N.D. Admin. Code 75-02-02.1-38.1

Current through Supplement No. 395, January, 2025

Section 75-02-02.1-38.1 - Post-eligibility treatment of income

Except in determining eligibility for workers with disabilities or children with disabilities, this section prescribes specific financial requirements for determining the treatment of income and application of income to the cost of care for an individual screened as requiring nursing care services who resides in a nursing facility, the state hospital, an institution for mental disease, a psychiatric residential treatment facility, or an intermediate care facility for individuals with intellectual disabilities, or who receives swing-bed care in a hospital.

1. The following types of income may be disregarded in determining medicaid eligibility:

a. Occasional small gifts;

b. For so long as 38 U.S.C. 5503 remains effective, ninety dollars of veterans administration improved pensions paid to a veteran, or a surviving spouse of a veteran, who has neither spouse nor child, and who resides in a medicaid-approved nursing facility;

c. Payments to certain United States citizens of Japanese ancestry, resident Japanese aliens, and eligible Aleuts made under the Wartime Relocation of Civilians Reparations Act [50 U.S.C. App. 1989 et seq.];

d. Agent orange payments;

e. German reparation payments made to survivors of the holocaust, and reparation payments made under sections 500 through 506 of the Austrian General Social Insurance Act;

f. Netherlands reparation payments based on Nazi, but not Japanese, persecution during World War II [ Pub. L. 103-286; 42 U.S.C. 1437 a, note];

g. Radiation Exposure Compensation Act [ Pub. L. 101 -426; 42 U.S.C. 2210, note];

h. Interest or dividend income from liquid assets; and

i. From annual countable gross rental income, an amount equal to real estate taxes for rental property that the recipient is responsible for paying on that property.

2. The mandatory payroll deductions under the Federal Insurance Contributions Act [ 26 U.S.C. 3101 et seq.] and medicare are allowed from earned income.

3. In establishing the application of income to the cost of care, the following deductions are allowed in the following order:

a. The nursing care income level;

b. Amounts provided to a spouse or family member for maintenance needs;

c. The cost of premiums for health insurance in the month the premium is paid or prorated and deducted from income in the months for which the premium affords coverage;

d. The cost of premiums for long-term care insurance carried by an individual or the individual's spouse in the month the premium is paid or prorated and deducted from income in the months for which the premium affords coverage;

e. Medical expenses for necessary medical or remedial care that are each:

(1) Documented in a manner which describes the service, the date of the service, the amount of cost incurred, and the name of the service provider;

(2) Incurred in the month for which eligibility is being determined, or was incurred in a prior month but was actually paid in the month for which eligibility is being determined and was not previously allowed as a deduction or offset of recipient liability, and was not applied previously to recipient liability;

(3) Provided by a medical practitioner licensed to furnish the care;

(4) Not subject to payment by any third party, including medicaid and medicare;

(5) Not incurred for nursing facility services, swing-bed services, or home and community-based services during a period of ineligibility because of a disqualifying transfer; and

(6) Claimed; and

f. The cost of services of an applicant's or recipient's guardian or conservator, up to a maximum equal to five percent of countable gross monthly income excluding nonrecurring lump sum payments.

4. For purposes of this section, "premiums for health insurance" include any payments made for insurance, health care plans, or nonprofit health service plan contracts which provide benefits for hospital, surgical, and medical care, but do not include payments made for coverage which is:

a. Limited to disability or income protection coverage;

b. Automobile medical payment coverage;

c. Supplemental to liability insurance;

d. Designed solely to provide payments on a per diem basis, daily indemnity, or nonexpense-incurred basis; or

e. Credit accident and health insurance.

N.D. Admin Code 75-02-02.1-38.1

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

Law Implemented: NDCC 50-24.1-02