Alaska Administrative Code

(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…

Notes 7 AAC 100.316 Eff. 7/20/2007, Register 183; repealed 1/1/2011, Register 196 State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features wil…

(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…

Before submitting an application for Medicaid under 7 AAC 100.500(2) or at the beginning of a continuous period of institutionalization, a potential applicant, the potential applicant's spouse, or a representative acting on behalf of either, may, upon request, receive the departm…

(a) An applicant for, or recipient of, Medicaid under 7 AAC 100.500 may allocate or transfer resources or income to a community spouse to prevent the community spouse from becoming impoverished while supporting the spouse residing in a medical institution or receiving home and co…

(a) The requirements of this section apply to (1) an individual eligible for long-term care Medicaid under 7 AAC 100.500 - 7 AAC 100.502; and (2) an individual who is receiving home and community-based waiver services, regardless of eligibility category. (b) To establish Medicaid…

(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 …