Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-25 - MEDICAID ELIGIBILITY › Section 560-X-25-.05 - General Categorical Eligibility Criteria

Current through Register Vol. 42, No. 9, June 28, 2024
(1) In order to qualify for Medicaid,
			 AFDC-related and MAGI-related individuals must meet the nonfinancial
			 eligibility criteria of the AFDC programs.
(2) SSI - related individuals must meet
			 general categorical criteria of age, disability or blindness, residence, and
			 citizenship for the appropriate coverage groups:
(a) Age Requirements -- To be eligible, the
			 individual must be 65 years of age or older. This factor is based on SSI policy
			 and must be verified based on evidence requirements stated in SSI
			 policy.
(b) Disability -- If under
			 age 65, an individual must be blind or disabled. Disability is defined as the
			 inability to engage in any substantial gainful activity by reason of a
			 medically determinable physical or mental impairment(s) which can be expected
			 to last for a continuous period of not less than 12 months.
(c) Blindness -- An individual meets
			 blindness criteria when his central vision acuity is 20-200 or less (even with
			 glasses) or a limited visual field of 20 degrees or less in the better eye. A
			 person determined to be blind for purposes of SSI benefits also qualifies as
			 blind for purposes of Medicaid.
(d)
			 Citizenship -- To be eligible for Medicaid, a person must be a citizen of the
			 United States, or, if an alien, must be a qualified alien. For qualified aliens
			 arriving before 8/22/1996, they must be a lawful permanent resident, American
			 Indian born in Canada, refugee, asylee, Cuban/Haitian entrant, battered
			 immigrant, Amerasian, person whose deportation has been withheld, honorably
			 discharged veteran, active duty U.S. military, person granted parole for 1 year
			 by INS, or person granted conditional entry under 203 of the immigration law in
			 effect before 4/1/1980. For qualified aliens arriving on or after 8/22/1996,
			 they must be a refugee, asylee, person whose deportation has been withheld,
			 Cuban/Haitian entrant (proceeding groups are eligible for 7 years from date of
			 entry), honorably discharged veteran, active duty U.S. military, Amerasian
			 (eligible for 5 years from date of entry) or lawful permanent resident in U.S.
			 at least 5 years. Aliens should have records to establish naturalization or
			 lawful admission. Non-qualifying aliens are eligible only for emergency
			 services for treatment of emergency medical conditions.
(e) State Resident -- A person must be a
			 resident of Alabama during the period covered by application, must indicate
			 intent to remain, and must be capable of indicating such intent.
(f) Interstate residency Agreements -- The
			 only time the above residency rule is not applicable is where the state has
			 entered into a residence agreement with another state. Where this occurs, the
			 state where the person physically resides is his residence for Medicaid
			 purposes. A list of states with which Alabama has entered into residency
			 agreements may be obtained from the Alabama Medicaid Agency.
(g) Eligibility for Other Benefits -- An
			 individual is required to apply for any payments or benefits from other sources
			 for which he may be eligible. If an individual is already receiving or is
			 entitled to receive benefits from other sources which are in excess of agency
			 standards or is receiving benefits under a VA contract, the individual is not
			 eligible for Medicaid benefits.
(h)
			 Assignment of Third Party Payments -- To be eligible for Medicaid, an
			 individual must assign all third-party benefits to the State. Third Party
			 benefits are any benefits for which an entity is or may be liable to pay all or
			 part of the medical cost of an applicant or recipient.
(i) Eligibility for Medicaid benefits ends
			 with the month in which the individual dies.
(j) Social Security Account Number -- An
			 individual is required to furnish his Social Security Account Number or
			 verification that he has made application for one.