02.1-24.3 - Eligibility for children with disabilities

1. A child must be enrolled as a member of the children with disabilities coverage if that child:

a. Is under age nineteen, including the month the child turns age nineteen;

b. Is disabled;

c. Meets the requirements of this section; and

d. Is not in receipt of any other Medicaid benefits under this chapter.

2. As a condition of eligibility, a child must be enrolled in a health insurance policy if:

a. The child's family has an employer-based health insurance plan available to them; and

b. The employer pays at least fifty percent of the premium.

3. A monthly premium is due on the tenth day of each month for which coverage is sought and is equal to five percent of the family's gross countable income. This premium may be offset by any other health insurance premium the family pays for a health insurance plan that provides coverage for the individual claiming eligibility under this section. This subsection does not apply to Indians who are exempt from cost-sharing under federal law.

4. If the premium established for an individual's coverage under this section is not paid for three months, the individual will be disenrolled and may not be reenrolled without first reestablishing eligibility under this section and paying all outstanding premiums. Any month in which no payment is due may not be counted as a month in which the individual's premium failed to be paid.

5. Payments received by the department from or on behalf of an individual claiming eligibility under this section will be credited first to the oldest unpaid premium. The department will credit payments on the day received, provided that credit for any payment made by an instrument that is not honored will be reversed. The department may require any individual who has attempted payment by a dishonored instrument to make subsequent payments in a specified manner.

6. No individual may be found eligible under this section if the individual and the individual's family have total net income in excess of two hundred fifty percent of the poverty level.

7. This section becomes effective March 1, 2008, remains effective as long as federal financial participation continues to be available and state law authorizes such coverage, and is thereafter ineffective.

8. For purposes of this section, "family" means any member of the Medicaid unit who is a spouse, parent, financially responsible caretaker relative, sibling, or child of the individual requesting benefits under this section.

9. The department may not require the payment of a premium or disenroll an individual for failure to pay a premium for families of children with disabilities coverage during a federally declared emergency if collection of the premium may impact the receipt of federal funds.

N.D. Admin Code 75-02-02.1-24.3

Amended byAdministrative Rules Supplement 375, January 2020, effective1/1/2020

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 50-24.1-31