{"data":{"id":"us-nc/n.c.-gen.-stat.-108a-70.38","jurisdiction":"us-nc","citation":"N.C. Gen. Stat. § 108A-70.38","heading":"Timely processing standards.","body":"(a)\tThe Department shall require counties to comply with timely processing standards. The timely processing standards are the average processing time standards and the percentage processed timely standards set forth in G.S. 108A-70.39 and G.S. 108A-70.40. The Department shall monitor county department of social services' compliance with these standards in accordance with this Part.\n(b)\tFor purposes of this Part, processing time is the number of days between the date of application and the date of disposition of the application, except in cases where an eligibility determination is dependent upon receipt of information related to one or more of the following:\n(1)\tMedical expenses sufficient to meet a deductible.\n(2)\tThe applicant's need for institutionalization.\n(3)\tThe applicant's plan of care for the home- and community-based waivers.\n(4)\tThe disability decision made by the Disability Determination Services Section of the Division of Vocational Rehabilitation of the Department.\n(5)\tMedical records needed to determine emergency dates for nonqualified aliens.\n(6)\tThe applicant's application or other information from the federally facilitated marketplace.\n(7)\tThe applicant's application or other information in connection with an application for a Low Income Subsidy for Medicare prescription drug coverage.\nIn these cases, processing time shall exclude the number of days between the date when the county determines all eligibility criteria other than the criteria in subdivisions (1) through (7) of this subsection and the date when the county receives the information related to the criteria in subdivisions (1) through (7) of this subsection.\n(c)\tProcessing times for the following types of cases shall be excluded from the calculation of the average processing time and percent processed timely:\n(1)\tNewborns who are automatically enrolled based on their mother's eligibility.\n(2)\tApplications for individuals who are presumptively eligible for Medicaid.\n(3)\tActive cases in which an individual who is eligible for one program is transferred to another program, regardless of whether the transfer occurs between allowable or nonallowable program categories.\n(4)\tCases in which an individual transfers from an open case to another case, including establishing a new administrative case for the individual.\n(5)\tActions to post eligibility to a terminated or denied case within one year of the termination or denial.\n(6)\tCases that are reopened because they were terminated in error or because reopening of the terminated case is allowed by policy.\n(7)\tCases in which the eligibility decision was appealed and the decision was reversed or remanded.\n(d)\tThe Department may, in its discretion, exclude days, other than those required by subsection (b) of this section, from the calculation of processing time under this section if the Department determines that the delay was caused by circumstances outside the control of county departments of social services. The Department also may, in its discretion, exclude types of cases, other than those described in subsection (c) of this section, from the calculation of processing time. When the Department exercises its discretion pursuant to this subsection, the Department's determination regarding circumstances outside the control of county departments of social services and the Department's decision to exclude types of cases shall be applied uniformly to all county departments of social services. (2016-94, s. 12H.17(b).)","path":["Chapter 108A. Social Services.","Article 2. Programs of Public Assistance.","Part 10. Medicaid Eligibility Decision Processing Timeliness."],"source_url":"https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_108A/GS_108A-70.38.html","current_through":"S.L. 2026-30","vintage":"","retrieved_at":"2026-08-27T18:16:22Z","sha256":"97e9ea113d52dce9acc50a178372e22e51627ebc168dff022eaf96f6cce7b828","source_id":"us-nc","stale":false,"prev":"us-nc/n.c.-gen.-stat.-108a-70.37","next":"us-nc/n.c.-gen.-stat.-108a-70.39"},"notice":"GroundRules: Original legal text. Not legal advice."}