16 Del. Admin. Code § 14000-14110

Current through Register Vol. 28, No. 7, January 1, 2025

Section 14000-14110 - State Residency

An applicant or beneficiary must be a Delaware resident.

17 DE Reg. 503 (11/01/13)

14110.1Definitions

The following words and terms, when used in the context of these policies, will have the following meaning unless the context clearly indicates otherwise:

Per 42 CFR 435.403(b), "Institution" has the same meaning as Institution and Medical Institution as defined in 42 CFR 435.1010. For purposes of state placement, the term also includes foster care homes, licensed as set forth in 45 CFR 1355.20, and providing food, shelter, and services to one or more persons unrelated to the proprietor.

Per 42 CFR 435.403(c), an individual is "Incapable of indicating intent" if the individual -

a) Has an I.Q. of 49 or less or has a mental age of 7 or less, based on tests acceptable to the Delaware Division of Developmental Disabilities;

b) Is judged legally incompetent; or

c) Is found incapable of indicating intent based on medical documentation obtained from a physician, psychologist, or other person licensed by the State in the field of intellectual disability.

17 DE Reg. 503 (11/01/13)

14110.2Placement by State in an Out-Of-State Institution

(42 CFR 435.403(e))

An individual who is placed in an institution in another State by a Delaware agency including an entity recognized under State law as being under contract with the State for such purposes is considered a Delaware resident. The State arranging or actually making the placement is considered as the individual's State of residence. Any action beyond providing information to the individual and the family constitutes arranging or making a State placement.

17 DE Reg. 503 (11/01/13)

14110.3Actions which do not Constitute State Placement

(42 CFR 435.403(e))

The following actions do not constitute State placement:

a. Providing basic information to the individual about another State's Medicaid and information about the availability of services and facilities in another State.

b. Assisting an individual in locating an institution in another State, provided the individual is capable of indicating intent and independently decides to move.

c. When a competent individual leaves the facility in which he/she is placed by State, the individual's State of residence for Medicaid purposes is the State where individual is physically located.

17 DE Reg. 503 (11/01/13)

14110.4Lack of Appropriate Facility

(42 CFR 435.403(e))

Where a placement is initiated by a State because the State lacks a sufficient number of appropriate facilities to provide services to its residents, the State making the placement is the individual's State of residence.

17 DE Reg. 503 (11/01/13)

14110.5[Reserved]

14110.6Individuals Receiving a State supplementary payment (SSP)

Per 42 CFR [435.403(f)]

Individuals of any age who are receiving an SSP, the State of residence is the State paying the SSP.

14110.7Individuals Receiving Title IV-E Payments

Per 42 CFR [435.403(g)]

Individuals of any age who are receiving Federal payments for foster care or adoption assistance under title IV-E of the Social Security Act, the State of residence is the State where the child lives.

14110.8Individuals Under Age 21

42 CFR 435.403(i)

For an individual under age 21 who is not eligible for Medicaid based on receipt of assistance under title IV-E of the Act, as addressed 14110.7 of this section, and is not receiving a State supplementary payment, as addressed in paragraph 14110.6 of this section, the State of residence is as follows:

a) For an individual who is capable of indicating intent and is married or emancipated from his or her parent, and is not residing in an institution, the State of residence is where the individual is living; and

* intends to reside including without a fixed address, or

* has entered the state with a job commitment or seeking employment (whether or not currently employed).

b) For an individual not described in a) and not living in an institution, the State of residence is:

* the state where the individual resides including without a fixed address; or

* the State of residency of the parent or caretaker, in accordance with 14110.9 of this section, with whom the individual resides.

c) For an institutionalized individual who is neither married nor emancipated, the State of residence is:

* the parent's or legal guardian's State of residence at the time of placement (if a legal guardian has been appointed and parental rights are terminated, the State of residence of the guardian is used instead of the parent's); or

* the parent's or legal guardian's current State of residence if the individual is institutionalized in that same State (if a legal guardian has been appointed and parental rights are terminated, the State of residence of the guardian is used instead of the parent's); or

* the State of residence of the individual who files an application is used if the individual has been abandoned by the parents (including deceased parents), there is no legal guardian, and is institutionalized in that state.

14110.9Individuals Age 21 and Over

42 CFR [435.403(h)]

For an individual over age 21 who is not eligible for Medicaid based on receipt of assistance under title IV-E of the Act, as addressed 14110.7 of this section, and is not receiving a State supplementary payment, as addressed in paragraph 14110.6 of this section, the State of residence is as follows:

a) For an individual not residing in an institution, the State of residence is the state where the individual is living and:

* intends to reside including without a fixed address; or

* has entered the state with a job commitment or seeking employment (whether or not currently employed).

b) For an individual not residing in an institution and who is not capable of stating intent, the State of residence is the state where the individual is living.

c) For any institutionalized individual who became incapable of indicating intent before age 21, the State of residence is:

* That of the parent applying for Medicaid on the individual's behalf, if the parents reside in separate States (if a legal guardian has been appointed and parental rights are terminated, the State of residence of the guardian is used instead of the parent's); or

* The parent's or legal guardian's State of residence at the time of placement (if a legal guardian has been appointed and parental rights are terminated, the State of residence of the guardian is used instead of the parent's); or

* The current State of residence of the parent or legal guardian who files the application if the individual is institutionalized in that State (if a legal guardian has been appointed and parental rights are terminated, the State of residence of the guardian is used instead of the parent's).

* The State of residence of the individual or party who files an application is used if the individual has been abandoned by his or her parent(s), does not have a legal guardian and is institutionalized in that State.

d) For any institutionalized individual who became incapable of indicating intent at or after age 21, (irrespective of any type of guardianship) the State of residence is the state in which the individual is physically present, except where another state makes a placement.

e) For any other institutionalized individual, the State of residence is the state where the individual is living and intends to reside.

17 DE Reg. 503 (11/01/13)

14110.10Specific Prohibitions for Denial or Termination of Eligibility

42 CFR 435.403(j); 42 CFR 435.956(c)(2)

Per 42 CFR 435.956(c)(2), Evidence of immigration status may not be used to determine that an individual is not a State resident.

A State cannot deny Medicaid eligibility to otherwise qualified resident of the State because:

a) The individual's residence is not maintained permanently or at a fixed address.

b) The individual has not resided in the State for a specific period of time; or

c) An institutionalized individual did not establish residence in the community prior to admission to an institution.

A State cannot terminate Medicaid eligibility for an otherwise qualified resident of the State due to temporary absence from the State if the person intends to return when the purpose of the absence has been accomplished, unless another State has determined that the person is a resident there for purposes of Medicaid.

A State cannot wait to approve Medicaid eligibility in situations where the individual has moved to Delaware from another State and the Medicaid case is still open in the former State. The individual is no longer a resident of the former State and is ineligible in that State. The case may not be closed yet due to administrative processes.

17 DE Reg. 503 (11/01/13)

14110.11Exceptions to General Residency Rules

When the following exists, it supersedes the general residency rules:

a) When two or more States cannot resolve which State is the State of residence, the State in which the individual is physically located is the State of residence.

17 DE Reg. 503 (11/01/13)

16 Del. Admin. Code § 14000-14110

17 DE Reg. 503(11/1/2013)
23 DE Reg. 306( 10/1/2019) (Final)