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Details for Service Durable Medical Equipment
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Service Name
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Durable Medical Equipment
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Program Name
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At-Risk Family Health and Safety Benefits
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Goal
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Provide outreach, support and services to individuals and families identified as being at risk of compromised health and safety to eliminate or reduce those risks.
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Objective
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Assure that families at risk of economic challenges receive health and safety benefits to mitigate those risks.
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Division
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Division of Health Benefits
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Service Description
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Durable Medical Equipment (DME) includes rented and purchased medical equipment and supplies that are provided for a person to use in their home. Examples of these types of equipment and supplies are: wheelchairs and other mobility devices, orthotics and prosthetics, enteral nutrition, oxygen and related supplies, urological supplies, etc. Repair and maintenance of equipment is also included in this service group.
A person’s physician must prescribe the equipment or supply and provide evidence of medical necessity. DME providers may bring the equipment and supplies to the person’s home or in some cases the items can be picked up in pharmacies and medical supply businesses.
Most Medicaid recipients are eligible to receive DME, but there may be restrictions depending on the person’s type of Medicaid eligibility.
| Durable Medical Equipment services are mandatory, however Orthotics and Prosthetics are optional. Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) program requires that states offer these services, if medically necessary, to children up to age 21. | |
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Web Site
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http://www.ncdhhs.gov/dma/
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Year First Initiated
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1970
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Available State Wide
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Yes
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Geographic Area Served
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Grants Provided
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No
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Competitive Bidding
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No
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Competitive Bidding Details
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Waiting List
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No
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Waiting List Start Date
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Number Waiting
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Waiting List Details
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Income Eligibility
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Yes
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Income Eligibility Method
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Eligibility for Medicaid is determined by the county departments of social services (DSS) and the Social Security Administration (SSA) for Supplemental Security Income (SSI) recipients.
200% FPL - MIC children under age 6
185% FPL - MPW
133% FPL - MIC children age 1-5
100% FPL - MIC children 6-18, MAD, MAA, MAB
150% FPL -HCWD
MAF-CN, HSF Categorically Needy:
1 person - $362
2 - $472
3 - $544
4 - $594
5 - $648
MAF, MAD, MAA, MAB Medically Needy:
1 person - $242
2 - $317
3 - $367
4 - $400
5 - $433
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Income Eligibility Type
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Earned income such as: wages, self-employment
Unearned income such as: RSDI, unemployment, VA, retirement, child/spousal support, worker's compensation, etc.
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Whose Income Eligibility
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Individual on the Medicaid case + financially responsible individuals in the home - (Parent for child under age 21 or spouse).
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Income Disregard
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Yes
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Income Disregard Desc
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Earned Income Disregards:
MAA, MAD, MAB: $65 + 1/2 remainder
MAF-C - 27-1/2%
MAF-N/M, MIC, MPW, HSF: $90 + child/adult care up to $175/200
Unearned income disregards:
MAA, MAD, MAB: $20 general exclusion, 1/3 child support
MAF, MIC, MPW, HSF: $50 of child/spousal support
Work expense exclusion for the blind: MAB, HCWD
MAF, MIC, MPW, HSF: $50 of child/spousal support
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Income Verified
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Yes
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Income Verified Method
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Electronic match with ESC, SSA, wage stubs, verification from source of income, such as VA, employer, award letter, self-employment records
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Income Criteria
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Federal and State Statutes are used as a base for setting income levels.
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Income Eligibility Change
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1/1/2006
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Income Eligibility Method Prior To Change
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185% MIC children less than 1
133% MIC children 1-5
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Income Eligibility Other
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Age Range Start
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Age Range End
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0
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100+
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Authorization Level
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Authorization Type
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Citation
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Federal
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Code of Federal Regulations
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42CFR 440.70(a)(3); 440.110; 414.229
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Budget Information
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State Fiscal Year (SFY)
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As of the month of
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Authorized Budget Fiscal Year 2024
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SFY 2023-2024 Year To Date Expenditures
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Balance
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Salary and Fringes (1X)
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0
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0
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0
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Salary Other (1X)
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0
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0
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0
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Operating (2X-5X)
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0
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0
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0
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Contracts/Allocations (6X)
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0
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0
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0
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Reserves (7X)
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0
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0
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0
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Transfers (8X)
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0
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0
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0
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Total Requirements
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0
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0
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0
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Receipts-Federal
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0
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0
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0
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Receipts- Local receipts
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0
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0
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0
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Receipts- Other receipts
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0
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0
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0
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Total Receipts
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0
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0
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0
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General Fund Appropriations
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0
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0
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0
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Match
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State
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Local
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Other
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0
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0
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0
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