§ 40-8.7-6. Eligibility.
(a) To be eligible for benefits under the Medicaid buy-in program:
(1) The person shall be an individual with disabilities as defined in § 40-8.7-4, but without regard to the person's ability to engage in substantial gainful activity,
as specified in the Social Security Act, 42 U.S.C. § 423(d)(4);
(2) The person shall be employed as defined in § 40-8.7-4;
(3) For the Sherlock Act Medicaid buy-in program the person's net accountable income shall
either not exceed two hundred fifty percent (250%) of the federal poverty level, taking
into account the SSI program disregards and impairment-related work expenses as defined
in 42 U.S.C. § 1396a(r)(2) or for the Ticket to Work Program buy-in program there are no income or asset limits
to be considered as part of the eligibility determination;
(4) A maximum of ten thousand dollars ($10,000) of available resources for an individual
and twenty thousand dollars ($20,000) for a couple shall be disregarded as shall any
additional resources held in a retirement account, in a medical savings account, or
any other account, related to enhancing the independence of the individual and approved
under rules to be adopted by the executive office for the Sherlock Act; there are
no income or asset limits for the Ticket to Work Program; and
(5) The person shall be a current medical assistance recipient under § 40-8.5-1 [CNIL] or § 40-8-3(5)(v) [MNIL]; or shall meet income, assets (except as modified by subsection (a)(4) of
this section), and eligibility requirements for the medical assistance program under
§ 40-8.5-1 [CNIL] or § 40-8-3(5)(v) [MNIL], as such requirements are modified and extended by this chapter.
(b) Appeals Process. The director or designee shall review each application filed in accordance with regulations,
and shall make a determination of whether the application will be approved and the
extent of the benefits to be made available to the applicant, and shall, within thirty
(30) days after the filing, notify the applicant, in writing, of the determination.
If the application is rejected, the applicant shall be notified of the reason for
the denial. The director may at any time reconsider any determination. Any applicant
for or recipient of benefits aggrieved because of a decision, or delay in making a
decision, shall be entitled to an appeal and shall be afforded reasonable notice and
opportunity for a fair hearing conducted by the director, pursuant to chapter 8 of
this title.