reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 4 - Under-21 Medicaid › 7 AAC 100.250 - Under-21 Medicaid

Current through May 31, 2024
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 specific eligibility category. The
					 following Family Medicaid eligibility requirements do not apply to under-21
					 Medicaid eligibility categories under
					 7 AAC 100.102(c) (2) - (6):
(1) the maximum age of a dependent child
				  under 7 AAC 100.104(a) (1)(A) - (B);
(2) deprivation under
				  7 AAC 100.106;
(3) the requirement under
				  7 AAC 100.110 that a dependent child live with a
				  caretaker relative;
(4) the
				  limitations on temporary absences under
				  7 AAC 100.112;
(5) the age limit under
				  7 AAC 100.122 for deeming the income of a minor parent's
				  parent available to child who is a minor parent;
(6) the requirements under
				  7 AAC 100.136 (Resources of the Sponsor of an Alien) and
				  7 AAC 100.176(a) - (b) (Income of the
				  Sponsor of an Alien), if the alien entered the United States under an affidavit
				  of support signed on or after December 19, 1997; however, the requirements
				  under 7 AAC 100.176(c)
				  (Income of a Disqualified Alien) apply;
(7) the deduction under
				  7 AAC 100.184(a) (2).
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 4 - Under-21 Medicaid › 7 AAC 100.252 - Under-21 individual living with a parent, spouse, or independently

Current through May 31, 2024
(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) of this section; or
(4) a minor living independently of the
				  individual's parents but who is in the care of a responsible adult or
				  agency.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 4 - Under-21 Medicaid › 7 AAC 100.254 - Under-21 individual in the custody or supervision of the department

Current through May 31, 2024
(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 and who are not receiving Medicaid under any
				  other eligibility category.
(b) The
				  Family Medicaid adult-not-included, child-only standards set out in
				  7 AAC 100.190(a) (2) will be used to
				  determine income eligibility for an individual who is not living with that
				  individual's parent and in the protective custody or supervision of the
				  department. If the department places an individual with that individual's
				  parent, the
(1) income, resources, and
				  financial needs of the parent will be considered in determining eligibility
				  even if the department retains legal custody; and
(2) the adult-included standards set out in
				  7 AAC 100.190(a) (1) will be
				  used.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 4 - Under-21 Medicaid › 7 AAC 100.256 - Under-21 individual receiving state-only adoption assistance

Current through May 31, 2024
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 Assistance
					 (ICAMA). Eligibility will be based upon the child's household before entering
					 the household of the adoptive parent. A child is eligible under
					 7 AAC 100.002(c) (6) and this section
					 if the child
(1) is not eligible for
				  Title IV-E adoption assistance under
				  7 AAC 100.270; and
(2) immediately before execution of the
				  adoption assistance agreement,
(A) received
				  Medicaid from another state or would have been eligible in this state if
				  application had been made; or
(B)
				  would have been eligible to receive Medicaid if the filing unit rules and
				  income eligibility standards applicable to Title IV-E foster care had been
				  used.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 5 - Medicaid for Title IV-E Adoption, Foster Care, and Relative Guardianship Assistance Recipients › 7 AAC 100.270 - Title IV-E adoption, foster care, and relative guardianship assistance recipients

Current through May 31, 2024
(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
				  adoption has been issued;
(2) who
				  is receiving, or on whose behalf a foster parent is receiving, foster care
				  maintenance payments under 42 U.S.C. 670 -
				  675; or
(3) for whom a subsidized relative
				  guardianship assistance agreement under
				  42 U.S.C.
				  673(d) is in effect and
				  subsidized relative guardianship assistance is being paid.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 6 - Denali KidCare: Pregnant Women and Newborns › 7 AAC 100.300 - Applicability of Family Medicaid to pregnant women

Current through May 31, 2024
(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 otherwise provided in
				  7 AAC 100.300 -
				  7 AAC 100.306.
(b) The following Family Medicaid eligibility
				  requirements do not apply to the eligibility categories listed in (a) of this
				  section:
(1) the maximum age of a dependent
				  child under
				  7 AAC 100.104(a) (1)(A) -
				  (B);
(2) deprivation under
				  7 AAC 100.106;
(3) the requirement under
				  7 AAC 100.110 that a dependent child live with a
				  caretaker relative;
(4) the
				  limitations on temporary absences under
				  7 AAC 100.112;
(5) the age limit under
				  7 AAC 100.122 for deeming the income of a minor parent's
				  parent available to child who is a minor parent;
(6) the resource limit under
				  7 AAC 100.130;
(7) the requirements under
				  7 AAC 100.136 (Resources of the Sponsor of an Alien) and
				  7 AAC 100.176(a) - (b) (Income of the
				  Sponsor of an Alien), if the alien entered the United States under an affidavit
				  of support signed on or after December 19, 1997; however, the requirements
				  under 7 AAC 100.176(c)
				  (Income of a Disqualified Alien) apply;
(8) the deduction under
				  7 AAC 100.184(2).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 6 - Denali KidCare: Pregnant Women and Newborns › 7 AAC 100.302 - Medicaid eligibility for pregnant women

Current through May 31, 2024
(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).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 6 - Denali KidCare: Pregnant Women and Newborns › 7 AAC 100.304 - Eligibility for postpartum Medicaid coverage

Current through May 31, 2024
(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 postpartum coverage
				  under this section is not required to meet the medical support assignment
				  requirements in
				  7 AAC 100.040.
(c) A pregnant woman who applied for Medicaid
				  before the date her pregnancy ended and who is subsequently found eligible for
				  Medicaid, even if the eligibility determination is not made until after the
				  date her pregnancy ended, will be considered to have been receiving Medicaid
				  for the purposes of (a) of this section.
(d) Except as provided in (c) of this
				  section, the department will not grant retroactive eligibility under this
				  section.
(e) Coverage under this
				  section continues through the last day of the month in which the woman's
				  postpartum period ends, without regard to any change in income that may
				  occur.
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 6 - Denali KidCare: Pregnant Women and Newborns › 7 AAC 100.306 - Medicaid eligibility for newborns

Current through May 31, 2024
(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 changes in household income that may
				  occur, eligibility continues until the end of the month in which the child
				  turns one year of age, if
(1) the child
				  continues to live in the birth mother's household; and
(2) both mother and child remain residents of
				  the state.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 7 - Denali KidCare: Poverty-Level Children › 7 AAC 100.310 - Applicability of Family Medicaid to poverty-level children

Current through May 31, 2024
(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.
(b) The following Family Medicaid eligibility
				  requirements do not apply to the eligibility categories listed in (a) of this
				  section:
(1) the maximum age of a dependent
				  child under
				  7 AAC 100.104(a) (1)(A) -
				  (B);
(2) deprivation under
				  7 AAC 100.106;
(3) the requirement under
				  7 AAC 100.110 that a dependent child live with a
				  caretaker relative;
(4) the
				  limitations on temporary absences under
				  7 AAC 100.112;
(5) the age limit under
				  7 AAC 100.122 for deeming the income of a minor parent's
				  parent available to child who is a minor parent;
(6) the resource limit under
				  7 AAC 100.130;
(7) the requirements under
				  7 AAC 100.176(a) - (b) (Income of the
				  Sponsor of an Alien), if the alien entered the United States under an affidavit
				  of support signed on or after December 19, 1997; however, the requirements
				  under 7 AAC 100.176(c)
				  (Income of a Disqualified Alien) apply;
(8) the deduction under
				  7 AAC 100.184(a) (2).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 7 - Denali KidCare: Poverty-Level Children › 7 AAC 100.312 - Medicaid eligibility for poverty-level children

Current through May 31, 2024
(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 size of the child's household;
				  or
(2) the appropriate income level
				  in AS
				  47.07.020(b)(13) and may not
				  have current health insurance coverage as described in
				  7 AAC 100.314.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 7 - Denali KidCare: Poverty-Level Children › 7 AAC 100.314 - Health insurance coverage

Current through May 31, 2024
(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 preferred-provider health plan;
(4) Medicare;
(5) Medicaid;
(6) TRICARE or another military-sponsored
				  health plan;
(7) a state high-risk
				  insurance pool;
(8) a public health
				  plan established or maintained by a state or local government; or
(9) a health benefit plan under
				  22 U.S.C.
				  2504(e) (Peace Corps Act)
				  provided for Peace Corps volunteers.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 8 - Medicaid Eligibility for the Aged and Disabled › 7 AAC 100.400 - Applicability of APA regulations

Current through May 31, 2024
(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 AAC 40.090 (Factors of Eligibility);
(3)7 AAC 40.120 (Qualifying Age);
(4)7 AAC 40.140(a), (c), and (d) (Blindness);
(5)7 AAC 40.160(b) (Review of Blindness
				  Determination);
(6)7 AAC 40.170(a), (c), and (e) (Disability);
(7)7 AAC 40.190 (Review of Disability Determination);
(8)7 AAC 40.200 (Drug and Alcohol Addiction);
(9)7 AAC 40.210 (Prescribed Treatment Requirement);
(10)7 AAC 40.230 (Financial Need);
(11)7 AAC 40.240 (Income and Resources of Spouses);
(12)7 AAC 40.250 (Income and Resources of Sponsors of
				  Aliens);
(13)7 AAC 40.260(Resources);
(14)7 AAC 40.270 (Resource Limits);
(15)7 AAC 40.280 (Resource Exclusions);
(16)7 AAC 40.300(Income);
(17)7 AAC 40.310 (Income Eligibility Standards);
(18)7 AAC 40.320 (Income Exclusions);
(19)7 AAC 40.350 (Computation of Income);
(20)7 AAC 40.360 (Prior Resources).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 8 - Medicaid Eligibility for the Aged and Disabled › 7 AAC 100.410 - Medicaid eligibility for SSI and APA recipients

Current through May 31, 2024
(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
				  is eligible for SSI or APA, but who chooses not to receive the cash benefit
				  under one of those programs, is eligible for Medicaid under
				  7 AAC 100.002(d) (3) and this
				  subsection.
(d) An individual is
				  not eligible for Medicaid under this section because that individual is
				  eligible for or receiving interim assistance under
				  7 AAC 40.375.
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 8 - Medicaid Eligibility for the Aged and Disabled › 7 AAC 100.412 - Medicaid eligibility under section 1619(b) of the Social Security Act

Current through May 31, 2024
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
					 Security Act).
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 8 - Medicaid Eligibility for the Aged and Disabled › 7 AAC 100.414 - Medicaid eligibility based on SSI or APA ineligibility for reasons that do not apply to Medicaid

Current through May 31, 2024
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 individuals may be found eligible
					 under this section:
(1) a
				  low-birth-weight infant who has received a presumptive disability determination
				  by the Department of Labor and Workforce Development;
(2) a qualified alien as described in
				  7 AAC 100.052, who became ineligible for SSI because of
				  that individual's alien status under
				  8 U.S.C.
				  1611 -
				  1613;
(3) a qualified alien as described in
				  7 AAC 100.052, subject to the deeming of income from a
				  sponsor under
				  7 AAC 40.250, who entered the United States before
				  August 22, 1996, or who entered the United States under an affidavit of support
				  executed before December 19, 1997; for the purpose of determining Medicaid
				  eligibility under this section, the department will deem the of income from an
				  alien's sponsor available to the alien under
				  7 AAC 40.250 only when a qualified alien's sponsor has
				  signed an I-864 affidavit of support form on or after December 19, 1997, or a
				  successor form issued by USCIS;
(4)
				  an individual eligible under a Medicaid eligibility category listed in
				  7 AAC 100.002, except for an eligibility category listed
				  in 7 AAC 100.002(e),
				  who relies on the use of a qualifying income trust under
				  7 AAC 100.610 to reduce the individual's total monthly
				  income.
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 8 - Medicaid Eligibility for the Aged and Disabled › 7 AAC 100.416 - Medicaid eligibility based on SSI or APA ineligibility as a result of OASDI cost of living increases received after April 1977

Current through May 31, 2024
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 of application for
				  Medicaid;
(3) be ineligible for SSI
				  or APA in the month of application for Medicaid; and
(4) have a level of income that would enable
				  the individual to financially qualify for SSI or APA if all OASDI
				  cost-of-living adjustments received since the last month the individual was
				  eligible for both OASDI and either SSI or APA cash benefits were
				  deducted.
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 8 - Medicaid Eligibility for the Aged and Disabled › 7 AAC 100.420 - Disabled adults receiving child OASDI benefits

Current through May 31, 2024
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 SSI or APA on or after July 1, 1987, when the individual's
				  income increased
(A) because the individual
				  became eligible for Social Security benefits as the child of an OASDI
				  recipient; or
(B) because of an
				  increase in OASDI benefits received as the child of an OASDI recipient;
				  and
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 8 - Medicaid Eligibility for the Aged and Disabled › 7 AAC 100.422 - Grandfathered eligibility categories

Current through May 31, 2024
(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
				  subsection, the applicant must verify to the department that the applicant
(1) was eligible for Medicaid in December
				  1973; and
(2) is currently residing
				  in and has continuously resided in a medical institution since December
				  1973.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 8 - Medicaid Eligibility for the Aged and Disabled › 7 AAC 100.424 - Disabled child living at home

Current through May 31, 2024
(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 determination that the child is disabled
				  according to SSI criteria;
(3) the
				  child would be eligible for Medicaid under
				  7 AAC 100.002(d) (4) if the child were
				  living in a medical institution;
(4) the child is living in the home of the
				  child's parent or legal guardian;
(5) the department has determined that the
				  child needs a level of care offered in
(A) an
				  acute care hospital or long-term care, as determined under
				  7 AAC 140.505;
(B) an intermediate care facility for the
				  mentally retarded, as determined under
				  7 AAC 140.600; or
(C) an inpatient psychiatric hospital, as
				  determined under (c) of this section;
(6) the department determines that the child
				  may receive necessary medical care in a setting other than a medical
				  institution described in (5) of this subsection, and the determination is
				  recorded in the plan of care approved by the department; and
(7) the department has determined that the
				  estimated cost of services provided to the child outside the home will cost
				  less than the cost of institutionalization.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 8 - Medicaid Eligibility for the Aged and Disabled › 7 AAC 100.426 - Working disabled Medicaid buy-in

Current through May 31, 2024
(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 AAC 100.002(d) (6) and this section
				  if
(1) the family monthly net income as
				  determined under (b) of this section is less than 250 percent of the federal
				  poverty guidelines for this state, adopted by reference under
				  7 AAC 100.980;
(2) excluding all earned income, including
				  any deemed earned income as determined under (c) of this section, the disabled
				  individual's remaining unearned income is equal to or less than the monthly
				  need standard identified in
				  7 AAC 40.310;
(3) the Department of Labor and Workforce
				  Development or the United States Social Security Administration determines that
				  the individual is disabled according to SSI criteria;
(4) the individual's nonexcludable resources
				  do not exceed $10,000 for the individual or, if the individual is living with a
				  spouse, the nonexcludable resources of the individual and individual's spouse
				  do not exceed $15,000;
(5) the
				  individual meets all other nonfinancial eligibility criteria for APA;
				  and
(6) the individual pays a
				  monthly premium as required under this section.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 9 - Long-term Care Medicaid Eligibility › 7 AAC 100.500 - Long-term care Medicaid related to APA

Current through May 31, 2024
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 in a general hospital, skilled
				  nursing facility, or intermediate care facility;
(2) individuals described in
				  7 AAC 100.002(d) (4) who are residing
				  in a medical institution other than an assisted living home;
(3) individuals described in
				  7 AAC 100.002(d) (8) who are residing
				  at home or in an assisted living home, but who would require placement in a
				  long-term care facility if not for the fact that they are receiving home and
				  community-based waiver services.
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 9 - Long-term Care Medicaid Eligibility › 7 AAC 100.502 - Long-term care eligibility criteria

Current through May 31, 2024
(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 penalty period under
				  7 AAC 100.510(d) - (e);
(2) have nonexcluded resources that exceed
				  the limits applicable under
				  7 AAC 100.400(a) (14), after the
				  spousal allocation requirements of
				  7 AAC 100.506 are applied;
(3) own a home that has an equity value that
				  exceeds $500,000; this paragraph does not apply if residing in the home is the
				  applicant's or recipient's
(A)
				  spouse;
(B) child under 21 years of
				  age; or
(C) child who is blind, as
				  set out in 7 AAC 40.140(a),
				  or disabled, as set out in
				  7 AAC 40.170(a); or
(4) have total monthly income that
				  exceeds the amount set out in
				  AS
				  47.07.020(b)(6).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 9 - Long-term Care Medicaid Eligibility › 7 AAC 100.504 - Elective pre-application resource assessment

Current through May 31, 2024
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 department's pre-application assessment of the
					 potential applicant's resources or the married couple's combined resources.
					 Consistent with
					 7 AAC 100.502 and
					 7 AAC 100.506, the department will calculate the value
					 of the individual's or married couple's countable resources as of the date on
					 which the potential applicant entered or is likely to enter a medical
					 institution. If a requester disagrees with the department's pre-application
					 resource assessment, the requester may not appeal that decision, but may file
					 an application to receive an eligibility determination. When the department
					 receives a Medicaid application, the department will determine eligibility
					 based on the information submitted with the application and verified after the
					 application date. The department will not conduct the assessment under this
					 section for an individual applying for home and community-based waiver services
					 under 7 AAC 100.500(3).
As of Register 204 (January 2013), and under
						AS
						44.62.125(b)(6), the
						regulations attorney made technical corrections to
						7 AAC 100.504.
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 9 - Long-term Care Medicaid Eligibility › 7 AAC 100.510 - Transfer of assets

Current through May 31, 2024
(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.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 9 - Long-term Care Medicaid Eligibility › 7 AAC 100.512 - Life estates

Current through May 31, 2024
(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
				  department will determine if the conveyance constitutes a transfer of an asset
				  for less than fair market value.
(b) The value of a life estate or of the
				  remainder of real property is the value as of any moment in the first day of
				  the month. This value is determined by multiplying the fair market value of the
				  entire property by the life estate factor corresponding to the recipient's age
				  identified in the United States Social Security Administration's
Program Operations Manual System (POMS)
, Section SI 01140.120,
				  Unisex Life Estate or Remainder Table, revised as of April 19, 1999, and
				  adopted by reference.
(c) The
				  purchase of a life estate interest in another individual's home is a transfer
				  of an asset for less than fair market value, unless the purchaser actually
				  resides in the home for a period not less than one year after the date of
				  purchase. If the applicant is living in the home at the time of application but
				  has not yet lived in the home for one year, the department will not impose a
				  transfer-of-asset penalty unless the applicant or recipient moves from the home
				  before having lived in the home for one year. If an applicant or recipient
				  moves from the home without having lived in the home for one year, the
				  department will impose a transfer-of-asset penalty beginning with the date of
				  application.
The Unisex Life Estate or Remainder Table adopted by
						reference in
						7 AAC 100.512 is available on the Internet at
						https://s044a90.ssa.gov/apps10/poms.nsf/aboutpoms.
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 9 - Long-term Care Medicaid Eligibility › 7 AAC 100.514 - Annuities

Current through May 31, 2024
(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.
				  408(b) or (q);
(2) is irrevocable and
				  nonassignable;
(3) is actuarially
				  sound in accordance with (b) of this section;
(4) provides for equal monthly payments
				  during the term of the annuity, with no deferral or balloon payments;
(5) is purchased commercially;
(6) names the Medicaid recipient as the
				  primary beneficiary, or the recipient's spouse if part of a transfer under
				  7 AAC 100.506; and
(7) names the state as remainder beneficiary
(A) in the first position for at least the
				  total amount of medical assistance paid by the department on behalf of the
				  annuitant; or
(B) in the second
				  position, after the recipient's community spouse, minor child, or disabled
				  child named in the first position, if the community spouse or child disposes of
				  any remainder for less than fair market value.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 9 - Long-term Care Medicaid Eligibility › 7 AAC 100.516 - Transfer-of-asset undue hardship exemption

Current through May 31, 2024
(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 exemption must submit the following to the department no later
				  than 30 days after the date of notice that a transfer-of-asset penalty is being
				  imposed:
(1) a written statement indicating
				  how the applicant, recipient, or community spouse would face undue hardship if
				  the penalty were imposed;
(2) a
				  written statement describing
(A) why the
				  assets transferred for less than fair market value cannot be returned;
				  and
(B) what efforts the applicant
				  or recipient has made to retrieve the assets.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 9 - Long-term Care Medicaid Eligibility › 7 AAC 100.519 - Definitions

Current through May 31, 2024
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 of years;
(2) "asset" means all income and resources
				  under 7 AAC 100.400 of the individual and
				  of the individual's spouse, including
(A)
				  income or resources to which the individual is entitled but does not receive
				  based on the action of the individual or person acting on the individual's
				  behalf to avoid receipt of the asset; and
(B) money used to purchase a promissory note,
				  loan, or mortgage;
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 10 - Post Eligibility and Cost of Care › 7 AAC 100.550 - Applicability to post-eligibility and cost-of-care liability

Current through May 31, 2024
(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 the recipient, fails to pay the
				  cost-of-care liability for home and community-based waiver services, the
				  department may terminate the recipient's eligibility for home and
				  community-based waiver services.
(b) The post-eligibility requirements of 7 AAC 100.550 -
				  7 AAC 100.579 apply to an individual
(1) residing in a medical institution and
				  receiving long-term care services, except for an SSI or APA recipient who
				  receives SSI or APA
(A) cash benefits because
				  the individual is temporarily institutionalized for a period of 90 days or
				  less; or
(B) personal needs
				  payments under
				  7 AAC 40.390; or
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 10 - Post Eligibility and Cost of Care › 7 AAC 100.552 - Collection of recipient's cost-of-care liability

Current through May 31, 2024
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 for collecting from the recipient or from
					 the recipient's representative, on behalf of the recipient, the amount
					 determined under
					 7 AAC 100.554 as the recipient's cost-of-care liability.
					 The department will reduce its payment to a provider by the amount of the
					 recipient's cost-of-care liability, even if the recipient or the recipient's
					 representative, on behalf of the recipient, does not pay the cost-of-care
					 liability to the provider.
Authority:
AS
						47.05.010
AS
						47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 10 - Post Eligibility and Cost of Care › 7 AAC 100.554 - Cost-of-care liability determination

Current through May 31, 2024
(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 recipient.
(b) The department will deduct from a
				  recipient's total monthly income the following disregards, as applicable:
(1) a payment from the United States
				  Department of Veterans Affairs for unusual medical expenses or aid and
				  attendance; for a recipient living in the Alaska Veterans' Home (Palmer
				  Pioneers' Home); the disregard in this paragraph is limited to $90;
(2) any portion of a United States Social
				  Security Administration payment that is withheld for the purpose of recovering
				  a previous overpayment;
(3) an SSI
				  payment received by a recipient who is eligible for SSI benefits under
				  42 U.S.C.
				  1382 h(a) or (b) (secs. 1619(a) and (b) of
				  the Social Security Act);
(4) an
				  SSI or APA payment that is continued at the rate payable to a recipient living
				  in the community when the individual is in the first 90 days of
				  institutionalization, if that institutionalization is not expected to exceed 90
				  days;
(5) monthly income of $4 or
				  less from an interest-bearing account;
(6) retroactive SSI or OASDI benefits
				  received in a month that is not the month of intended use as determined by the
				  United States Social Security Administration.
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 10 - Post Eligibility and Cost of Care › 7 AAC 100.558 - Personal needs allowance

Current through May 31, 2024
(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 facility, the personal needs allowance is
				  $75 per month.
(c) For a recipient
				  who is a veteran living in a long-term care facility, including a swing-bed
				  facility, who does not have a spouse or dependent child and who is receiving a
				  $90 monthly payment from the United States Department of Veterans Affairs for
				  unusual medical expenses or aid and attendance, the personal needs allowance is
				  $90 per month.
(d) For a recipient
				  who is living at home and receiving home and community-based waiver services,
				  the personal needs allowance is $1,656.
(e) For a recipient who is living in an
				  assisted living home and receiving home and community-based waiver services,
				  the monthly personal needs allowance is $1,396.
(f) The department will increase the personal
				  needs allowance to cover
(1) mandatory
				  withholdings from earned and unearned income to pay for federal, state, or
				  local income taxes;
(2) federal,
				  state, or local income taxes that are
(A) not
				  subject to mandatory withholdings;
(B) owed and actually paid;
(3) the amount of income garnished
				  for child support during the same period covered by the personal needs
				  allowance;
(4) the amount of income
				  needed to fulfill an approved plan for achieving self support in accordance
				  with 7 AAC 40.320(a) (22);
(5) property taxes that are owed and actually
				  paid on the recipient's home, unless that tax is paid on a home for which a
				  home maintenance allowance is made under
				  7 AAC 100.568; and.
(6) the fee actually charged to the recipient
				  by a guardian or conservator, not to exceed
(A) $100 per month; or
(B) for the office of public advocacy, the
				  limit set in
				  2 AAC 60.100(f).
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 10 - Post Eligibility and Cost of Care › 7 AAC 100.560 - Community spouse allowance

Current through May 31, 2024
(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 authorized under
				  42 U.S.C.
				  1396 r - 5(d)(3) without exceeding that
				  allowance.
(b) The community spouse
				  allowance may be increased by a decision under 7 AAC 49 or court order that a
				  greater monthly amount is needed based on extreme financial duress of the
				  community spouse.
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 10 - Post Eligibility and Cost of Care › 7 AAC 100.562 - Dependent family member allowance

Current through May 31, 2024
(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 authorized under
				  42 U.S.C.
				  1396 r - 5(d)(1)(C) without exceeding that
				  allowance. If the dependent family member is living with an individual other
				  than the community spouse, the dependent family member allowance is determined
				  by deducting the dependent family member's income from the Family Medicaid
				  qualifying income standards under
				  7 AAC 100.190(a) (2).
(b) The dependent family member allowance may
				  be increased by a decision under 7 AAC 49 or court order that a greater monthly
				  amount is needed based on extreme financial duress of the dependent family
				  member.
(c) In this section
				  "dependent family member" means a dependent child, as defined in
				  7 AAC 100.579, dependent parent, or dependent sibling of
				  the long-term care recipient.
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 10 - Post Eligibility and Cost of Care › 7 AAC 100.564 - Insurance premium allowance

Current through May 31, 2024
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 is a
					 joint premium, only the portion applicable to the long-term care spouse may be
					 deducted.
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 10 - Post Eligibility and Cost of Care › 7 AAC 100.566 - Unpaid medical expense allowance

Current through May 31, 2024
(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 any other health insurance. A deduction under
				  this section is permitted only once per outstanding debt.
(b) The maximum medical expense allowance per
				  month may not exceed the amount necessary to result in a zero cost-of-care
				  liability for that month. If the outstanding debt is larger than the maximum
				  medical expense allowance for the month, an additional monthly medical expense
				  allowance may be given for subsequent months until the accumulated allowances
				  equal the entire unpaid medical expense. Once the cumulative allowances have
				  covered the entire unpaid medical expense, no further allowances may be given
				  for that unpaid medical expense, even if the recipient has failed to pay off
				  the debt.
Authority:
AS
						47.05.010
AS 47.07.020
AS
						47.07.040
Alaska Administrative Code › Title 7 - Health and Social Services › Part 7 - Medicaid Assistance Eligibility › Chapter 100 - Medicaid Eligibility › Article 10 - Post Eligibility and Cost of Care › 7 AAC 100.568 - Home maintenance allowance

Current through May 31, 2024
(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 home
				  immediately before admission to the medical institution;
(2) does not have a community spouse or
				  dependent child; and
(3) is
				  expected to remain in the medical institution for six months or less.