Family and Children's Medicaid MA-3230 ELIGIBILITY OF INDIVIDUALS UNDER Age 21

IIi. POLICY RULES - INDIVIDUAL UNDER AGE 19, M-IC

When the age requirement is met or ceases to be met during a month, the a/r is eligible for that month if all other eligibility factors are met. Prior to termination of benefits the recipient’s eligibility must be evaluated for all other programs.

EXAMPLE: A child becomes age 19 on 4/2/06. Eligibility exists for M-IC for April if all other eligibility factors are met for the month.

To be eligible, an individual must:

A. Be under age 19.

B. Be a citizen of the United States or meet alienage requirements. Refer to MA-3332, US Citizenship Requirements and/or MA-3330, Alien Requirements.

C. Be a resident of North Carolina as defined in, MA-3335, State Residence.

D. Meet income requirements:

1. For private living budgeting, refer to MA-3305, MAF, MIC, and HSF Budgeting, to establish appropriate income levels and needs unit.

a. 185% of poverty: Under age 1 (birth through 12 months) for MIC-N.

b. 133% of poverty: Through age 5 for MIC-N.

c. Greater than 185% or 133% of poverty but less than 200% of poverty: Birth through age 5 for MIC-1.

d. 100% of poverty: Through age 18 for MIC-N.

2. For long-term care need budgeting, refer to MA-3325, Long Term Care Budgeting.

E. Not be receiving Medicaid from another assistance category, county, or state.

REISSUED 07/01/10 - CHANGE NOTICE 08-10

(III.)

F. Provide verification of all health insurance coverage for himself and assign to the State all rights to third party payments from such insurance coverage. Refer to MA-3510, Third Party Recovery (TPR).

G. Furnish his Social Security number, or apply for a number if he does not already have one, and furnish all Social Security numbers which he has used or under which he has received benefits. Refer to MA-3355, Enumeration.

H. Be evaluated for continuation of coverage when an M-IC child is hospitalized or in a nursing facility on the last day of the month in which he becomes age 1 or 6. Refer to MA-3305, MAF, MIC, HSF Budgeting.

I. Apply for all benefits to which he may be entitled (For example: UIB, Disability, SS, etc.). Refer to MA-3300, Income.

NOTE: Once determined eligible for MIC, Medicaid eligibility is continuous for 12 months without reacting to changes in income or in household composition. Refer to MA-3305, M-AF, M-IC, H-SF Budgeting, for continuous eligibility.

J. Cooperate with the local child support enforcement agency in establishing paternity and securing medical and child support for any child who lacks parental care and support due to continued absence of one or both parents for reasons other than death and for whom assistance is requested under any aid program/category. Refer to MA-3365, Child Support. (This applies only if the individual under age 19 is the caretaker of a child who is also applying for or receiving Medicaid.)