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Details for Service Nursing Facility
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Service Name
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Nursing Facility
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Program Name
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Adult Out of Home Supports
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Goal
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Provide services and protection to individuals and families experiencing serious health and safety needs who are not, at least temporarily, able to assist themselves with the goal of helping them to return to independent, community living.
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Objective
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Assure that adults being served in out-of-home placements receive support services designed to assist them in their return to home and/or community living.
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Division
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Division of Health Benefits
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Service Description
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Nursing facilities are licensed long term care facilities which provide round the clock medical, nursing and attendant care. People entering a nursing facility must be prior approved by Medicaid’s fiscal agent. Prior approval is granted only if recipients meet the state’s medical criteria for admission.
The federal Pre-admission Screening and Annual Resident Review (PASARR), which also must be met, screens and evaluates applicants and residents of Medicaid-certified nursing facilities for mental illness, mental retardation, developmental disabilities and related conditions.
Physicians are required to complete a form which establishes medical necessity for the person entering a long term care facility.
Nursing facility services are mandatory for individuals over age 21. 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.
Children institutionalized 12 months or less:
200% FPL - MIC - children under age 6
133% FPL - MIC children age 1-5
100% FPL - MIC children age 6-18
MAF-C/N, 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
Adult:
1. Gross income less than Medicaid reimbursement rate for facility, or
2. Net countable income less than the facility's private rate, or
3. Net countable income minus facility's private rate for 31 days compared to total amount of predictible medical expenses that will not be covered by the nursing facility.
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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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Recipient's income only
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Income Disregard
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Yes
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Income Disregard Desc
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Adults: $30 Personal needs allowance
Unmet medical needs - depends on the amount for each recipient, if any
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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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21
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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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State
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Administrative Rules
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10 NCAC 22O,0116; .0403; .0409
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Federal
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Code of Federal Regulations
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42 CFR 440.40
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Budget Information
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State Fiscal Year (SFY) 2021
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As of the month of November 2020
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Authorized Budget Fiscal Year 2021
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SFY 2020-2021 Year To Date Expenditures
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Balance
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Salary and Fringes (1X)
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1,834,491
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687,819
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1,146,673
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Salary Other (1X)
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5,306
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979
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4,327
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Operating (2X-5X)
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3,569,238
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1,039,348
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2,529,890
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Contracts/Allocations (6X)
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2,068,619
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887,580,002
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-885,511,382
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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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2,824,457
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640,955
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2,183,502
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Total Requirements
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10,302,111
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889,949,103
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-879,646,990
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Receipts-Federal
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1,104,306,930
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635,409,868
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468,897,062
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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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1,937,630
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362,174
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1,575,456
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Total Receipts
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1,106,244,560
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635,772,042
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470,472,518
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General Fund Appropriations
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-1,095,942,448
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254,192,242
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-1,350,134,691
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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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