(a)  The county department of social services and Division of Medical Assistance shall make corrections required by Rule .0202 of this Section within 30 days after discovery of the need for action unless good cause exists for failure to act timely.

(b)  Good cause is limited to:

(1)           The need to verify other conditions of eligibility before authorizing eligibility; or

(2)           The county department of social services is unable to locate the applicant or recipient; or

(3)           The county department of social services disagrees with a decision requiring corrective action and has requested administrative review by the Medicaid Eligibility Section;

(c)  To receive state and federal financial participation in any benefits authorized retroactively by corrective actions, the effective date of the correction must correspond with the date assistance would have been effective but may be no earlier than the following dates:

(1)           Retroactive to the date ordered by the appeal or court decision if all eligibility conditions are met, including any legal retroactive coverage period associated with the adverse action; or

(2)           Retroactive to the date that all requirements of eligibility are met but no earlier than the 12th month immediately preceding the month the change is reported or the administrative error was discovered; or

(3)           Retroactive to the date required for corrective action due to errors cited from monitoring under application processing standards in 10A NCAC 23C .0202.

(d)  If the change is adverse to the recipient, it shall be effective with the first calendar month following expiration of the 10 work day advance notice period.


History Note:        Authority G.S. 108A-54; 42 C.F.R. 431.246; 42 C.F.R. 431.250; 42 C.F.R. 435.904; Alexander v. Bruton, U.S.D.C., File No. C-C-74-183-M, Consent Order dismissed effective February 1, 2002;

Eff. June 1, 1990;

Temporary Amendment Eff. March 1, 2003;

Amended Eff. August 1, 2004;

Transferred from 10A NCAC 21A .0603 Eff. May 1, 2012.