7 AAC 100 — Medicaid Eligibility (Article 1 to 15)

(a) An applicant 18 years of age or older may appoint a representative who, in the applicant's place, is authorized to apply for Medicaid on the applicant's behalf. An individual who is 18 years of age or older may be an authorized representative. The appointment of an authorized…

(a) A new application must be made if, at the time of application, the individual is not receiving Medicaid under this chapter and is not a member of a household receiving Medicaid under this chapter. (b) The department may determine eligibility without requiring the applicant or…

(a) The department will make a finding of eligibility or ineligibility for every identifiable application for Medicaid that it receives under 7 AAC 100.004, unless (1) a written request to withdraw the application is submitted by an individual authorized to sign the application u…

(a) An applicant for Medicaid under one of the following eligibility categories must participate in at least one face-to-face interview with a caseworker or fee agent, unless waived by the department under (c) of this section: (1) Family Medicaid under 7 AAC 100.002(a) (1); (2) F…

(a) The department will verify whether an applicant or recipient meets eligibility requirements. (b) The department will request in writing that an applicant or recipient provide documentation that the applicant or recipient meets eligibility requirements if the required document…

(a) No later than 30 days after an application is received, or 90 days if a disability determination is required, a district office of the division handling public assistance matters in the department or the office of the department handling matters for children in the department…

(a) Except as provided in (h) of this section, at least once every 12 months, the department will require a recipient who is eligible for Medicaid to submit a review application on a form provided by the department and furnish the documentation requested by the department to supp…

(a) A timely review application is one that is received on or before the date requested. If the department determines that a timely review application requires additional documentation, the department will send a notice to the recipient requesting the additional documentation and…

(a) Except as provided in (d) of this section, to be eligible for Medicaid an applicant must do one of the following: (1) present to the department or a fee agent the applicant's actual social security card or a photocopy of it; (2) submit a written statement giving the applicant…

(a) Except as otherwise provided in this section, to be eligible for Medicaid, a member of a household who may be eligible for benefits under one or more of the following programs must apply for and, if eligible, accept benefits from that program: (1) workers' compensation under …

(a) To be eligible for Medicaid, an applicant or recipient must (1) cooperate with the department in obtaining or identifying third-party resources that may be available to pay for medical care for which Medicaid coverage is sought; and (2) assign to the department the applicant'…

(a) A custodial parent or guardian of a child who is a Medicaid applicant or recipient must assign to the state the right to receive and retain medical support from a noncustodial parent on behalf of all children for whom the applicant is seeking Medicaid benefits. (b) Signing an…

(a) Except as otherwise provided in this section, an applicant for Medicaid who is 18 years of age or older and who is a parent, or who can legally assign rights to medical support for a child in the applicant's care, must cooperate with the child support services agency of the D…

(a) In accordance with 7 AAC 100.042(b) (7), the department will find that good cause for refusal to cooperate with the child support services agency exists if(1) cooperation would increase the risk of physical harm to the child, custodial parent, or caretaker relative; (2) coope…

(a) A parent or other adult who is required to cooperate with the child support services agency, but who fails to do so without good cause, is ineligible for Medicaid until the parent or adult cooperates as required. Only a parent or other adult who can legally assign rights to m…

(a) To be eligible for Medicaid, an individual must meet all other eligibility requirements under this chapter, including the state residency requirement under 7 AAC 100.060, and (1) be or claim to be a United States citizen under 7 AAC 100.054; (2) be a qualified alien described…

(a) Medicaid eligibility for an alien is based on whether the alien is a qualified alien or nonqualified alien, regardless of the date of that alien's physical entry into the United States. (b) A qualified alien is an alien who, at the time the alien applies for or receives a Med…

(a) If the department is unable to verify both identity and United States citizenship through a data match with the United States Social Security Administration, an applicant for Medicaid may verify both identity and United States citizenship by submitting to the department (1) a…

(a) Unless exempt under 7 AAC 100.058, a qualified alien as described in 7 AAC 100.052 who enters the United States on or after August 22, 1996, is not eligible for Medicaid for a period of five years beginning on the date the alien physically entered into the United States. A no…

The five-year bar described in 7 AAC 100.056 does not apply to an alien who is (1) a refugee granted asylum or an individual with a similar status described in 8 U.S.C. 1613(b)(1); (2) a veteran of, or who is on active duty in, the United States armed forces as described in 8 U.S…

(a) To be eligible for Medicaid in this state an applicant must be a resident of the state. (b) Except as otherwise provided in (c) in this section, a resident of the state is an individual who is physically present in the state and living in the state voluntarily with the intent…

(a) An applicant who has recently arrived in the state with the intent to remain and who is still receiving assistance from another state meets the residency requirement of 7 AAC 100.060. However, the department will not issue Medicaid benefits until Medicaid benefits from the ot…

(a) An applicant for or recipient of Medicaid benefits continues to be a resident of the state while the applicant or recipient is temporarily absent from the state if (1) the applicant or recipient intends to return to the state when the purpose of the absence has been accomplis…

(a) If a Medicaid recipient is placed in an institution located in another state, the state of residence is determined according to 42 C.F.R. 435.403, revised as of October 1, 2005, and adopted by reference. (b) If a recipient leaves an institution or foster care setting and also…

(a) Except as provided in this section, the department will not reimburse Medicaid services provided to a Medicaid-eligible individual while the individual resides in a public institution, regardless of whether placement was voluntary or involuntary, unless the individual is (1) …

(a) Except as provided in (b) and (c) of this section, a child under 19 years of age who is eligible for Medicaid remains eligible for Medicaid for a continuous 12-calendar-month period beginning with the month a prospective eligibility determination is made. Each time a new pros…

(a) At the time of application or interview, an applicant may request Medicaid coverage for a maximum of three months immediately preceding the month of application if the applicant has unpaid medical expenses for dates of service any time during that three-month period. (b) The …

The department will suspend, rather than terminate, an individual or household's eligibility if the individual or household is likely to be ineligible for only one month. The department will not count the suspension month as a month in which earned income deductions are allowed u…

The provisions of 7 AAC 100.100 - 7 AAC 100.199 establish Family Medicaid eligibility criteria under 7 AAC 100.002(a) (1). Except as otherwise provided in this chapter, 7 AAC 100.100 - 7 AAC 100.199 apply to all eligibility categories under 7 AAC 100.002(a) or (c). Notes 7 AAC 10…

(a) To determine eligibility for Family Medicaid, the department will first determine who is in the Family Medicaid household under (b) of this section and then determine if the household is financially eligible under (c) of this section. (b) A Family Medicaid household is the co…

(a) Unless otherwise provided in this chapter, the following individuals are mandatory members for the household for the purposes of determining Family Medicaid eligibility if they are living in the same home: (1) a dependent child; to be determined a dependent child, an individu…

(a) To be eligible for Family Medicaid, a dependent child must be deprived of the parental support and care of one or both of the child's parents. Deprivation occurs (1) when a parent does not continue to live in the home of the child, except for a temporary absence authorized un…

(a) To be eligible for Family Medicaid, a dependent child must be living with a caretaker relative in the home of that caretaker relative. (b) The department will consider a dependent child to be living with a caretaker relative if the caretaker relative maintains a home for the …

(a) The department will consider a dependent child and a caretaker relative to be living together even though the dependent child or the caretaker relative is absent from the home, if one of the following circumstances is true for the duration of the absence: (1) the dependent ch…

(a) A Family Medicaid household may include any of the following: (1) one adult and any number of dependent children for whom the adult is a caretaker relative; (2) only a dependent child or children if the caretaker relative is not included in the Medicaid household for the purp…

(a) In addition to the mandatory members of the household identified in 7 AAC 100.104, one or more of the following individuals, if the individual chooses to apply, may be included in a Family Medicaid household if everyone is living in the same home: (1) any dependent child who …

(a) A Family Medicaid household may not include a child or adult who is receiving SSI, APA, or foster care maintenance payments. The department will disregard the financial needs, income, and resources of a child or adult receiving SSI, APA, or foster care payments when determini…

(a) The financial needs, income, or resources of the following individuals are not included in a Family Medicaid eligibility determination even if the individual is living in the same home as a dependent child: (1) a recipient of SSI or APA; (2) the sibling of a dependent child i…

(a) A minor parent is a parent who is not married, is under 18 years of age, and has not been emancipated under AS 09.55.590. For the purpose of determining who is included in a Family Medicaid household, a minor parent is only considered a parent if (1) the minor parent lives ap…

(a) Notwithstanding 7 AAC 100.300 - 7 AAC 100.304, the department will determine Family Medicaid eligibility for a pregnant woman who does not have other children living in the household who are eligible for Family Medicaid, if the pregnant woman is in the last 91 days of pregnan…

(a) A household is not eligible for Family Medicaid if the household has nonexempt resources, as determined under 7 AAC 100.138 and 7 AAC 100.140, with a total value, as determined under 7 AAC 100.144, in excess of $2,000 or, if the household includes an individual 60 years of ag…

(a) In determining eligibility for Family Medicaid benefits, the department will include a nonexempt resource in the determination only if the resource is actually available to meet the financial needs of a dependent child who is included in the Family Medicaid household. (b) If …

(a) To determine whether a household's nonexempt resources exceed the resource limit in 7 AAC 100.130, the department will consider the following factors: (1) what nonexempt resources the caretaker relative has; (2) whether the caretaker relative's nonexempt resources are conside…

(a) In determining the eligibility of an applicant who is an alien under 7 AAC 100.050 and 7 AAC 100.052, the department will count the nonexempt resources of the alien's sponsor and the sponsor's spouse who is living with the sponsor, if the sponsor(1) or the sponsor's spouse ar…

(a) The department will not consider exempt resources in determining eligibility for Family Medicaid benefits. A resource is exempt if it is determined to be wholly or partially exempt under this section or 7 AAC 100.140. (b) The physical structure that serves as the applicant's …

(a) Except as provided in (b) of this section, a pension plan and an employment-related retirement plan is an exempt resource if the applicant or recipient (1) cannot immediately withdraw and use the money in the pension plan to meet the needs of the applicant's or recipient's fa…

(a) In the month in which one resource is converted to, or exchanged for, another resource, the department will not consider the newly acquired resource to be income. The new resource is subject to 7 AAC 100.100 - 7 AAC 100.199. (b) For purposes of 7 AAC 100.100 - 7 AAC 100.199, …