North Carolina Administrative Code
Title 10A - HEALTH AND HUMAN SERVICES
Chapter 23 - MEDICAL ASSISTANCE ADMINISTRATION
Subchapter G - MEDICAID CERTIFICATION, CORRECTION OF ELIGIBILITY AND REDETERMINATION OF ELIGIBILITY
Section .0300 - REDETERMINATION OF ELIGIBILITY AND CHANGE IN SITUATION
Section 23G .0304 - CHANGE IN SITUATION

(a) For the purposes of this Rule, a "change in situation" includes:

(b) The Medicaid client or his or her representative shall report any change in situation in the budget unit or household as defined by 42 C.F.R. 435.603 that affects eligibility to the county department of social services within 10 calendar days of knowledge of the change. 42 C.F.R. 435.603 is incorporated by reference, including subsequent amendments and editions, available and free of charge at https://www.ecfr.gov.

(c) Once the county department of social services learns from any source that there has been a change in situation that affects eligibility, it shall verify that information by reviewing its files or electronically as defined by 42 C.F.R. 435.949, which is incorporated by reference including subsequent amendments and editions, and available free of charge at https://www.ecfr.gov. When the change in situation cannot be verified from its files or electronically, it shall send a notice of the need to obtain verification, as defined by 10A NCAC 23A .0102, of the change. No notice shall be sent if the change in situation can be verified in the county department of social services' files or electronically.

(d) For Medicaid applications, the application processing standards set forth in 10A NCAC 23C .0201 shall apply.

(e) For an active case with an ongoing certification period, once the county department of social services learns from any source that there has been a change in situation, it shall review the case and determine eligibility. Processing shall be completed within 30 calendar days after the agency learns of the change.