AN ACT TO ADDRESS MEDICAID ELIGIBILITY DETERMINATIONS AND MONITORING WHEN THERE ARE FEDERAL RESTRICTIONS OR LIMITATIONS PREVENTING THE STATE FROM DISENROLLING CERTAIN INDIVIDUALS FROM THE MEDICAID PROGRAM, TO ESTABLISH STANDARDS FOR QUALIFIED HOSPITALS ABLE TO MAKE PRESUMPTIVE ELIGIBILITY DETERMINATIONS FOR THE MEDICAID PROGRAM, TO REQUIRE APPLICANTS FOR FOOD AND NUTRITION SERVICES BENEFITS TO COOPERATE WITH THE CHILD SUPPORT ENFORCEMENT PROGRAM AS A CONDITION OF ELIGIBILITY FOR BENEFITS AND REPORT ANY CHANGE IN CIRCUMSTANCES TO ALLOW RE-VERIFICATION OF ELIGIBILITY AND TO LIMIT THE MEANS BY WHICH A PERSON MAY BE GRANTED CATEGORICAL ELIGIBILITY FOR PURPOSES OF RECEIVING FOOD AND NUTRITION SERVICES BENEFITS UNDER THE SUPPLEMENTAL NUTRITION AND ASSISTANCE PROGRAM (SNAP).
Revises GS 108A-55.5 to require the Department of Health and Human Services (DHHS) to conduct a monthly rather than quarterly review of information concerning changes in circumstances that might affect medical assistance beneficiaries' eligibility to receive medical assistance benefits.
Enacts GS 108A-55.6, requiring DHHS to direct county departments of social services (dss) to continue to conduct redeterminations of eligibility for medial assistance in the same manner and to act on redeterminations to the fullest extent permissible under the law in the event the State receives federal funding for medical assistance that is contingent upon temporary maintenance of effort restrictions or that limits the ability of the State to disenroll individuals from the State's medical assistance program. Additionally, when such circumstances arise, directs DHHS to conduct a full audit within 60 days of the expiration of the restrictions or limitations, consisting of four specified actions, including ensuring that counties complete and act upon eligibility redeterminations for all cases that have not had a redetermination within the last 12 months; requesting approval from the Centers for Medicare and Medicaid Services (CMS) for the authority to conduct and act upon eligibility determinations for each beneficiary enrolled during the period of restriction or limitation who had been enrolled for more than three total months and requiring counties to complete and act on the redeterminations within 60 days of CMS approval.
Applies to any applicable restrictions or limitations placed upon the NC Medicaid program on or after October 1, 2021.
Enacts GS 108A-55.7, establishing required actions qualified hospitals, as defined by statutory cross-reference, must take when making a presumptive eligibility determination for Medicaid benefits, including notification of DHHS within five business days of the determination, assisting individuals with completing and submitting a full application, and providing written notification to applicants regarding the effect of either failing to properly submit a full application or properly submitting a full application upon the presumptive eligibility determination. Directs DHHS to establish standards to ensure accurate presumptive eligibility determinations are made by each qualified hospital, which must be related to the following three identified measures: DHHS receipt of the Medicaid presumptive eligibility card within five business days of the determination date; the proportion of individuals determined to be presumptively eligible by the qualified hospital who submit a full application for benefits before the end of the presumptive eligibility period; and the proportion of individuals determined to be presumptively eligible who are eligible based on a submitted full application for benefits. Requires DHHS to notify a qualified hospital failing to meet the established standards, in writing, within five days from the date DHHS determined the standard was not met. Details notice requirements, including consequences of second and third findings of failure to meet the established standards, including mandatory staff training by DHHS for the second finding, followed by disqualification from eligibility to make presumptive eligibility determinations of any kind for a third finding. Explicitly provides that failure to meet the established standards more than twice results in disqualification under specified federal law and disqualification from eligibility to make presumptive eligibility determinations of any kind for a third finding.
Adds that DHHS and dss cannot be designated as a qualified entity for the purpose of making presumptive eligibility determinations for Medicaid coverage unless required by federal law.
Applies to presumptive eligibility determinations made on or after October 1, 2021.
Enacts GS 108A-52.1, directing DHHS to require applicants for electronic food and nutrition benefits to cooperate with the Child Support Enforcement Program under GS Chapter 110 as a condition of eligibility for the benefits pursuant to specified federal law.
Enacts GS 108A-52.2, establishing a new requirements for persons eligible to receive electronic food and nutrition benefits to report to DHHS any change in circumstances within 10 days of the date of the change to allow DHHS to re-verify the person's eligibility.
Enacts GS 108A-52.3, barring DHHS from granting a person categorical eligibility under specified federal law defining "eligible households" for the food and nutrition services program based on noncash, in-kind, or other benefits unless expressly required by federal law.
Effective January 1, 2022.