Individual eligibility for a substance use disorder treatment voucher

1. The individual completes a voucher application in the form and manner prescribed by the department; 2. The individual resides in North Dakota; 3. The individual is twelve years of age or older; 4. The individual grants the department access to treatment and payment records consistent with the confidentiality requirements found under title 42, Code of Federal Regulations, part 2 and title 45, Code of Federal Regulations, part 164; 5. The individual does not have resources to cover any care for treatment or meets one of the following conditions: a. Individual's third-party payment resources will not cover all costs for treatment; b. Individual has a pending application for medical assistance which presents a barrier to timely access to treatment; or c. Individual would not qualify for medical assistance and has no alternative third-party payment resources. 6. The individual has an annual income no greater than two hundred percent of federal poverty guidelines.