Alabama Administrative Code › Title 660 - ALABAMA DEPARTMENT OF HUMAN RESOURCES › Chapter 660-2-5 - MEDICAID ELIGIBILITY › Section 660-2-5-.01 - Administrative Responsibilities

Current through Register Vol. 42, No. 9, June 28, 2024
The Department determines eligibility for Medicaid in
				accordance with the provisions of Title XIX of the Social Security Act. The
				Department determines the individual's eligibility for AR in accordance with
				the provisions of Title IV-A of the Act and the non-SSI individual's
				eligibility for supplementation in accordance with Title XVI of the Act, and
				certifies the Alabama Medicaid Agency individuals in the following groups and
				court rulings.
(a) All individuals
			 receiving assistance under the State's approved plan for Title IV-E of the Act
			 or the Medicaid for Low Income Families Program or Aid to Refugees Program (AR)
			 or who were terminated due wholly or partly to increased earnings or hours of
			 employment of the grantee relative or due wholly or partly to expiration of the
			 one-third or $30 earned income disregard or due to the principal wage earner no
			 longer meeting the definition of unemployed in relation to the 100 hour rule or
			 due to child support collected by the State. To be eligible for this extended
			 coverage, an individual or assistance group must have been eligible for and
			 receiving assistance under Title XIX in Alabama for at least three of the six
			 calendar months immediately preceding the month in which such individual or
			 assistance group became ineligible for medical assistance because of increased
			 earnings from employment of the grantee relative, expiration of the one-third
			 or $30 disregard, the principal wage earner no longer meeting the definition of
			 unemployed in relation to the 100 hour rule or collection of child support by
			 the State. In addition, sanctioned individuals who would have otherwise been
			 members of the assistance unit that became ineligible due to increased earnings
			 of the grantee, expiration of the one-third or $30 disregard, or the principal
			 wage earner no longer meeting the definition of unemployed in relation to the
			 100 hour rule are eligible. The extended period of coverage may not exceed four
			 calendar months for terminations due to collection of child support or twelve
			 calendar months for terminations due to the increased earnings or hours worked
			 of the grantee relative, due to expiration of the one-third or $30 disregard or
			 due to the principal wage earner no longer meeting the definition of unemployed
			 in relation to the 100 hour rule;
(b) All individuals receiving mandatory state
			 supplementary benefits, as required by P.L. 93-66 ;
(c) Any individual(s) who, for the month of
			 August 1972, was eligible for and received financial assistance under the
			 State's plan for ADC, OAP, AB, or APTD and who was also entitled to monthly
			 insurance benefits under the Title II program and who, except for the increase
			 in monthly insurance benefits under Title II resulting from enactment of P.L.
			 92-355, would have been eligible for financial assistance for the current
			 month;
(d) Aged, blind, or disabled
			 persons who receive an approved state supplementary payment and who, except for
			 the level of their income, would be eligible for benefits under Title XVI of
			 the Act. The individual's gross income may not exceed established limits and
			 net income may not exceed the established level of supplementation;
(e) All individuals who, in the month of
			 December 1973, were eligible as inpatients or residents in Title XIX
			 institutions and would have been, except for being an impatient or resident,
			 eligible to receive assistance under the State's plan for OAP, AB, or
			 APTD;
(f) All financially eligible
			 children under 21 years of age not otherwise eligible under a plan, for whom
			 public agencies are assuming full or partial financial responsibility and who
			 are in foster homes or private child caring institutions;
(g) Any individual who, for the month of
			 April 1977 or thereafter, was eligible for and receiving financial assistance
			 under the State's plan for OAP, APTD, and AB and who was also entitled to
			 monthly insurance benefits under the Title II program and who except for the
			 increase(s) in monthly insurance benefits under Title II resulting from
			 enactment of P.L. 94-566 would be eligible for State Supplementation for the
			 current month;
(h) Certain
			 categorically related coverage groups as follows:
1. Denied or deceased applicants for AR, and
			 State SUP, provided all conditions of eligibility were met as outlined in
			 660-2-2, except 660-2-4, and 660-2-5 and they received medical services in that
			 period of a type covered under the Title XIX State Plan.
2. Approved, denied, or deceased applicants
			 for Medicaid and State SUP are entitled to three-month retroactive Medicaid
			 from the date of application if they have received medical services of a type
			 covered under the Title XIX State Plan during any or all of the three-months
			 prior to an application for assistance and met the eligibility requirements of
			 the categorical assistance programand for Medicaid during the month(s) for
			 which retroactive Medicaid eligibility is determined.
3. Individuals State Supplementation because
			 of stepparent or alien sponsor deeming.