Adult Medicaid Manual MA-2220 STATE RESIDENCE

III. Procedures

A. Establishing Residence

1. An individual cannot be required to be in the state for a specified period of time in order to establish residence for Medicaid purposes.

2. Applicants must provide proof of residence for Medicaid purposes.

3. In case of disputed state residence, the individual is a resident of the state in which he is physically located until the issue is resolved. The Medicaid Eligibility Unit (919 855-4000) can assist the county dss in resolving disputed state residence.

4 A non-qualified alien can meet the N.C. residency requirement by providing a DMA-5152, North Carolina Residency Declaration, from his employer, clergy, or other person with personal knowledge of his intent to live in N.C. permanently or for an indefinite period of time, or that the applicant is residing in N.C. to seek employment or with a job commitment. Two of the documents listed in II.A.7. must also be provided. If he does not have two documents, he must sign a DMA-5153, North Carolina Residency Applicant Declaration, declaring that he cannot provide said documents. However, this declaration from the individual applying may be insufficient. Other evidence that verifies residence may be considered at the county’s discretion.

5. Non-immigrants may be legally admitted to the U.S., but only for a temporary or specified period of time. In order for a non-immigrant to be allowed to come to the U.S., he must demonstrate that he maintains a residence outside the U.S. to which he plans to return and that he will stay in the U.S. for a limited period of time. These non-immigrants are issued two documents.

a. VISA or DSP-150 Border Crossing Card - A visa allows an individual to travel to the United States. It classifies the visit as business, tourism, etc. It is usually valid for multiple trips during a specified period of time generally 10 years. However, a visa does not guarantee that an individual will be allowed to enter the U.S. Do not use the visa to determine the period of time an individual is allowed to remain in the U.S. The DSP-150 Border Crossing Card is the same as a B1-B2 Visa. The I-586 Border Crossing Card is no longer valid.

b. I-94 - (Arrival/Departure Record)—This is given to individuals upon arrival in the U.S. The Bureau of Citizenship and Immigration Services (BCIS) authorizes admittance and creates an I-94 record with the date, place of arrival, class of admission, and length of time the visitor may remain in the U.S. Once he is in the country, he may apply for an extension with the BCIS under the same status or different status. Use the “Admitted Until” date on the I-94 card to determine the current status of the alien and the length of time he may remain in the U.S.

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(III.A.5.)

If the time limit on the I-94 has expired, verify with BCIS whether an extension has been requested and/or granted. (See EIS 1108, SAVE Verification Information System, for SAVE procedures.) An alien admitted for a limited period of time that does not leave the U.S. when the period of time expires or who does not request an extension becomes an illegal alien. This individual may be considered a N.C. resident if satisfactory proof of intent to remain is established.

6. An alien who has applied to BCIS for a change in his alien status to a status that indicates his stay in the U.S. is not time limited (such as LPR, refugee, etc.) may be considered a N.C. resident if he provides the required documentation listed in II.A. above.

B. Individual Moves To Another State

An individual does not retain residence in NC if he moves to another state with the intent of remaining there permanently or for an indefinite period.

1. An individual who arranges long-term care placement in another state on his own or through his representative becomes a resident of the other state, unless he is expected to return home within 6 months. Follow policy in MA-2270, Long Term Care Need and Budgeting, for documenting expectation to return home in 6 months.

2. An individual who is placed in an out-of-state facility by the staff of an agency of NC including a county dss retains residence in NC.

NOTE: Except in unusual situations, the county dss should not be involved in out-of-state placements in long-term care.

C. State to State Residency Criteria

An individual living in NC retains residence in a prior state for Medicaid purposes when the individual:

1. States or it is verified that his primary residence is in a prior state or that he is temporarily absent from the prior state with the intent to return to that prior state, except for a person in NC for employment purposes.

A person who is in NC for employment purposes is a resident of NC even if he maintains a primary place of residence in another state. Any real property he owns in the other state must be evaluated by policy in MA-2230, Financial Resources.

2. Was placed in a NC institution by the staff of an out-of-state agency regardless of the individual’s indicated intent or ability to indicate intent.

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(III.C.2.)

a. Placement by an out-of-state agency means a state, local, or federal agency, including a county dss, contracted to take the initiative for planning and arranging for a facility to accept the individual for care.

b. Placement does not include:

(1) Providing basic information to individuals about another state’s Medicaid program and information about the availability of health care services and facilities in another state, or

(2) Assisting an individual to locate an institution if such individual is capable of indicating intent and independently decides to move.

3. The residence of a spouse or ownership of real property in one state does not have direct bearing on state to state residence for an individual in long-term care in another state. Refer to MA-2230, Financial Resources.

D. Child in Custody of a Social Services Agency

1. Child in Custody of Another State

A child in the custody of an agency of another state and who lives in or moves into NC retains residence in the prior state UNLESS:

a. The child receives Title IV-E payments for foster care or adoption assistance from the other state or there is a current Adoption Assistance Agreement from the other state, or

b. The originating state relinquishes custody.

Refer to MA-3230, Eligibility of Individuals Under 21.

2. Child in Custody of an NC Agency

A child in the custody of NC placed in a foster home or with a relative in another state retains residence in NC, UNLESS:

a. The child receives Title IV-E payments for either foster care or adoption assistance from NC, or

b. The child takes action himself to establish or abandon residence, or

c. Foster parents complete a legal adoption, or

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(III.D.2.)

d. The other state voluntarily accepts a transfer of the custody.

E. Individual Temporarily Absent

Temporary absence from the state of residence with subsequent return or intent to return when the purpose of the absence has been accomplished does not interrupt continuity of residence unless another state has determined that the individual is a resident of its state.

1. An M-AABD recipient may be absent from NC for the purpose of obtaining medical care/treatment in a hospital or nursing facility in another state and remain eligible in NC.

2. Denial or termination of assistance for state residence during a temporary absence (intends to return when the purpose of the absence has been accomplished) from the state is prohibited unless the other state determines that the individual is eligible for assistance in that state.

3. Eligibility for NC Medicaid is not a guarantee of payment for medical services in another state. See VII. below.

F. Medical Care and Services Provided Outside the State

Medical care and services provided outside the state to eligible residents of the state will be covered only under certain conditions, as indicated in VII. below.