Section 75-03-23-04 - Eligibility criteria for Medicaid waiver programAn applicant is eligible to receive services funded by the Medicaid waiver program if:
1. The applicant is sixty-five years and older; or2. The applicant is under age sixty-five with a congenital disability, a disability due to trauma, or a disability that is acquired and:a. The disability must not be the result of mental illness as the primary diagnosis or the result of mental retardation, or a closely related condition; andb. The disability must meet the social security administration's definition of disability or the individual must be determined physically disabled by the state review team under section 75-02-02.1-14.3. The applicant is receiving Medicaid;4. The applicant is evaluated to be in need of a nursing facility level of care;5. The applicant's needs may be met by one or more of the covered services, as determined by an assessment conducted in accordance with department policies and procedures;6. The applicant's service provider is not the applicant's spouse, except when allowed by an approved waiver, or, if the applicant is less than eighteen years old, the applicant's service provider is not the applicant's parent, stepparent, or a person legally responsible for the care of the individual unless allowed by an approved waiver;7. The applicant agrees to accept services provided under the Medicaid waiver program instead of nursing home care; and8. The applicant agrees to the plan of care developed for the provision of home and community-based services.N.D. Admin Code 75-03-23-04
Effective June 1, 1995; amended effective January 1, 2009.Amended by Administrative Rules Supplement 2023-391, January 2024, effective 1/1/2024.General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-01(3), 50-06.2-03(5), 50-06.2-03(6)