Family and Children's Medicaid MA-3340 COUNTY RESIDENCE

II. DETERMINING COUNTY OF RESIDENCE

A. Non-Institutional Living Arrangement

1. An individual has residence in the county in which he lives.

2. DSS custody

a. A child in the custody of the county dss retains the residence of the county having custody until he reaches age 18, or until age 21 if he is in school, and requests that his custody remain with the county DSS.

b. A child born to a minor mother in DSS custody retains the residence of the county that has custody of the minor mother.

3. Child under age 21

a. Living in the home

A child under age 21 living in the home of his parent(s) has residence in the county of his parents.

(II.A.3.)

b. Living outside of the home

A child under age 21 living outside of his parents’ home has residence in the county in which he resides, except a child who is temporarily absent from his parents’ home. See 4. below for determination of temporary absence.

c. Job Corp

A participant in the Job Corp Program retains the county of residence of the adult caretaker with whom he was residing prior to entering the program.

d. Student

A student, under age 21, is a resident of the county in which the adult caretaker with whom he was residing prior to admission to school resides.

The exception is a student living independently who has assumed total financial responsibility for his own support (tuition and living expenses) and care. This student has residence in the county in which he resides.

e. Receiving Title IV-E or Special Needs Adoption Assistance from North Carolina

A child under age 18 receiving Title IV-E or Special Needs Adoption Assistance has residence in the county in which the adoption assistance was established. SSI children receiving adoption assistance also have residence in the county in which the adoption assistance was established.

(1) The county can enter in EIS the county of residence for a child receiving Title IV-E and SSI. These children remain IAS.

(2) However, the county of residence for SSI children receiving Special Needs Adoption Assistance is determined by the SDX and may be different from the county that established the adoption assistance. In these situations, coordinate with the Social Security Administration to have the county of residence changed on the SSI record. This change will be reflected in EIS. If you are unable to coordinate with your local SSA office, please contact the Medicaid Eligibility Unit.

f. Receiving Title IV-E or Special Needs Adoption Assistance from Another State

(1) A child receiving Title IV-E Adoption Assistance from another state has the county of residence in the county where he resides with his adoptive parents.

(II.A.3.f.)

(2) A child under age 18 who moved to North Carolina and was approved as part of the Interstate Compact on Adoption and Medical Assistance (ICAMA) has the county of residence in the county where he currently lives with his adoptive parents. If the child receives SSI and SSI has his address established incorrectly for Medicaid purposes, contact and coordinate with the Social Security Administration to have the county of residence changed on the SSI record. The change will then be reflected in EIS. If you are unable to coordinate with your local SSA office, contact the Medicaid Eligibility Unit.

g. A child receiving Title IV-E Foster Care assistance from another state has the county of residence in the county where he is placed.

4. Temporary Absence From the County

a. Temporary absence from the county of residence with subsequent return or intent to return does not change the county of residence unless another county has determined that the person is a resident there.

Absence ceases to be temporary at the point a decision is made that the individual will not be returning to the family home within 12 months.

b. Verify and document temporary absence by client statement, including reason for absence and anticipated date of return.

5. Absence from the County for Treatment

a. An individual may be absent for the purpose of obtaining medical care/treatment in a hospital, skilled nursing, intermediate care facility or psychiatric residential treatment facility provided the absence is not expected to exceed 12 months.

b. If treatment is expected to last less than twelve months, no change to the Medicaid status is necessary.

(1) Evaluate expected duration of absence initially and at next re-enrollment by sending a letter to the facility.

(2) Include the following in the letter and ask the facility to verify:

(II.A.5.b.(2))

(a) Date entered

(b) Time spent in the facility to date

(c) Expected length of stay

c. If treatment is expected to exceed 12 months, immediately consider the individual to be in long-term care. Follow the instructions in MA-3325, Long Term Care Budgeting.

6. Temporary absence does not apply to situations in which:

a. The child is not wanted in the home, or

b. There is no room for the child in the home, or

c. The relatives are unable physically or mentally to maintain a home for the child.

B. Institutional Living Arrangement

1. A Child Under Age 21

a. A child has residence in the county of the parents or custodial relative with whom he resided prior to admission.

b. If a child is not living with a relative or parent prior to admission, he has the residence of his mother or, if that is unknown, the residence of the father. If neither residence is known, the minor is a resident of the county in which he is found.

c. A child’s residence changes if the relative with whom he was residing prior to entering the facility or institution establishes another residence before the child reaches age 21.

d. Once the individual reaches age 21, he retains residence in the county he was in the month prior to turning 21.

2. An individual, placed in an institution as a minor and being prepared for placement outside the institution, may establish a county of residence regardless of his parent’s legal residence. Residence will be based on the individual’s intent, if capable, to remain in North Carolina in whatever local facility can best meet his needs. His placement in a community setting establishes county residence.

(II.)

C. Disputed County Of Residence

If the county of residence is disputed, counties should contact their Medicaid Program Representative (MPR) for settlement. The county in which the applicant files the application must proceed to process the application without delay. Upon review of all facts in the case, the MPR will notify the counties of the decision regarding residence.

If the county who processed the application is not the county of residence, then that county should immediately contact the Claims Analysis Section of DMA. Additionally, the county should identify any claims charged in error to the county by reviewing the “Recipient Payment Register.” Once claims are identified, notify the Claims Analysis Section in writing of the charges. Include the recipient’s name, individual identification number, and dates of service.

NOTE: This is different from the situation in which a county took a courtesy application and the county of residence refuses to accept the application. For this situation, see MA-3200, Initial Contact.

D. Individuals With No Permanent Address

A person with no fixed or permanent address is a resident of the county where he states his intent to remain. If the individual is incapable of stating his intent to remain, he is a resident in the county in which he is found.