(a)  The first month of Medicaid coverage shall be:

(1)           the month of application, or for SSI recipients, the month of application for SSI;

(2)           as much as three months prior to the month of application when the client received medical services covered by the program and was eligible during the month or months of medical need; or

(3)           if the client applies prior to meeting a non‑financial requirement, no earlier than the calendar month in which all non‑financial requirements are met.

(b)  Assistance shall be authorized beginning on the first day of the month except when:

(1)           the client's income exceeds the income level and he or she must spenddown the excess income for medical care. The assistance shall be authorized on the day his or her incurred medical care costs equal the amount of the excess income; or

(2)           otherwise stated in the Medicaid State Plan.

(c)  Medicaid coverage shall end on the last day of the last month of eligibility except for those individuals eligible for emergency conditions only as described in 10A NCAC 23E .0102. The last month of eligibility shall be the month in which the notice of termination period described in 10A NCAC 21A .0301 expires.


History Note:        Authority G.S. 108A‑54; 108A-54.1B; 42 C.F.R. 435.915;

Eff. September 1, 1984;

Amended Eff. January 1, 1995; October 1, 1991; August 1, 1990;

Temporary Amendment Eff. March 1, 2003;

Amended Eff. August 1, 2004;

Readopted Eff. July 1, 2018.