Adult Medicaid Manual MA-2220 STATE RESIDENCE

II. Requirements

A. Resident of North Carolina (NC)

1. An applicant must live in North Carolina and meet all other eligibility requirements in order to receive NC Medicaid benefits. In order to meet NC Medicaid state residency requirements, an individual must be domiciled in NC with the intention to remain there permanently or for an indefinite period or show that he entered NC to seek employment or with a job commitment. A person is domiciled in NC if NC is his fixed, established, or permanent place of residence with the intention to remain there permanently or for an indefinite period.

2. An applicant for Medicaid benefits who is capable of stating his intent, is not institutionalized, must provide satisfactory proof that he is a resident of North Carolina and that he is not maintaining a temporary residence (the person intends to return when the purpose of the absence has been accomplished) in order to receive Medicaid benefits. The two exceptions are in a. and b. below.

a. An applicant who is incapable of stating his intent to remain in NC is a resident of the state in which he is physically located. No statement of intent or proof is needed. Refer to II.C. for exception.

b. An applicant who is institutionalized and capable of stating his intent to remain in NC is a resident of NC if he lives in an institution in NC, and states his intent to remain in NC permanently or for an indefinite period of time. No additional proof of residence is necessary.

3. An individual who claims to be a resident of NC but is temporarily absent in another state must show satisfactory proof of residence in NC before he can be considered temporarily absent for Medicaid purposes.

4. If the applicant requests assistance obtaining residency verification, it is the responsibility of the dss to assist. See MA-2303, Verification Requirements for Applications.

5. Always ask all applicants to provide two of the documents listed in II.A.7. Applicants who state that they do not have two of the documents must sign the DMA-5153, North Carolina Residency Applicant Declaration, subject to prosecution, that they do not have two of the documents listed. However, this declaration from the individual applying may be insufficient. Other evidence that verifies residence may be considered at the county’s discretion.

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(II.A.)

6. A non-qualified alien applicant who does not have two of the documents listed in II.A.7 must sign the DMA-5153, North Carolina Residency Applicant Declaration, declaring that he does not have two documents.. However, this declaration from the individual applying may be insufficient. Other evidence that verifies residence may be considered at the county’s discretion.

7. To verify residency, the applicant may provide documentation that verifies the address he has listed on his application as his physical or mailing address. Documents from at least two of the following categories may be provided. This means a document or proof must be from two of the little letters below. Example: An item from c. and d. would be acceptable. Two documents outlined in b. are not acceptable.

a. A valid North Carolina drivers’ license or other identification card issued by the North Carolina Division of Motor Vehicles.

b. A current North Carolina rent, lease, or mortgage payment receipt, or current utility bill in the name of the applicant or the applicant’s legal spouse, showing a North Carolina address.

c. A current North Carolina motor vehicle registration in the applicant’s name and showing the applicant’s current North Carolina address.

d. A document verifying that the applicant is employed in North Carolina.

e. One or more documents proving that the applicant’s home in the applicant’s prior state of residence has ended, such as closing of a bank account, termination of employment, or sale of a home.

f. The tax records of the applicant or the applicant’s legal spouse, showing a current North Carolina address.

g. A document showing that the applicant has registered with a public or private employment service in North Carolina.

h. A document showing that the applicant has enrolled his children in a public or private school or a child care facility located in North Carolina.

i. A document showing that the applicant is receiving public assistance (such as Food Stamps) or other services which require proof of residence in North Carolina. Work First and Energy Assistance do not currently require proof of NC residency.

j. Records from a health department or other health care provider located in North Carolina which shows the applicant’s current North Carolina address.

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(II.A.7.)

k. A written DMA-5152, North Carolina Residency Declaration, from an individual who has a social, family, or economic relationship with the applicant, and who has personal knowledge of the applicant’s intent to live in North Carolina permanently, for an indefinite period of time, or residing in North Carolina in order to seek employment or with a job commitment.

l. A current North Carolina voter registration card.

m. A document from the U.S. Department of Veteran’s Affairs, U.S. Military or the U.S. Department of Homeland Security, verifying the applicant’s intent to live in North Carolina permanently or for an indefinite period of time, or that the applicant is residing in North Carolina to seek employment or has a job commitment.

n. Official North Carolina school records, signed by school officials, or diplomas issued by North Carolina schools (including secondary schools, colleges, universities, community colleges), verifying the applicant’s intent to live in North Carolina permanently or for an indefinite period of time, or that the applicant is residing in North Carolina to seek employment or with a job commitment.

o. A document issued by the Mexican consular or other foreign consulate verifying the applicant’s intent to live in North Carolina permanently or for an indefinite period of time, or that the applicant is residing in North Carolina to seek employment or has a job commitment.

The county retains the right to deny eligibility and/or declare that the documents provided are unacceptable if it is believed that the documentation is false or is found to be unsatisfactory. The county can require that supporting documentation be provided. The county has the authority to determine what is considered satisfactory proof.

B. Individual in a Private Living Arrangement

1. Individual Age 21 or Over

An individual over age 21 is a NC resident for Medicaid purposes if he:

a. Lives in NC with the intention to remain there permanently or for an indefinite period, and

(1) Provides 2 documents from the categories listed in II.A.7. above, or

(2) Provides a statement that he does not have two documents, using DMA-5153, North Carolina Residency Applicant Declaration, or

(3) Is incapable of stating intent but is physically located in NC. See II.A., above.

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(II.B.1.)

b. Lives in NC and has entered NC with a job commitment or seeking employment, including migrant workers and military personnel, whether or not he is currently employed, and

(1) Provides two documents from the categories listed in II.A.7. above, or

(2) Provides a statement that he does not have two documents using DMA-5153, North Carolina Residency Applicant Declaration, or

(3) Is incapable of stating intent but is physically located in NC. See II.A., above.

Or,

c. Applies for Emergency Medicaid and lives in NC with the intent to live in NC permanently or for an indefinite period of time or is residing in NC to seek employment or with a job commitment, and

(1) Meets Emergency Medicaid requirements. Refer to MA-2504, Alien Requirements, and

(2) Provides two documents from the categories listed in II.A.7 above, or

(3) Provides a statement that he does not have two documents using DMA-5153, North Carolina Residency Applicant Declaration.

For either a. b. or c. above, owning a homesite in another state to which he intends to return at some time does not affect his residence in NC. However, the homesite must be evaluated according to MA-2230, Financial Resources to determine if the home is a countable resource.

2. Individual Under Age 21

An individual under age 21 is a resident of NC if he:

a. Lives with his financially responsible parent(s) who is a resident of NC (see II.A. above), or

b. Is in the custody of a NC county department of social services, or

c. Receives State Foster Home funds from NC, or

d. Lives in NC and receives Title IV-E payments from either foster care or adoption assistance from NC or any state, or

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(II.B.2.)

e. Moves to North Carolina with his adoptive parent(s) and was receiving Medicaid as a special needs adoption child from a state that participates as an Interstate Compact

on Adoption and Medical Assistance. Refer to MA-3230, Eligibility of Individuals Under Age 21, or

f. Is a student and:

(1) Is enrolled in a school in NC, and

(a) Lives with his parent(s) who is a NC resident (See II.A. above) or

(b) Lives in NC independently from his parent(s) for his total financial support and care, including tuition and living expenses, and does not regularly return to his parent(s)’ home to live except for brief visits during school breaks, or

(2) Is enrolled in school in another state, his parent(s) is a NC resident (see II.A above), and he is dependent upon his parent(s) for financial support and care, or

g. Is not a student and:

(1) Lives in NC voluntarily (proof of residence must be verified (see II.A.7. above), and

(2) His parents are not financially responsible for him, which means he:

(a) Lives outside his parent(s)’ home on a permanent basis, or

(b) Is emancipated from his parents as evidenced by the fact that he:

1) Is or has been in military service, or

2) Is or has been married, or

3) Has been issued a court order of emancipation.

and

(3) Does not receive assistance from another state.

C. Individual In An Institution

1. Definition of Institution for State Residence

Institution has a different meaning for purpose of determining state residence than it does for budgeting. For budgeting purposes, an institution is limited to medical institutions; e.g. nursing homes, hospitals over 30 days, etc. For determining state residence, institution has a much broader meaning. It includes many living arrangements that would be considered private living for budgeting purposes.

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(II.C.)

For determining state residence an institution is an establishment that provides food, shelter, and some treatment or services to 4 or more persons who are not related to the owner. Institution includes the following:

a. Nursing facilities (SNF, ICF-MR),

b. Hospitals,

c. State hospitals,

d. Adult Care Homes (rest homes/domiciliary care facilities/assisted living),

e. Residential treatment facilities –refer to the EIS Facility Table for the latest update on Medicaid certified facilities, and

f. Children’s group homes, including orphanages.

If you encounter a living arrangement not listed here and you do not know if it is an institution, refer to MA-2510, Living Arrangement.

2. Individual Age 21 or Over

An institutionalized individual age 21 or older is an NC resident when he:

a. Lives in an institution in NC, was not placed in the institution by an out-of-state agency, including a county department of social services (dss), and

(1) Is capable of stating and does state his intent to remain in NC permanently or for an indefinite period of time. “Indefinite” indicates that the individual does not have a date in mind when he will no longer be a resident of NC, or

(2) Became incapable of indicating intent as described in IV.C. below, on or after age 21, or

(3) Became incapable of indicating intent as described in IV.C. below, before age 21 and a parent(s) or a legal guardian appointed at the time of placement lived in NC with proof of residence in NC,

Owning a home site in another state to which he intends to return does not affect his residence in NC when institutionalized. There is no time limit on how long before he returns and his medical or mental condition is not considered. He is a resident of NC while in an NC institution for an indefinite period of time. If he intends to return home at some time, the homesite is not a countable resource. Refer to MA-2230, Financial Resources.

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(II.C.2.)

or

b. Lives in an out-of-state institution and the placement was arranged by an NC agency, including a county dss. See III.C., below, for a description of what constitutes placement by an agency of the state, or

c. Lives in an out-of-state institution, became incapable of stating his intent (See IV.C., below.) before age 21 and

(1) His parent(s), or, if his parents live in separate states, the parent applying on his behalf, had verified residence in NC at the time of placement and do(es) not live in the same state as the institution, or

(2) His legal guardian had verified residence in NC at the time of placement and does not live in the same state as the institution.

3. Individual Under Age 21

An institutionalized individual under age 21 has residence in NC if he:

a. Lives in an institution in NC, and

(1) His parent(s), or, if his parents live in separate states, the parent applying on his behalf, lives in NC (and the residency of the parent has been verified), or

(2) Parental rights have been terminated, a legal guardian has been appointed, and the guardian has verified residence in NC, or

(3) He has been abandoned by his parent(s), no legal guardian has been appointed, and the individual or party applying on his behalf resides in NC, or

(4) He is age 18 or older, his parent(s) live in another state, and he established residence in NC according to rules for private living arrangement prior to institutionalization.

b. Lives in an institution in another state, and

(1) His parent(s), or, if his parents live in separate states, the parent applying on his behalf, had residency verified in NC at the time of placement and do(es) not live in the same state as the institution, or

(2) His legal guardian had residency verified in NC at the time of placement and does not live in the same state as the institution.

(3) His placement was arranged by an NC agency, including a county dss. See III.C. below for state to state residency criteria.

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