Family and Children's Medicaid MA-3335 STATE RESIDENCE

V. INDIVIDUAL MOVING TO NC WAS PREVIOUSLY ELIGIBLE IN ANOTHER STATE

A. If an individual who was receiving Medicaid in another state prior to moving to NC applies for NC Medicaid, the IMC is responsible for contacting the prior state to:

1. Notify the State of the applicant’s move to NC, and

2. Request that eligibility in the other state be terminated as of the date the individual moved to NC with the intent to remain, so that eligibility for NC Medicaid can be determined, and

3. Obtain any information on resources such as bank accounts, stocks, bonds, promissory notes, former homesite, etc., that will aid in determining eligibility in NC, and

REISSUED 08/01/13 – CHANGE NO. 04-13

4. Verify whether the other state’s Medicaid program will cover bill(s) incurred in NC if the applicant has outstanding medical bills in NC in the same month he received Medicaid in the other state.

NOTE: A lot of Medicaid programs in other states are similar to NC. They only cover out-of-state services if it is an emergency or the service was prior approved.

B. If the applicant has a bill in NC that will NOT be covered by the other state, authorize Medicaid in NC if eligible for that month.

C. If the other state will pay the NC claims:

1. Contact the medical provider(s) and verify whether he is enrolled or is willing to enroll with the other state.

2. If providers are not willing to enroll and file claims with the other state, authorize NC Medicaid if eligible.

3. If providers are willing to enroll and bill the other state, there is no need for NC coverage for that month(s).

D. Follow-up with the out-of-state agency at least every 2 weeks until a response is received if written verification was requested.

E. Attach letters/documents or notes on telephone contacts with the out-of-state agency to the base document to verify the applicant’s eligibility status.

F. Contact the Medicaid Eligibility Unit (Refer to EIS 1200, State Office Contacts) if there is a question about whether payment for out-of-state services is available in NC or if assistance is needed in verifying out-of-state eligibility or coverage.

G. If out-of-state Medicaid coverage terminates other than the last day of the month, authorize NC Medicaid the first of the month in which the out-of-state Medicaid terminates.