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

The department will determine the prospective eligibility of a household by making, under 7 AAC 100.168, its best estimate of income, resources, and other circumstances that are anticipated to exist for the household during the month for which eligibility is being determined. To …

(a) Except as otherwise provided in this chapter, the department will consider money received by an individual included in the household to be income in the month it was received. If any of that money remains available to the household in the next month, the department will consi…

(a) For the purpose of determining Family Medicaid eligibility, the department will review all household income that is not exempt income under 7 AAC 100.160 and 7 AAC 100.162 to determine if that income is earned income, self-employment income, or unearned income. (b) Earned inc…

(a) The department will not consider exempt income under this section or 7 AAC 100.162 in determining eligibility for Family Medicaid benefits. The following items are exempt income if received by an individual included in the household:(1) home produce that is consumed by indivi…

(a) The earned income of a dependent child who is a full-time or part-time student is exempt when determining Family Medicaid eligibility. (b) In this section, (1) "full-time student" means a student who is regularly attending (A) vocational training that is designed to prepare a…

Except for those portions administered, funded, or insured under 20 U.S.C. 1070 - 1099c-2 (Title IV of the Higher Education Act of 1965), or under a United States Department of Interior, Bureau of Indian Affairs student assistance program, an educational grant, scholarship, or ot…

(a) Except as provided in (b) of this section, a child support payment made in cash is income for the purpose of determining eligibility for Family Medicaid when that child support payment is actually received. (b) Of a child support payment that is received by the applicant or r…

(a) For the purpose of determining the eligibility of a household for Family Medicaid benefits under 7 AAC 100.154, the department will make a best estimate of the prospective income for a household by using the actual income received or anticipated to be received in the month fo…

(a) If an applicant or recipient works for more than one month before receiving a single payment in full settlement for the work performed, regardless of whether that person is an employee or self-employed, working with or without a contract, the department will (1) prorate the i…

(a) Nonpersonal costs of doing business allowed under this section may not be deducted from income received from the production or sale of goods or services unless the department has determined that the individual is self-employed under this section. An individual is self-employe…

The department will prorate self-employment income, as determined under 7 AAC 100.172(i), over (1) a 12-month period if the yearly self-employment income exceeds 185 percent of the federal poverty guidelines for this state, adopted by reference under 7 AAC 100.980, for the size o…

(a) In determining the income eligibility of an alien applicant as identified in 7 AAC 100.050 and 7 AAC 100.052, the department will include, in accordance with (b) of this section, the combined total monthly income of an alien's sponsor and the sponsor's spouse who is living wi…

(a) Except as provided in (c) of this section, when determining the income eligibility of a Family Medicaid household, the department will include in the household's total monthly income the income of the stepparent who is living in the household, after applying the following ded…

(a) Before determining eligibility under (b) of this section, the department will first determine if a household's (1) resources are within the limits of 7 AAC 100.130; and (2) total monthly income is equal to, or less than, the applicable 185-percent standard established in 7 AA…

In calculating a household's countable income under 7 AAC 100.180(b), the department will deduct (1) $90 from the total gross monthly earned income of each individual included in the household who is employed and has not received Medicaid benefits in the state in any of the four …

(a) In calculating a household's countable income under 7 AAC 100.180(b), the department will disregard, as a necessary cost of earning income, the anticipated cost for the care of a child or incapacitated parent whose financial needs are included in the Family Medicaid eligibili…

(a) The department will determine a Family Medicaid household's income eligibility under 7 AAC 100.180 and Under-21 household eligibility under 7 AAC 100.252 and 7 AAC 100.254 by using the following qualifying income standards: (1) adult-included standards, used when the househol…

In 7 AAC 100.100 - 7 AAC 100.199, unless the context requires otherwise, (1) "countable income" means total monthly income less all applicable deductions and disregards from income under 7 AAC 100.184 and 7 AAC 100.186; (2) "dependent child" means an individual determined to be a…

(a) Medicaid eligibility under 7 AAC 100.002(a) (2) and 7 AAC 100.200 - 7 AAC 100.209 is available for up to 12 months if the household (1) was eligible for and in receipt of Family Medicaid in any three of the six months, including months of retroactive eligibility, immediately …

(a) The department will determine Transitional Medicaid eligibility for the Transitional Medicaid household. A Transitional Medicaid household includes (1) all individuals who are living together and whose income and financial needs were included in determining Family Medicaid el…

(a) Transitional Medicaid begins the first month after the month the department (1) terminates Family Medicaid eligibility; or (2) would have terminated Family Medicaid eligibility had (A) the household timely reported increased earnings as required under 7 AAC 100.900; and (B) t…

(a) The department will reinstate a terminated Transitional Medicaid benefit only if (1) reinstatement is ordered following a hearing under 7 AAC 49; (2) the household moved out of state and then returned to this state; or (3) the caretaker relative makes a timely request for con…

In 7 AAC 100.200 - 7 AAC 100.209, "earnings" means the sum of monthly earned income and self-employment income. In this section, "earned income" and "self-employment income" have the meaning given in 7 AAC 100.199. Notes 7 AAC 100.209 Eff. 7/20/2007, Register 183; am 10/1/2009, R…

(a) Medicaid eligibility under 7 AAC 100.002(a) (3) will be extended up to four months after a household loses Family Medicaid eligibility under 7 AAC 100.002(a) (1) if the household (1) was eligible for and in receipt of Family Medicaid in any three of the six months, including …

The department will determine eligibility for the under-21 Medicaid eligibility categories under 7 AAC 100.002(c) (2) - (6) according to Family Medicaid eligibility criteria in 7 AAC 100.100 - 7 AAC 100.199, except as otherwise provided in 7 AAC 100.250 - 7 AAC 100.256 for a spec…

(a) The eligibility categories identified in 7 AAC 100.002(c) (2) - (4) include an individual under 21 years of age who is(1) living with one or both parents; (2) married and living with the individual's spouse; (3) living independently of parent or spouse as determined under (c)…

(a) Except for an individual who is entitled to receive Title IV-E foster care assistance under 7 AAC 100.270, the eligibility category identified in 7 AAC 100.002(c) (5) includes individuals under 21 years of age who are in the protective custody or supervision of the department…

Medicaid eligibility under 7 AAC 100.002(c) (6) and this section is limited to individuals who are under 21 years of age and for whom the department has entered into a reciprocal adoption assistance agreement with another state under the Interstate Compact on Adoption and Medical…

(a) Medicaid eligibility under 7 AAC 100.002(a) (8) and this section is limited to a child(1) for whom a subsidized adoption assistance agreement under 42 U.S.C. 670 - 675 is in effect, regardless of whether an adoption assistance payment is being made or a judicial decree of ado…

(a) Medicaid eligibility for pregnant women under 7 AAC 100.002(a) (4) and 7 AAC 100.002(c) (7) and (9) will be determined according to Family Medicaid eligibility requirements in 7 AAC 100.100 - 7 AAC 100.199, except as otherwise provided for each eligibility category and as oth…

(a) To be eligible for Medicaid under 7 AAC 100.300(a), a woman must (1) be pregnant as verified in accordance with 7 AAC 100.124(e); and (2) have monthly household income that does not exceed the appropriate income level in AS 47.07.020(b)(14). (b) To determine income eligibilit…

(a) A pregnant woman who was eligible for and receiving Medicaid coverage under any eligibility category on the last day of pregnancy, including eligibility approved under 7 AAC 100.072, is eligible for postpartum coverage under AS 47.07.020(o). (b) A woman eligible for postpartu…

(a) A child born to a woman who was eligible for and receiving Medicaid in the month of delivery, including retroactive eligibility determined under 7 AAC 100.072, is eligible for Medicaid under 7 AAC 100.002(a) (5) and this section without application. Without regard to any chan…

(a) Medicaid eligibility for poverty-level children under 7 AAC 100.002(a) (6) and (7) and 7 AAC 100.002(c) (8) will be determined according to Family Medicaid eligibility requirements in 7 AAC 100.100 - 7 AAC 100.199, except as otherwise provided in 7 AAC 100.310 - 7 AAC 100.314…

(a) To be eligible under one of the poverty-level eligibility categories listed in 7 AAC 100.310(a), a child must have monthly household income that does not exceed (1) 150 percent of the federal poverty guidelines for this state, adopted by reference under 7 AAC 100.980, for the…

(a) For the purpose of determining eligibility under 7 AAC 100.312(a) (2)(A), the department considers a child to have health insurance if that child is covered by (1) individual health insurance; (2) governmental or private group health insurance; (3) a group managed care or pre…

(a) The following APA regulations apply to Medicaid eligibility determinations for the eligibility categories described in 7 AAC 100.002(b), (d), and (e) and 7 AAC 100.400 - 7 AAC 100.426, unless otherwise provided in this chapter: (1)7 AAC 40.030 (SSI Program Requirements); (2)7…

(a) An individual who is eligible for and receiving SSI is eligible for Medicaid under 7 AAC 100.002(b) (1) and this subsection. (b) An individual who is eligible for and receiving APA is eligible for Medicaid under 7 AAC 100.002(d) (1) and this subsection. (c) An individual who …

The department will not issue Medicaid benefits to an applicant under 7 AAC 100.002(b) (2)(B) until the department receives verification from the United States Social Security Administration of that individual's eligibility under 42 U.S.C. 1382 h(b) (sec. 1619(b) of the Social Se…

To be eligible for Medicaid under 7 AAC 100.002(b) (3) and this section, an individual must be ineligible for SSI or APA because of the application of an SSI rule or requirement of 7 AAC 40 that the department does not use for Medicaid-only determinations. The following individua…

To be eligible for Medicaid under 7 AAC 100.002(b) (4) and this section, an individual must (1) have been entitled to receive both OASDI and either SSI or APA cash benefits in at least one month after April 1977; (2) be eligible for and receiving OASDI benefits during the month o…

To be eligible for Medicaid under 7 AAC 100.002(b) (6) and this section, an individual must (1) be 18 years of age or older; (2) have received SSI or APA benefits on the basis of blindness or a disability before the individual was 22 years of age; (3) have lost eligibility for SS…

(a) To be eligible for Medicaid under 7 AAC 100.002(b) (8) and this subsection, the applicant must verify to the department that the applicant was or would have been eligible for OAA, AB, or APTD in August 1972. (b) To be eligible for Medicaid under 7 AAC 100.002(b) (9) and this …

(a) A child with a disability who does not qualify for SSI because of parental income or resources is eligible for Medicaid under 7 AAC 100.002(d) (5) and this section if (1) the child is under 19 years of age; (2) the Department of Labor and Workforce Development has made a dete…

(a) An individual with a disability who is ineligible for APA under 7 AAC 40 or APA-related Medicaid under 7 AAC 100.400 - 7 AAC 100.424 because of earned income that is either the individual's own income or the income of the individual's spouse, is eligible for Medicaid under 7 …

Eligibility for the following Medicaid eligibility categories is determined in accordance with 7 AAC 100.400, except as otherwise provided in 7 AAC 100.502 - 7 AAC 100.519: (1) individuals described in 7 AAC 100.002(d) (2) who would be eligible for APA if they were not residing i…

(a) To be financially eligible for Medicaid under 7 AAC 100.002(d) (4) while living in a medical institution or under 7 AAC 100.002(d) (8) while receiving home and community-based waiver services, an applicant or recipient may not (1) be subject to or within a transfer-of-asset p…