Human Services

CHAPTER 40-8.7
Health Care Assistance for Working People With Disabilities

SECTION 40-8.7-6

§ 40-8.7-6. Eligibility.

(a) To be eligible for benefits under the Medicaid buy-in program:

(1) The person shall be an individual with disabilities as defined in § 40-8.7-4, but without regard to his or her ability to engage in substantial gainful activity, as specified in the Social Security Act, 42 U.S.C. § 423(d)(4);

(2) The person shall be employed as defined in § 40-8.7-4;

(3) The person's net accountable income shall not exceed two hundred fifty percent (250%) of the federal poverty level, taking into account the SSI program disregards and impairment-related work expenses as defined in 42 U.S.C. § 1396a(r)(2);

(4) A maximum of ten thousand dollars ($10,000) of available resources for an individual and twenty thousand dollars ($20,000) for a couple shall be disregarded as shall any additional resources held in a retirement account, in a medical savings account, or any other account, related to enhancing the independence of the individual and approved under rules to be adopted by the department; and

(5) The person shall be a current medical assistance recipient under § 40-8.5-1 [CNIL] or § 40-8-3(v) [MNIL]; or shall meet income, assets, (except as modified by subdivision (4) above) and eligibility requirements for the medical assistance program under § 40-8.5-1 [CNIL] or § 40-8-3(v) [MNIL], as such requirements are modified and extended by this chapter.

(b) Appeals Process. The director or designee shall review each application filed in accordance with regulations, and shall make a determination of whether the application will be approved and the extent of the benefits to be made available to the applicant, and shall within thirty (30) days after the filing notify the applicant, in writing, of the determination. If the application is rejected, the applicant shall be notified the reason for the denial. The director may at any time reconsider any determination. Any applicant for or recipient of benefits aggrieved because of a decision, or delay in making a decision, shall be entitled to an appeal and shall be afforded reasonable notice and opportunity for a fair hearing conducted by the director, pursuant to chapter 40-8.

History of Section.
(P.L. 2004, ch. 343, § 1; P.L. 2004, ch. 354, § 1; P.L. 2011, ch. 241, § 1; P.L. 2011, ch. 253, § 1.)