Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 477 - MEDICAID ELIGIBILITY
Chapter 3 - APPLICATION PROCESS
Section 477-3-004 - APPLICANT AND CLIENT RESPONSIBILITIES

Universal Citation: 477 NE Admin Rules and Regs ch 3 ยง 004

Current through September 17, 2024

Each applicant or client is required to:

(A) Provide complete and accurate information. State and federal law provides penalties that may include a fine, imprisonment, or both, for persons found guilty of making false statements or failing to report promptly any changes in their circumstances to obtain assistance or services for which they are not eligible;

(B) Report a change in circumstances no later than 10 days following the change. This includes information regarding:

(i) Change or receipt of a resource including cash, stocks, bonds, or a motor vehicle. Changes in resources do not apply to clients whose eligibility is determined using modified adjusted gross income (MAGI)-based methodology;

(ii) Change in unit composition, such as the addition, loss of, or temporary absence of a unit member;

(iii) Change in residence;

(iv) Living arrangement;

(v) Disability status;

(vi) New employment;

(vii) Termination of employment; or

(viii) Change in the amount of monthly income, including:
(1) All changes in unearned income; and

(2) Changes in the source of employment, in the wage rate, or in employment status, such as part-time to full-time or full-time to part-time.
(a) For reporting purposes, full-time employment is considered at least 30 hours per week. The client must report new employment within 10 days of receipt of the first paycheck, and a change in wage rate or hours within 10 days of the change. To avoid adverse action, a client must prove good cause for any failure to report a change to the Department within 10 days. Unconfirmed statements do not constitute good cause;

(C) Present his or her Medicaid card to providers;

(D) Inform the medical provider and the Department of any third-party resources which may be liable for his or her medical expenses, in whole or in part, and cooperate in obtaining these third-party resources;

(E) Enroll in a health plan and maintain enrollment if:

(i) One is available to the client;

(ii) The client is able to enroll on his or her own behalf; and

(iii) The Department has determined enrollment in the plan to be cost effective;

(F) Reimburse to the Department or pay to the provider any third-party resources received directly for services payable by Medicaid;

(G) Pay any unauthorized medical expenses;

(H) Pay any required medical copayment;

(I) Meet the requirements of Managed Care, if applicable; and

(J) Cooperate with state and federal quality control.

Disclaimer: These regulations may not be the most recent version. Nebraska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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