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

(a) Conveyance of a life estate in real property, or of the remainder of real property with the reservation of a life estate in the transferor, is a transfer of an asset. For purposes of determining whether to impose, under 7 AAC 100.510, a transfer-of-asset penalty, the departme…

(a) For purposes of determining whether to impose, under 7 AAC 100.510, a transfer-of-asset penalty, the department will consider the purchase of an annuity to be a transfer of an asset for less than fair market value unless the annuity (1) is an annuity described in 26 U.S.C. 40…

(a) An applicant or recipient, or a long-term care facility on behalf of an applicant or recipient, may request an undue hardship exemption from a transfer-of-asset penalty period imposed under 7 AAC 100.510(d) or (e). (b) An applicant or recipient who seeks an undue hardship exe…

In 7 AAC 100.500 - 7 AAC 100.519, unless the context requires otherwise, (1) "annuity" means an actuarially sound contract in which an individual pays an entity a lump sum of money in return for the right to receive fixed, equal, periodic payments, either for life or for a term o…

(a) After establishing initial Medicaid eligibility, the department will determine if a recipient must pay a portion of the cost of the recipient's long-term care services or home and community-based waiver services. If a recipient or a recipient's representative, on behalf of th…

A provider that is enrolled under 7 AAC 105.200 and providing services as a long-term care facility, as a home and community-based waiver services provider, or as a residential supported-living services provider licensed under AS 47.32 as an assisted living home is responsible fo…

(a) A recipient's cost-of-care liability in any given month is the recipient's total monthly income, less the applicable disregards and allowances in (b) and (c) of this section, not to exceed the actual cost of long-term care services paid by the department on behalf of the reci…

(a) The personal needs allowance is the amount of the recipient's income allocated for the personal and maintenance needs of the recipient while the recipient is receiving long-term care services. (b) For a recipient living in a long-term care facility, including a swing-bed faci…

(a) The community spouse allowance is the amount of the recipient's income that, when combined with the community spouse's own income, will bring the community spouse's total gross income as close as possible to the maximum community spouse monthly maintenance allowance authorize…

(a) The dependent family member allowance is the amount of the recipient's income that, when combined with the dependent family member's own income, will bring the dependent family member's total gross income as close as possible to the maximum dependent family member allowance a…

The insurance premium allowance is the cost of Medicare and other health insurance premiums paid by the recipient and not reimbursed by Medicaid. If a premium is paid by the community spouse on behalf of the recipient, that premium also may be deducted. If the insurance premium i…

(a) The unpaid medical expense allowance is a deduction from the total monthly income of the recipient for the purpose of keeping that income available to the recipient to cover any outstanding medical expenses incurred by the recipient that are not paid by Medicaid, Medicare, or…

(a) The home maintenance allowance is the amount of the recipient's income deducted from the recipient's total monthly income to maintain the recipient's home while the recipient is in a medical institution. This section applies only to an individual who (1) was residing in the h…

At any time, the department may make a retroactive adjustment to a recipient's cost-of-care liability to compensate for a previously understated or overstated cost-of-care determination. If retroactive adjustment results in a larger liability for the recipient, the department wil…

In 7 AAC 100.550 - 7 AAC 100.579, unless the context requires otherwise, (1) "available income" means income to which a community spouse has access and over which a community spouse has control; (2) "dependent child" means the minor child of the recipient who lives with the commu…

(a) The provisions of 7 AAC 100.600 - 7 AAC 100.619 apply to an individual who is eligible for Medicaid under an eligibility category identified in 7 AAC 100.002(a) - (e). However, an applicant or recipient may not use a recognized Medicaid trust under 7 AAC 100.604 to meet incom…

(a) Except as provided under 7 AAC 100.604, if an applicant or recipient is the grantor of a revocable trust, (1) the entire principal counts as an available resource to the applicant or recipient; (2) a payment from the trust to, or for the benefit of, the applicant or recipient…

(a) The following three types of recognized Medicaid trusts are exceptions to the general trust requirements in 7 AAC 100.602 for trusts: (1) a qualifying income trust authorized under 42 U.S.C. 1396 p(d)(4)(B) that meets the requirements of 7 AAC 100.610; (2) a special needs tru…

(a) A payment that would otherwise be available to an applicant or recipient that is deposited directly into a recognized Medicaid trust account, or earnings of the trust account that remain in the trust account, is not income for the purposes of determining Medicaid eligibility.…

(a) If a recognized Medicaid trust terminates by death of the recipient or by court order, a recognized Medicaid trust may pay for any outstanding legal and administrative fees associated with establishing and maintaining the trust and trust account before paying the state under …

To be approved by the department, a qualifying income trust (1) must consist exclusively of income to the applicant or recipient, including accumulated interest; (2) must be irrevocable; (3) may not contain an asset other than income; (4) must terminate upon a court order or the …

(a) To be approved by the department, a special needs trust must (1) be established for the sole benefit of the applicant or recipient who is under 65 years of age and who is blind under 7 AAC 40.140(a) or disabled under 7 AAC 40.170(a); (2) consist exclusively of the income and …

(a) To be approved by the department, a pooled trust must (1) be established and managed by a nonprofit association; (2) contain the assets of beneficiaries who are blind under 7 AAC 40.140(a) or disabled under 7 AAC 40.170(a); (3) maintain a separate account for each beneficiary…

In 7 AAC 100.600 - 7 AAC 100.619, unless the context requires otherwise, (1) "beneficiary" means an individual designated by a trust document to receive the benefits of the trust; (2) "irrevocable trust" means a trust that, absent a court order, may not be revoked or modified by …

(a) An alien who is ineligible for full Medicaid coverage because the alien does not meet the requirements of 7 AAC 100.050 may apply for limited coverage under 7 AAC 100.002(f) if the alien is a resident of the state under 7 AAC 100.060 and would otherwise be eligible under any …

(a) To be eligible under 7 AAC 100.002(d) (7), a woman must (1) at the time of application, have been screened through the department's Breast and Cervical Health Check program or through a similar program from another state that is part of the United States Department of Health …

(a) The Medicaid coverage available under the eligibility categories listed in 7 AAC 100.002(e) is limited to assistance with the cost of Medicare premiums, deductibles, and coinsurance as provided under each category. Medicaid covered services described in 7 AAC 105 - 7 AAC 160 …

(a) To be eligible for Medicaid coverage as a qualified Medicare beneficiary under 7 AAC 100.002(e) (1), an individual must (1) be eligible for and enrolled in Medicare Part A hospitalization coverage; (2) have total monthly income that does not exceed 100 percent of the federal …

(a) To be eligible for Medicaid coverage as a special low-income Medicare beneficiary under 7 AAC 100.002(e) (3), an individual must (1) be eligible for and enrolled in Medicare Part A hospitalization coverage; (2) have total monthly income that does not exceed 120 percent of the…

(a) To be eligible as a special low-income Medicare beneficiary qualifying individual under 7 AAC 100.002(e) (4), an individual must (1) be eligible for and enrolled in Medicare Part A hospitalization coverage; (2) have total monthly income that does not exceed 135 percent of the…

(a) To be eligible for coverage as a qualified disabled and working individual under 7 AAC 100.002(e) (2), an individual must (1) have lost SSDI because of earnings; (2) continue to have the same blindness or disability that contributed to the individual's former eligibility for …

(a) A Medicaid recipient eligible under 7 AAC 100.002(a) or (c) must report to the department any change in the household that may affect the household's eligibility within 10 days after the date the recipient knows of the change. Changes affecting a household or individual inclu…

(a) In addition to the Medicaid eligibility review under 7 AAC 100.020, the department may conduct a special review of the eligibility of a recipient or recipient's household in the same manner that the department determines the eligibility of a new applicant if the department ha…

(a) The department will issue a written recovery notice to an individual, and will seek to recover Medicaid expenditures from that individual, if Medicaid expenditures are made on behalf of that individual and that individual (1) is determined under 7 AAC 100.912, to have (A) com…

(a) If the department has reason to believe that an individual has committed an intentional program violation or program abuse, the department will conduct a full investigation in accordance with 42 C.F.R. 455.15. If, after a full investigation, the department determines that an …

The United States Department of Health and Human Services federal poverty guidelines for this state, established in 72 Fed. Reg. 3147 - 3148, revised as of January 24, 2007, and as amended from time to time, are adopted by reference. Notes 7 AAC 100.980 Eff. 7/20/2007, Register 1…

In this chapter, unless the context requires otherwise, (1) "AB" means aid to the blind under former 42 U.S.C. 1201 (Title X of the Social Security Act); (2) "adoption" means the establishment of a parent-child relationship between a child and an adult who is not the child's birt…