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500 OVERVIEW OF AGED, DISABLED AND LONG TERM CARE MEDICAID
The Alaska Department of Health administers the Medicaid program in accordance with federal and state laws and regulations. The Medicaid program is authorized under Title XIX and Title XXI of the Social Security Act and the Code of Federal Regulations, Title 42 Part 435 and Title 45 Part 233.
Alaska joined the Medicaid program in September 1972. New services and eligible groups have been added to the program since that time by the Legislature. The Medicaid program in Alaska is authorized under Alaska Statutes 47.07.010 - 47.07.900 and the Alaska Administrative Code, Title 7 Chapter 100 through chapter 160.
Medicaid is jointly financed by the federal government and the state. Certain groups of individuals and services are required by federal law, while other optional groups of individuals and services are selected by the state.
The Division of Public Assistance (DPA) processes Medicaid applications and determines eligibility.
The Division of Health Care Services (DHCS) oversees the processing of Medicaid claims, payment to health care providers, and overall fiscal responsibilities of the Medicaid program. DHCS contracts with Health Management Systems (HMS) to handle the day-to-day processing of medical claims and payments.
The Division of Senior and Disabilities Services (DSDS) determines the Level of Care for Home and Community Based waiver services.
500 A. APPLICABLE ELIGIBILITY CATEGORIES
This manual contains Medicaid eligibility policy for the following Adult Public Assistance (APA) related eligibility categories:
Supplemental Security Income (SSI) Recipient
APA Adult Public Assistance Recipient
SSI Supplemental Security Income Eligible - Not Receiving Cash Payments
APA Adult Public Assistance Eligible - Not Receiving Cash Payments (Refused Cash)
Expanded Refused Cash -- APA Adult Public Assistance ineligible due to countable income over the appropriate need/payment standard but below the Expanded Refused Cash income limit shown in ADLTC MS 530(C)
SSI Supplemental Security Income or APA Adult Public Assistance Ineligibles for Reasons Prohibited by Medicaid
Working Disabled Medicaid Buy-In
Special Long Term Care
Disabled Children at Home ( TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 )
"Pickle People"
"Section 1619(b)" Eligible
SSI Supplemental Security Income Disabled Children
Disabled Widow(er)
Individuals receiving APA Adult Public Assistance and SSI Supplemental Security Income may be eligible for Medicaid if they meet all other factors of eligibility.
Note: Effective October 1, 2026 SSI Supplemental Security Income and APA Adult Public Assistance related categories must also meet Medicaid qualified alien requirements. Refer to section 522 and MAGI Manual Section 808 for policy on U.S. citizenship and eligible alien status.
Individuals who meet the categorical requirements of APA Adult Public Assistance -related Medicaid, but require an institutional living arrangement or home and community based care may be eligible for Medicaid under the Special Long Term Care category.
In addition, Alaska has the Medicare Savings Programs that help pay Medicare costs, but do not offer regular Medicaid coverage:
Qualified Medicare Beneficiary (QMB);
Qualified Disabled and Working Individuals (QDWI);
Specified Low Income Medicare Beneficiary (SLMB); and
Specified Low Income Medicare Beneficiary Plus (SLMB Plus).
Please refer to ADLTC MS 580 for additional information.
Note: If the individual has not yet received a favorable disability determination but states they are seeking a determination, process under MAGI Modified Adjusted Gross Income Medicaid rules. If the individual does not pass under MAGI Modified Adjusted Gross Income rules, refer the application to the FFM Federally Facilitated Marketplace .
500 B. MEDICAID COVERED SERVICES
Payment for Medicaid services will only be made to enrolled providers. It is the responsibility of the recipient to find out if the medical provider is enrolled with Alaska Medicaid before receiving the service.
The Division of Health Care Services (DHCS) publishes and distributes the Alaska Medicaid Recipient Services booklet for all Medicaid recipients. This booklet gives detailed information about what medical services are covered by the Alaska Medicaid program and how to use those services. Many services require a prior-authorization by the medical provider before payment can be made by the Medicaid Program.
Any services received by a recipient that are not covered by Medicaid, or were not prior authorized when required, are the responsibility of the recipient.
Note: The Alaska Medicaid Recipient Services booklet is available on the DHCS Division of Health Care Services web site at https://health.alaska.gov/dhcs/Documents/PDF/Recipient-Handbook.pdf .
500 C. MEDICAL SERVICES RECEIVED OUT-OF-STATE
Medical services may be received out-of-state if those services are not available in Alaska as long as the service is prior authorized and the health care provider is enrolled in the Alaska Medicaid program. Services received without prior authorization because of an emergency or because the recipient’s health would be endangered if required to return to Alaska to receive medical care may also be covered if the provider subsequently enrolls in the Medicaid program.
A recipient living in a community with convenient road access to a Canadian medical provider and no access to a U.S. medical provider other than by chartered airplane may receive medical care in the Canadian community. Medicaid will reimburse covered services provided by Canadian providers if one of the following conditions is met:
The services were provided because of a medical emergency. A medical emergency exists when a recipient has a severe, life threatening, or potentially disabling condition that requires intervention within minutes or hours; or
The State of Alaska has agreed that the needed health care services are more readily available in Canada at equal or less cost.
All other services received out-of-state must be prior authorized by Affiliated Computer Services to be covered by Medicaid.
500 D. FREEDOM OF CHOICE OF PROVIDERS
Medicaid recipients are free to choose their own health care provider(s), as long as that provider is enrolled with the Alaska Medicaid program, with the following exceptions :
When a recipient is placed in the Care Management Program; or
When a recipient must use a non-enrolled provider during an emergency, but that provider subsequently enrolls in the Medicaid program.
500 E. FREEDOM OF CHOICE RESTRICTION - CARE MANAGEMENT PROGRAM
The state’s fiscal agent, Affiliated Computer Systems (ACS), administers the Medicaid Lock-In program. ACS Affiliated Computer Systems may restrict a recipient's choice of providers if they find that the recipient has used a medical service at a frequency or in an amount that is considered improper, excessive, or unusual. This restriction is imposed by placing a recipient into the Care Management Program.
When this occurs, ACS Affiliated Computer Systems will notify the recipient of the finding and assign the individual a provider who will be the only provider available for the services identified by ACS Affiliated Computer Systems . Once placed in the Care Management Program, the recipient may not receive medical services from another enrolled provider without first getting a written referral from their care management provider except in the case of a life threatening or potentially disabling emergency.
The recipient has a right to a fair hearing to contest this finding. Recipients may request a fair hearing by contacting either their caseworker or the Medicaid Recipient Helpline toll free at 1-800-780-9972 (both inside and outside Anchorage area). A Fair Hearing Representative from the Division of Health Care Services will then contact the recipient regarding this request.
When an individual is placed into the Care Management Program, ACS Affiliated Computer Systems staff will enter a "PC" code for that individual on the EIS Eligibility Information System Medical Resource (MERE) screen. DPA Division of Public Assistance will authorize the benefit in the normal manner, and EIS Eligibility Information System will show a benefit issued. The Recipient Identification card (coupons) for the individual will be mailed separately by ACS Affiliated Computer Systems , usually within three days of the system issuance.
DPA Division of Public Assistance is unable to issue or print manual coupons for a Care Management Program recipient, but may contact ACS Affiliated Computer Systems at 907-644-6842 or by email at Jason.Ball@acs-inc.com to request coupons on behalf of the recipient.
500 F. CONFIDENTIALITY
Refer to Administrative Manual Section 100-3 .
500 G. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
Health or medical information that the Department of Health may have is protected under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This federal law provides individuals with certain rights about how health information is used and disclosed. Refer to Administrative Procedures Manual Section 100-8 for HIPAA policy.
Previous Section Next Section MC #73 (09/26)
501 MEDICAID RECIPIENT IDENTIFICATION CARD
501 A. ISSUING MEDICAID TO ELIGIBLE RECIPIENTS
There are four ways that the Department issues written documentation that a recipient is Individualized Supports eligible for APA Adult Public Assistance -related Medicaid coverage in a given month. These documents inform the recipient and their health care provider of the recipient’s Medicaid identification number (e.g., 060000000 / 060100000), which is needed by the provider when submitting a claim for payment to Medicaid. Many medical providers require written proof of Medicaid eligibility before they will provide service to an individual. Any of the following documents will serve as proof of Medicaid eligibility:
1. Standard System Issued Recipient Identification Card
Children enrolled in Medicaid will receive a Denali KidCare card while adults will receive a Denali Care card. This includes Medicaid cases authorized in both EIS Eligibility Information System and ARIES Alaska's Resource for Integrated Eligibility Services . This card can be used for health care and certain medical related services only for the person named on the card. Each person approved for Medicaid will receive a Medicaid Recipient Identification (ID) card.
Standard cards are mailed to recipients for the following circumstances:
One card per recipient per authorized application
One card per new member add-on
Cards can also be reissued for the following circumstances:
Change in name
Client identification number
Date of birth
Lost, stolen, or client request
Cards are not issued to recipients eligible for SLMB Specified Low Income Medicare Beneficiaries coverage.
2. Non-Standard System Issued Recipient Identification Card
A non-standard Recipient Identification card has similar recipient and medical resource information as the standard Denali Care or Denali KidCare card but is used for a recipient whose Medicaid coverage is restricted to certain services, such as an exam for a blindness or disability determination, or waiver screening. This ID card contains a statement of the service limitation. A provider may photocopy this card and submit it with their claim for reimbursement.
3. Field Benefit Issuance
Once Medicaid coverage has been authorized in ARIES Alaska's Resource for Integrated Eligibility Services or EIS Eligibility Information System a Field Benefit Issuance can be printed at any DPA Division of Public Assistance office. A Field Benefit Issuance contains similar recipient and medical resource information as a standard system issued Denali Care or Denali KidCare ID card. A Field Benefit Issuance is provided when the Denali Care or Denali KidCare Card is needed immediately, and the recipient cannot wait for mail delivery. A Field Benefit Issuance printed from ARIES Alaska's Resource for Integrated Eligibility Services looks different than a Field Benefit Issuance printed from EIS Eligibility Information System .
Note: Do not F9 out of the MEMC screen on EIS Eligibility Information System unless you want to cancel the issuance. You must always type in the "F" issuance indicator and press "Enter" to record the issuance so the recipient’s medical claims will be paid.
4. Manual Benefit Issuance
A Manual Benefit Issuance is the only form of documentation that can be printed for aliens eligible for emergency treatment because coverage for this special category is not considered regular Medicaid. Although similar to a Field Benefit Issuance, additional instructions must be entered in the Special Information field on the Manual Benefit Issuance to specify the covered dates of services. A Manual Benefit Issuance printed from ARIES Alaska's Resource for Integrated Eligibility Services looks different than a Manual Benefit Issuance printed from EIS Eligibility Information System .
A Manual Card for a recipient eligible for any category of Medicaid that is assigned for the Care Management Program can only be printed by Health Management Systems (HMS). A card can be requested on behalf of the recipient by contacting the HMS Health Management Systems at 907-644-6842.
501 B. AUTHORIZED REPRESENTATIVE
If an authorized representative (e.g., a public guardian) requests the Recipient Identification card and notices to be sent to him or her, the caseworker must enter the authorized representative's address in the mailing address field on the EIS Eligibility Information System Address ( ADDR Address screen ) screen. To have the Medicaid ID cards mailed to the recipient and the notices mailed to the representative, the authorized representative's address must be entered in the mailing address field on the ADDR Address screen and the recipient's address in the Medicaid benefit address field on the ADD2 Address Screen Change Benefit Mailing Address screen.
501 C. USING THE ID CARD OR MANUAL COUPON
The caseworker must advise the recipient that it is the recipient’s responsibility to:
Present a current ID card or manual coupon when each medical service is received;
Ensure that the medical provider they choose is an enrolled provider in the Alaska Medicaid program;
Ensure that the service they are receiving is covered by Medicaid;
Be prepared to present proof of their identity;
Guard their coupons to prevent use by unauthorized persons; and
Pay for any medical services for which an ID card or manual coupon was not properly presented.
Previous Section Next Section MC #73 (09/26)
505 THIRD PARTY LIABILITY ( TPL ) AND RECOVERY
A Medicaid recipient may have a third party that is available or required to provide direct services or payment of their medical care. A Medicaid recipient is required to assign to the state their right to their medical care and cooperate in obtaining or identifying any health resource available. Assignment is automatic upon application. The assignment ends when Medicaid ends. Adult applicants and recipients may be denied or terminated from Medicaid for failure to assign rights or cooperate, as specified in this section.
By law, the state is required to maximize all third party health care sources to the fullest extent possible before Medicaid will pay for services. Medicaid is the payer of last resort, except for the U.S. United States Public Health Service (Alaska Area Native Health Service ( AANHS Alaska Area Native Health Service ) or Indian Health Service ( IHS ). Persons eligible for Medicaid and AANHS Alaska Area Native Health Service have the option to choose between AANHS Alaska Area Native Health Service facilities and private health care providers for all medical services covered under Alaska Medicaid.
The Medicaid program is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage ( FMAP Federal Medicaid Assistance Percentage ). The regular State of Alaska FMAP Federal Medicaid Assistance Percentage is 50% but certain groups receive a higher reimbursement so it is important to make sure individuals receive Medicaid in the correct category, with the correct Medicaid subtype. Alaska can receive a FMAP Federal Medicaid Assistance Percentage of 100% for individuals who are eligible for IHS Indian Health Service so it is required that IHS Indian Health Service eligibility be coded in the eligibility system(s) so that the State of Alaska can be fully reimbursed for these Medicaid expenditures.
Note: When a client is IHS Indian Health Service eligible, the information must be populated in ARIES Alaska's Resource for Integrated Eligibility Services under IHS Indian Health Service Details and/or in EIS Eligibility Information System on the MERI Medical Resource Information screen.
Medicare is also a third party resource. Applicants and recipients who appear to be Medicare eligible must pursue Medicare enrollment to become or remain eligible for Medicaid. See Subsection 505-C for information about exceptions for children. See Section 506-A for information about Medicare eligibility. See Section 506-B for information about Medicare enrollment.
The Division of Health Care Services ( DHCS ) edits medical claims submitted for payment which indicate that services have been delivered related to an accident or injury. Their TPL Third Party Liability Unit develops this information and acts as a clearinghouse for all reports of Third Party Resources ( TPR Third Party Resource ) or Third Party Liability ( TPL ), making referrals to the appropriate office or agency.
505 A. DEFINITIONS
Indemnity Policy: Insurance which provides payment directly to the policyholder under certain conditions. Indemnity policies are a potential third party resource, which are subject to the assignment of rights provisions if the benefits payable are designated for medical care or can be used for that purpose. There are many variations in this type of policy. The caseworker must examine each policy to determine the type of benefit it provides and the purposes for which it can be used. If not a third party resource, the proceeds from this type of policy are usually considered income.
Medical Support: Payment of the costs of medical care ordered by a court or administrative process established under state law.
Private Insurer: A commercial insurance company offering health or casualty insurance to individuals or groups.
505 B. WHAT IS A THIRD PARTY RESOURCE ( TPR Third Party Resource )
A third party resource is an entity, individual, or program that is, or may be, liable to pay all or part of a recipient's health care. Third parties include, but are not limited to:
Private or group health insurance, including Medicare;
Pre-paid Medical plans;
Employment-related health insurance;
Indemnity policies;
Medical support from an absent parent;
Self-insured and self-funded medical plans, or trusts;
Auto or homeowner liability insurance;
Tenant or landlord insurance;
Court judgments or settlements from a liability insurer, malpractice, wrongful injury, or civil assault lawsuit;
Workers' compensation;
First party probate-estate recoveries;
Other federal programs, with the exception of AANHS Alaska Area Native Health Service or IHS Indian Health Service programs; and
Long Term Care Insurance
Note: Since Long Term Care insurance is not a valid type on the Medical Resource Information ( MERI Medical Resource Information ) Screen, when a Medicaid eligible individual has a Long Term Care Insurance policy, caseworkers must email the policy information to the TPL Third Party Liability unit at doh.hcs.rec.info@alaska.gov . If the Long Term Care payments are going directly to the client, they are counted as unearned income and used to determine COCA Cost of Care . If the client is determined eligible for Medicaid, the caseworker must case note the information and send an email to the TPL Third Party Liability unit. If the payments are going directly to the facility, the caseworker only needs to case note the information and send an email to the TPL Third Party Liability unit as Long Term Care payments made directly to the facility do not count as income to the client.
505 C. APPLICANT / RECIPIENT RESPONSIBILITY
An applicant or recipient must:
Provide all available information about any third party resources and must inform their caseworker of any changes;
Assign his/her rights (and the rights of any other eligible individuals on whose behalf he/she has legal authority under state law to assign such rights) to medical support and to payment for medical care from any third party;
Cooperate in establishing paternity and obtaining medical support and payments;
Cooperate, in the absence of good cause, in providing information to assist the state in pursuing any liable third party;
Except for poverty level pregnant women, cooperate with CSED Child Support Enforcement Division in establishing paternity and obtaining medical support; and
Provide verification of TPR Third Party Resource / TPL Third Party Liability termination.
Note: A pregnant woman must cooperate in identifying and providing information in pursuing third parties ( TPR Third Party Resource ) who may be liable to pay for medical care and services, unless good cause is established.
Cooperation with third party recovery is required from all applicants and recipients of Medicaid. However, a child is never penalized for the non-cooperation of a parent or other person who may be applying for them.
505 D. INDICATORS OF A POTENTIAL THIRD PARTY RESOURCE
During the intake process, the following indicators may represent potential third party resources:
1. Age
An applicant over age 65 is usually eligible for Medicare coverage. A student may have insurance available through the school they attend. A minor child may also be covered through an absent parent.
2. Death
An application on behalf of a deceased person should be examined for last illness coverage through any life insurance policies.
3. Income
Certain income sources are indicators of possible health insurance coverage:
Railroad Retirement Benefits and Social Security Retirement or Disability indicates eligibility for Medicare.
Long Shore and Harbor Workers Compensation (LHWC) and Workers' Compensation (WC) - employees who suffer work-related accidents or injuries must file for benefits to compensate for incurred medical expenses and lost income. Payment for medical expenses may be a lump sum award.
Black Lung Benefits payable under the Coal Mine Workers' Compensation Program are awarded on a diagnosis of pneumoconiosis. Payments are made monthly and medical expenses are paid as incurred.
Child Support Payment from an absent parent strongly indicates potential medical support for a child. An absent parent may be required by court order to provide health insurance coverage for the child as well as cash payments. If the absent parent is employed, with health insurance available through that employment, CSED Child Support Enforcement Division is required by federal law to obtain a court order for health insurance coverage for the child.
Earned Income indicates that health insurance may be available through employment. This may be the case with individuals receiving Transitional Medicaid coverage.
4. Work History
A look at work history may indicate eligibility for cash and medical benefits described above. Previous military service, or an absent parent on active duty or retired from the military, suggests the potential for VA Department of Veterans Affairs Department of Veterans Affairs or TRICARE Standard coverage.
5. Monthly Expense
A look at work expenses may show that the applicant pays health insurance premiums.
6. Disability Information
If a disability is indicated in the application or brought up in the interview, look for a casualty or accident involving a legally responsible third party. Chronic renal disease applicants are probably eligible for Medicare. Medicare coverage for a disabled individual is not available until the individual is entitled to receive a social security disability benefit for more than 24 months.
An Application for Social Security Disability is an application for Medicare as well.
7. Change In Marital Status
Marriage or divorce of a recipient may indicate the possibility of health insurance coverage for a member of the household.
505 E. CASEWORKER ACTIONS RELATED TO TPL Third Party Liability / TPR Third Party Resource
1. Application, Case Review, Report Of Change
During application, case reviews, or reports of change, the caseworker must take the following actions in these specific situations when a TPR Third Party Resource is known to exist:
If the applicant meets all other eligibility criteria but does not have specific TPR Third Party Resource information available at the time of application, authorize the Medicaid and then pend the case for information about the resource.
If the client refuses to provide third party or insurance information available to them after they have received adequate notice, then they are ineligible for Medicaid. You must close the Medicaid case for the client who is refusing to provide third party insurance information. If the non-cooperating person later agrees to cooperate, his or her eligibility may begin in the month cooperation begins.
If a minor child is involved in the application or case review, continue to process the application for the child, either removing the non-cooperating parent from the need standard while including their income and resources, or determine eligibility for the child under MAGI Modified Adjusted Gross Income .
2. Definite Third Party Resources
If the applicant or recipient names a definite third party resource, enter any known specific information on the MERI Medical Resource Information screen. The information requested on that screen includes:
The carrier code indicating the insurance company;
Type of insurance;
Policy number;
Group number; and
The start and end dates.
The Division of Health Care Services ( DHCS Division of Health Care Services ) TPL Third Party Liability unit may also update the MERI Medical Resource Information screen.
3. Possible Third Party Resource
If there is an indication of a possible third party resource, including insurance coverage, liable party for an accident or injury, or absent parent coverage, but not enough specific information necessary for entry on the MERI Medical Resource Information (insurance company, type of insurance, etc.), collect all data the client is able to provide (e.g., name, address, phone number of the insurance company, SSN Social Security Number of policy holder, employer of an absent parent) and send an email message with this information to the DHCS Division of Health Care Services TPL Third Party Liability unit at doh.hcs.rec.info@alaska.gov . The TPL Third Party Liability unit will research the information.
4. Third Party Resource Is Available
If the client indicates that a third party resource is available to a member of the household for which the household member has not applied, notify the applicant or recipient that they must apply and send notice M006 - Application for Other Benefits. If the individual is a mandatory member of the household and refuses to apply for the available resource, remove the recipient from participation in Medicaid, but do not remove any children for whom the recipient can legally assign rights.
5. Third Party Resource is Available - Unable To Provide Information
If the client reports an accident or injury, mentions a Workers' Compensation claim, or reports receipt of any lump sum income which is, or appears to be, related to an accident, or indicates that there is a possibility of a third party resource (absent parent with employment), but the client does not have access to the information. Collect as much information as the client can provide and email the DHCS Division of Health Care Services TPL Third Party Liability unit at doh.hcs.rec.info@alaska.gov . Do not deny the case because the client is unable to provide all the information requested.
6. No Third Party Resources
The client indicates that they do not have any third party resource and there is none available to them or any member of their household for whom they are applying. No further action is needed regarding TPL Third Party Liability .
505 F. COOPERATION WITH TPL Third Party Liability / TPR Third Party Resource AND INDIVIDUALS UNDER 21
In Alaska, individuals have legal authority to conduct their own business when they are 18, married, or legally emancipated. For these individuals, follow the procedures outlined in this manual section for cooperation as though the minor were an adult. If a minor applies for Medicaid, and is living independently in the community, the minor may sign the Medicaid application (assigning rights to medical support and indicating cooperation with TPL Third Party Liability ). Ask the minor under 18 if his or her parents have any health insurance coverage, and email the TPL Third Party Liability unit at doh.hcs.rec.info@alaska.gov if any information is available. DHCS Division of Health Care Services will follow-up on the TPL Third Party Liability information. Do not require the minor to obtain the health insurance policy of the parent for verification unless the minor indicates a willingness to do so.
505 G. TRICARE
TRICARE Standard is the government’s health insurance program for members of the uniformed services, their families, survivors, and retired members. A TRICARE Standard eligible who resides within a forty-mile radius of a military health facility (see Catchment Area in H. below) must get certification of non-availability of medical services from the base health benefits advisor to receive non-emergent services from a facility other than the military treatment facility. If they do not obtain this statement, TRICARE Standard will not cover the expense.
505 H. RESERVED
505 I. INDIAN HEALTH SERVICE FACILITIES
Alaska Native Medical Center and Anchorage Service Unit;
Barrow Service Unit;
Kotzebue Service Unit;
PHS Public Health Service Alaska Native Health Center, Ketchikan;
Annette Island Service Unit, Metlakatla; and
Yukon-Kuskokwim Delta, Bethel.
Clinics (contract services for IHS Indian Health Service ) include:
SEARHC Southeast Alaska Regional Health Consortium , Juneau (includes Mt. Edgecumbe Hospital and Sitka Alcoholism Therapy Unit);
Tanana Chiefs, Fairbanks (Chief Andrew Isaac Health Center);
Bristol Bay Health Corporation, Dillingham (Kanakanak Hospital); and
Norton Sound Health Corporation, Nome.
505 J. RESOURCE CODES
The DHCS Division of Health Care Services Division of Health Care Services TPL Third Party Liability unit updates the carrier codes on a monthly basis for each insurance carrier registered by the DHCS Division of Health Care Services . A complete listing of these carriers and codes can be obtained at doh.hcs.rec.info@alaska.gov .
505 K. WAIVERS FOR COOPERATION WITH TPL Third Party Liability REQUIREMENTS
It is a condition of Medicaid eligibility that every applicant or recipient provide third party resource information and cooperate in identifying the resource. Inform clients that a good cause waiver of cooperation is available if physical or emotional harm may occur, either to himself or herself or to another person for whom the individual may assign rights, if cooperation is required of them.
If the client claims that cooperation in identification and pursuit of a third party resource is reasonably anticipated to result in physical or emotional harm, (excluding situations related to CSED Child Support Enforcement Division ) the client must provide evidence to substantiate the claim.
Issue benefits to an otherwise eligible recipient pending resolution of whether a waiver should be granted, if the applicant or recipient meets all other eligibility factors and has submitted the evidence to determine good cause.
Email hss.dpa.policy@alaska.gov that a good cause waiver determination is needed and send the documents supporting the claim. The Program Officer will notify the caseworker and the DHCS Division of Health Care Services TPL Third Party Liability unit of approval or disapproval of the good cause claim.
Previous Section Next Section MC #68 (04/25)
506 MEDICARE
Medicare is a government health insurance program for people 65 and over, some people under the age of 65 with disabilities, and people of any age living with permanent kidney failure. It pays for many health care expenses but does not cover them all.
Medicaid has limits on the type of care it will pay for and for how long. For example, Medicare covers only medically "reasonable and necessary" care and does not cover personal care that helps you with things like bathing, dressing, etc.
506 A. MEDICARE ENROLLMENT
To be eligible for Medicaid, an individual who appears to be eligible for Medicare must apply for and pursue Medicare coverage. See section 505 for information about Third Party Resources and section 510 for information about Assignment of Rights.
Note: If an individual applies for Medicare and is denied Part A because they would only be eligible if they pay for part A, Medicaid continues, and the caseworker must make the QMB Qualified Medicare Beneficiaries determination.
This includes individuals who receive Medicare Part A at no charge, but who have not elected Medicare Part B because they were not willing or able to pay the associated monthly premium.
If an individual is receiving Medicare Part A but not Part B, email DHCS Division of Health Care Services at doh.hcs.rec.info@alaska.gov requesting that they start the Medicare Savings Program. This will open Part B without having to pend the case.
The M008 - Medicare Benefits Available notice is used for this purpose. If the individual fails, without good cause to apply for the Medicare benefits within 30 days, the caseworker must deny the Medicaid application or close the Medicaid case.
Exception: An SSI Supplemental Security Income recipient who fails to apply for Medicare by the due date should not have their Medicaid case closed as they are categorically eligible.
Information from the SSA Social Security Administration may be obtained by direct contact with the serving SSA Social Security Administration office, or by viewing the SOLQ State Online Query , SVES State Verification Exchange System , or BENDEX Beneficiary and Earnings Data Exchange interfaces.
Note: The Medicaid application should not be delayed during the 30 day period allowed for application of Medicare. If the individual meets all other eligibility factors except for the application of Medicare, the Medicaid application should be approved.
506 B. MEDICARE eLIGIBILITY
Generally, an individual is eligible for Medicare at age 65 or older if:
They are a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years; and
They or their spouse has worked long enough to be eligible for Social Security or railroad retirement benefits - usually having earned 40 credits from about 10 years of work - even if they are not yet receiving these benefits; or
They or their spouse are a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working.
An individual may qualify for Medicare under age 65 if:
They have been entitled to Social Security disability benefits SSDI Social Security Disability Insurance (not including SSI Supplemental Security Income ) for at least 24 months (which need not be consecutive); or
Note: There is no need to refer SSDI Social Security Disability Insurance recipients under the age of 65 to apply for Medicare. These individuals are automatically enrolled in Medicare Part A after their two-year waiting period ends.
They receive a disability pension from the Railroad Retirement Board and meet certain conditions; or
They have Lou Gehrig's disease (amyotrophic lateral sclerosis), which qualifies them immediately; or
They have permanent kidney failure requiring regular dialysis or a kidney transplant - and they or their spouse has paid Social Security taxes for a certain length of time, depending on their age.
If an individual age 65 or older does not qualify for Medicare based on their own or their spouses work record, they may still receive Medicare if:
They are a U.S. citizen or a legal resident for at least five years; and
They pay premiums for Part A, Part B, and Part D.
506 C. MEDICARE CARD
When Social Security determines that an individual is eligible for Medicare, the beneficiary will receive a red, white and blue Medicare Health Insurance card (as seen below). This card usually arrives about 3 months before the actual eligibility date.
The card will show the beneficiary's name, Medicare Beneficiary Identifier (MBI), sex, Part A and/or Part B effective dates, and the beneficiary's signature block. The Health Insurance Claim (HIC) number is being replaced by the MBI Medicare Beneficiary Identifier on the card. The HIC Health Insurance Claim number will still be used by DHCS Division of Health Care Services . To find the HIC Health Insurance Claim number, use the SVES State Verification Exchange System interface. The HIC Health Insurance Claim number will still be entered in EIS Eligibility Information System and ARIES Alaska's Resource for Integrated Eligibility Services . DHCS Division of Health Care Services will be collecting the MBI Medicare Beneficiary Identifier directly from CMS Centers for Medicare & Medicaid Services so there is no need to communicate the MBI Medicare Beneficiary Identifier to DHCS Division of Health Care Services . If the client provides the MBI, it should be entered into the case note.
A recipient should present their Medicare card and the Medicaid Recipient Identification Card to health care providers as proof of both Medicare and Medicaid coverage. See Section 501(C) for policy using the Medicaid Recipient Identification Card or coupon. Subsequent Medicare cards issued, in addition to Bendex updates, will reflect the newest effective dates. A photocopy of the recipients Medicare Card should be kept in the case file.
506 D. MEDICARE PART A THROUGH D
1. Part A - Hospital Insurance
Part A helps cover:
Inpatient care in a hospital
Inpatient care in a skilled nursing facility (not custodial or long term care)
Hospice care
Home health care
Inpatient care in a religious non-medical health care institution
Most people who have Part A do not pay monthly premiums because they have at least 10 years of Medicare covered employment. Those who do not have 10 years of employment must pay a monthly premium. See Addendum 1 .
Individuals who begin receiving Social Security benefits at age 65 are enrolled in free Medicare Part A at the same time.
Disabled individuals who receive Social Security Disability Insurance ( SSDI ) are automatically enrolled in Medicare Part A after 24 months. Disabled individuals receiving SSI Supplemental Security Income benefits do not automatically qualify for Medicare Part A. Once they reach age 65, they may be eligible for Medicare Part A, but they are charged a premium.
2. Part B - Supplementary Medical Insurance
Part B helps cover:
Services from doctors and other health providers
Outpatient care
Home health care
Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment and supplies)
Many preventative services (like screenings, shots, and yearly "wellness" visits)
3. Part C - Medicare Advantage Plans
While the majority of people with Medicare get their health coverage from Original Medicare, some choose to get their benefits from a Medicare Advantage Plan, also known as a Medicare private health plan or Part C. Medicare Advantage Plans contract with the federal government and are paid a fixed amount per person to provide Medicare benefits.
Many Medicare Advantage Plans also offer prescription drug coverage (Part D).
4. Part D - Prescription Drug Coverage
Part D helps cover:
Costs of prescription drugs
Part D plans are run by private insurance companies that follow rules set by Medicare.
To be eligible for Medicare Part D prescription drug coverage, the beneficiary must be entitled to Part A or enrolled under Part B. The beneficiary does not need both Part A and Part B coverage to choose prescription drug coverage.
Medicare Part D prescription drug coverage replaces Medicaid prescription drug coverage for recipients who are eligible for both programs. Medicare pays for prescription drugs through private plans.
People with both Medicare and Medicaid, known as "dual eligible", are automatically enrolled in a plan. An applicant or recipient who has other creditable prescription drug coverage, such as employer or union coverage (including COBRA COBRA Consolidated Omnibus Budget Reconciliation Act ) is not required to join a Medicare drug plan. This is because an applicant or recipient who drops employer or union coverage may not be able to get it back. This may also affect coverage for spouses and dependents. Applicants and recipients should be instructed to call Medicare at 1-800-633-4227 or the plan listed in their letter telling them they don't want to be in a Medicare drug plan. TTY users can call 1-877-486-2048.
Persons who have been automatically assigned to a prescription drug plan can opt-out of a plan, or change plans at any time as long as they remain eligible for Medicaid. However, if a person chooses to opt-out of a prescription drug plan without enrolling in another plan, Medicaid will not pay for the cost of their prescription drugs, and he or she will have a lapse in drug coverage.
Note: Send EIS Eligibility Information System notice "M710 - Medicare Drug Coverage Begins" when a Medicaid applicant has Medicare, and when a recipient becomes eligible for Medicare.
506 E. HEALTH INSURANCE CLAIM NUMBER
The Medicare card shows the type of health insurance the person has, the effective date of the coverage, and the health insurance claim ( HIC ) number. This may be his/her own SSN Social Security Number , a spouse or parent SSN Social Security Number , and will have a suffix further clarifying eligibility type.
Note: The HIC Health Insurance Claim # may be changed by SSA Social Security Administration with subsequent changes in eligibility. If this occurs, update the MERE Medical Reference screen accordingly and send an email to doh.hcs.rec.info@alaska.gov so the Medicare Savings Program can be corrected.
506 F. DISABILITY CLAIM NUMBER SUFFIX HA
When Medicare eligibility is based upon an individual’s disability, the SSA Social Security Administration adds a suffix of HA to the beneficiary's SSN Social Security Number to indicate a disability claim. This number is not to be confused with a Health Insurance Claim number ( HIC #). The disability claim number, which will look like 123456789HA , will appear on all SSA Social Security Administration correspondence to the beneficiary regarding his/her disability claim, including Medicare coverage related to that disability. This number should not be entered to MERE Medical Reference as the HIC Health Insurance Claim # as it will interfere with Medicare Savings Program. Enter the accurate HIC Health Insurance Claim # from the Medicare Card or BENDEX Beneficiary and Earnings Data Exchange update. If these are not available, this information may be obtained from the SSA Social Security Administration or DHCS Division of Health Care Services .
506 G. RAILROAD CLAIM NUMBER
Railroad beneficiaries have claim numbers consisting of 6 or 9 digits that do not fit into the HIC Health Insurance Claim # field on MERE Medical Reference without conversion. The caseworker should first document the Railroad Claim Number exactly as it appears on the RRB Medicare card in a case note ( CANO ) and then notify DHCS Division of Health Care Services who will make a conversion to the appropriate ID number for input to EIS Eligibility Information System . Verification of Railroad benefits may be made by contacting the Railroad Retirement Board toll free at 1-800-808-0772.
506 H. MEDICARE SAVINGS PROGRAMS
Medicaid recipients who are Medicare eligible are automatically eligible for and enrolled in the Low-Income Subsidy (LIS) Program. Depending on countable income and resources, they may also be eligible for a Medicare Savings Program. Please see section 580 for additional information.
506 I. SDX State Data Exchange , BENDEX Beneficiary and Earnings Data Exchange , and SVES State Verification Exchange System
The SSA Social Security Administration produces the State Data Exchange ( SDX ), the Beneficiary Data Exchange ( BENDEX Beneficiary and Earnings Data Exchange ), and the State Verification Exchange System ( SVES State Verification Exchange System ) information systems. Information from these sources is useful in determining who is eligible for or receiving Part A or Part B.
SDX State Data Exchange contains a record of all people who are eligible for SSI Supplemental Security Income payments or federally administered state supplements.
BENDEX Beneficiary and Earnings Data Exchange provides only the data exchange that the state has requested. The BENDEX Beneficiary and Earnings Data Exchange file provides SSA Social Security Administration payment status, SSI Supplemental Security Income payment status and Medicare eligibility, Supplemental Medical Insurance premium (Part B) payer, changes to HIC Health Insurance Claim #, and Medicare entitlement dates. SSA Social Security Administration sends Bendex Beneficiary and Earnings Data Exchange data to the state each time a change occurs to the beneficiary record or household. SVES State Verification Exchange System provides data when an inquiry is initiated on EIS Eligibility Information System . A response is returned to EIS Eligibility Information System within approximately three working days. The information from the SVES State Verification Exchange System response from SSA Social Security Administration verifies social security number, social security, Title II benefits, and supplemental security income.
506 J. SOCIAL SECURITY OFFICES
The following Social Security offices and telephone/fax numbers are available to the public:
SSA National Number: 1-800-772-1213 TTY Users: 1-800-325-0778
Anchorage 222 W. 8 th Ave, RM A11 Anchorage, AK 99513 1-866-772-3081 1-833-950-2930 (fax) Juneau 709 W. 9 th Street, RM 231 PO Box 21327 Juneau, AK 99802 1-800-478-7124 1-833-950-2928 (fax) Fairbanks 101 12 th St., RM 138 Fairbanks, AK 99707 1-800-478-0391 1-833-950-2930 (fax) 907-456-0333 (fax)
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507 ESTATE RECOVERY
Under the Omnibus Budget Reconciliation Act of 1993 (OBRA 93), state Medicaid agencies are required to recover from the individual’s estate the cost of Medicaid that was provided to persons age 55 and older for nursing facility services, home and community based services, and related hospital and prescription coverage. These requirements may have a significant impact on estate planning, particularly for individuals who wish to protect family assets from the high cost of nursing home care. Under the rules for estate recovery, the state must seek reimbursement from the estate of the deceased Medicaid recipient. Property that was exempt during the Medicaid recipient's lifetime is Individualized Supports no longer exempt when the recipient dies, except that the State cannot collect from an estate if there is a:
Surviving spouse;
Minor child; or
Disabled (as determined by social security) dependent child of any age residing on property included in the deceased's estate.
Previous Section Next Section MC #9 (7/08)
510 ASSIGNMENT OF RIGHTS
It is a requirement of the Medicaid program that each legally able recipient assign to the Department of Health, all rights to medical support and payments for medical care from any third party, including health insurance benefits available to the Medicaid recipient. The recipient must also cooperate with any third party liability ( TPL ) recovery efforts of the department. See Section 505 for policy on third party liability and recovery. The applicant’s signature on the application is a satisfactory showing of compliance with this provision.
510 A. DEFINITIONS
Assignment means the recipient has transferred the right to collect and retain third party and medical support payments to the extent that medical services are paid for under the Medicaid program.
Cooperation in Assignment of Medical Support means applicants and recipients must assist in securing medical support payments and third party payments. Cooperation also includes assisting in establishing paternity and establishing or modifying medical support orders and third party payments.
510 B. COOPERATION AND ASSIGNMENT REQUIREMENTS
The assignment of third party and medical support payments and the requirement for cooperation applies to all household members who are legally able to assign rights.
A specified relative who is a Medicaid recipient and who fails to cooperate in the assignment of medical support for an individual in their household when he or she can legally assign rights will be ineligible for any category of Medicaid, unless good cause is established. The specified relative remains ineligible for Medicaid until he or she cooperates in the assignment of medical support.
There is no minimum period of ineligibility for the ineligible specified relative. The ineligible specified relative may regain eligibility immediately upon cooperating.
510 C. EXCEPTIONS
The state must provide Medicaid to any person who cannot legally assign his or her rights and who would be eligible for Medicaid but for the refusal of the person legally able to assign those rights to cooperate. If a specified relative refuses to cooperate in assignment of medical rights, the specified relative must be denied Medicaid coverage; however, the children are eligible for Medicaid assuming they meet all other eligibility requirements.
Cooperation in assignment of medical support is not required for a pregnant woman, including a woman who is in the sixty-day post partum period. She is not required to cooperate in establishing paternity and in obtaining medical support for herself, as well as for any other person for whom she can legally assign rights.
However, a pregnant woman must cooperate in identifying and providing information in pursuing a third party ( TPL ) who may be liable to pay for care and services, unless good cause is established. See Section 505 K .
510 D. FUTURE THIRD PARTY AND MEDICAL SUPPORT RIGHTS
When Medicaid is terminated for a recipient, or for his or her child, the assignment of rights ends. However, the assignment remains in effect for the period during which the recipient’s child continues to receive Medicaid.
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511 CHILD SUPPORT COOPERATION
An APA Adult Public Assistance -related Medicaid applicant or recipient may apply for Medicaid on behalf of a child. Most adults applying for Medicaid on behalf of a child must cooperate with the Child Support Enforcement Division (CSED) and their effort to secure medical support for the child. Cooperation in child support services activities means the individual helps CSED Child Support Enforcement Division :
Establish the paternity of each child for whom the individual can legally assign rights;
Identify and locate the absent parent of each child included in the household; and
Obtain medical support or medical support payments for each child in the household.
CSED Child Support Enforcement Division is required by federal law to obtain a court or administrative order for medical support from any absent (or "obligor") parent who has available health insurance or other financial resources. An obligor parent may not satisfy this requirement by enrolling the child in Medicaid category. The obligor parent is required to repay the state for the cost Medicaid provided to the child that should have been provided under the medical support order (e.g., dependent care coverage under the obligor parent’s health insurance).
511 A. WHO IS REQUIRED TO COOPERATE
Generally, any individual age 18 or older who is a parent or who can legally assign rights to medical support for a child in their care and who is requesting or receiving Medicaid or Denali KidCare benefits for that child is required to cooperate with the CSED Child Support Enforcement Division . This includes an adult who is an APA Adult Public Assistance -related Medicaid recipient applying for Medicaid on behalf of the adult’s own child or a child for whom the adult is the specified relative.
511 B. WHO IS NOT REQUIRED TO COOPERATE
For the purpose of determining Medicaid eligibility, the following individuals are not required to complete the CSED Child Support Enforcement Division 1603 or otherwise cooperate with CSED Child Support Enforcement Division :
A pregnant woman through the end of her 12-month postpartum period;
An applicant who is under the age of 21 and is applying for medical assistance only for him or herself, regardless of the applicant’s living arrangement;
An applicant who is under the age of 18 who is applying on behalf of his or her own child;
An applicant who is applying on behalf of a child who is a beneficiary of Indian Health Service ( IHS Indian Health Service ) funded Native health services and those services are reasonably available. In Alaska, IHS Indian Health Service services are reasonably available to almost all IHS Indian Health Service beneficiaries;
A custodial parent who is applying on behalf of a child who is already covered under either the custodial or non-custodial parent’s third-party health insurance; or
A specified relative who cannot legally assign rights to benefits for a child in their care for whom they are applying;
Cooperation is also not required in the following circumstances where, for practical purposes, there is no ”absent parent”:
Either natural or adoptive parents are living in the home;
In a single-parent adoption case and the adoptive parent is living in the home;
When the absent parent is deceased; or
When a child is in the protective custody of the Office of Children’s Services ( OCS Office of Children's Services ). OCS Office of Children's Services cooperates directly with CSED Child Support Enforcement Division for children in state custody.
In the event of these circumstances, the caseworker should not complete the Absent Parent Identification (APID) and related screens on EIS Eligibility Information System . This prevents an unnecessary referral to CSED Child Support Enforcement Division .
511 C. HOW AN INDIVIDUAL COOPERATES WITH CSED Child Support Enforcement Division
An individual cooperates with CSED Child Support Enforcement Division by:
Completing and signing the CSED Child Support Enforcement Division 1603, "Child Support Information" form;
Appearing at a CSED Child Support Enforcement Division office to provide information or evidence relevant to the case;
Appearing as a witness in a court or other proceeding;
Providing information or attesting to lack of information under penalty of perjury or unsworn falsification;
Paying to the state any medical support payments received that are covered by the assignment of rights; and
Taking any other reasonable steps to assist in establishing paternity and securing medical support and payments.
511 D. WITHDRAWAL FROM CASH SUPPORT ENFORCEMENT
An applicant or recipient of a Medicaid-only case may elect to withdraw from cash support enforcement. CSED Child Support Enforcement Division will not pursue cash support enforcement if the applicant or recipient has checked the " no " box on Page 3 of the CSED Child Support Enforcement Division 1603a form indicating that they do not want to pursue cash support. In this situation, CSED Child Support Enforcement Division will pursue a medical support order only.
CSED Child Support Enforcement Division will establish a cash support order on Medicaid-only cases, unless the applicant or recipient elects to withdraw from cash support enforcement. Once a cash support order is established, the absent parent’s legal obligation to support his or her child begins. The cash support order will identify the amount of cash support the child is due.
511 E. PENALTY FOR FAILURE TO COOPERATE
An individual who is required to cooperate with CSED Child Support Enforcement Division , but who fails to do so without good cause, is ineligible for Medicaid. To stop Medicaid benefits from going out on an APA Adult Public Assistance case, the eligibility worker will code the ineligible Medicaid individual "OU" on the SEPA Setup Participations screen and then authorize the APA Adult Public Assistance benefits. The eligibility worker will then initialize the case into the next month. The Medicaid issuance job will not issue the Medicaid benefit and EIS Eligibility Information System will not allow a field issuance. Should that individual want Medicaid benefits in the future, cooperation is required.
An APA Adult Public Assistance -related Medicaid case of a non cooperating parent must be denied, or closed with adverse action.
Exception: An SSI Supplemental Security Income recipient will remain Medicaid eligible. Once the SSI Supplemental Security Income ends, the eligibility worker will take action to close the stand-alone Medicaid case.
Refer to MAGI MS 812 for more information about child support cooperation and good cause claims.
Previous Section Next Section MC #73 ( 09/26)
513 ALASKA RESIDENCY
The agency must provide Medicaid to eligible residents of the State, including residents that are absent from the State.
Note: If during the application process DPA Division of Public Assistance finds that an individual has open public assistance benefits of any kind in another state or they are an SSI Supplemental Security Income recipient with an out of state address, the individual is claiming to be a resident of that other state. Until DPA Division of Public Assistance verifies that the individual has reported their move to Alaska to the other state or SSI Supplemental Security Income , the caseworker must find their Alaska residency questionable. Once residency is no longer questionable, we can start benefits in Alaska as outlined in the program policy manuals.
513 A. ALASKA RESIDENCY REQUIREMENTS
If Alaska residency is already established for an individual, the individual's residency continues until he or she abandons it.
If residency requirements are questionable for an individual, determine if the individual meets one of the following conditions:
Lives in Alaska and intends to continue living in Alaska permanently or for an indefinite period of time, even without a fixed address; or
Entered the state looking for a job; or
Entered the state with a job commitment.
Residency depends on a person's intent or purpose in coming to the state at the time of application. An individual is not considered to be an Alaska resident if he or she is in Alaska for a temporary reason such as a vacation or a business trip.
1. Residency of a Minor Child
A child is a resident of the state in which the parent or caretaker is a resident.
Example: A family consisting of dad and mom who are in the U.S. United States on student Visas, attending the University of Anchorage, and one child that was born in the U.S. United States applies for Medicaid. When asked, they declare they intend to return to their home country when finished with school. Since the parents do not intend to remain Alaska residents indefinitely, they are ineligible for Medicaid and the child, although a citizen, is not considered a resident of Alaska, as the parents do not meet residency requirements.
2. Residency of a Student
A full-time time student from another state is not considered to be an Alaska resident if the student is 18 to 22 years old and all three of the following conditions are met:
1. Neither of the student’s parents live in Alaska;
2. The student is claimed as a tax dependent by a person who is a resident of another state; and
3. The student is applying for Medicaid on his or her own behalf.
513 B. TEMPORARY ABSENCE AND RESIDENTS RESIDING OUT OF THE STATE
A person may be temporarily out of state. Medicaid applicants or recipients may not be denied or terminated because an individual is temporarily absent from the state if that individual intends to return to the state when the purpose of the absence has been accomplished, unless another state has determined that the individual is a resident for purposes of receiving Medicaid. There is not a specified period before someone loses Alaska State residency. However, the person must demonstrate intent to continue to reside in Alaska. If it is suspected a household has moved out of state, attempts should be made to contact the household. There is no need to contact the other state.
For an individual who moves out of Alaska permanently, close the case with timely notice of adverse action.
Note: Unlike SSI Supplemental Security Income and APA Adult Public Assistance policy, an individual may not be excluded from Medicaid because they have exceeded the APA Adult Public Assistance temporary absence policy.
Example 1: A client who is receiving Medicaid must stay with her ill grandmother in another state. She may be gone for several months but she is maintaining her apartment in Alaska. Therefore, she is considered a resident of Alaska. Example 2 : A client leaves Alaska to take a temporary job in another state. She is planning to return when the job ends which may be in about 3 to 6 months. She will be renting an apartment in the other state and will not be keeping her residence or belongings here. She is no longer considered a resident of Alaska.
A temporary absence from the state before or after submitting an application, but before eligibility is determined, does not constitute abandonment of residency if the absence occurred for a specific purpose that did not involve intent to change residence and the individual has a plan to return to Alaska at a future date.
Even though an Alaska Medicaid recipient is temporarily absent from the state, Medicaid will only pay for services provided out of state if they are prior authorized by Health Management Systems (HMS), and the out-of-state provider is enrolled in the Alaska Medicaid program.
513 C. IF RESIDENCY IS QUESTIONABLE
Ask whether the intent is to remain in Alaska. If the intent is to remain in Alaska then ask the following:
For temporary visa holders, what has changed in their circumstances to change their intent filed with their current visa? No verification is needed; document the intent and determine if the intent is reasonable.
Lawfully present aliens in the U.S. United States with current un-expired student, business, religious workers or tourist/visitor visas are admitted for a temporary stay depending on the type of visa. These visa holders may have changes in their circumstances that will allow them to change their status with USCIS U.S. Citizenship and Immigration Services while in the U.S. United States The exception is tourist/visitor holders, who are rarely eligible for adjustment of their status while still in the U.S United States .
For Medicaid eligibility, at each application or renewal, temporary visa holders must show that their visa is still in effect. All temporary visa holders excluding business visa holders must be asked their intent to remain an Alaska resident when their current visa expires.
For all individuals with questionable residency, is the individual keeping a home, property or residence in the state/country that person left?
If no, the individual meets residency requirements with the declared intent.
If yes, does the person have the residence/property listed for sale, if not why?
If individual is still maintaining home/property or residence and cannot document why, that person is not an Alaska resident and the request for medical assistance should be denied.
An individual, who states the intent to return home after completing school or the visa expires, does not meet residency requirements.
An individual, who enters the state with a job commitment or to search for work, meets residency requirements. This includes business visa holders.
Example 1: A family consisting of dad, mom, and two children have just moved to Alaska from California in search of seasonal work. They maintain a home in California to which they intend to return after the season is over. They apply for Medicaid as they search for work. Because they entered Alaska in search of work, they meet residency requirements. Example 2: A family consisting of dad, mom, and two children have just moved to Alaska from Oregon due to dad's new job. They apply for Medicaid due to one child's sudden illness. They have their home in Oregon rented and will be listing the home for sale when the market improves. Because they entered Alaska with a job commitment, they meet residency requirements. If they meet all other eligibility criteria, the children are eligible for Medicaid. Example 3: A non-immigrant family with two children applies for Emergency Treatment for Aliens. They submit current visas for the entire family with R1 and R2 codes (religious workers and dependents). When asked, they declare they intend to remain Alaska residents, and they have no home or property in their home country. Because they entered Alaska with a job commitment, they are considered residents. Example 4: A non-immigrant family consisting of mom, dad, and one child applies for Emergency Treatment for Aliens. They submit current F1 and F2 visa's (foreign student and dependents) for the family and proof of pregnancy for mom. They state they intend to remain in Alaska. When asked about their temporary visa and their intention to remain in Alaska, they say they hope that an employer will petition for their adjustment once school is completed. They declare they have no home or property in their home country. Since they stated the intent to remain an Alaska resident and are not maintaining a residence in their home country they meet residency requirements. Example 5: A 21-year-old student attending University of Fairbanks applies for Pregnant Women Medicaid. She supplies her school grant and loan information which states she is attending the university as a non-resident. When asked her intentions when she finishes school she states she intends to return to Montana where her family lives when she completes her degree in 2 years. Since she does not meet residency requirements, she is ineligible for Medicaid. Example 6: A husband and wife, admitted to the U.S. with F1 student visas apply for Emergency Treatment for Aliens for the husband due to a recent hospitalization. The applicant's state they intend to remain in Alaska indefinitely, however, they have a home that is not listed for sale in their home country. When asked what they plan to do with the home, the family has no response. Since they are maintaining a residence in their home country, Emergency Treatment for Aliens coverage is denied for failure to meet residency requirements.
513 D. VERIFICATION OF RESIDENCY
A statement from the individual is sufficient to document his or her intent unless there is conflicting information. The caseworker may require applicants or recipients to provide proof of Alaska residency if there is reason to doubt their state residency. Items that can be used to prove state residency include, but are not limited to: rent receipts, utility bills, in-state school tuition, current driver’s license, current voter’s registration card, city directory, and statements from other individuals who are aware of the household’s situation.
513 E. PERMANENT ADDRESS NOT REQUIRED
An applicant or recipient is not required to have a permanent address as a condition of eligibility. If an applicant or recipient does not have a permanent address, provisions are made to assure the person receives their Medicaid card or coupons. The recipient should be given a choice of an alternate mailing address for their Medicaid card or coupons.
513 F. OUT-OF-STATE INDIVIDUAL MOVES TO ALASKA
When an individual has received benefits in another state prior to applying in Alaska, verify termination of benefits in the other state before establishing eligibility for Alaska benefits.
Alaska Medicaid benefits may not be issued to a person who has been issued Medicaid benefits in another state in the same month, unless case closure in the other state has been verified and the following conditions are met:
The other state was unable to or did not stop the benefit issuance before the individual arrived in this state; and
The applicant states benefits issued from the other state were not used to pay for any medical services provided in the month.
513 G. OUT-OF-STATE TREATMENT IN A MEDICAL INSTITUTION
If an Alaska state agency, such as Office of Children’s Services (OCS), places an individual in an out-of-state medical institution or foster care setting, that individual is considered to be an Alaska resident, except for Title IV-E individuals (see MAGI MS 829 ). If the recipient leaves the medical institution or foster care setting (and legal custody) of the state of Alaska, the state of residence, for Medicaid purposes, is the state where the individual is physically located. If the recipient leaves an out-of-state medical institution, but remains out of state temporarily for follow up or transitional care, that individual is considered only to be temporarily absent and remains a resident of Alaska as long as the treatment plan calls for the individual to return to Alaska.
Previous Section Next Section MC #68 (04/25)
514 RESIDENTS OF INSTITUTIONS
514 A. DEFINITIONS
Inmate: An individual who is Individualized Supports living in a penal or public institution that is not defined as a medical institution.
Inpatient: A patient who has been admitted to a medical institution and who
receives room, board and professional services in the institution for a 24 hour period or longer, or
is expected by the institution to receive room, board and professional services in the institution for a 24 hour period or longer even if the patient dies, is discharged, or is transferred to another facility before 24 hours have elapsed.
Medical Institution: An institution certified under state law to provide medical care, including nursing and convalescent care, such as hospitals, nursing facilities ( SNF Skilled Nursing Facility ), intermediate care facilities (I CF ), intermediate care facility for the Intellectually Developmentally Disabled ( ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled ); residential psychiatric treatment centers ( RPTC Residential Psychiatric Treatment Center ); and certain assisted living homes providing residential supported living and habilitation services, such as Alaska Pioneer Homes.
Penal Institution: A correctional or holding facility for individuals who are held as prisoners (e.g., prison or jail), such as the Fairbanks Correctional Center.
Public Institution: A facility that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. A medical institution is excluded even if it is administered by a governmental unit.
514 B. MEDICAL INSTITUTION
Medicaid eligibility may be available to an individual residing in a medical institution if all eligibility criteria are met.
514 C. PUBLIC INSTITUTION
An individual residing in a public institution, regardless of whether the placement was voluntary or involuntary, is not eligible for Medicaid.
Exceptions:
An individual age 65 or older receiving active treatment in an institution for mental disease, such as in the Alaska Psychiatric Institute (API) may be Medicaid eligible providing he or she has continuously resided in an inpatient psychiatric hospital since being determined Medicaid eligible;
An individual placed in a public facility on a short-term emergency basis pending other arrangements appropriate to the individual's needs such as a child placed in McLaughlin Youth Center waiting for foster placement may be Medicaid eligible; or
An individual living in a public facility may be Medicaid eligible providing he or she is there solely in order to receive educational or vocational training, such as in Mt. Edgecumbe High School.
514 D. PENAL INSTITUTION
An individual incarcerated in a penal institution, including a juvenile committed by the court to a correctional facility, is excluded from Medicaid coverage while the individual is an inmate, however covered services are suspended. The inmate status continues until the individual is released on parole, or is pardoned. An individual is still considered an inmate if he or she:
Leaves a correctional facility but continues to be in DOC Department of Corrections custody, or
Leaves a correctional facility for treatment in an acute care medical facility.
Is a child who is temporarily sent to an evaluation or diagnostic center for a determination of the most appropriate institutional placement resulting from a court order for commitment under the penal system.
An individual living outside a correctional facility serving a period of temporary commitment by electronic monitoring is not considered incarcerated in a penal institution.
Most medical care for adults (including juveniles waived to adult status) who are incarcerated by the state is provided through the Department of Corrections. A juvenile in a correctional facility receives most medical care through the Division of Juvenile Justice.
1. Incarceration and Medicaid
Medicaid benefits cannot be denied or terminated solely because an individual is incarcerated.
Even though incarcerated individuals may continue to meet all other eligibility requirements, Medicaid will not pay for medical claims while the individual is incarcerated, with one exception. Incarcerated adults and children who are Medicaid eligible and have been admitted to a hospital for more than 24 hours may have the medical charges paid by Medicaid.
All of the eligibility requirements for Medicaid must still be met to receive this coverage. If an incarcerated individual no longer meets all eligibility factors, his or her case will be closed or denied with adequate notice.
Applications:
The hospitals will assist the incarcerated individual with completing an application if the individual is not already receiving Medicaid. If eligible, the Medicaid case will be authorized for 12 months, using the correct incarceration subtype.
EXAMPLE: Noah is incarcerated and does not have on-going Medicaid. On 11/26/2016 he becomes ill and is admitted to the hospital for more than 24 hours. He turns in a Medicaid application on 11/30/16 and is determined eligible for Medicaid from 11/01/2016 - 10/31/2017 with the appropriate incarcerated subtype.
On-going Medicaid:
When it has been reported that a recipient is incarcerated, the Medicaid subtype must be changed to "incarcerated" the month following the report of incarceration. If the individual is on a case with other household members, the individual must be removed from the case and treated as an applicant. The first case with the other household members must be processed accordingly due to the report of change.
EXAMPLE: Craig, his spouse, and children are together on an on-going Medicaid case. Craig is reported incarcerated by his spouse on 06/03/16. Craig is coded out of his family's Medicaid case starting 07/01/2016. Craig is determined eligible for incarcerated Medicaid on a new case by himself. His certification period is 07/01/2016 - 06/30/2017. The Medicaid case with the other household members is processed accordingly with the household size report of change.
Applications for OCS Office of Children's Services Title IV-E children in DJJ Division of Juvenile Justice custody will continue to be processed by OCS Office of Children's Services in EIS Eligibility Information System .
In some instances, a child is released from a correctional facility into a medical institution, treatment facility, or community setting permanently or indefinitely, but the child remains in DJJ Division of Juvenile Justice custody. In such a case, the child may become eligible for Medicaid beginning in the first month in which the child is out of the correctional facility for at least one full day. After making a prospective eligibility determination, a caseworker may authorize eligibility for the child up to three working days prior to the release date, provided the release date is verified by DJJ Division of Juvenile Justice . To verify the release date, the caseworker must contact (in the order given) one of the following individuals:
The Youth Corrections Operations Manager at (907) 261-4335;
The State Office Juvenile Probations Officer at (907) 465-2212;
The OCS Office of Children's Services Medicaid Coordinator at (907) 465-3633.
See Addendum 2 for the incarceration Medicaid subtypes.
514 E. SUBSTANCE ABUSE TREATMENT FACILITIES AND COMMUNITY RESIDENTIAL CENTERS (HALFWAY HOUSES)
Full Medicaid eligibility may be available to an incarcerated individual who is not confined in a penal institution. Community Residential Centers (aka halfway houses) reserve a small number of beds for individuals on probation or parole that may be ordered to live in a structured environment as a condition of their supervision.
In order for the incarcerated individual to be eligible for full Medicaid benefits, they must have freedom of movement at the Community Residential Center ( CRC Community Residential Center ). Individuals are considered to have freedom of movement if all three of the following criteria are met:
The individual can work outside the CRC Community Residential Center in employment available to individuals who are not under justice system supervision; and
The individual can use community resources such as libraries, grocery stores, recreation, education, etc. at will; and
The individual can seek health care treatment in the broader community to the same or similar extent as other Medicaid recipients.
An incarcerated individual living at a CRC Community Residential Center may or may not have freedom of movement. Do not attempt to verify freedom of movement by calling the CRC Community Residential Center directly. The CRC Community Residential Center 's are not staffed by Department of Corrections ( DOC Department of Corrections ) employees and only DOC Department of Corrections can verify if the inmate is confined or has freedom of movement (furlough placement).
If an individual applies for Medicaid benefits and the application shows a CRC Community Residential Center address, the Eligibility Technician must send an email to doc.idodoc@alaska.gov in order to verify if the individual is confined or on a furlough placement. Please reference Addendum 6 for a list of CRC Community Residential Center addresses. When sending the email to DOC Department of Corrections , the subject line should state " CRC Community Residential Center Verification for Medicaid" and the body of the email must include the individual's name and date of birth.
Remember to use the appropriate Medicaid subtype. An incarcerated individual who is confined at a CRC Community Residential Center is eligible for limited inmate Medicaid benefits but an incarcerated individual who has freedom of movement in a furlough placement at a CRC Community Residential Center is eligible for full Medicaid benefits.
An incarcerated individual receiving active treatment in a substance abuse treatment facility may also qualify for Medicaid coverage if the individual meets all eligibility criteria; however, Medicaid does not cover the cost of the treatment in the facility.
All incarcerated individuals who are placed at a substance abuse treatment facility by Department of Corrections are on a furlough placement. Department of Corrections will never place a confined inmate at a substance abuse treatment facility.
514 F. PARTIAL MONTH STATUS
Medicaid payments are available for services received by an otherwise eligible applicant during the first and last partial months of residence in a public facility because he or she resided outside the facility for part of each month.
EXAMPLE: Alison applies for Medicaid on 07/03/2017. When processing the application, the caseworker discovers that Alison became incarcerated on 07/09/2017 with an unknown release date. She meets all other eligibility factors. As Alison was not incarcerated for the entire month of 07/2017, she is eligible for regular Medicaid benefits for 07/2017. The appropriate incarcerated Medicaid subtype will be used starting 08/2017.
514 G. CHILDREN IN TREATMENT
A child may be temporarily absent from his or her home for treatment in a residential care facility. If the child is ineligible for MAGI Modified Adjusted Gross Income Medicaid and has resided in the residential treatment facility for more than 30 days, eligibility may be determined in the Special LTC Long Term Care category explained in ADLTC MS 550(C) .
If the hospitalized child is determined eligible for the Special LTC Long Term Care category, their effective date of eligibility is retroactive to the first day of the 30-day period of institutionalization.
Example: A child who is not receiving Medicaid was hospitalized on May 14. We received a Medicaid application for the child on June 22, after the child had been in the hospital for more than 30 days. The child is ineligible for MAGI Modified Adjusted Gross Income Medicaid due to parental income so the caseworker must determine the child's eligibility for the Special LTC Long Term Care category. An interview is completed and all factors of eligibility are checked, including resources. If determined eligible, Medicaid eligibility in the Special LTC Long Term Care category would start May 1.
When determining the child's eligibility for Medicaid in the Special LTC category, the child is considered to be living independently of his or her parents when the child has:
Not lived in the home of the child's parent(s) for at least 30 days immediately preceding the date of application; or
Left the home to enter a medical institution or treatment facility in Alaska that involves a residential living arrangement and that treatment has lasted 30 days or longer; or
Left the home to enter an out of state medical institution or treatment program that involves a residential living arrangement and a 30-day out of state placement is prior authorized by Health Management Systems (HMS). Contact hss.dpa.policy@alaska.gov for special case processing instructions.
A child admitted for less than 30 days is not considered to be living separately from his or her parents, unless the caseworker verifies that the child did not go home, was transferred directly to another institutional or treatment setting, and the result is a total of 30 days or longer stay away from the child's home.
The Special LTC Long Term Care category is processed in EIS Eligibility Information System . The child must have monthly countable income equal to or less than the Special LTC Long Term Care Income Standard and have less than $2,000 in countable resources. See Addendum 1 .
Processing Note: Applications from the medical institution: If a Medicaid application comes from a medical institution and the child is already receiving Medicaid, leave the child on the current case. In this situation, the application is treated as a report of change. If a Medicaid application comes from a medical institution and does not include information about the parents, default to non-filer rules and determine eligibility using MAGI Modified Adjusted Gross Income rules. The case will be set up in ARIES Alaska's Resource for Integrated Eligibility Services as a child only case. If a Medicaid application comes from a medical institution and does include information about the parents, attempt to determine eligibility using MAGI Modified Adjusted Gross Income methodology. If the child is not eligible or we are unable to make an eligibility determination because of missing information, determine eligibility for the child only in the Special LTC Long Term Care category. Pursue resource information for the child and document this information in the CANO Case Notes . Remember that the DKC Denali KidCare subtypes in EIS Eligibility Information System are programmed not to count resources so if a child has resources in excess of the income limit, the case will need to be manually denied. If eligible, the case will be set up in EIS Eligibility Information System as a child only case and the Denali Kid Care ( DKC Denali KidCare ) Medicaid subtypes for a single child will be used. The case should be CARC'd to 5-58. Applications from the parent/caretaker: If a Medicaid application comes from the child's parent/caretaker and the household is eligible for MAGI Modified Adjusted Gross Income Medicaid, authorize the family together in ARIES Alaska's Resource for Integrated Eligibility Services . If a Medicaid application comes from the child's parent/caretaker and the household is found to be ineligible for MAGI Modified Adjusted Gross Income Medicaid, the child who has been in a medical institution for more than 30 days must be evaluated for the Special LTC Long Term Care category. Pursue resource information for the child and document this information in the CANO Case Notes . Remember that the DKC Denali KidCare subtypes in EIS Eligibility Information System are programmed not to count resources so if a child has resources in excess of the resource limit, the case will need to be manually denied. If eligible, the case will be set up in EIS Eligibility Information System as a child only case and the DKC Denali KidCare Medicaid subtypes for a single child will be used. The case should be CARC'd to 5-58.
EIS INFORMATION Eligibility Code: 11 Pregnant Woman 24 LTC Long Term Care (300%) Institutionalized Medicaid Subtype: IN LTC (300%)
Previous Section Next Section MC #64 (12/23)
516 RETROACTIVE MEDICAID
Retroactive Medicaid eligibility is available when there is an unpaid medical bill for a service provided within three full months immediately before the month of application providing the individual meets all the eligibility criteria in the retroactive month requested. An applicant does not need to be eligible in the month of application (or current month) to be eligible for one or more months of Retroactive Medicaid. An applicant or recipient may ask for Retroactive Medicaid coverage at any time.
The individual requesting Retroactive Medicaid must meet all of the requirements for the Medicaid category, both financial and non-financial.
An individual can request Retroactive Medicaid at any time, even if they have been denied previously for failing to provide requested verification. The ET Eligibility Technician can determine eligibility for Retroactive Medicaid for the three months prior to any application for Medicaid.
The date of application, rather than the date of the eligibility determination, establishes the beginning of the three-month retroactive period. Eligibility for a retroactive month cannot be assumed based on current month eligibility. Determine eligibility for each month separately using the eligibility rules in effect for that month.
The ET Eligibility Technician must review the application for request of retroactive Medicaid coverage and accept and document the applicant's statement of medical need.
Retroactive Medicaid is determined using:
Eligibility criteria for the category of Medicaid;
Actual gross income received in each month;
Adjusted net income for self-employment (See APA MS 441-E ); and
Actual resources that were available as of the first moment of each month. Unless questionable, resources do not need to be verified. See Administrative Procedures Manual section 105-1C regarding verification of questionable information.
Example: Carolyn applies for Medicaid coverage in June. The caseworker determines that Carolyn was eligible for retroactive Medicaid coverage in March and April, but not in May or June. Any services received in March and April that have not already been paid for may be eligible for Medicaid coverage.
Deceased Applicants -- Application for Retroactive Medicaid coverage may be made on behalf of a deceased person. Payment will be made for covered services rendered to the deceased person during each month the person was eligible for Medicaid during the three month period. However, Medicaid does not pay transportation expenses for recipients who are deceased.
Medicaid Coverage During Retroactive Period -- Individuals eligible for Retroactive Medicaid are eligible for the same amount and scope of Medicaid services as was available to other Medicaid recipients during that time period. Coverage of services that normally require prior authorization are not automatically denied due to lack of approval prior to receipt of services during the retroactive eligibility period.
Only Unpaid Medical Bills -- Medicaid will only pay enrolled providers for unpaid medical claims for covered Medicaid services during the three-month retroactive period. Medicaid will not reimburse a recipient for medical services received during the retroactive period that have already been paid.
When an individual is found eligible for Retroactive Medicaid, the individual must provide evidence of this eligibility to their medical provider. Inform the recipient to give a copy of the retroactive Medicaid approval notice to the health care provider to assure that any retroactive claim is processed appropriately. The provider can then attach a copy to the claim before submitting it for payment. The individual remains liable for the unpaid medical bills until the provider has been given this evidence of eligibility and agrees to accept payment by billing Medicaid for this service.
Previous Section Next Section MC #68 (04/25)
517 FAIR HEARINGS
Medicaid applicants and recipients who are affected by an adverse action on their case, taken by DPA Division of Public Assistance , may be entitled to a fair hearing. The request may be made to any employee of DPA Division of Public Assistance in writing, by telephone, via mail and in person. DPA Division of Public Assistance may also receive a request for Fair Hearing through the FFM Federally Facilitated Marketplace . Requests through the FFM Federally Facilitated Marketplace are monitored by the Contracted Service Quality Assurance Unit (CSQA).
In addition, Medicaid recipients who are denied coverage of a specific medical need, including nursing home care by DHCS Division of Health Care Services , may be entitled to a fair hearing.
For fair hearing availability, policies, and procedures, see Administrative Procedures Manual Section 117 .
Previous Section Next Section MC #55 (12/20)
518 ALIEN SPONSOR INCOME
A sponsored alien is an alien admitted into the United States for permanent residence as defined in the Immigration and Nationality Act and, as a condition of entry, was sponsored by a person who executed an affidavit of support for the alien.
518 A. SPONSOR tO ALIEN DEEMING
Sponsors are required to execute an affidavit of support with the Immigration and Nationalization Service (INS) and demonstrate that they can provide enough financial support to the sponsored alien so he or she does not have to rely on public assistance benefits.
One way of showing financial support is to count part of the sponsor's income and resources as the alien's own when determining the alien's Medicaid eligibility and benefit level. This attribution of income is called deeming.
When a sponsored alien applies for Medicaid, a portion of the income and resources belonging to the sponsor (and sponsor's spouse if the spouse is living with the sponsor) who has signed a legally binding affidavit of support is required to be deemed to the alien, regardless of actual availability.
The deeming rules apply only to eligible lawful permanent residents (LPRs) whose sponsor has signed a legally binding affidavit or support (Form I-864 or I-964A) on or after December 19, 1997.
If necessary, the caseworker may verify whether an alien has a sponsor by submitting INS Form G-845 and G845 Supplement (Document Verification Request and Supplement) to INS and requesting completion of block #7 Affidavit of Support.
518 B. ALIENS NOT SUBJECT tO SPONSOR-tO-ALIEN DEEMING
Aliens without sponsors, including refugees, asylees, parolees, persons granted withholding of deportation, Amerasians, Cuban or Haitian entrants.
Note: Although some of these aliens may be sponsored by an organization such as a church, they are not sponsored on an I-864 Affidavit of Support and that organization does not have to sign a legally binding affidavit of support that would subject that individual to deeming requirements.
Aliens with 40 qualifying quarters of work.
Aliens who became lawful permanent residents before December 19, 1997 and aliens whose sponsors signed affidavits of support before December 19, 1997.
Aliens who are a battered spouse, battered child, or parents or a child of a battered person. Deeming does not apply during any 12-month period providing the battered alien lives in a separate household from the person responsible for the battery. The exemption can be extended for additional 12-month periods if the alien demonstrates that the battery is recognized by a court, administrative order, or by the INS Immigration and Nationalization Service and if DPA Division of Public Assistance determines that the battery has a substantial connection to the need for benefits.
Indigent aliens, whose total income and any cash or in-kind assistance provided by the sponsor or others are less than the gross income limit for the alien's household size. Notify hss.dpa.policy@alaska.gov if such determinations are made. Each indigence determination is effective for 12-months and may be renewed for additional 12-month periods.
Aliens who are children under 18 years old.
518 C. PERIODS oF DEEMING
Sponsor deeming lasts until:
The sponsored alien becomes a naturalized citizen;
The sponsored alien can be credited with 40 quarters of work;
The sponsored alien is no longer in the U.S. United States and is no longer a lawful permanent resident;
The sponsored alien meets one of the exceptions listed in ADLTC MS 518-B ;
The sponsored alien becomes blind or disabled (at any age) after admission to the U.S. United States as a LPR Lawful Permanent Resident ;
The sponsored alien turned 65 years old after admission to the U.S. as a LPR Lawful Permanent Resident ;
The sponsored or the sponsored alien dies; or
Three years (36 months) after the date the sponsored alien was admitted to the U.S. United States as a LPR Lawful Permanent Resident .
518 D. DEEMING SPONSOR INCOME aND RESOURCES
See APA MS 460-2(B) .
518 E. CHANGES iN SPONSOR
If the alien reports during the certification period that the sponsor has changed, the deemed income and resources are recalculated based on the income and resources of the new sponsor and sponsor's spouse.
If an alien loses his/her sponsor and does not obtain another, the deemed income and resources of the previous sponsor continue to be attributed to the alien until another sponsor is obtained or until the period of deeming ends, which occurs first.
If the sponsor dies, the deemed income of the sponsor is no longer attributed to the alien.
518 F. SPONSORED ALIEN'S RESPONSIBILITIES
Provide information and verification needed to calculate deemed income at initial application and renewal.
Report the required information about the sponsor and sponsor's spouse if the alien obtains a new sponsor during the certification period.
Report if the sponsor or the sponsor's spouse change or lose employment or die during the certification period.
518 G. CASEWORKER'S RESPONSIBILITIES
Obtain at initial application the name, address, and the phone number of the sponsor; verification of the income and resources of the sponsor and sponsor's spouse (if living with the sponsor).
Verify the income, resources, and any questionable information needed to determine the household's eligibility and benefit amount.
Assist the alien in obtaining verification.
Previous Section Next Section MC #55 (12/20)
520 ELIGIBILITY REQUIREMENTS THAT FOLLOW APA Adult Public Assistance POLICY
520 A. APPLICATION PROCESS
In order for the Division of Public Assistance (DPA) to determine a household's eligibility, the household must:
Submit an application that meets the identifiable application requirements in one of the following ways:
by mail;
in person;
online;
by fax;
by phone; or
by email.
Note: A Medicaid application submitted through the FFM Federally Facilitated Marketplace or SSP Self Service Portal can be used for any category of Medicaid. For ADLTC Aged, Disabled, and Long Term Care Medicaid categories, the caseworker will need additional information from the household, such as resources, before they can determine eligibility. An FFM Federally Facilitated Marketplace or SSP Self Service Portal application can only be used to apply for Medicaid, not APA Adult Public Assistance .
Participate in an interview with DPA Division of Public Assistance caseworker or DPA Division of Public Assistance contracted fee agent; and provide documentation and verification, including required forms, needed to determine program eligibility.
All households may file an application the same day they contact DPA Division of Public Assistance to establish a protected filing date. DPA Division of Public Assistance will help all households with the application and renewal process.
A Native Family Assistance Program (NFAP) application form is an acceptable application and renewal form.
Medicaid also uses the MED 4 application form for an individual applying for or receiving institutional or HCB Home and Community-Based waiver services. The application must be completed, and necessary forms signed by the applicant, a relative or a guardian acting on his or her behalf. If the applicant is married and living with his or her spouse or entering a nursing home, collect income and resource information of the spouse in order to determine if the community spouse should receive an income maintenance allowance from the institutional or HCB Home and Community-Based waiver spouse.
Fee agents help households who live in communities that do not have a local DPA Division of Public Assistance office apply for public assistance. The fee agent can help the household apply online or use DPA Division of Public Assistance applications and other forms provided by DPA Division of Public Assistance . Households are not required to go to a fee agent and may apply directly through DPA Division of Public Assistance .
The receipt of an identifiable application by DPA Division of Public Assistance establishes the application filing date. An identifiable application must contain the applicant's name, address, and signature.
When the applicant asks to apply for another program prior to a timely Medicaid eligibility determination, use the original filing date and benefit start date for all programs. If the request occurs more than 45 days after a MAGI Modified Adjusted Gross Income Medicaid application was received or more than 90 days after an ADLTC Aged, Disabled, and Long Term Care Medicaid application was received, a new application is required for another program.
Note: Online applications include an electronic signature. Paper applications can be signed by e-signature, digital signature, or a handwritten signature created on an electronic device (finger/stylus to screen) starting October 1, 2024. Telephonic signatures must be recorded by a caseworker through the VCC Virtual Call Center .
When households apply for multiple programs, DPA Division of Public Assistance must make a Medicaid determination based on the information in the application. DPA Division of Public Assistance must not delay the Medicaid determination if more information is needed for other programs.
Children in SSI Supplemental Security Income -related categories (for examples, SSI Supplemental Security Income , TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 , HCB Home and Community-Based waiver services, Special LTC Long Term Care Standard, etc.) are reviewed annually.
When a new or review application is received for other DPA Division of Public Assistance programs, prior to the established date for the Medicaid renewal, the new or review application should not be used to establish a new certification period for Medicaid benefits. It should be reviewed for reports of change.
An interview is not required at renewal. See section 522(D) .
520 B. WHEN AN APPLICATION IS REQUIRED: |
Upon the individual's first application for Medicaid.
Upon application from a denied, withdrawn, or closed status, unless the denial or closure was the result of an administrative error.
Any time the caseworker believes the individual's circumstances have changed sufficiently to justify conducting a special redetermination of eligibility, including when an office conducts a special review project for all or part of its caseload.
Note: If an individual is losing eligibility in the Expansion Group because they are turning 65 or have been determined disabled, we must attempt to determine their eligibility for ADLTC Aged, Disabled, and Long Term Care Medicaid without requiring an application or interview.
520 C. PROOF OF UNITED STATES CITIZENSHIP AND QUALIFIED ALIEN STATUS
Refer to MAGI MS 808 for policy on U.S. United States citizenship and eligible alien status. See this section for U.S. United States citizenship verification procedures and identity verification procedures.
Citizenship and qualified alien status must be verified for most individuals. Verification of satisfactory immigration status is not required for an individual applying for Emergency Treatment for Aliens (See section 576 ). In addition, some U.S. United States citizens are exempt from the requirement to provide proof. See section 520-C(1) below.
Once a person’s U.S. United States citizenship is documented and recorded, it is not necessary to get proof again unless that person’s citizenship becomes questionable.
Proof of U.S. United States United citizenship or qualified alien status is only needed for the individuals who will receive Medicaid benefits, not for individuals applying for or renewing Medicaid on behalf of someone else.
If a mandatory household member is found ineligible for Medicaid for lack of verification of citizenship and identify, or immigration status, that individual's needs and income continue to be included in the financial eligibility determination for the household.
Reminder: If an individual claims he or she is an U.S. United States citizen or qualified alien and the proof of status cannot be promptly verified through a computer match or others acceptable documentation, the individual must be given a reasonable opportunity period (90 days) to provide acceptable proof of their citizenship or qualified alien status. See Section 520(C) .
1. WHEN PROOF OF U.S. CITIZENSHIP IS NOT REQUIRED
The following U.S. United States citizens are exempt from the requirement to provide proof:
A current Supplemental Security Income (SSI) recipient
An individual entitled to or enrolled in any part of Medicare
An individual receiving Social Security Disability Insurance (SSDI) benefits
Children in state foster care or Title IV-E adoption assistance
Children receiving Newborn Medicaid coverage
Qualified aliens receiving these benefits are still required to provide proof of their qualified alien status.
Note: In some circumstances non-citizens may receive SSDI Social Security Disability Insurance , SSI Supplemental Security Income or Medicare. Therefore, receipt of these programs does not exempt the individual from verifying their alien status.
2. ELECTRONIC AND INTERFACE VERIFICATION FOR U.S. CITIZENSHIP
Data Matches and Interfaces
Verification of an individual's citizenship is first pursued through an electronic interface.
A) Federal Data Services HUB
In most cases, proof of citizenship will be immediately available in ARIES Alaska's Resource for Integrated Eligibility Services through a data match with the federal data services hub.
B) State Verification Exchange System (SVES) with the Social Security Administration (SSA)
If proof is not available through the federal data services hub in ARIES Alaska's Resource for Integrated Eligibility Services , it is possible that acceptable proof may be available through other data matches in EIS Eligibility Information System , but only if the individual is already known to EIS Eligibility Information System . For individuals whose Medicaid eligibility is being determined in EIS Eligibility Information System , proof of citizenship or qualified alien status must be sought through electronic data interfaces in EIS Eligibility Information System .
Proof of citizenship will be available within a few days through a SVES State Verification Exchange System data match with SSA Social Security Administration . If the SVES State Verification Exchange System response does not verify citizenship, the caseworker must confirm that the correct name and SSN Social Security Number was used for the data match. If not, the caseworker must make the corrections in either ARIES Alaska's Resource for Integrated Eligibility Services or EIS Eligibility Information System and request a new data match.
The SVES State Verification Exchange System interface in EIS Eligibility Information System may be used to verify a person's SSN Social Security Number , U.S. United States citizenship and identity. The ET Eligibility Technician may accomplish this by submitting a SVES State Verification Exchange System inquiry for one or more persons on the INME/SVIR or SSDO SSN / Date of Birth / Sex screens.
3. PROOF OF U.S. United States CITIZENSHIP
If proof through an electronic data match or interface is not promptly available, verification of the individual's citizenship or qualified alien status may be obtained through documentary proof.
When accepting documentary proof, a photocopy, fax, scanned, or other copy of a document must be accepted to the same extent as an original document, unless there is good reason to question the document or the information on the document. Although some documents contain a statement, DO NOT COPY, DPA Division of Public Assistance staff may copy and file these documents in the case file for official purpose of establishing Medicaid eligibility.
4. DOCUMENTARY PROOF OF U.S. United States CITIZENSHIP
The following documents are considered acceptable evidence of citizenship for other DPA Division of Public Assistance programs requiring proof of identity, these documents are acceptable evidence for both citizenship and identity.
A U.S. United States Passport, including a U.S. United States Passport Card issued by the Department of State, even if expired, as long as such Passport or Card was issued without limitation
A Certificate of Naturalization
A Certificate of U.S. United States Citizenship
A valid State-issued driver's license if the state issuing the license requires proof of U.S. United States citizenship, or obtains and verifies a social security number from the applicant who is a citizen before issuing such license. All of these enhanced drivers licenses have a picture of the U.S. United States flag on the front of the license.
Note: Washington, Michigan, Minnesota, New York, and Vermont are the only states that currently issue an enhanced driver's license (EDL).
Documentary evidence issued by a federally recognized Indian Tribe, such as a Tribal enrollment card or Certificate of Degree of Indian Blood, which:
Identifies the Federally recognized Indian Tribe that issued the document; and
Identifies the individual by name; and
Confirms the individual's membership, enrollment, or affiliation with the Tribe.
5. PROOF OF U.S. United States CITIZENSHIP OBTAINED USING A LISTED DOCUMENT AND PROOF OF IDENTITY
Only if citizenship cannot be obtained through an electronic interface and the individual does not provide a document listed in section 520 B(4), a document from the following list and proof of identity from section 520 B(6) may be used for U.S. United States citizenship verification.
A U.S. United States public birth certificate showing birth in one of the 50 States, the District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam, the Virgin Islands of the U.S. United States (on or after January 17, 1917), American Samoa, Swain's Island, and the Northern Mariana Island (after November 4, 1986). This document may be obtained from a data match or online access with the Health Analytics & Vital Records ( HAVR Health Analytics & Vital Records ). When birth information is verified through the online HAVR Health Analytics & Vital Records Health access look up, a screen print of the information must be marked 'For DPA Division of Public Assistance Use Only' and must be placed in case file. These screen prints must not be copied for other uses.
A certification of Report of Birth issued to U.S. United States citizens who were born outside the U.S. United States
A Report of Birth Abroad of a U.S. United States Citizen.
A U.S. United States Citizen I.D. Card.
A Northern Marianas Identification Card issued to a collectively naturalized citizen, who was born in the Northern Marianas Islands before November 4, 1986.
An American Indian Card issued by the Department of Homeland Security with the classification code "KIC." These are issued to identify a member of the Texas Band of Kickapoos.
A final adoption decree showing the child's name and U.S. United States place of birth, or if an adoption is not final, a statement from a state-approved adoption agency that shows the child's name and U.S. United States place of birth.
Evidence of U.S. United States Civil Service employment before June 1, 1976.
U.S. United States Military Record showing a U.S. United States place of birth.
A data match with the Systematic Alien Verification for Entitlements (SAVE) Program or any other process established by the Department of Homeland Security to verify that an individual is a naturalized citizen.
Documentation that a child meets the requirements of section 101 of the Child Citizenship Act of 2000.
Extract of a hospital record on hospital letterhead established at the time of the person's birth that was created 5 years before the initial Medicaid application date and indicates the U.S. United States place of birth, excluding souvenir 'birth certificates.' For children under 16 years old, the document must have been created near the time of birth of 5 years before the date of Medicaid application.
Life, health, or other insurance record that indicates a U.S. United States place of birth. The record must have been created 5 years before the initial Medicaid application date.
Official religious record recorded with the religious organization within 3 months of birth showing that the birth occurred in the U.S. United States
School records, including preschool, Head Start and day-care, showing the child's name and U.S. United States place of birth and the names and places of birth of the applicant's parents.
Once of the following documents that show a U.S. United States place of birth and was created at least 5 years before the application Medicaid. For children under 16. the document must have been created near the time of birth or 5 years before the date of application:
Seneca Indian tribal census
Bureau of Indian Affairs tribal census records of the Navajo Indians
U.S. United States State Vital Statistics official notification of birth registration
A delayed U.S. United States public birth record that is recorded more than 5 years after the person's birth
Statement signed by the physician or midwife who was in attendance at the time of birth
The Roll of Alaska Natives maintained by the Bureau of Indian Affairs
Institutional admission papers from a nursing facility, skilled care facility or other institution created at least 5 years before the initial Medicaid application date that indicates U.S. United States place of birth.
Clinic, doctor, or hospital records, excluding immunization records created at least 5 years before the initial Medicaid application date that indicates the U.S. United States place of birth. For children under 16, the document must have been created near the time of birth or 5 years before the date of application.
If an applicant does not have one of the document listed above, he or she may submit two written affidavits signed under penalty of perjury by 2 other individuals who can reasonably attest to the applicant's citizenship, and that contains the applicant's name, date of birth, and place of U.S. United States birth. The individuals attesting to the applicants U.S. United States citizenship must be knowledgeable regarding the citizenship claim, and if known, why the applicant's claim to citizenship does not exist or cannot be easily obtained. The individual's must also provide proof of their own citizenship and identity. At least one of the attesting individuals must not be related to the applicant. A written affidavit must also be provided by the applicant explaining why proof does not exist or cannot be obtained. The affidavits do not have to be notarized.
6. PROOF OF IDENTITY ONLY
A driver's license issued by a state or territory with a photograph or other identifying information. Refer to section 520-B(4) when reviewing a driver's license from Michigan, New York, Vermont, or Washington, as the driver's license, if meeting requirements, may verify citizenship.
School identification card with a photograph.
U.S. United States military card or draft record.
Identification card issued by the federal, state, or local government with the same information included on the drivers' licenses.
Military dependent's identification card.
Certificate of Degree of Indian Blood, or other American Indian/Alaska Native Tribal Document that does not meet the requirements outlined in section 520(B)4 .
U.S. United States Coast Guard Merchant Mariner card.
Finding of identity from a federal or state governmental agency. The agency may accept as proof of identity a finding from a federal agency or another state agency, including, but not limited to a public assistance, law enforcement, internal revenue or tax bureau, or corrections agency, if the agency has verified and certified the identity of the individual.
For children under age 16, a clinic, doctor, hospital, or school record. School records may include nursery or day-care records and report cards that are verified by the nursery or day-care.
Identity affidavit signed under penalty of perjury by a residential care facility director or administrator on behalf of an institutionalized disabled individual in the facility. It is not required to be notarized.
7. PROOF OF QUALIFIED ALIEN STATUS
If verification of alien status is not available from electronic sources, an individual must provide proof of his or her alien status.
The following documents are acceptable for determining alien status and whether the alien is subject to the five-year waiting period. Certain USCIS U.S. Citizenship and Immigration Services documents can be viewed online at https://www.uscis.gov/forms/forms .
IMMIGRATION STATUS VERIFICATION DOCUMENT (USCIS FORMS) Legal Permanent Resident I-551 (referred to as a permanent resident card), or I-94 annotated with a temporary I-551 stamp (for recent arrivals or aliens who have applied for a replacement I-551). Refugee I-94 stamped showing admission under section 207 of the INA and date of entry to the U.S. United States , or I-668B annotated 274a. 12(a)(3), or I-766 annotated A3, or I-571. (Refugees usually adjust to LPR Lawful Permanent Resident status after 12 months in the U.S. however, they are still considered refugee for eligibility purposes when they have a I-551 with a code of RE-6, RE-7, RE-8, or RE-9.) Special Immigrants I-94 or passport stamped with an "S" category. Asylee I-94 stamped showing grant of asylum under section 208 and date of entry, or A grant letter from the Asylum Office of the USCIS U.S. Citizenship and Immigration Services , or I-688B annotated 274a. 12(a)(5), or I-766 annotated A5, or Court order of an immigration judge showing asylum granted under section 208. Parolee I-94 annotated with stamp showing grant of parole under 212(d)(5) and a date showing granting of parole for at least 1 year. Deportation Withheld Order of an immigration judge showing deportation withheld under section 243(h) and date of grant, or I-688B annotated 274a. 12(a)(10), or I-766 annotated A-10. Conditional Entrant I-94 with stamp showing admission under section 203(a)(7), refugee-conditional entry, or I-688B annotated 274a. 12(a)(3), or I-766 annotated A3 Battered Spouse of Child of U.S. United States Citizen or Permanent Legal Resident Approved or pending I-130 or I-360 petition showing a prima facie case that he or she is protected under Violence Against Women Act, and Verification that the individual responsible for the battery or cruelty is no longer living in the household of the victim. Cuban or Haitian Entrant I-94 with stamp showing parole as Cuban/Haitian Entrant under section 212(d)(5) of the INA Immigration & Nationality Act . Form I-551 with code CU6, CU7, or CH6. Foreign passport containing an unexpired temporary I-551 stamp with the code CU6 or CU7. U.S. United States Military Veteran, Active Duty Military (includes spouse and unmarried dependent children under 21) Green Form DD-2 marked ACTIVE, or A current order showing the individuals is on the full-time duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard (Reserves are not considered active duty), or DD-214 indicating honorable discharge, or Discharge papers indicating honorable discharge Victims of Trafficking (includes certain eligible immediate family members holding a derivative T-Visa) Letter of certification from the Office of Refugee Resettlement (ORR). The caseworker must verify the validity of this letter and notify ORR Office of Refugee Resettlement of the benefits for which the individual has applied by calling the toll-free trafficking verification line at 1-866-401-5510. Form I-797a indicating Class T-1 Visa. Form I-797a indicating T-2 (spouse), T-3 (child), T-4 (parent, or T-5 (unmarried sibling under age 18 years on the date such alien's T visa application was filed), known as a Derivative Visa. Note: T status is valid for 3 years from date of approval and is not renewable. However, the individual may adjust to lawful permanent resident status within the 90-day period immediately preceding the expiration of T status. American Indian Born in Canada Birth or baptismal certificate issued on a reservation, or Tribal records, or Letter from the Canadian Department of Indian Affairs, or School records.
Note: If an applicant presents a receipt indicating that he or she has applied to USCIS U.S. Citizenship and Immigration Services for a replacement document for one of the documents identified above, contact the USCIS U.S. Citizenship and Immigration Services to verify status by filing a G-845 with the local USCIS U.S. Citizenship and Immigration Services district office and attach a copy of the receipt.
8. SYSTEMATIC ALIEN VERIFICATION FOR ENTITLEMENTS (SAVE) PROGRAM
The Systematic Alien Verification for Entitlements ( SAVE Systematic Alien Verification for Entitlements ) is a program run by the U.S. United States Citizenship and Immigration Services which provides both an online system and a paper-based process to verify the immigration status of aliens.
The Verification Information System (VIS) is the online verification system. The paper-based process makes use of the G-845, Document Verification Request.
The documents provided by each alien as verification of immigration status must be authenticated by using the SAVE Systematic Alien Verification for Entitlements program. The VIS Verification Information System system will identify whether or not the alien has been lawfully admitted into the U.S. United States However, it may not provide enough information to determine whether or not the individual is a "qualified alien." The date of entry indicated on the VIS Verification Information System database may not accurately reflect the date an immigrant physically arrived in the U.S. United States Secondary verification may be needed if no records are found or if there are discrepancies between the alien's documents and VIS Verification Information System .
Written consent from the household is required to contact USCIS U.S. Citizenship and Immigration Services to obtain documentation or information to verify the alien's status.
If the alien does not want the caseworker to contact USCIS U.S. Citizenship and Immigration Services , the household can withdraw its application or participate without that member.
Written consent is not required to contact USCIS U.S. Citizenship and Immigration Services to verify the validity of documentation provided by the alien or use the SAVE Systematic Alien Verification for Entitlements Program inquiry process.
Verification of each alien's status through the SAVE Systematic Alien Verification for Entitlements program is required whenever an application is processed for a household containing one or more alien members, and whenever an alien is added to a household. All such contacts must be clearly documented in the case record.
See Administrative Procedures Manual Section 105-14 for instructions on how to use the SAVE Systematic Alien Verification for Entitlements program.
520 D. ALASKA NATIVE CLAIMS SETTLEMENT ACT (ANCSA) pAYMENTS aND aSSETS
Refer to APA Manual Section 442-3(A)8 and APA MS 432-4L for policy on ANCSA Alaska Native Claims Settlement Act payments and Assets.
Note: The Alaska Native Settlement Trust Act (HR 42) excludes certain payments from a settlement trust to an aged, blind, or disabled Alaskan Native or descendant of an Alaskan Native from being used to determine the individual's eligibility for need-based federal programs. This exclusion applies for a five-year period beginning on the date the law was enacted July 7, 2025, through July 6, 2030. ANCSA Alaska Native Claims Settlement Act payments are excluded from income the month of receipt and as a resource if retained the following month. This exemption also applies to cost of care calculations for Long Term Care.
520 E. DISABILITY DETERMINATIONS
The case file should contain a copy of the recipient’s long-term care medical authorization, approval for HCB Home and Community-Based waiver services from the DSDS Division of Senior and Disabilities Services , and the SSI Supplemental Security Income or SSA Social Security Administration approval, whichever are applicable. If the person is disabled, it is very important to record the SSA Social Security Administration date of disability onset, as this date may determine the start date for retroactive Medicaid eligibility.
Refer to APA Manual Section 425 and Administrative Procedures Manual Section 115-9 for policy and procedures on disability determinations.
Exception: SGA Substantial Gainful Activity is not a factor for Working Disabled Medicaid Buy-In. See Section 534 .
Note: A disability decision made by the Social Security Administration ( SSA Social Security Administration ) always trumps a decision made by Disability Determination Service ( DDS Disability Determination Service ). Once SSA Social Security Administration determines that an individual does not meet the disability requirements, it supersedes any state only disability determination that found the individual disabled. If we have an open APA Adult Public Assistance / ME Medicaid case based on a determination of disability made by DDS Disability Determination Service and SSA Social Security Administration then determines that there is no disability, we would close down the APA Adult Public Assistance / ME Medicaid case based on the SSA Social Security Administration denial. Social Security non-pay status does not necessarily mean that the individual is no longer disabled. An individual in non-pay status may still be eligible for Medicaid, providing they meet all other factors of eligibility. We must always determine if an individual is eligible for another category of Medicaid rather than just closing the case. See APA MS 480-5 .
520 F. VERIFICATION AND DOCUMENTATION
Refer to APA Manual Sections 400-4 & 410-4 for policy on verification, and APA Manual Section 400-5 for policy on documentation.
520 G. CHANGES
Refer to APA Manual Section 480-3 for policy on changes.
520 H. NOTICES
Refer to MAGI MS 802 for policy on notices.
520 I. LOSS OF CONTACT
Refer to APA Manual Section 480-6 for policy on loss of contact.
520 J. AGE
Refer to APA Manual Section 424 for policy on qualifying age.
Exceptions: • SSI Supplemental Security Income Child Cases. A blind or disabled child receiving a SSI Supplemental Security Income payment and related Medicaid must be under age of 18. These children are not included in any other Medicaid categories. • Disabled Child at Home ( TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 ) . To be eligible for the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility category, an individual must be under the age of 19.
520 k. ABLE ACCOUNTS
Refer to APA Manual Section 433-4 for policy on ABLE Achieving a Better Life Experience Act accounts.
520 l. CROWDFUNDING aCCOUNTS
Crowdfunding is the practice of obtaining needed funding by soliciting contributions from a large number of people, typically from the online community, e.g. go fund me. If the client sets up the account themselves and has access to it, it is countable income in the month received and a countable resource the following month.
If the client is a recipient of funds from a crowdfunding account, it is countable income in the month received, except any funds directly paid to vendors on behalf of the client.
520 M. INELIGIBLE SPOUSE RETIREMENT FUND
Retirement funds belonging to an ineligible community spouse is excluded as a resource per APA MS 460-4A . APA MS 431-2G provides a list of possible retirement funds that an ineligible spouse may have.
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521 COORDINATION WITH THE FEDERALLY FACILITATED MARKETPLACE
Applications for Medicaid may be submitted any time to DPA Division of Public Assistance or through the Federally Marketplace (FFM). Applications for qualified health plans through the FFM Federally Facilitated Marketplace are only accepted during the annual open enrollment period and special enrollment periods.
The special enrollment period allows some individuals to enroll in a qualified health plan through the FFM Federally Facilitated Marketplace after the open enrollment period ends. There are three reasons listed that relate to Medicaid:
Medicaid to Marketplace Transfer
Someone is eligible for special enrollment if they were found ineligible for Medicaid and their application was not transferred between the State and the FFM Federally Facilitated Marketplace in time for the individual to enroll in a plan during open enrollment. This includes those who applied with the Division of Public Assistance and were found ineligible for Medicaid and referred to the FFM Federally Facilitated Marketplace as well as people who applied for health care through the FFM Federally Facilitated Marketplace , were assessed eligible for Medicaid by the FFM Federally Facilitated Marketplace and were subsequently found ineligible for Medicaid and referred back to the FFM Federally Facilitated Marketplace .
Unresolved Casework
This refers to applications pended for more information where the pend period did not end before the end of the open enrollment period.
Life Changes
If an individual reports a life change such as a loss of income or divorce.
An individual who receives a special enrollment period for being "in line" prior to the end of open enrollment and selects coverage will be able to claim a hardship exemption from responsibility for payments for months prior to the effective date of their coverage. In other words, they will not be charged a financial penalty for failing to enroll before the end of open enrollment.
521 A. APPLICATION SUBMITTED THROUGH THE FEDERALLY FACILITATED MARKETPLACE
When an individual submits an application to the FFM Federally Facilitated Marketplace and is assessed for Medicaid eligibility, the application information is transferred to ARIES Alaska's Resource for Integrated Eligibility Services via account transfer. The account will contain all of the information the individual provided on the application as well as indication as to whether information was verified through the HUB. The FFM Federally Facilitated Marketplace uses different date sources as verification, but we must accept any finding relating to a criterion of eligibility made by the FFM Federally Facilitated Marketplace , without further verification. The account transfer will also identify individuals who should be screened for eligibility on a basis other than MAGI Modified Adjusted Gross Income and whether an individual has requested a full eligibility determination by Alaska.
Determined Eligible: As of November 1, 2015, Alaska entered into an agreement with the FFM Federally Facilitated Marketplace that gave them the authority to make a final determination of MAGI Modified Adjusted Gross Income Medicaid. The FFM Federally Facilitated Marketplace will not make an eligibility determination for Medicaid categories other than MAGI Modified Adjusted Gross Income .
Undetermined: If the FFM Federally Facilitated Marketplace determines a full formal Medicaid determination is needed or an application for Non-MAGI or Emergency Treatment for Aliens is received, DPA Division of Public Assistance must make an eligibility determination using our normal process. DPA Division of Public Assistance cannot pend for information already given to the FFM Federally Facilitated Marketplace .
Potentially Eligible: If the FFM Federally Facilitated Marketplace determines that the individual appears likely to be eligible for Medicaid, but they had identified an inconsistency between information on the application and information obtained through the HUB, the application is transferred to ARIES Alaska's Resource for Integrated Eligibility Services for resolution and a final eligibility determination.
Partial Eligible: In some situations, the FFM Federally Facilitated Marketplace may be able to verify eligibility for some household members but not other. in these situations, for household members determined eligible, DPA Division of Public Assistance will use the information transferred from the FFM Federally Facilitated Marketplace to issue Medicaid benefits. For those that the FFM Federally Facilitated Marketplace could not determine eligible, then DPA Division of Public Assistance must make a full determination.
Note: If we determine an individual ineligible for Medicaid (denial or termination), and the case is in EIS, a referral must be made to the FFM by sending the M070. Individuals who are found ineligible for Medicaid due to procedural reasons and those who do not attest to U.S. citizenship or eligible alien status should not be referred to the FFM Federally Facilitated Marketplace . A procedural denial or termination is one based on something other than a confirmation of ineligibility. Examples are failure to provide information needed to determine eligibility (including failure to verify eligible alien status after a reasonable opportunity period), failure to comply with assignment of rights or medical child support cooperation requirements, and failure to apply for other benefits for which the individual may be eligible.
521 B. APPLICATION SUBMITTED THROUGH DPA Division of Public Assistance
Medicaid eligibility will be determined for each application for medical assistance submitted to DPA Division of Public Assistance . If the household is not eligibility for any category of Medicaid, the application will be denied and household information will be transferred to the FFM Federally Facilitated Marketplace by entering the information into ARIES Alaska's Resource for Integrated Eligibility Services . The FFM Federally Facilitated Marketplace will then determine the household's eligibility for the APTC and provide information to the household about QHP Qualified Health Plan they may purchase.
Note: If we determine an individual ineligible for Medicaid (denial or termination), and the case is in EIS, a referral must be made to the FFM Federally Facilitated Marketplace by sending the M070. Individuals who are found ineligible for Medicaid due to procedural reasons and those who do not attest to U.S. citizenship or eligible alien status should not be referred to the FFM Federally Facilitated Marketplace . A procedural denial or termination is one based on something other than a confirmation of ineligibility. Examples are failure to provide information needed to determine eligibility (including failure to verify eligible alien status after a reasonable opportunity period), failure to comply with assignment of rights or medical child support cooperation requirements, and failure to apply for other benefits for which the individual may be eligible.
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522 MEDICAID EXCEPTIONS TO APA Adult Public Assistance ELIGIBILITY POLICY
Note: Effective October 1, 2026 individuals must meet Medicaid qualified alien requirements. Refer to MAGI MS 808 for policy on U.S. citizenship and eligible alien status. Refer to MS 520(C) for U.S. citizenship verification procedures and identity verification procedures.
522 A. SPECIAL NON-IMMIGRANT GROUPS
Some aliens may be lawfully admitted but only for a temporary or specified time (visitors, tourists, students, diplomats, crewmen on shore leave, temporary workers, members of the foreign press, etc.). These aliens are not eligible for Medicaid because of the temporary nature of their admission status. It is conceivable, but highly unlikely, that a legal, non-immigrant would meet the state residency requirements, under section 513 . If they are residents and they meet all other Medicaid eligibility criteria, they would be eligible for emergency coverage for aliens under MS 576 .
Compact of Free Association (COFA) migrants from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau are classified as "non-immigrants" but are eligible for Medicaid benefits without the five-year waiting period due to a change in law effective that was effective December 27, 2020.
If a COFA Compact of Free Association migrant applies for U.S. United States citizenship and their status changes to a qualified alien as outlined in MAGI MS 808-2 , the five-year waiting period would now apply unless they meet an exception listed in MAGI MS 808-4 .
Note: Non-Immigrants, with the exception of COFA Compact of Free Association migrants, are not eligible for Medicaid. However, if they are Alaska residents and meet all other Medicaid eligibility criteria, they may be eligible for Emergency Treatment for Aliens (see MS 576 ).
522 b. ACTIONS TAKEN ON THE APPLICATION
Every applicant must be provided with adequate written notice of the action taken on the application. Adequate notice means that the individual is informed of the action taken, the reasons for the action, and the appropriate federal and state regulations that support the action.
1. APPROVING THE APPLICATION
An approval notice must be sent to the household following a determination of eligibility. Same day eligibility determinations are expected whenever possible. If the application cannot be worked right away, the agency must process the application within 45 days.
Eligible First Month/Ineligible Second Month:
A household may be eligible for the month of the application and ineligible in the subsequent month. In this case, the household is approved only for the month of application.
Ineligible First Month/Eligible Second Month:
A household may be ineligible for the month of application but eligible in the subsequent month. Even though they are denied for the month of application, the household does not have to reapply. The same application is used for the first month denial and the determination of eligibility for the subsequent month.
Note: The first month of the certification period is the first month the household is found eligible for assistance. Example: Application received 4/14/22. The individual is not eligible for April 2022 benefits but is eligible for May 2022 benefits. The certification period is 5/01/22 - 4/30/23.
2. BENEFIT START DATE
The benefit start date is the first day of the month that an application is filed with the agency and the agency determines the household is eligible.
The application filing date is the date an identifiable application is received in the office. Applications may be received in several ways:
Online - Each online application will have a time and date stamp whether received through the SSP Self Service Portal or the FFM Federally Facilitated Marketplace . The application filing day will be the date recorded in the time and date stamp.
Paper - Paper applications may be submitted in person, received in the mail, or left in a drop box at the office.
In person - The application date is the date the application is submitted.
By mail - The application date is the date the application is delivered to the office. This includes applications submitted by fee agents.
Drop Box - An application delivered to the drop box before 5pm will have that date as the application date. When an application is delivered to the drop box after 5pm or when the office is closed, the application received date is the following business day.
Telephone - When an application is taken by phone, the application date is the date the phone call was received.
Fax and email - An application can be received via fax or email. The application date is the business day the application is received via fax or scan. If received outside normal office hours, the application date is the first business day after the application is received via fax or email.
3. PENDING THE APPLICATION
When all attempts to verify eligibility requirements electronically have failed and DPA Division of Public Assistance has not been able to verify information by phone, the application must be pended for information needed to determine eligibility. DPA Division of Public Assistance cannot pend for information already given to the FFM Federally Facilitated Marketplace . A notice that clearly informs the applicant what is needed to complete the application must be sent. Applicants will be given at least 15 days, but no more than 30 days, from the date of this notice to provide the verification. Refer to Admin MS 104-4(B) for guidelines.
Applicants contacting the agency within the pend period expressing difficulty in obtaining required verification will be offered assistance. The caseworker must extend the pend period if additional time is needed to obtain the information. A new pend notice must be sent.
4. DENYING THE APPLICATION
A denial notice must be sent to the applicant explaining the reason for the denial. This notice should be sent as soon as possible following the determination of ineligibility, but not later than 45 days following the application filing date.
Applicants denied for failing to provide needed verification by the end of the pend period will be sent a notice of denial at the end of the pend period. If the applicant provides the verification after the pend period but within 45 days of the application filing date, the caseworker must accept the verification and make an eligibility determination without requiring a new application. If the household is found eligible, the caseworker will use the original benefit start date.
Note: When the deadline for processing an application or providing verification does not fall on a workday, it will be extended to the next workday.
5. WITHDRAWING AN APPLICATION
The applicant may voluntarily withdraw the application at any time before the eligibility determination is made.
The signed and dated request to withdraw must be submitted in writing. A telephonically recorded signature over the VCC Virtual Call Center is acceptable. The applicant must be given at least 15 days to provide the requested information. If the information is not provided within the pend period, the case will be denied due to failure to provide requested information.
Document in the case note the reason for the withdrawn application. If the applicant does not provide this information, document the reason as "unknown." Deny the application and send the Medicaid denied-other reasons notice (M213), selecting withdrawal as the reason.
If the applicant verbally requests to withdraw their Medicaid application or their written request does not contain both a signature and a date, the caseworker must send the applicant a notice requesting the required documentation. The applicant must be given at minimum 15 days to respond to the notice. Deny the application if the applicant fails to provide the requested documentation within the pend period. The denial notice must inform the applicant of their right to submit a new application at any time to reapply for Medicaid.
6. DELAYED APPLICATION
If a household's eligibility has not been determined or benefits have not been authorized to an eligible household by the 45th day following the application filing date, the application is delayed. The caseworker will determine the cause for the delay and take appropriate action:
Agency-caused delays
Includes cases where the application was not approved, denied or pended within the allowable time limits.
If an eligibility determination cannot be made by the 45th day from the application filing date because of action required by the agency, the case is left in a pending status. The household must be sent a pend notice by the 45th day.
An application can be used for more than month of application and the following month when there is an agency caused processing delay and a notice of eligibility or ineligibility is not sent by the 45th day. Please note that using the application for more than two months is only allowed when there is an agency caused delay in processing and we are already past the two-month period.
Household-caused delays
Includes situations where the office cannot take further action on the application without an action from the household.
If the household fails to submit the required information by the 45th day from the application filing date, the application is denied.
If the application is not denied timely and information is received from the client after the due date but prior to the agency denying the application, the agency will use the information received to determine applicant eligibility.
522 c. rEASONABLE OPPORTUNITY PERIOD
If an individual's citizenship or qualified alien status cannot be verified through a computer match, the household may submit proof. If the household does not have proof of their citizenship or alien status the caseworker must provide a reasonable opportunity period (90 days) for the household to provide proof of their citizenship or qualified alien status.
1. PROVIDING ASSISTANCE TO APPLICANTS
During the reasonable opportunity period the caseworker must, if needed to verify the individual's status:
Help the individual get a Social Security Number;
Try to resolve any inconsistencies, including errors, between information provided by the individual and data from an electronic source. The caseworker must resubmit corrected information to the electronic data source.
Give the individual information on how to contact the source of the electronic data so they can attempt to resolve the conflict(s) directly.
Let the individual provide other acceptable documentation of citizenship or qualified alien status.
2. MEDICAID ELIGIBILITY DURING REASONABLE OPPORTUNITY PERIOD
Medicaid eligibility for individuals who claim to be U.S. citizens or qualified aliens may not be delayed or denied during the reasonable opportunity period if the individual meets all other eligibility factors. Medicaid benefits must be provided as soon as all other eligibility factors are confirmed. If otherwise eligible, Medicaid benefits begin the first day of the month of application.
If, be the end of the 90-day reasonable opportunity period, the required verification has not been received, the individual must have their Medicaid eligibility terminated with notice of adverse action.
An individual may have more than one reasonable opportunity period. A new application is needed for each 90-day period. If an individual receives more than one reasonable opportunity period in order to provide adequate proof of U.S. citizenship or qualified alien status, a fraud referral may be appropriate.
A fraud referral would be appropriate if it appears the individual is not just experiencing difficulty in providing the necessary proof but is instead seeking to receive Medicaid benefits to which the individual is not entitled.
Note: Children under the age of 19 are not eligible for a 12-month continuous eligibility period if their citizenship or qualified alien stats has not been verified. See MAGI MS 816-1C .
Example: Client applies for medicaid on 4/29/23. Proof of citizenship is not available electronically. The caseworker issues Medicaid and sends a notice informing the individual they have 90 days to provide the needed information, or their Medicaid will end. The information is due 8/02/23. The requested information was not received. The case is closed with adverse action notice effective 8/31/23. Client would receive Medicaid for 5 months.
522 D. RENEWAL INTERVIEW
An interview is not required for a Medicaid renewal.
522 E. RENEWAL REQUIREMENTS
DPA Division of Public Assistance will renew ADLTC Aged, Disabled, and Long Term Care Medicaid eligibility every twelve months.
DPA Division of Public Assistance must attempt to determine continued eligibility using electronic data approximately 60 days before the end of the certification period. This includes checking all interfaces listed in APA MS 410-4 and for reasonable compatibility as outlined in section 523(B) . Federal regulations do not allow us to send a renewal form to the household unless we are unable to determine continued eligibility using the ex parte process.
Individuals who have no income counted on their case and no income is found when checking data sources can only be approved using the ex parte process if we received an application or renewal form attesting to zero income within the last 3 years. After this time frame, a renewal form must be sent to the household for completion to attest to their income.
If continued eligibility can be determined, authorize a new 12 month certification period and send a Medicaid renewal approved notice.
If continued eligibility cannot be determined, document the reason and let EIS Eligibility Information System mail a renewal form approximately 45 days before the end of the certification period.
If not returned by the due date, the case will auto close. Remember to send the FFM Federally Facilitated Marketplace Referral Notice (M070).
If returned by the due date, DPA Division of Public Assistance must make an eligibility decision and mail written notice within 45 days from the date a renewal was received.
Medicaid may end before the end of the certification period if a change is reported that affects the household's eligibility.
If the caseworker has verified information that the household is ineligible, close the case with 10 day notice of adverse action. Remember to add verbiage to the free form section of the closure notice referring them to the FFM Federally Facilitated Marketplace .
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523 MEDICAID EXCEPTIONS TO APA Adult Public Assistance INCOME POLICY
Countable income is determined according to the criteria of the APA Adult Public Assistance program, except as provided below:
523 A. SOCIAL SECURITY BENEFITS
Increases in Social Security retirement, survivors, and disability insurance benefits and SSA Social Security Administration COLAs are disregarded for certain grandfathered individuals. See sections 531 and 540 .
523 B. REASONABLE COMPATIBILITY
Reasonable compatibility refers to the standard used to address discrepancy between the client stated earned income and the earned income reported by an electronic data source.
The reasonable compatibility standard is only used when client stated earned income is below the standard and data sources are above the standard.
To be considered reasonably compatible, income electronically reported by Department of Labor (DOL) must be within 10% of the client stated gross monthly income. The most recent quarter reported by DOL Department of Labor and Workforce Development is divided by three to get the average monthly income amount.
Note: Apply the Income Exclusions listed in APA MS 442 before comparing the client's statement of earnings and DOL Department of Labor and Workforce Development electronic verification. The verification code will need to be "interface" for client statement. Actual income information must be used for the cost of care calculation described in section 570 and Working Disabled Medicaid cases.
Actions :
Both the client stated earned income and the electronic data are at or below the income standard. Take client statement and authorize Medicaid. There is no need to check for reasonable compatibility.
Both the client stated earned income and the electronic data are above the income standard. Take client statement and deny the Medicaid. There is no need to check for reasonable compatibility.
Client stated earned income is above the income standard and the amount verified using electronic data is at or below the income standard. Accept client statement and deny the Medicaid. There is no need to check for reasonable compatibility.
Client stated earned income is at or below the income standard and the amount verified using electronic data is above the income standard. Check for reasonable compatibility. If the data source is within 10% of the client stated income, approve Medicaid using the client stated income.
Client stated they have a new job; there is no electronic history. In this type of scenario, the caseworker must pursue further verification of income.
Example: Client stated monthly gross earned income is $3,500 Subtract $20 = $3,480 Subtract $65 = $3,415 Subtract one half = $1,707.50 Client stated monthly gross earned income $1,707.50 10% of $1,707.50 is $170.75 Add $170.75 to $1,707.50 = $1,878.25 Subtract $170.75 from $1,707.50 = $1,536.75 The 10% range determined by the client stated income is $1,536.75 - $1,878.25 The DOL Department of Labor and Workforce Development monthly average is $3,733.33 Subtract $20 = $3,713.33 Subtract $65 = $3,648.33 Subtract one half = $1,824.17 There is reasonable compatibility as the DOL Department of Labor and Workforce Development monthly average of $1,824.17 is within the 10% range.
523 C. POST-ELIGIBILITY DETERMINATION
SSI Supplemental Security Income benefits are disregarded in the post-eligibility determination process for the first two months of institutionalization of persons eligible under sections 1619(a) or (b) of the Social Security Act if the person was receiving SSI Supplemental Security Income benefits in the month before entering the institution. See section 530-E for policy on 1619(b) eligible individuals.
523 D. COST-OF-CARE DETERMINATION
The withheld portion of an SSA Social Security Administration overpayment is disregarded in the post-eligibility cost of care determination. Payments from Alaska’s Senior Benefits Program count as income in the cost of care determination. Because federal income tax returns are disregarded as income, they cannot be used to determine the cost of care for institutionalized individuals and certain individuals eligible for services under a HCB Home and Community-Based waiver. However, the PNA Personal Needs Allowance may still be increased to cover mandatory withholding from earned and unearned income to cover federal, state, and local taxes. See section 570-E(1) .
523 E. VETERANS AFFAIRS PAYMENTS
Payments made by the Veterans Affairs up to $200 per month are not counted as income in the post-eligibility computation for a Medicaid recipient residing in a state Veteran’s Home or an institutional facility.
523 F. INCOME DISREGARDS
Income disregards are not applied to an adult applicant's gross income when determining financial eligibility for the Special Long Term Care eligibility category. These recipients do not receive the $20 general income disregard. Deductions to support a non-institutionalized spouse and dependents are not allowed when determining initial financial eligibility. See section 550-C for policy on Special Long Term Care eligibility.
If the applicant is institutionalized or receiving Home and Community Based ( HCB Home and Community-Based ) waiver services and has a spouse remaining in the community, the spouse’s income is deemed available to the applicant through the month they ceased living together. The community spouse’s income is no longer considered available to the institutional spouse beginning the first full month that the institutional spouse lived in the institution or received HCB Home and Community-Based waiver services.
If a couple is living together and only one is receiving HCB Home and Community-Based waiver services, the income eligibility standard for one individual is used to determine Medicaid eligibility for the HCB Home and Community-Based waiver recipient.
Note: This section does not apply to a disabled child living at home who is eligible under MS 533 ( TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 ), which looks only at the child’s income.
523 G. FEDERAL POVERTY GUIDELINES FOR ALASKA
The Federal Poverty Guidelines for Alaska are used in place of the APA Adult Public Assistance standard when determining eligibility for Qualified Medicare Beneficiary ( QMB Qualified Medicare Beneficiaries ), Special Low-Income Medicare Beneficiary ( SLMB Specified Low Income Medicare Beneficiaries ) categories, and Qualified Disabled and Working Individuals ( QDWI Qualified Disabled and Working Individuals ) eligibility categories. See Addendum 1 .
523 H. IN-KIND SUPPORT AND MAINTENANCE
The APA Adult Public Assistance policy regarding the value of any support and maintenance that an individual or couple receives in-kind at APA Manual section 440-3 does not apply when determining eligibility for the Special Long Term Care category. See section 526-D for policy on how in-kind income is counted for the Special Long Term Care category.
523 I. INDIVIDUAL INDIAN MONEY ACCOUNTS
Funds deposited or held in an Individual Indian Money ( IIM Individual Indian Money ) account are excluded as income. (See section 524-K for resource policy on IIM Individual Indian Money accounts.)
IIM Individual Indian Money accounts primarily contain money collected by the federal government from farming and grazing leases, timber sales, mining, oil and gas production, and other activities on trust land, as well as certain per capita distributions. The funds in IIM Individual Indian Money accounts are held in trust by the federal government for the benefit of individual Indians.
523 J. ALASKA NATIVE / AMERICAN INDIAN REAL PROPERTY RENTAL INCOME
Rental income received from exempt property in Alaska belonging to an Alaska Native / American Indian is exempt income when determining Medicaid eligibility and post eligibility treatment of income (cost of care).
523 k. dEVELOPMENT OF INCOME REQUIREMENTS DO NOT APPLY TO MEDICAID
Medicaid applicants and recipients are not required to pursue sources of income as a condition of Medicaid eligibility.
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524 MEDICAID EXCEPTIONS TO APA Adult Public Assistance RESOURCE POLICY
The value and count-ability of resources is determined according to the criteria of the APA Adult Public Assistance program, except as provided below.
524 A. REASONABLE COMPATIBILITY
Reasonable compatibility refers to the standard used to address discrepancy between the client stated resources and information from an electronic data source.
Information from an electronic data source (in this case, AVS Asset Verification System in IEVS Instant Eligibility Verification System ) is reasonably compatible if is results in the same eligibility outcome as the client stated information.
This policy change does not alter other program requirements for which resources must be verified or how resources are counted for program eligibility.
Note: Actual resource information must be used for Long Term Care cases and Medicaid cases that use a Medicaid qualifying trust.
Actions:
Both the client stated countable resources and electronic data are at or below the resource limit. Take client statement and authorize Medicaid.
Both the client stated countable resources and the electronic data are above the resource limit. Take client statement and deny the Medicaid.
Client stated countable resources are above the resource limit and the amount verified using the electronic data is at or below the resource limit. Accept client statement and deny Medicaid.
Client stated countable resources are at or below the resource limit and the amount verified using electronic data is above the resource limit. Further verification is required.
The reasonable compatibility test will only be applied to resources that have not otherwise been verified (for example, if a recipient submits bank statements as part of their renewal or if the resource has been verified by another program). It can only be applied when resource information is available through AVS Asset Verification System .
Example 1:
Shania is due for her Medicaid renewal and previously reported the following countable resources:
Savings account: $5 (A)
AVS Asset Verification System returns the following information:
Savings account: $200 (match with A)
Undisclosed checking account: $800 (new)
Reasonable Compatibility Determination:
Medicaid Resource Limit: $2,000
Total client stated resources: $5
Total AVS Asset Verification System and client stated resources: $200 + $800 = $1,000
Result: reasonably compatible because the sum of both calculations is less than the resource limit. No further verification is requested from Shania. Client statement is used to determine resource eligibility.
Example 2:
Johnny is due for his Medicaid renewal and previously reported the following countable resources:
Checking account: $500 (A)
Savings account: $700 (B)
Savings bond: $300 (B)
AVS Asset Verification System returns the following information:
Checking account: $800 (matched with A)
Savings account: $400 (matched with B)
Undisclosed checking account: $900 (new)
Reasonable compatibility determination:
Medicaid Resource Limit: $2,000
Total client stated resources: $500 + $700 + $300 = $1,300
Total AVS and client stated resources: $800 + $700 + $900 + $300 = $2,700
Result: not reasonably compatible because the sum of countable resources from AVS Asset Verification System is above the Medicaid resource limit. In this case, the $700 savings account amount is used when calculating the total countable resources as it is the higher amount when comparing the client stated and AVS Asset Verification System information. Verification of countable resources is required.
Example 3:
Dolly is due for Medicaid renewal and previously reported the following countable resources:
Checking account: $1000 (A)
Savings account: $500 (B)
AVS Asset Verification System Returns the following information:
Checking account: $2000 (match with A)
savings account: $2500 (match with B)
Reasonable compatibility determination:
Medicaid Resource Limit: $2,000
Total client stated countable resources: $1,000 + $500 = $1,500
Total AVS Asset Verification System and / or client stated resources: $2,000 + $2,500 = $4,500
Result: not reasonably compatible because the sum of countable resources from AVS Asset Verification System is above the Medicaid resource limit. Verification of countable resources is required.
524 B. COMMUNITY SPOUSE RESOURCE ALLOWANCE
Resources may be transferred from the Long Term Care spouse to his or her community spouse to meet the eligibility resource limit (see Addendum 1 for current year allowance amount) to qualify for Medicaid under the Special Long Term Care eligibility category. See Section 553 .
524 C. CONDITIONAL BENEFITS
The APA Adult Public Assistance policy regarding conditional benefits at APA Manual Section 433-2 does not apply. Medicaid does not provide conditional benefits.
524 D. PROPERTY FOR SALE
The APA Adult Public Assistance policy regarding property up for sale at APA Manual Sections 432-1D and 433-2 does not apply in Medicaid-only determinations. Medicaid has no exemption for property up for sale.
524 E. TRANSFER OF RESOURCES
The APA Adult Public Assistance policy regarding transfer of resources at APA Manual Section 433-1 does not apply to Medicaid-only determinations. See Section 554 for Medicaid transfer of asset policy for institutional or waiver applicants and recipients. Federal income tax returns are not subject to Medicaid transfer of asset penalty provisions for 12 months from the date the payments are received. However, payments given away after the exempt period are subject to Medicaid transfer of asset penalty provisions.
524 F. INSTITUTIONAL ALLOTMENT OF RESOURCES
The APA Adult Public Assistance policy regarding financial responsibility of spouses who no longer live together at APA Manual Section 460-2(A) does not apply to institutional or waiver applicants. See Section 553-D for resource eligibility determination and allotment of resources policy.
524 g. INSTITUTIONALIZED INDIVIDUALS WITH SUBSTANTIAL HOME EQUITY
The APA Adult Public Assistance policy regarding exemption of an individual’s home, regardless of its value, APA Manual Section 432-1 , does not apply to institutional or waiver applicants for payment of long-term care services. See Section 553-C for resource eligibility determination and allotment of resources policy.
524 H. PROMISSORY NOTES, LOANS, AND PROPERTY AGREEMENTS
For transfer of asset purposes only, the APA Adult Public Assistance policy regarding promissory notes, loans, and property agreements. APA Manual Section 431-2(I) does not apply to institutional or waiver applicants. See Section 554-H for purchase of promissory notes, land, or mortgages policy.
524 I. LIFE ESTATES
For transfer of asset purposes only, the APA Adult Public Assistance policy regarding life estates. APA Manual Section 431-1(B)(6) does not apply to institutional or waiver applicants. See Section 554-J for purchase of life estates policy.
524 J. RESOURCE LIMIT FOR THE WORKING DISABLED BUY-IN CATEGORY
The APA Adult Public Assistance policy regarding the resource limit at APA Manual Section 430-2 does not apply to the Working Disabled Buy-In category. See Section 534-B for the resource limit.
524 K. INDIVIDUAL INDIAN MONEY ACCOUNTS
Funds deposited or held in an Individual Indian Money ( IIM Individual Indian Money ) account are excluded. However, once funds are removed from an IIM Individual Indian Money account, they become a countable resource.
IIM Individual Indian Money accounts primarily contain money collected by the federal government from farming and grazing leases, timber sales, mining, oil and gas production, and other activities on trust land, as well as certain per capita distributions. The funds in IIM Individual Indian Money accounts are held in trust by the federal government for the benefit of individual Indians.
524 L. ALASKA NATIVE AND AMERICAN INDIAN REAL PROPERTY RESOURCE EXCLUDED
All real property in Alaska owned by an Alaska Native or American Indian is excluded from being a countable resource or as a potential transfer of asset penalty. This includes land and any structures built on the land. The real property does not need to be Native restricted land for this exclusion to apply.
If real property has been determined to be excluded as a resource using the policy described above, it should not be counted as a resource for any other household members' Medicaid eligibility.
Note: Alaska Native property shall remain exempt if it passes from AN/AI Alaska Native / American Indian to one or more relatives, such as a spouse or a child. even if the relatives are not AN/AI Alaska Native / American Indian .
When property owned by an Alaska Native or American Indian is sold, the proceeds are no longer exempt. See conversion of resources in APA MS 440-3(C) .
524 M. DINGELL ACT LANDS
Certain Alaska Native Americans who served in the Armed Forces during the period between August 5, 1964, and December 31, 1971 and haven't received a Native Allotment may receive up to 160 acres in Alaska from the Dingell Act. This land is an exempt resource.
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525 GENERAL MEDICAID TRUST POLICY
Generally, a trust is Individualized Supports an arrangement in which a grantor transfers resources or income to a trustee to be held, managed, or administered by the trustee for the benefit of the grantor or another beneficiary. Medicaid trust provisions that apply to trusts created on or after August 11, 1993 may be divided into two main parts:
General APA Adult Public Assistance /Medicaid trust policy; and
Exceptions to the general Medicaid trust policy.
There are a variety of reasons why a trust is established and there are different types of trusts. General APA Adult Public Assistance /Medicaid trust policy applies to a trust written for purposes other than providing for the Medicaid eligibility of the grantor or beneficiary. See APA Manual Section 431-2(F) .
The kind of trust that a caseworker is more likely to see is a trust that is specifically intended to limit the applicant or recipient’s income and/or resources for the express purpose of Medicaid eligibility. If written and administered correctly, these "Medicaid Qualifying Trusts" will qualify for exceptions to the general trust policy, and are described in the following sections:
Qualifying Income Trusts (see Section 526 );
Special Needs Trusts (see Section 527 ); and
Pooled Trusts (see Section 527 ).
The rules in this manual apply to trusts established after August 11, 1993. If a trust was established before August 11, 1993, different rules apply, which are not included in the manual.
If you encounter a trust that was established prior to August 11, 1993, email the Program Officer at hss.dpa.policy@alaska.gov for guidance.
525 A. DEFINITIONS RELATED TO TRUSTS
Annuity: An annuity is a right to receive fixed, periodic payments, either for life or for a term of years. See section 554(K) for treatment of an annuity.
Beneficiary : A beneficiary is an individual designated by the trust instrument as benefiting from the trust. Commonly, the Medicaid applicant or recipient is the beneficiary.
Corpus: The principal amount of a trust.
Grantor: A grantor is the individual who creates the trust. An individual should still be considered a grantor if their spouse or some other person or entity, with the legal authority to act on their behalf, acts at the direction of the individual to create the trust with income or resources that belong to the individual. A grantor may also be the beneficiary of a trust.
Irrevocable Trust: A trust that does not empower the beneficiary with the ability to revoke the trust in any way and use the principal for his or her own support and maintenance.
Payment: A payment is a disbursement from the trust that benefits the party receiving it. Payments may be in cash or in kind (e.g., the right to use property, such as a home).
Revocable Trust: A trust that the beneficiary can revoke, or request the trustee to revoke, in order to access the principal.
Trust: An arrangement in which a grantor transfers resources or income to a trustee to be held, managed, or administered by the trustee for the benefit of the grantor or another beneficiary. There must be a trust instrument or agreement valid under Alaska Statutes. Trust provisions also apply to legal instruments or devices similar to trusts.
Trustee: A trustee is an individual, individuals, or entity that manages a trust or similar legal device and has a duty to act for the benefit of the trust’s beneficiary.
525 B. GENERAL TRUST PROVISIONS
Some trusts are established by a third party with assets that did not belong to beneficiary at the time it was established, such as a trust created by will from the assets of a relative. Follow policy at APA Manual Section 431-2(F) to determine countable income and resources for one of these trusts.
For all other trusts that do not meet one of the Medicaid exceptions, use the following policy:
1. If the trust is revocable :
The entire principal counts as a resource;
A payment from the trust made to or for the benefit of the beneficiary is income to the beneficiary; and
A payment not made for the benefit of the beneficiary is a transfer of asset for less than fair market value. See Subsection D below.
Note: Use a 60-month look-back period for a transfer of asset from a revocable trust.
2. If the trust is irrevocable :
The principal of the trust does not count as a resource, but a payment that could be made from the trust to or for the benefit of the beneficiary is a countable resource;
A payment from the trust to or for the benefit of the beneficiary is income to the beneficiary; and
A payment made from the trust that is not for the benefit of the beneficiary, is a transfer of asset for less than fair market value.
Note: There is a 36-month look-back period for transfer of assets from an irrevocable trust. If the trust provides that a payment cannot be paid to or for the benefit of the individual, there is a 60-month look-back period. See Subsection D.
525 C. PAYMENTS FROM A TRUST
1. Current Payments:
A payment from the trust is counted as income if it is paid directly to the beneficiary, paid to someone acting on behalf of the beneficiary, or is used to purchase something from which the beneficiary receives some benefit.
2. Future Payments:
If the trust provides that a payment can be made to or for a beneficiary at a future date or under a prescribed set of circumstances, the potential payment is considered an available resource. This is true even if the payment is available in the distant future or only in circumstances unlikely to occur. These future payments are not transfers of assets at less than fair market value; they are payments that could be made for the purpose of determining available resources.
Example: A trust established with money that is set aside for an eight-year old Medicaid beneficiary’s college education, is considered an available resource now.
Note: If you encounter a situation where application of trust policy conflicts with the transfer of assets policy contained in the Transfer of Assets Section 554 , the trust policy supersedes the Transfer of Assets policy. Please contact the Program Officer when this situation occurs for further guidance.
525 D. TRANSFER OF ASSETS FROM A TRUST
The use of a trust may involve a transfer of assets for less than fair market value. See section 554 to determine who is subject to transfer of asset rules. A transfer of asset for less than fair market value may occur when a portion of the trust cannot be paid to or for the benefit of the beneficiary.
The date that portion of the trust is considered to be transferred is the date the trust was established or the date on which payment to the beneficiary was foreclosed, whichever is later. A 60-month look-back period is used.
Any addition to the trust that cannot be paid to or for the benefit of the beneficiary that occurred after the first transfer is considered a new transfer of asset for less than fair market value.
525 E. HARDSHIP EXCEPTIONS
A transfer of asset penalty for a transfer of asset into a trust cannot be applied if it would cause an undue hardship on the beneficiary, such as a beneficiary being forced to go without life sustaining services, see section 554(M)
The Program Officer makes the hardship exception determination on a case specific basis. The caseworker must submit a written statement from the beneficiary or the beneficiary’s representative indicating how the beneficiary’s life or health would be endangered. Please email any hardship requests to hss.dpa.policy@alaska.gov .
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526 QUALIFYING INCOME TRUSTS
A Qualifying Income Trust ( QIT ) is a trust that allows the beneficiary to control the amount of income that is used to determine Medicaid eligibility. A QIT Qualifying Income Trust is often referred to as a Miller Trust . Income that flows directly into the trust is not considered for the purpose of determining Medicaid eligibility. Only payments made from the trust to the beneficiary are countable income. A QIT Qualifying Income Trust may be used to qualify for any category of Medicaid, although it is most often used to qualify for long-term care Medicaid.
A QIT Qualifying Income Trust must meet the following requirements:
The trust must be composed of only the beneficiary’s income , including accumulated interest from the corpus of the trust; and
Upon the death of the beneficiary, the state receives all amounts remaining in the trust, up to an amount equal to the total Medicaid paid on behalf of the beneficiary.
526 A. CASH ASSISTANCE PROGRAMS
The SSI Supplemental Security Income and APA Adult Public Assistance programs do not recognize a QIT Qualifying Income Trust . Therefore, a beneficiary may be eligible for Medicaid but not SSI Supplemental Security Income or APA Adult Public Assistance cash assistance.
526 B. RESOURCES
The principle (or corpus) of an irrevocable qualifying income trust is not a countable resource. If the trust is revocable, the principle is available. APA Adult Public Assistance policy is used to determine the amount of resources available to the beneficiary.
526 C. INCOME PLACED INTO A QIT Qualifying Income Trust
Income placed into a QIT Qualifying Income Trust does not have to be irrevocably assigned to the trust and is not counted in determining the beneficiary’s eligibility for Medicaid. Income, such as Social Security payments, certain federal pensions, and state PERS Public Employees Retirement System and TRS Teacher Retirement System may go into the trust without being considered available to the beneficiary for Medicaid purposes.
Income generated by the trust that remains in the trust is not income to the beneficiary.
526 D. PAYMENTS MADE FROM A QIT Qualifying Income Trust
Payments made from a QIT Qualifying Income Trust are counted as income according to the income rules of the eligibility category for which the beneficiary is applying.
For APA Adult Public Assistance -related and long-term care categories: APA Adult Public Assistance rules are used for counting income, except that a vendor payment made for any form of shelter (room rent, mortgage payments, real property taxes, heating fuel, gas, electricity, water, garbage) is considered income. However, the amount of vendor payments that counts as income cannot exceed the sum of $20 plus one-third of the appropriate SSI Supplemental Security Income eligibility standard. Do not count vendor payments in excess of this amount as income.
Payments made from the trust to a nursing facility for an individual's cost-of-care are exempt as income.
526 E. POST ELIGIBILITY (COST-OF-CARE)
For a beneficiary subject to post-eligibility rules, the cost-of-care liability is calculated using the beneficiary’s total gross income. The amount of income going into a QIT Qualifying Income Trust is added to any other income the beneficiary received in the month to calculate cost-of-care liability. Since income received by the trust has already been subject to post eligibility rules, do not consider payments from the trust for post eligibility purposes. See Section 570 .
By applying post eligibility cost-of-care rules to income going into the trust, a typical QIT Qualifying Income Trust used by a recipient with a cost-of-care liability will not accumulate funds over time. Amounts received by such a trust that are above what may be distributed to the client should go toward cost-of-care. Some deductions allowed for post eligibility purposes may still count as income for eligibility purposes, such as money distributed to a client to maintain a home.
526 F. FUNDS HELD IN A QUALIFYING INCOME TRUST
For a beneficiary subject to Medicaid transfer of asset rules, when the income placed in an irrevocable QIT Qualifying Income Trust exceeds the amount of money paid out to or for the benefit of the beneficiary (e.g., cost-of-care) or the beneficiary’s spouse (e.g., community spouse allowance), the excess income retained by the trust is not subject to the transfer of asset provisions described in the Transfer of Assets Section 554 . The trustee may use these excess funds on behalf of the beneficiary. Any funds remaining in trust at the time the trust is terminated must be paid to the state, up to the amount the state paid in Medicaid benefits for the recipient while the trust existed.
Example : Mr. Baker resides in a nursing facility and has an irrevocable Qualifying Income Trust. On December 5th, he receives a CIRI Cook Inlet Region, Inc. dividend in the amount of $50,000. This amount exceeds Mr. Baker’s $10,000 monthly cost-of-care. The amount remaining in the trust after his monthly cost of care obligation is paid may be retained by the trust and used by the trustee on Mr. Baker's behalf.
526 G. DISSOLVING A TRUST
A trustee cannot dissolve an irrevocable trust without first petitioning the court for legal or practical reasons. For example, if the beneficiary initially relied on the trust to qualify as an APA Adult Public Assistance recipient, but the beneficiary later enters a nursing home or is approved for home and community-based waiver services, the trustee may petition the court to dissolve the trust because the beneficiary’s income is below the nursing home eligibility standard without the trust. If the court dissolves a trust because it is no longer needed for eligibility purposes, the trust provision to repay the state for Medicaid expenditures should be honored by the court.
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527 SPECIAL NEEDS AND POOLED TRUSTS
A Special Needs Trust ( SNT ) and a Pooled Trust are very similar. Both trusts allow the beneficiary to control the amount of both income and resources that are used to determine Medicaid eligibility. Only the payments made from the trust are countable income. Resources held in the trust are exempt while the trust is in place.
527 A. COMMON TRUST PROVISIONS
A Special Needs Trust and a Pooled Trust have the following in common:
The beneficiary must be determined disabled using Social Security criteria.
Note: This can be verified by the receipt of SSDI Social Security Disability Insurance or a State Only Disability Determination; and
The trust may contain the assets of the beneficiary, but may include income the beneficiary receives after the trust is established.
527 B. SPECIAL NEEDS TRUSTS ( SNT )
In addition to the common trust provisions in (A) above, an SNT Special Needs Trust must meet the following criteria:
The disabled beneficiary must be under age 65 at the time the SNT Special Needs Trust is established;
The trust is established for the sole benefit of the beneficiary by the individual, a parent, grandparent, legal guardian of the beneficiary, or a court;
Upon the death of the beneficiary, the State receives all amounts remaining in the trust, up to an amount equal to the total amount of medical assistance paid on behalf of the beneficiary.
Any augmentation of a Special Needs Trust that occurs after the beneficiary reaches age 65 is not covered by this exception.
527 C. POOLED TRUSTS
In addition to the common trust provisions in (A) above, a Pooled Trust must meet the following criteria:
The trust is established and managed by a non-profit entity for the benefit of more than one beneficiary;
A separate account is maintained for each beneficiary of the trust, but for purposes of investment and management, the funds in each account are pooled together;
Each account in the trust is established solely for the benefit of the beneficiary by the beneficiary, the parent, grandparent, legal guardian of the beneficiary, or a court; and
Upon the death of the beneficiary, the non-profit entity may retain a portion of the beneficiary’s trust account (for the purposes of maintaining the Pooled Trust for all beneficiaries). All amounts remaining in the beneficiary’s trust account not retained by the non-profit entity must be paid to the state up to an amount equal to the total amount of medical assistance paid on behalf of the beneficiary.
527 D. INCOME AND RESOURCES
Use the Income policy described for QIT Qualifying Income Trust ’s for the treatment of income placed into an SNT Special Needs Trust or Pooled Trust if the income placed in the trust belongs to the beneficiary. If the income belongs to someone else, income going into the trust is exempt as income to the beneficiary.
Resources placed in an irrevocable SNT Special Needs Trust or Pooled Trust count as resources in the months prior to the month they are placed into the trust. Once a resource is placed in an irrevocable SNT Special Needs Trust or Pooled Trust, that resource is exempt. However, a transfer of assets at less than fair market value may occur unless the transfer is specifically exempted under the Transfer of Assets Section 554 or the resource placed in the trust can be used for the benefit of the beneficiary to purchase items and services for the beneficiary at fair market value.
527 E. CASH ASSISTANCE PROGRAMS
A trust that meets the Medicaid criteria for a Special Needs or a Pooled Trusts is an exempt resource for APA Adult Public Assistance and SSI Supplemental Security Income purposes. However, any money distributed directly to the APA Adult Public Assistance or SSI Supplemental Security Income recipient from the trust counts as income. See APA Manual Section 431-2(F)(3) .
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528 PROCESSING CASES WITH TRUSTS
528 A. INITIAL CASE PROCESSING
The following process must be followed for all initial applications where a Medicaid Qualifying Trust ( MQT Medicaid Qualifying Trust ) is being used to establish Medicaid eligibility. This includes individuals that are reapplying immediately after case closure.
The trust should not be sent to policy for review until the interview has been completed and the application is ready to be approved.
Request and obtain a complete copy of the trust document.
Email hss.dpa.policy@alaska.gov with the PI's client ID, the name of the individual that the trust belongs to, and what type of trust needs to be reviewed. Policy will find the trust document in ILINX with this information. Only one trust will be reviewed per email so if an individual has more than one trust to be reviewed, each trust needs a separate email.
Note: Policy will enter a case note on the existing Medicaid case number if the trust is approved. Policy will send the trust approval document or an explanation of what changes need to be made before the trust can be approved via email to the specific LTC Long Term Care office caseworker who submitted the trust for review. If the trust was submitted by any other office, Policy will send this to the general office email address. If other unrelated documents are attached with the trust in ILINX, the email will be returned and the caseworker will be required to resubmit it without the additional pages.
Request and obtain a copy of the trust bank account showing when the account was established and the monies being deposited into the account.
Note: Although the state cannot require it, it is best practice and highly encouraged that the client deposit all of their countable income directly into the trust bank account. The trustee can then transfer the allowable monthly amount into the client's personal bank account. This helps avoid accidental under-funding of the trust.
Request and obtain a copy of the court document showing that the trust has been registered with the court or use the CourtView Search website to verify registration of the trust. The CourtView Search website is available at: www.records.courts.alaska.gov .
Follow these instructions to determine if a trust has been registered with an Alaskan court:
Type in the first and last name of the trustee and click the search button.
When the search results are displayed, choose the appropriate court record and click on the case number.
The summary screen is displayed that provides the name of the trust, the trustee(s), the case number and the date the trust was registered with the court.
After receiving trust approval, copies of bank statements, and the court document showing the recording of the trust; the Medicaid case can be opened.
If the Medicaid Qualifying Trust is used to establish or maintain Medicaid eligibility, email the following information to the DHCS Division of Health Care Services TPL Third Party Liability Unit at: doh.hcs.rec.info@alaska.gov :
Complete copy of the trust document;
Completed Trust Reporting form that contains the name of the client, the trustee, trustee contact information, bank, and bank account number (The Trust Reporting form is located under e-forms); and
Copy of the trust approval form showing approval from Policy.
528 B. PROCESSING APA Adult Public Assistance -RELATED MEDICAID CASES WITH TRUSTS
When opening a Medicaid case with a Qualifying Income Trust ( QIT Qualifying Income Trust ) , send the following notices:
M140 - APA Adult Public Assistance Medicaid - Qualified Income Trust
M144 - Miller Trust Information - APA Adult Public Assistance
When opening an APA Adult Public Assistance -Medicaid case with a Special Needs or Pooled Trust , send the following notices:
M141 - Medicaid - Special Needs or Pooled Trust
M143 - Special Needs or Pooled Trust Information
Mail the appropriate brochure to the trustee and client:
MED 21 - Trustee Information
MED 22 - Special Needs or Pooled Trusts
MED 23 - Qualifying Income Trusts
528 C. PROCESSING LONG TERM CARE APPLICATIONS WITH TRUSTS
When opening a Waiver case with a Qualifying Income Trust ( QIT Qualifying Income Trust ) , send the following notices:
M112 - Medicaid Approval - Waiver Services
M130 - Cost of Care / Waiver
M142 - Medicaid Trust Information - LTC Long Term Care
When opening a Nursing Home Medicaid Case with a QIT Qualifying Income Trust , send the following notices:
M120 - Cost of Care / LTC Long Term Care Facility
M121 - Medicaid Approved - LTC Long Term Care Facility
M142 - Medicaid Trust Information - LTC Long Term Care
When opening a case with a Special Needs or Pooled Trust , send the following notices:
M141 - Medicaid - Special Needs or Pooled Trust
M143 - Special Needs or Pooled Trust Information
Mail the appropriate brochure to the trustee and the client:
MED 21 - Trustee Information
MED 22 - Special Needs or Pooled Trusts
MED 23 - Qualifying Income Trusts
528 D. PROCESSING RENEWALS WITH TRUSTS
Review file for the following: Complete signed copy of the trust document; Trust approval; Name and contact of trustee; and Bank statement of trust account.
Contact the trustee, confirm he or she remains the trustee, and get current contact information.
If the trustee is no longer acting in this capacity: Request a copy of the addendum naming the new trustee; Get current contact information of new trustee; and Complete a new Trust Reporting form with new trustee information and email the new updated trustee information to the DHCS Division of Health Care Services TPL Third Party Liability Unit at: doh.hcs.rec.info@alaska.gov .
Request current bank statement, review for discrepancies by: Review balance; Compare current balance with balance from previous year renewal to ensure that cost of care has been paid and that trust funds have been used appropriately; Review deposit information to ensure money is being deposited into trust account; and Compare balance and monthly activity with any cost of care obligation, etc.
Note: Although the State cannot require it, it is best practice and highly encouraged that the client deposit all of their countable income directly into the trust account. The trustee can then transfer the allowable monthly amount into the client's personal bank account. This helps avoid accidental under-funding of the trust.
If there are any discrepancies: Request statements from past 12 months; and Discuss use of the trust with trustee and clarify appropriate use of trust. If, after being advised of the proper use of the trust, the trustee continues to misuse the trust, the caseworker may declare the trust an invalid Medicaid Qualifying Trust. If declared invalid, the trust shall be treated as an irrevocable trust under the general trust provisions in manual sections 525(B) and 525(C) . The caseworker may declare the trust to be valid again if the trustee provides adequate evidence that the trust is being used appropriately.
At every renewal send the following:
MED 21 - Trustee Information;
MED 22 - Special Needs or Pooled Trusts or MED 23 - Qualifying Income Trusts; and
Notice: M143; or M142; or M144 and M140.
528 E. DOCUMENTATION
Initial Case Note: When opening a Medicaid case that has an approved Medicaid trust, a separate CANO Case Notes must be recorded with the following information:
CANO Title: Trust Established
Body of text: Name and contact information of Trustee Type of trust Name of bank and trust bank account number Beginning trust bank account balance Cost of care obligation for QIT’s (if applicable)
All documentation about the trust must be created in a separate CANO Case Notes titled Trust Information . Trust information must be identifiable to ensure information is sufficiently passed on to other caseworkers.
Note: The Policy & Program Development Unit will create a trust approval case note when review of the trust has been completed and it is found to meet the requirements of a Medicaid Qualifying Trust. The trust approval case note will be entered on the existing Medicaid case number, if a stand-alone case number has not yet been registered. If this occurs, the Eligibility Technician processing the application will be required to copy the trust approval case note into the stand-alone case number that is created when the Medicaid is authorized.
Renewal Case Note: When renewing a case that has an approved Medicaid trust, a separate CANO Case Notes must be recorded with the following information:
CANO Title: Medicaid Trust
Body of text: Name and contact information of Trustee Name of bank and trust bank account number Balance in trust bank account balance at time of renewal Cost of care obligation for QIT Qualifying Income Trust cases (if applicable)
528 F. CLOSING A CASE WITH A MEDICAID TRUST
Determine the reason for closure.
If the closure is because of death, enter the date of death on the MERE Medical Reference screen.
Close out the TPR Third Party Resource and MCR Medicare segments on the MERI Medical Resource Information screen. Close all TPR Third Party Resource segments with the actual date of death, and close out the MCR Medicare segment with the last day of the month in which they deceased.
Send a closure notice and email a copy to the DHCS Division of Health Care Services TPL Third Party Liability Unit at: doh.hcs.rec.info@alaska.gov
528 G. TRUST CHANGES
When a trust is amended it must be sent to policy for review and approval.
When a new trustee is assigned, the court paperwork assigning the new trustee, and the paperwork showing the trustee has accepted the assignment must be sent to policy for approval. After approval by policy the Med 20 with the new trustee information must be sent to DHCS Division of Health Care Services .
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531 DEEMED AN SSI Supplemental Security Income / APA Adult Public Assistance RECIPIENT UNDER THE PICKLE AMENDMENT
Named after its congressional sponsor, J. J. Pickle (D-Texas), and enacted in 1976, the Pickle Amendment established a separate category of Medicaid eligibility. This amendment requires that an individual be deemed an SSI Supplemental Security Income or APA Adult Public Assistance recipient (and so eligible for Medicaid) if the individual meets the eligibility factors in subsection A below. This category applies to an individual who is Individualized Supports ineligible for SSI Supplemental Security Income or APA Adult Public Assistance because of cost-of-living adjustments in that individual’s Social Security, Title II Old Age, Survivors, and Disability ( OASDI ) benefits.
531 A. ELIGIBILITY FACTORS
An individual who has lost his or her SSI Supplemental Security Income or APA Adult Public Assistance benefits may qualify for Medicaid benefits if he or she:
Was entitled to receive both OASDI Old Age, Survivors, and Disability Insurance (Social Security) and SSI Supplemental Security Income or APA Adult Public Assistance cash benefits in at least one month after April 1977 (see Note below);
Is currently eligible for and receiving OASDI Old Age, Survivors, and Disability Insurance (Social Security) benefits;
Is currently ineligible for SSI Supplemental Security Income or APA Adult Public Assistance ;
Receives income that would allow the individual to qualify for SSI Supplemental Security Income or APA Adult Public Assistance after deducting all OASDI Old Age, Survivors, and Disability Insurance (Social Security) cost-of-living adjustments received since the last month in which the individual was eligible for both OASDI Old Age, Survivors, and Disability Insurance (Social Security) and SSI Supplemental Security Income ; and
Meets all other Medicaid eligibility requirements.
Note: The individual need not literally receive both SSI Supplemental Security Income and Social Security checks in the same month, but need only be entitled to both for the same month. There is a one-month lag in OASDI Old Age, Survivors, and Disability Insurance (Social Security) payments, which are not disbursed until the month after entitlement, while SSI Supplemental Security Income payments are paid in the month of entitlement. It is common for an individual to receive SSI Supplemental Security Income while awaiting receipt of OASDI Old Age, Survivors, and Disability Insurance (Social Security) payments. Once the monthly OASDI Old Age, Survivors, and Disability Insurance (Social Security) begins, if it exceeds the SSI Supplemental Security Income rate, he or she receives just OASDI Old Age, Survivors, and Disability Insurance (Social Security) thereafter. In such circumstances, even though the individual never actually received simultaneous payments from both programs in a single month, he or she meets the first Pickle requirement. This is true even if income from a retroactive OASDI Old Age, Survivors, and Disability Insurance (Social Security) payment exceeds the SSI Supplemental Security Income benefit level for all months in which SSI Supplemental Security Income was received.
531 B. SCREENING
The following screening process will eliminate most applicants from consideration of eligibility under this category without the need for performing any mathematical calculations. For those who pass Plan for Achieving Self-Support this initial screening, the Pickle Amendment table in Addendum 1 , page 2 provides a simple formula for performing the necessary mathematical calculations. The screening process is as follows:
Step 1:
Ask the applicant, are you now receiving a Social Security check? If the answer is no, the person cannot be Pickle eligible. If the answer is yes, go to step 2.
Step 2:
Ask the applicant, after April 1977, did you ever get an SSI Supplemental Security Income check at the same time that you got Social Security, or did you get SSI Supplemental Security Income or APA Adult Public Assistance in the month just before your Social Security started? If the answer is no, the person cannot be Pickle eligible. If the answer is yes, go to step 3.
Step 3:
Ask the applicant, what is the last month in which you received SSI Supplemental Security Income ?
Step 4:
Look up the month in which the applicant last received SSI Supplemental Security Income or APA Adult Public Assistance in the Pickle Amendment Table in Addendum 1 , page 2. Find the percentage that applies to that month/year. Multiply the present amount of the applicants (and/or spouse’s) Social Security benefits by the applicable reduction factor.
Step 5:
Add the figure that you have just calculated to any other countable income the person may have. If the resulting total is less than the current APA Adult Public Assistance Need Standard, the applicant is income eligible for Pickle Medicaid benefits.
Note: Because rounding factors may make a difference, if the total is within $20 of the current APA Adult Public Assistance Need Standard, please email the Program Officer at dpapolicy@alaska.gov for guidance.
Step 6:
Review for all other factors of eligibility.
Example: Mrs. Lewis received both Social Security and SSI Supplemental Security Income checks in 1978-79. However, her SSI Supplemental Security Income / APA Adult Public Assistance was terminated in March 1979 because she started receiving a private pension that, added to her Social Security benefits, raised her income to an amount above the 1979 SSI Supplemental Security Income and APA Adult Public Assistance income limits. There have been gradual increases in her income since 1979. She now receives a Social Security benefit of $1050 per month. Her private pension is $270 a month, for a combined total of $1,320 monthly.
In 2004, the income limit for APA Adult Public Assistance is $1047 (plus a $20 general income disregard = $1067) for an individual. Thus, Mrs. Lewis’ income is over the income limit for persons who are aged, blind or disabled.
Screen Mrs. Lewis for Pickle eligibility as outlined above. Determining that the last month that she received both Social Security and SSI Supplemental Security Income or APA Adult Public Assistance was March 1979, look up that time period in the following table and find the corresponding reduction factor (.360). Multiply Mrs. Lewis’s current Social Security benefit of $1050 by that factor, to determine her current countable Pickle income.
$1050
x .360 (reduction factor)
$378 ( Pickled Social Security income, rounded downward)
$378 countable Social Security income
+ $270 private pension
$648 total countable Pickle income.
Since $648 is less than the current APA Adult Public Assistance income limit (including the standard $20 disregard) of $1067, Mrs. Lewis is eligible for Medicaid.
531 C. EIS INFORMATION
EIS Eligibility Information System INFORMATION Eligibility Code: 11 Pregnant woman 20 No other eligibility codes apply Medicaid Subtype: BB Individual lost SSI Supplemental Security Income / APA Adult Public Assistance eligibility from 1977 SSA Social Security Administration COLA Cost of Living Allowance
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532 SSI Supplemental Security Income OR APA Adult Public Assistance INELIGIBLE FOR REASONS THAT DO NOT APPLY TO MEDICAID
Medicaid is available to an individual who would be eligible for SSI Supplemental Security Income / APA Adult Public Assistance except that they do not meet an SSI Supplemental Security Income / APA Adult Public Assistance rule that is specifically prohibited in the Medicaid program.
Note: Effective October 1, 2026 individuals must also meet Medicaid qualified alien requirements. Refer to section 522 and MAGI Manual Section 808 for policy on U.S. citizenship and eligible alien status.
Example: Mr. Gibson has been determined disabled by the State Disability Determination Service ( DDS ) and meets APA Adult Public Assistance financial eligibility criteria. However, he chooses not to apply for SSI Supplemental Security Income . Because pursuit of SSI Supplemental Security Income is not required for Medicaid-only cases, Mr. Gibson may be determined eligible for Medicaid.
These individuals, including low-birth weight infants, must still meet APA Adult Public Assistance criteria for blindness, disability, or age.
532 A. LOW BIRTH WEIGHT INFANT
Before a low-birth weight infant can be found eligible for APA Adult Public Assistance -related Medicaid, a DDS Disability Determination Service determination of presumptive disability must be made.
532 B. QUALIFIED ALIEN
This category should be used for a qualified alien who lost SSI Supplemental Security Income because of his or her alien status under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. This category cannot be used for non-qualified aliens. See APA Manual Section 421-7 .
532 C. QUALIFYING INCOME TRUSTS
An individual who meets all other SSI Supplemental Security Income or APA Adult Public Assistance eligibility requirements, except for excess income may qualify for Medicaid-only by limiting their countable income using a Qualifying Income Trust. See Section 526 .
532 D. EIS Eligibility Information System INFORMATION
EIS Eligibility Information System INFORMATION Eligibility Code: 11 Pregnant woman 20 No other eligibility codes apply 24 LTC Long Term Care (300%) institutionalized Medicaid Subtype: NS Ineligible for SSI Supplemental Security Income / APA Adult Public Assistance because of requirements that do not apply to Medicaid SA Ineligible for SSI Supplemental Security Income / APA Adult Public Assistance because of alien sponsor deeming ST QIT Qualifying Income Trust established for Medicaid eligibility
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533 A. TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 ELIGIBILITY
Eligibility is subject to all of the following conditions:
The child must be under 19 years of age. When a child is turning 18 years old, they must be referred to apply for SSI Supplemental Security Income .
The child must meet the disability criteria for SSI Supplemental Security Income eligibility, meaning that disability has been determined by the Disability Determination Service (DDS).
The child would be eligible for Medicaid if institutionalized, under the Special LTC Long Term Care Income Standard listed in Addendum 1 and using the $2,000 APA Adult Public Assistance -related resource limit. This eligibility category generally follows provisions in the APA Adult Public Assistance manual.
Note: Effective October 1, 2026 individuals must also meet Medicaid qualified alien requirements. Refer to section 522 and MAGI Manual Section 808 for policy on U.S. citizenship and eligible alien status.
Exceptions:
Only the income and resources of the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 child are countable. Child support received on behalf of the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 child is countable income to the child.
Coverdell funds are not a countable resource for the account beneficiary (usually the disabled child).
529 plans (also known as a Qualified Tuition Program) are a countable resource for the account owner (usually the parent), but are not a countable resource for the account beneficiary (usually the disabled child).
UGMA/UTMA Uniform Gifts to Minors Act and/or Uniform Transfers to Minors Act accounts are not countable income or resources to the minor. However, if funds from these accounts are used to support the minor, they are counted as income in the month of receipt and as a resource the following month.
The child resides at home, not in a residential care setting. Temporary absence from the home is allowable. Children are not eligible for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 while living in an institution.
Note: While home is not restricted to living with the child's parents, in almost all cases a child not living with parents will be eligible for Medicaid under a less restrictive category of Medicaid, such as MAGI Medicaid. These children should not be evaluated for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 unless a change in circumstances is anticipated in the near future.
The child meets one of the following level of care (LOC) standards:
Acute care hospital, nursing facility, or intermediate care facility ( NF Acute Care Hospital, Nursing Facility, or Intermediate Care Facility - LOC Level of Care );
Intermediate care facility for the Intellectually Developmentally Disabled ( ICF Intermediate Care Facility - IDD Individuals with Intellectual and Developmental Disabilities - LOC Level of Care ); and
Inpatient psychiatric hospital ( IPH Inpatient Psychiatric Hospital - LOC Level of Care ).
The department contracts with Comagine Health to determine or facilitate the determination of the appropriate level of care.
The child is deemed appropriate to receive necessary medical care outside of that institution, as indicated on a Support Plan approved by Comagine Health.
The estimated cost of care (COC) for services rendered in the home must be less than the cost of institutionalization, as determined by Comagine Health. This process is referred to as cost neutrality.
The DPA Division of Public Assistance caseworker is responsible for ensuring that the applicant meets criteria 1 through 4 above and all other Medicaid program requirements.
Comagine Health is responsible for ensuring that an applicant meets criteria 5 through 7 above, which are referred to as the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 medical/cost criteria.
The caseworker must make sure that Comagine Health has approved the applicant and the DDS Disability Determination Service has determined disability before the child is authorized for Medicaid under this eligibility category.
Children in this category are eligible for all regular Medicaid services but they do not receive Home and Community Based (HCB) waiver services.
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533 B. TEFRA CONVERSIONS
When a child is eligible for another category of Medicaid, such as SSI Supplemental Security Income or MAGI Modified Adjusted Gross Income , and has been determined to meet on of the three LOC Level of Care categories, the case is referred to as a deferred TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case. It is important that parents are given a choice of the category of Medicaid they wish their child to receive. Take the following steps for a potential deferred TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case and current cases:
SSI Children
When SSI Supplemental Security Income starts, the case must be converted to an SSI Supplemental Security Income Medicaid case with the DC-54 MERE coding.
Comagine Health must be notified that the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case has been changed to an SSI Supplemental Security Income Medicaid case and advised to close the Comagine Health case. Comagine Health can be emailed at AKTefra-Waiver@Qualishealth.org .
Document the LOC Level of Care renewal date and set an alert that this was a former TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 child.
The SSI Supplemental Security Income case is then transferred to the appropriate local office.
If the child's SSI Supplemental Security Income benefit stops, the caseworker must evaluate the child's eligibility for MAGI Modified Adjusted Gross Income Medicaid, TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 , and a Continuous Eligibility Period (CEP).
If there is no MAGI Modified Adjusted Gross Income Medicaid, TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 , or a CEP continuous eligibility period , the case must be closed and a new application is required.
If there is eligibility for MAGI Modified Adjusted Gross Income Medicaid but not TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 , open the MAGI Modified Adjusted Gross Income Medicaid case and let the parents know that they can pursue TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 if they wish.
If there is no eligibility for MAGI Modified Adjusted Gross Income or TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 but the child has a CEP continuous eligibility period , the Medicaid case will continue until the CEP continuous eligibility period ends. The case should be referred to the LTC Long Term Care unit to determine TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility. In order for a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case to be opened, the case must meet the LOC Level of Care and disability diary date requirements. The LTC Long Term Care unit will work with the parents and Comagine Health. The LTC Long Term Care unit will check the LOC Level of Care and email Comagine Health at AKTefra-Waiver@Qualishealth.org to reopen the LOC Level of Care case if there is a current LOC Level of Care in place. If there is no LOC Level of Care , the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case will be pended for LOC Level of Care to be determined. The LTC Long Term Care unit will check the disability diary date. If there is no disability diary date, the case must be pended for a disability determination.
TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 and MAGI Modified Adjusted Gross Income
With every TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 application, the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 caseworker must screen for potential MAGI Modified Adjusted Gross Income Medicaid eligibility. If there appears to be MAGI Modified Adjusted Gross Income eligibility, the family should be notified of this and be allowed to pursue this coverage. The family should be advised that there may be a lapse in coverage after MAGI Modified Adjusted Gross Income ends while pursuing TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility. Parents should be offered the opportunity to pursue TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 and maintain TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility as a backup. If the parent chooses to pursue TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 :
Register a new case with the child as PI,
Pursue a disability determination,
Refer the child for a LOC Level of Care determination by Comagine Health, and
Transfer the MAGI Modified Adjusted Gross Income case to the LTC Long Term Care unit.
If LOC Level of Care and disability are approved, the parent must be contacted and given the choice of having the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case opened or maintaining the child's Medicaid eligibility within MAGI Modified Adjusted Gross Income . If the parent opts to continue eligibility with MAGI Modified Adjusted Gross Income , the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 caseworker will close the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case and document eligibility via MAGI Modified Adjusted Gross Income .
If MAGI Modified Adjusted Gross Income closed for earned income or failure to renew, the MAGI Modified Adjusted Gross Income caseworker should notify the LTC Long Term Care unit to review TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility and take the following actions:
Review case for LOC Level of Care status and DDS Disability Determination Service status.
If both LOC Level of Care and disability status are current, open the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case and notify Comagine Health that the case is now open and to reactivate the case in the Comagine system.
If LOC Level of Care or disability status has lapsed, pend the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 case for current disability approval and LOC Level of Care .
The EIS Eligibility Information System case notes and alert system must clearly indicate which child is the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligible child in the home.
Institutionalized Children
Children may go between their home and inpatient treatment. This happens most often with the IPH Inpatient Psychiatric Hospital - LOC Level of Care .
TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Recipients
If a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 child enters an inpatient facility, the caseworker must contact the family to determine the anticipated length of stay. If the stay will be for more than six months, Comagine Health must be notified to close the LOC Level of Care case.
If the say is expected to be more than 30 days, convert the case to a child only MAGI Modified Adjusted Gross Income case and transfer the case to the appropriate local office.
When the child is ready to return home, the MAGI Modified Adjusted Gross Income caseworker must notify the LTC Long Term Care unit. The LTC Long Term Care unit must review LOC Level of Care and disability status for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility. If disability and LOC Level of Care are not current, the LTC Long Term Care unit must initiate the process for both.
New Applications and Institutionalized Children
A TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 application may be received at the same time that the family is pursuing inpatient care for their child. If the child is institutionalized prior to TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility being established and the stay is anticipated to be greater than 30 days, take the following actions:
Open a child only MAGI Modified Adjusted Gross Income case and transfer the case to the appropriate local office,
Set an alert and case note alerting the MAGI Modified Adjusted Gross Income worker that this is a potential TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 child, and
Notify the family to contact their case coordinator, the LTC Long Term Care unit, and Comagine Health when a discharge date is determined so the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 process can be initiated prior to the child's return.
Note: A new application is not needed to go between one category of Medicaid and another. Caseworkers must use the alert and case note system to identify these children and make appropriate referrals to maintain coverage and ensure there are no breaks in service.
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533 C. REFERRAL AND INTERAGENCY COMMUNICATIONS
Communication is essential to ensure a quick and timely determination. The agencies and individuals involved in a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid eligibility decision and their roles are outlined below.
Comagine Health is responsible for:
Referring families to care coordination agencies and the LTC Long Term Care unit,
Working closely with care coordinators regarding the medical eligibility decision and required paperwork,
Making NF Acute Care Hospital, Nursing Facility, or Intermediate Care Facility - LOC Level of Care and IPH Inpatient Psychiatric Hospital - LOC Level of Care review determinations, including notifying care coordinators and families of the annual LOC Level of Care renewal requirement,
Making the Support Plan and COC Cost-of-care review determinations for NF Acute Care Hospital, Nursing Facility, or Intermediate Care Facility - LOC Level of Care and IPH Inpatient Psychiatric Hospital - LOC Level of Care cases,
Making the Support Plan and COC Cost-of-care review determinations for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care cases and maintaining a record of the LOC Level of Care approval by DDS Disability Determination Service , and
Emailing the DPA Division of Public Assistance LTC Long Term Care unit, the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant and Care Coordinators when LOC Level of Care is approved or emailing the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant when LOC Level of Care is denied.
The Care Coordination Agency is responsible for:
Completing and submitting the Support Plan, COC Cost-of-care , and LOC Level of Care documentation to Comagine Health for all NF Acute Care Hospital, Nursing Facility, or Intermediate Care Facility - LOC Level of Care and IPH Inpatient Psychiatric Hospital - LOC Level of Care cases,
Completing the Support Plan and COC Cost-of-care for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled -LOC cases and working with DSDS Division of Senior and Disabilities Services in the development and completion of the Inventory for Client and Agency Planning (ICAP) assessment packet,
Submitting all necessary information to Comagine Health and DSDS Division of Senior and Disabilities Services ,
Explaining to parents that they must complete a DPA Division of Public Assistance application with a referral to the appropriate DPA office, and
Contacting parents when the annual LOC Level of Care reassessment is due.
Note: TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 care coordinators only receive payment for screening, initial assessment, and yearly reassessment for LOC Level of Care and the Support Plan. TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 does not pay for monthly care coordination.
The Disability Determination Service (DDS) is responsible for:
Starting the disability determination process upon receiving the disability packet from the DPA Division of Public Assistance caseworker, and
Determining if a child is disabled using Social Security Administration criteria.
It is beneficial to include copies of relevant medical, psychological, and developmental information in the DDS Disability Determination Service packet in order to speed up the disability process. This may include Infant Learning Assessments, Individual Education Plans, current medical records (from within the past year), counseling reports, etc. See APA MS 425-3(C) and Admin Procedures MC 115-9 for policy and procedures on disability determinations.
DPA Division of Public Assistance is responsible for:
Sending the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 welcome letter (MED 16) and TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid for Disabled Children at Home brochure (MED 15) to the parent or guardian whenever an application is received for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid. This must be documented in the CANO,
Note: The MED 16 is not the same welcome letter that Comagine Health sends the child's parent as described in MS 533(D)(2) .
Completing the Medicaid eligibility determination,
Submitting the disability packet to DDS Disability Determination Service for initial applications, tracking disability review dates, and submitting a disability review at the application time,
Making referrals to Comagine Health with the GEN 140B form once the family has interviewed,
Pending the application until all factors of eligibility are met. TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 applications must be approved or denied within 90 days. Follow the procedures below:
Pend new applications for 60 days from the date of application.
Send the M320, Information Needed - TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 notice, to pend a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 application. Send a copy of this notice to the care coordinator.
On day 61:
If the LOC Level of Care decision is missing, notify Comagine Health and request a LOC Level of Care update. If LOC Level of Care has not been determined and it appears the decision may go past 90 days, contact the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant. The DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will work with Comagine Health to determine the appropriate action. The LTC Long Term Care unit will be notified of status.
If the DDS Disability Determination Service decision is missing, contact DDS Disability Determination Service and request an update on the disability decision. If a disability decision has not been determined and it appears the decision may go past 90 days, contact the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant. The DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will work with DDS Disability Determination Service to determine the appropriate action. The LTC Long Term Care unit will be notified of status.
Exceptions to the 90-day Processing Time Frame for Initial Applications: Refer requests for extensions to the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant. When an extension is needed 90 days after date of initial application, the person making the request will need to provide the reason(s) for the extension. Extensions will only be approved when the parent submits a written request stating the reason for the extension and acknowledging and accepting the delay in processing. Although not required, they may use the Initial Application Extension Request Form (MED 36) to make the request.
Making the final approval or denial of TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid in EIS Eligibility Information System . The DPA TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will send the denial notice,
Issuing DE 25 disability exam coupons if the child needs additional screenings,
Issuing WD 19 screening coupons for the care coordinator, and
Communicating with Comagine Health any changes in status, including:
When a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 child is approved for HCB Home and Community-Based waiver services,
When a child becomes eligible for and the family elects to move the child to a different category of Medicaid,
When a Medicaid case closes for any reason, including failure to submit a DPA Division of Public Assistance renewal, and
When a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 application is denied.
The Division of Senior and Disabilities Services (DSDS) is responsible for:
Completing the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care assessment and making ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care determinations,
Processing all referrals for initial ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care determinations and renewals received from Comagine Health,
Reviewing submission of the completed ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care packet to ensure it is submitted by the care coordinator, is complete, and DSDS Division of Senior and Disabilities Services is able to make a level of determination within specified time frames. If not, DSDS Division of Senior and Disabilities Services will notify Comagine Health,
Reporting ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care approvals or denials to Comagine Health, and
Certifying all care coordinators, including TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 care coordinators.
Note: The same regulations are used to determine level of care for IDD Individuals with Intellectual and Developmental Disabilities waivers that are used for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled assessments for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 . If a child is approved LOC Level of Care for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 but denied LOC Level of Care for HCB Home and Community-Based waiver services, the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant must be contacted immediately.
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533 D. CASE PROCESSING
Initial Applications
An initial application can come in the following forms:
MED 4 application or referral from denied MAGI Modified Adjusted Gross Income Medicaid application. If a MED 4 application is submitted or a referral from a denied MAGI Modified Adjusted Gross Income Medicaid case is received, send notice M320, Information Needed - TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 .
Referral from MAGI Modified Adjusted Gross Income Medicaid when there is no MAGI Modified Adjusted Gross Income Medicaid eligibility and the application includes a disabled child.
If the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 process starts from a denied or closed MAGI Modified Adjusted Gross Income case, send notice M322, PEND TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Disabled Child Denied DKC Denali KidCare . The family is allowed 15 days to:
Contact Comagine Health to be connected with a care coordinator for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 and begin the LOC Level of Care assessment process,
Return the MED 1, MED 2, and any accompanying medical information for a disability determination, and
Complete an interview.
The caseworker must follow procedure outlined in MS 533(C)(4) .
Actions for NF Acute Care Hospital, Nursing Facility, or Intermediate Care Facility - LOC Level of Care and IPH Inpatient Psychiatric Hospital - LOC Level of Care
After receiving a referral from DPA Division of Public Assistance by the receipt of the GEN 140B, Comagine Health will send the child's parent or guardian a welcome letter and ask the parent to contact Comagine Health within 30 days for care coordinator referrals. This letter also instructs the parent to contact DPA Division of Public Assistance if needed.
If the parent contacts a care coordinator and begins the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 assessment process, Comagine Health will:
Receive ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care applications and make appropriate referrals to DSDS Division of Senior and Disabilities Services (refer to step below for further ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled processing) and track the process to ensure the care coordinator provides a completed assessment for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care , completed COC Cost-of-care , and completed Support Plan within required time frames . The care coordinator's failure to provide these documents will result in denial.
Track the process to ensure the care coordinator provides a completed assessment for NF Acute Care Hospital, Nursing Facility, or Intermediate Care Facility - LOC Level of Care and IPH Inpatient Psychiatric Hospital - LOC Level of Care , completed COC Cost-of-care , and completed Support Plan within required time frames . The care coordinator's failure to provide these documents will result in denial.
If the care coordinator follows through and provides all documentation in the required time frames, Comagine Health will make a LOC Level of Care decision and notify DPA Division of Public Assistance of approval or denial.
If LOC Level of Care is denied, Comagine Health notifies the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant with the following information:
Name of child,
The child's care coordinator, and
Rationale for denial.
The DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant issues the denial letter and sends a copy to the LTC Long Term Care unit. The LTC Long Term Care unit completes all actions in EIS Eligibility Information System .
Actions for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care
If an application for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled - LOC Level of Care is received, Comagine Health will make a referral and provide the following information to DSDS Division of Senior and Disabilities Services for all new applications and ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled renewals:
Child's name, date of birth, and SDS Senior Disability Services ID number,
Date required for LOC Level of Care determination to meet DPA Division of Public Assistance time frames, and
Care coordination agency and main contact person.
After the initial referral, the following steps occur:
Step 1:
DSDS Division of Senior and Disabilities Services sends the care coordinator an email requesting the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care packet be forwarded to DSDS Division of Senior and Disabilities Services .
Step 2:
The care coordinator has 30 days to send the ICAP Inventory for Client and Agency Planning Evaluation packet to DSDS Division of Senior and Disabilities Services .
If the packet is not completed and a level of care determination cannot be made within 90 days, Comagine Health will issue a denial due to not completing the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care packet.
If DSDS Division of Senior and Disabilities Services receives all documentation and determines the child does not meet LOC Level of Care , DDS Disability Determination Service notifies Comagine Health that LOC Level of Care is denied and provides the reason(s) for the denial. Comagine Health notifies the DPA Division of Public Assistance Project Assistant who then issues the denial letter to the parent and notifies the LTC Long Term Care unit of the denial. The LTC Long Term Care unit must close or deny the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid case in EIS Eligibility Information System .
Step 3:
The care coordinator will contact DSDS Division of Senior and Disabilities Services if there is difficulty completing the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care packet within the 30-day period and explain any problems being encountered. If an extension is needed, DSDS Division of Senior and Disabilities Services will refer the care coordinator to Comagine Health. Comagine Health will work with the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant to provide guidance in completing the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care packet.
Step 4:
DSDS Division of Senior and Disabilities Services will notify Comagine Health with the results of the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care determination. If the LOC Level of Care determination results in an approval, Comagine Health will notify the care coordinator, DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant, and the LTC Long Term Care unit of the approval.
If the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care determination results in a denial, the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will:
Send a letter to the parents with copies to the care coordinator, Department of Law, and DSDS Division of Senior and Disabilities Services notifying them of the LOC Level of Care denial, and
Notify the LTC Long Term Care unit of the LOC Level of Care denial to either close or deny the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid.
Getting Adequate Documentation for ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care Processing
The ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care determination may require information that is not readily available such as a current IQ test or psychological evaluation.
The care coordinator will assist new applicants in scheduling an appointment with a Medicaid provider. After the appointment is scheduled, the parent must contact the LTC Long Term Care unit and request a disability exam coupon (DE 25) for the month the appointment is scheduled.
The care coordinator will assist current TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 recipients in scheduling an appointment with a Medicaid provider. The evaluation or testing will be billed to Medicaid.
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533 DISABLED CHILDREN AT HOME (TEFRA)
A disabled child who does not qualify for SSI Supplemental Security Income cash assistance due to parental income or resources may be eligible for Medicaid based on the child's own income and resources. Children in this category are often called TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 kids (named after the Tax Equity and Fiscal Responsibility Act, P.L. 97-248 that authorized this eligibility category). The LTC Long Term Care unit processes this specialized eligibility category.
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533 E. TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 REVIEWS
Each TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 recipient is subject to the following reviews:
DPA Division of Public Assistance annual review,
LOC Level of Care annual review, and
Periodic disability reviews by DDS Disability Determination Service .
Note: The LOC Level of Care , DSDS Division of Senior and Disabilities Services , and DPA Division of Public Assistance review dates often occur at different times during the eligibility period. If a LOC Level of Care or DSDS Division of Senior and Disabilities Services denial occurs in the middle of an ongoing eligibility period, the caseworker must review for twelve-month continuous eligibility before closing the case. Refer to MS 515 for policy on continuous eligibility.
DPA Division of Public Assistance Reviews
At the time of renewal, the DPA Division of Public Assistance caseworker must:
Check for current LOC Level of Care status,
Check for current disability status,
Review the child's income and resources, and
Check the child's age. If turning 18 years old, they must be referred to apply for SSI Supplemental Security Income . Send notice M315 Application for SSI Supplemental Security Income - TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 .
If LOC Level of Care , disability, and the child's income and resources are within APA Adult Public Assistance standards, approve the Medicaid case.
If LOC Level of Care is not current, contact Comagine Health for current status, and take the following actions:
If LOC Level of Care has been denied, the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will send the denial notice and inform the LTC Long Term Care unit to close the Medicaid case, or
If the parent failed to complete LOC Level of Care reassessment, the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will send the denial notice and inform the LTC Long Term Care unit to close the Medicaid case, or
If LOC Level of Care has not been renewed, but it is determined by the LTC Long Term Care caseworker that there were extenuating circumstances and the care coordinator or parent has requested an extension, approve Medicaid.
If a DPA Division of Public Assistance review is denied for any reason, including failure to renew, notify Comagine Health and the care coordinator of the case closure.
If the DDS Disability Determination Service review is due, assume continued disability until a new decision is received (see below).
DDS Disability Determination Service Review Processing
When a DDS Disability Determination Service file is returned with an approved disability decision, document this in the case notes and set an alert with a due date 60 days prior to the next disability review.
When a child is due for a disability review, send the parent the MED 1 and MED 2 forms and EIS Eligibility Information System notice M025, Disability Review Needed, requesting these forms be returned with current medical information within 30 days. The notice must explain that failure to respond to this request will result in case closure.
The TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid case remains open until a new DDS Disability Determination Service decision is received, unless LOC Level of Care is denied or the parent fails to renew while waiting for a new DDS Disability Determination Service decision.
If the DDS Disability Determination Service decision is an approval, document the new Continued Disability Review ( CDR Continuing Disability Review ) date in the CANO Case Notes .
If the DDS Disability Determination Service decision is denial of disability, the caseworker must email a copy of the DDS Disability Determination Service denial letter to the DPA Division of Public Assistance Policy email address hss.dpa.policy@alaska.gov and the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will issue a closure letter to the parent, the care coordinator, Comagine health, DSDS Division of Senior and Disabilities Services , and the Department of Law. The LTC Long Term Care unit will close the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid case in EIS Eligibility Information System . Before case closure, check for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 twelve-month continuous eligibility. See MS 515 for policy on continuous eligibility.
LOC Level of Care Renewal Process
Comagine Health has the primary responsibility for tracking all LOC Level of Care renewal dates for all three LOC Level of Care standards. Comagine Health will maintain a database of open TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid cases. The database will include the LOC Level of Care , current renewal date, and other identifying information.
For NF Acute Care Hospital, Nursing Facility, or Intermediate Care Facility - LOC Level of Care and IPH Inpatient Psychiatric Hospital - LOC Level of Care :
Comagine Health will send a letter 90 days prior to the month the renewal is due notifying the care coordinator that a child's LOC Level of Care is due and request renewal paperwork. When the care coordinator submits the Support Plan, COC Cost-of-care , and LOC Level of Care documentation, Comagine Health will approve or deny continued LOC Level of Care . Comagine Health will email the DPA Division of Public Assistance caseworker with the approval decision for the caseworker to take appropriate action. Comagine Health will email the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant with the denial decision. The DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will send the denial notice and notify the LTC Long Term Care unit to close the Medicaid case.
For ICF Intermediate Care Facility / IDD Individuals with Intellectual and Developmental Disabilities - LOC Level of Care :
Ninety (90) days prior to the month of renewal, Comagine Health will make a referral to DSDS Division of Senior and Disabilities Services for an ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care determination. Comagine Health will also notify the care coordinator indicating that an ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care referral has been made.
When the ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled LOC Level of Care determination is completed and a LOC Level of Care decision rendered, DSDS Division of Senior and Disabilities Services will forward the results to Comagine Health. Comagine Health will review COC Cost-of-care and Support Plan status and notify DPA Division of Public Assistance of the LOC Level of Care determination. If the child does not meet LOC Level of Care , the DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant will issue a closure notice to the parent. The LTC Long Term Care unit will take appropriate action to close the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid case in EIS Eligibility Information System .
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533 F. EIS INFORMATION
EIS INFORMATION SEPA MERE APMM SUBTYPE ELIG CODE HH TYPE ME-AD DK 11 Pregnant Woman DKH 54 SSI Child / Med Only
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534 WORKING DISABLED MEDICAID BUY-IN
An individual with a disability who is ineligible for Medicaid because of earned income that is either the individual's own income or the individual's spouse's earned income, may be eligible for Medicaid under the Working Disabled Medicaid Buy-In eligibility category. An individual may be eligible for the Working Disabled Medicaid Buy-In category even if he or she has not received Medicaid or disability related benefits before. See Addendum 8 for additional information about Working Disabled Medicaid Buy-In procedures.
534 A. DEFINITIONS
For the purposes of Family Income Test and determining the need standard, count all family members as defined below:
Family means the applicant, the applicant's spouse, and any dependent children of either the applicant or spouse who are living in the same household a majority of the time in a month.
Dependent Child means the natural or adopted child of either the eligible or ineligible spouse, who lives in the same household with the applicant and who is under age 18, or a student under age 22 is regularly attending a school, college, university, or vocational school in preparation for gainful employment. See APA Manual Section 442-2(D) for the definition of regular school attendance.
534 B. RESOURCES
Countable resources may not exceed:
$10,000 for an individual; or
$15,000 for an individual living with a spouse, whether or not the spouse is eligible for assistance.
534 C. INCOME
The income eligibility determination is a two-step process:
1. The Family Income Test (Step 1)
Determine if the family's monthly net income is below 250% of the FPG Federal Poverty Guidelines for Alaska. See the FPG Federal Poverty Guidelines chart in Addendum 1 . To determine a family's monthly net income, combine all countable income of each family member and then, using APA Adult Public Assistance methodology, subtract all disregards and exemptions, including impairment related work expenses (IRWE) as described in APA Manual Section 442-2 (G) .
Spousal Deeming : APA spousal deeming rules do not apply to the Family Income Test (Step 1) since that policy is designed to look at the income of a couple, not family income, and because the income of all family members is combined regardless.
Note: A n income allocation for an ineligible child (see APA Manual Section 460-5A ) is not allowed in the Family Income Test because income allocations are part of the APA Adult Public Assistance spousal deeming process.
If the family's net income is equal to or greater than 250% FPG Federal Poverty Guidelines for the appropriate household size, the individual is not eligible for this category. If the family net income is less than 250% FPG Federal Poverty Guidelines , proceed to Step 2.
2. Individual Unearned Income Test (Step 2)
Determine whether the disabled individual meets the financial and nonfinancial requirements to be eligible for APA Adult Public Assistance related Medicaid. Use the Expanded Refused Cash or Special Long Term Care Income Standard, depending on what Medicaid Category they would be eligible for. Apply APA Adult Public Assistance financial methodology, but exclude all earned income , including deemed earned income of the spouse. Do count the unearned income deemed from a spouse. Also, count the unearned income of the parents of a disabled individual under age 18.
For spousal deeming calculations, use the MED 6 - Working Disabled Deeming Worksheet available on DPA Division of Public Assistance e-forms.
534 D. DISABILITY DETERMINATION NEEDED
A disability determination is required. If the individual is already considered disabled for the purposes of Social Security, APA Adult Public Assistance , or Medicaid, honor that determination. Verification from SSA Social Security Administration of a future disability review date should be documented. Disability is considered to exist until disallowed by the Disability Determination Service ( DDS Disability Determination Service ).
If the applicant has no past history of SSI Supplemental Security Income or SS-DS with a current disability review date, a State-only disability determination must be pursued.
The Referral for Disability Determination form (GEN 141) is used when a disability determination is needed. The caseworker must check the box Working Disabled Medicaid Buy-In to clearly indicate to the DDS Disability Determination Service to disregard substantial gainful activity ( SGA Substantial Gainful Activity ).
The applicant must complete a Disability and Vocational Report (APA 4) and the Authorization for Release of Medical Information forms (MED 2) for this determination. Follow procedures described in Administrative Procedures Manual Section 115-9 .
For an applicant age 65 or older who is over income for Expanded Refused Cash or LTC Long Term Care Medicaid because of earnings from SGA Substantial Gainful Activity , a disability determination is required to qualify for the Working Disabled Buy-In category.
534 E. PREMIUMS MAY BE REQUIRED
An individual who is eligible under this category may have to pay a premium to the Division of Health Care Services to continue to receive coverage. The Division of Health Care Services Third Party Liability (TPL) Unit will determine the premium amount, send the client notice of premiums due, and collect the premiums. Premiums are assessed on a sliding fee schedule based on the family's annual net income. No one with family annual income below 100% FPG Federal Poverty Guidelines will pay a premium. No one will pay a premium in excess of 10% of their annual net family income.
Notify the Division of Health Care Services (DHCS) for every Working Disabled Medicaid Buy-In application approved. Send an email message to doh.hcs.rec.info@alaska.gov so that the premium amount, if any, can be established. The message must include the case initials, case number, and the date the application was approved. If a premium is due, the DHCS Division of Health Care Services TPL Third Party Liability worker will send an EIS Eligibility Information System notice to the recipient. DHCS Division of Health Care Services staff may also make notes in the CANO Case Notes screen.
Note: Before opening a Working Disabled Medicaid Buy-In case, it is important to make sure a previous case (regardless of the case number used) was not closed for failure to pay the required premiums. A new Working Disabled Medicaid Buy-In case cannot be opened until any back owed premium is paid.
534 F. REPORTING CHANGES
A Working Disabled Buy-In recipient is under the same obligation as all other recipients to report changes in income and resources. Because changes in income and household size may also affect the amount of the recipients premium, the caseworker must update the prospective budget on the EIS Eligibility Information System Working Disabled Medicaid Authorization ( WODM Working Disabled Medicaid Authorization ) screen and notify the DHCS Division of Health Care Services TPL Third Party Liability Unit. When a change is reported, the DHCS Division of Health Care Services TPL Third Party Liability Unit will recalculate the prospective annual income to determine if a premium adjustment is needed or if the premiums should end or begin.
534 G. WHEN PREMIUMS ARE DUE
Once eligibility is established for this category, the DHCS Division of Health Care Services TPL Third Party Liability Unit calculates the amount of the premium and needs time to give adequate notice of the premium obligation to the recipient. Therefore, the first premium is not due until the second month of eligibility following the month the recipient is notified of their eligibility for this category.
Example 1: Randy's APA Adult Public Assistance /Medicaid is set to close March 31 because of increased income. Randy receives notice in March that his APA Adult Public Assistance /Medicaid case is closing and that eligibility for the working disabled category begins April 1. May is the first premium month since it is the second month of eligibility following the month he was notified (March).
Example 2: Amy applies in January and requests retroactive coverage. The caseworker works the case and approves the application in February. Eligibility is determined for the month of application (January) and retroactive eligibility is determined for December, November, and October. April is the first premium month since it is the second month of eligibility following the month that Amy was notified (February).
534 H. FAILURE TO PAY PREMIUMS
DHCS Division of Health Care Services will monitor payments made. If an individual is at least 60 days delinquent in payment of premiums, Medicaid eligibility under the Working Disabled Buy-In category will be terminated. The DHCS Division of Health Care Services TPL Third Party Liability Unit will notify the caseworker that the person is ineligible. The caseworker should review the individual's current information to determine if there is eligibility for any other Medicaid category. If not, send timely notice (M413 - Medicaid Closed - Other Reasons ), citing that the individuals benefits will stop due to failure to pay their Medicaid premium.
Note: A DPA Division of Public Assistance hearing representative will handle a fair hearing request after loss of benefits for failure to pay Medicaid premiums like any other eligibility issue.
534 I. LOSING ELIGIBILITY IN ANOTHER CATEGORY
If an individual is losing Medicaid eligibility in another category, a new application for this category is not required. The caseworker should automatically make an eligibility determination if the individual is losing eligibility in another category due to earnings.
534 J. WORKING DISABLED AND HCB Home and Community-Based WAIVERS
An individual eligible under the Working Disabled Medicaid Buy-In category may also be eligible for Home and Community Based ( HCB Home and Community-Based ) Waiver services. Use the Special Long Term Care Income Limit in the unearned income test. This is most common with a Individuals with Intellectual and Developmental Disabilities ( IDD Individuals with Intellectual and Developmental Disabilities ) waiver. A Working Disabled/ HCB Home and Community-Based waiver recipient does not have a Cost-of-Care ( COC Cost-of-care ) obligation, but must pay the appropriate premiums.
534 K. EXAMPLES OF AN ELIGIBILITY DETERMINATION
1. Max Lucas is an individual with disabilities. He is married to Anita Lucas and they have one child, Edwin. Max receives APA Adult Public Assistance , Medicaid, and Social Security. Anita receives UIB Unemployment Insurance Benefit and Edwin receives Social Security. Max begins working and his earnings cause APA Adult Public Assistance and Medicaid closure. Without a new application, eligibility for the Working Disabled Medicaid Buy-In category is determined for the month following the APA Adult Public Assistance closure.
Note: The following calculations are based on current income standards.
Step 1 - Family Income Test
The income of all family members is considered and APA Adult Public Assistance disregards and exclusions are applied (if exempt income existed, it would be fully exempt in this step)
Max's SSDI Social Security Disability Insurance $885.00 Anita's UIB Unemployment Insurance Benefit $600.00 Edwin's SSA Social Security Administration $300.00 Total Unearned Income $1,785.00 $20 General Income Exclusion - $20.00 Countable Unearned Income $1,765.00 Max's earnings $4,000.00 $65 Earned Income Exclusion - $65.00 1/2 Earned Income Exclusion - $1967.50 Total Countable Earned Income $1967.50 Family Net $3,732.50 250% FPG Federal Poverty Guidelines (as of 4/1/2026) $7,115.00
Family Net Income is less than 250% FPG Federal Poverty Guidelines , so applicant passes Step 1.
Step 2 - Individual Income Test
Max's SSDI Social Security Disability Insurance (may end due to SGA Substantial Gainful Activity soon) $885.00 Anita - Spouses deemed unearned income $417.00 (From deeming worksheet MED 6) $20 General Income Exclusion - $20.00 Total Unearned Income $1,282.00 Expanded Refused Cash - A2S (as of 1/1/2026) $2,732.00
Max's total unearned income is less than the applicable Expanded Refused Cash need standard. Therefore, Max is eligible for the Working Disabled Medicaid Buy-In Category.
2. Katherine is an individual with disabilities who is eligible for an Individuals with Intellectual and Developmental Disability (IDD) HCB Home and Community-Based Waiver. Katherine receives Social Security Disability Income and recently started a job that causes her to go over the income limit. Without a new application, a Working Disabled Medicaid determination is made.
Note: The following calculations are based on current income standards.
Step 1 - Family Income Test
The income of all family members is considered and APA Adult Public Assistance disregards and exclusions are applied (if exempt income existed, it would be fully exempt in this step)
Katherine's SSDI Social Security Disability Insurance $1,590.00 Total Unearned Income $1,590.00 $20 General Income Exclusion - $20.00 Countable Unearned Income $1,570.00 Katherine's earnings $2,400.00 $65 Earned Income Exclusion - $65.00 1/2 Earned Income Exclusion - $1167.50 Total Countable Earned Income $1167.50 Family Net $2,737.50 250% FPG Federal Poverty Guidelines (as of 4/1/2026) $4,157.00
Family Net Income is less than 250% FPG Federal Poverty Guidelines , so applicant passes Step 1.
Step 2 - Individual Income Test
Katherine's SSDI Social Security Disability Insurance (may end due to SGA Substantial Gainful Activity soon) $1590.00 $20 General Income Exclusion - $20.00 Total Unearned Income $1,570.00 Special Long Term Care Income Standard (as of 1/1/2026) $2,982.00
Katherine's total unearned income is less than the applicable Special Long Term Care Income standard. Therefore, Katherine is eligible for the Working Disabled Medicaid Buy-In Category.
534 L. WORKING DISABLED WITH A MEDICAID QUALIFYING TRUST
A Medicaid Qualifying Trust can be used to reduce income in either Step 1 or Step 2 of the financial eligibility determination.
Countable income for the Step 1 test must include any payment to the applicant that comes out of the trust, plus any other income that the client receives that is not going into the trust.
In the Step-2 Unearned Income Test, a payment to the applicant from the trust is considered unearned income.
The Medicaid Qualifying Trust may pay the premium on behalf of the client. As long as the payment is sent directly to the Division of Health Care Services as a vendor payment, it will not count as income to the client.
534 M. EXAMPLE OF AN ELIGIBILITY DETERMINATION WITH A MEDICAID QUALIFYING TRUST
Jim Tiger is an individual with disabilities and has an approved Medicaid Qualifying Trust. He is married and his wife Dawn receives UIB Unemployment Insurance Benefit . Jim begins working and his earnings cause Medicaid closure. An eligibility determination is made for the Working Disabled Buy-In category for the month following the regular Medicaid closure.
Note: The following calculations are based on current income standards.
EXAMPLE 1: FAMILY NET MORE THAN 250% FPG Federal Poverty Guidelines (STEP 1) Step 1 Family Income Test Jim's SSDI Social Security Disability Insurance $1,748.00 Dawn's UIB Unemployment Insurance Benefit $916.00 Total Unearned Income $2,664.00 $20 General Income Exclusion - $20.00 Countable Unearned Income $2,644.00 Jim's earnings $6,201.00 $65 Earned Income Exclusion - $65.00 1/2 Earned Income Exclusion - $3,068.00 Total Countable Earned Income $3,068.00 Family Net $5,712.00 250% FPG Federal Poverty Guidelines (as of 4/1/2026) $5,636.00 - $76.00 The Family Net Income is more than 250% FPG Federal Poverty Guidelines , so Jim must increase the amount going into the trust by more than $76.00 to pass Test 1. Step 2 Individual Income Test Jim's SSDI Social Security Disability Insurance (may end due to SGA Substantial Gainful Activity soon) $1,748.00 Spouses deemed unearned income $916.00 $20 General Income Exclusion - $20.00 Total Unearned Income $2,644.00 Expanded Refused Cash -A2S (as of 1/1/2026) $2,732.00 Jim's total unearned income is less than the applicable Expanded Refused Cash need standard. Therefore, Jim is eligible for the Working Disabled Medicaid Buy-In Category by use of his Medicaid Qualifying Trust in Step 1.
EXAMPLE 2: UNEARNED INCOME OVER EXPANDED REFUSED CASH NEED STANDARD (STEP 2) Step 1 Family Income Test Jim's SSDI Social Security Disability Insurance $1,500.00 Dawn's UIB Unemployment Insurance Benefit $1,400.00 Total Unearned Income $2,900.00 $20 General Income Exclusion - $20.00 Countable Unearned Income $2,880.00 Jim's earnings $3,600.00 $65 Earned Income Exclusion - $65.00 1/2 Earned Income Exclusion - $1,767.50 Total Countable Earned Income $1,767.50 Family Net $4,647.50 250% FPG Federal Poverty Guidelines (as of 4/1/2026) $5,636.00 The Family Net Income is less than 250% FPG Federal Poverty Guidelines , so Jim passes Test 1. Step 2 Individual Income Test Jim's SSDI Social Security Disability Insurance (may end due to SGA Substantial Gainful Activity soon) $1,500.00 Spouse's deemed unearned income $1,400.00 $20 General Income Exclusion - $20.00 Total Unearned Income $2,880.00 Expanded Refused Cash Need Standard -A2S (as of 1/1/2026) $2,732.00 - $148.00 Jim's total unearned income is more than the applicable Expanded Refused Cash need standard. Therefore, Jim must increase the amount of the trust by at least $148.00 to qualify for the Working Disabled Medicaid Buy-In Category.
534 N. EIS INFORMATION
EIS Eligibility Information System allows you to enter all data for both the Step 1 and Step 2 eligibility process and then calculates both steps simultaneously.
EIS INFORMATION Eligibility Code: 11 Pregnant Woman 20 No other eligibility codes apply 31 Waiver Medicaid Adults with Physical and Development Disabilities 41 Waiver Medicaid Older and Disabled Adults 71 Waiver Medicaid Individuals with Intellectual and Developmental Disabilities 81 Waiver Medicaid Medically Complex Child Medicaid Subtype: DW Working Disabled Waiver Subtype: DA Adults with Physical and Developmental Disabilities AG Older and Disabled Adults MD Individuals with Intellectual and Developmental Disabilities MC Children with Complex Medical Conditions
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540 GRANDFATHERED ELIGIBILITY CATEGORIES
The following eligibility categories have been grandfathered into Medicaid by Congress. Encountering one of these individuals will be rare.
Note: Effective October 1, 2026 individuals must also meet Medicaid qualified alien requirements. Refer to section 522 and MAGI Manual Section 808 for policy on U.S. citizenship and eligible alien status.
Email hss.dpa.policy@alaska.gov if you are uncertain whether an applicant qualifies under one of these categories.
540 A. INDIVIDUALS ELIGIBLE FOR AFDC Aid to Families with Dependent Children EXCEPT FOR 1972 SOCIAL SECURITY INCREASE
Medicaid eligibility is available to an individual who would be eligible for AFDC Aid to Families with Dependent Children (if the program still existed) except for the 20 percent increase in Social Security old age, survivors, and disability insurance ( OASDI Old Age, Survivors, and Disability Insurance (Social Security) ) that occurred in 1972 as a result of Public Law 92-336, provided that in August 1972 the individual was eligible for AFDC Aid to Families with Dependent Children . Being eligible for AFDC Aid to Families with Dependent Children includes those who would have been eligible had they applied or had they not been in a medical institution or an intermediate care facility.
EIS Eligibility Information System INFORMATION Eligibility Code: 20 No other eligibility codes apply Medicaid Subtype: SS Individual eligible in 1972, grandfathered
540 B. ELIGIBLE FOR SSI Supplemental Security Income OR APA Adult Public Assistance PAYMENTS EXCEPT FOR 1972 SOCIAL SECURITY INCREASE
Medicaid eligibility is available to an individual who would be eligible for SSI Supplemental Security Income or APA Adult Public Assistance payments today, except for the 20 percent increase in Social Security old age, survivors, and disability insurance ( OASDI Old Age, Survivors, and Disability Insurance (Social Security) ) that occurred in 1972 as a result of Public Law 92-336, provided that in August 1972 the individual was eligible for the state’s Senior Benefits ( SB Senior Benefits ), Aid to the Blind ( AB ), or Aid to the Permanently and Totally Disabled (APTD). Being eligible for one of those programs includes those who would have been eligible had they applied or had they not been in a medical institution or an intermediate care facility.
EIS Eligibility Information System INFORMATION Eligibility Code: 20 No other eligibility codes apply Medicaid Subtype: SS Individual eligible in 1972
540 C. INDIVIDUALS ELIGIBLE FOR MEDICAID IN 1973
Individuals entitled to a mandatory state supplement based upon their receipt, in December 1973, of a cash payment through the state's Senior Benefits ( SB Senior Benefits ), Aid to the Blind ( AB ), or Aid to the Permanently and Totally Disabled (APTD) Programs are eligible for Medicaid.
Institutionalized individuals who were eligible for Medicaid in December 1973, as inpatients in Medicaid-approved medical or intermediate care facilities, and who have continuously met the Medicaid eligibility criteria for December 1973, remain institutionalized, and continue to need institutional care, are eligible for Medicaid.
Blind or disabled individuals who meet all current Medicaid eligibility criteria except those for blindness or disability, who were eligible as blind or disabled in December 1973, and continuously have met the December 1973 criteria, are eligible for Medicaid.
EIS INFORMATION Eligibility Code: 20 No other eligibility codes apply Medicaid Subtype: GF Individuals eligible for Medicaid in 1973
540 D. CHILDREN WHO LOST SSI Supplemental Security Income IN 1996 BECAUSE OF THE CHANGE IN DEFINITION OF DISABILITY
Children that were receiving SSI Supplemental Security Income on August 22, 1996, the date of enactment of the Personal Responsibility and Work Opportunity reconciliation Act of 1996, and lost SSI Supplemental Security Income because of the change in the definition of disability for children, continue to be eligible for Medicaid if they continue to meet all other factors of eligibility.
Note: This does not change the definition of disability established in that law or give Medicaid eligibility to children who were not receiving SSI Supplemental Security Income on August 22, 1996.
EIS INFORMATION Eligibility Code: 20 No other eligibility codes apply Medicaid Subtype: NS Ineligible for SSI /APA – Requirements do not apply to Medicaid.
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550 ELIGIBILITY CATEGORIES FOR AN INDIVIDUAL LIVING IN AN INSTITUTION
Note: Effective October 1, 2026 individuals must also meet Medicaid qualified alien requirements. Refer to section 522 and MAGI Manual Section 808 for policy on U.S. citizenship and eligible alien status.
550 a. SSI Supplemental Security Income OR APA Adult Public Assistance RECIPIENT LIVING IN AN iNSTITUTION
An individual who receives SSI Supplemental Security Income or APA Adult Public Assistance cash assistance while residing in a medical institution or nursing facility may remain eligible for cash assistance and Medicaid. Some individuals may be eligible for cash assistance because they are living in an institution. Because these individuals are eligible for Medicaid as a cash assistance recipient, they are not subject to Medicaid cost of care requirements. See section 570 . However, they may have their cash assistance grant reduced. See APA MS 450-5 and 452-5C .
Example 1: Mr. Scott is a disabled man residing in the community with his employed wife. He has no income of his own. Because of his wife's income, Mr. Scott is not eligible for SSI Supplemental Security Income or APA Adult Public Assistance . On March 5th, Mr. Scott enters a nursing facility. SSI Supplemental Security Income rules require that the wife's income be considered as available to her husband through the month in which they cease to live together (March). In April, his wife's income is no longer considered available to him since he is institutionalized, unless it is actually given to him. Mr. Scott applies for SSI Supplemental Security Income and APA Adult Public Assistance is found to be eligible as of April. He is Medicaid eligible as of April 1 based on the receipt of SSI Supplemental Security Income and APA Adult Public Assistance and is not required to contribute toward the cost of his care. Mr. Scott is not Medicaid eligible in March.
Example 2: Mr. Sawyer is a disabled man residing in the community and is receiving SSI Supplemental Security Income and APA Adult Public Assistance . On March 5th Mr Sawyer enters a nursing facility. He is eligible for Medicaid based on receipt of his March SSI Supplemental Security Income and APA Adult Public Assistance cash assistance. It is determined that Mr. Sawyer will remain eligible for reduced SSI Supplemental Security Income and APA Adult Public Assistance cash assistance in the institution because he has no other source of income. He is Medicaid eligible and is not required to contribute toward the cost of care.
EIS INFORMATION SEPA MERE APAS SUBTYPE ELIG CODE HH TYPE ME- AD Aid to the Disabled Under age 65 SI ST 11 Pregnant Woman NHP Nursing Home Personal Needs Allowance ME- OA Older Alaskans 65 and over 20 No other eligibility codes apply
550 b. iNDIVIDUAL ELIGIBLE FOR SSI Supplemental Security Income , APA Adult Public Assistance CASH ASSISTANCE, OR REFUSED CASH MEDICAID IF NOT IN AN INSTITUTION
An individual who would be eligible for SSI Supplemental Security Income , APA Adult Public Assistance cash assistance, or Refused Cash Medicaid if he or she were not residing in an intermediate care or skilled nursing facility is Medicaid eligible. This individual cannot qualify for a cash assistance program because his or her needs are less in the institution than they would be if the individual were residing in the community. First, establish eligibility and then establish the amount the individual must contribute toward the cost of care. See section 570 for policy on cost of care determinations.
EIS INFORMATION SEPA MERE APMM SUBTYPE ELIG CODE HH TYPE ME- AD Aid to the Disabled Under age 65 NH Nursing Home 11 Pregnant Woman NHP Nursing Home Personal Needs Allowance ME- OA Older Alaskans 65 and over 20 No other eligibility codes apply NHR Regular Nursing Home
550 c. sPECIAL LONG TERM CARE ELIGIBILITY CATEGORY
Note: Historically, this eligibility category was known as the Special Income 300% eligibility category because the income standard was 300% of the SSI Supplemental Security Income standard. In 2003, the income standard was frozen at the 2003 level of $1,656 and no longer reflected 300% of the current SSI Supplemental Security Income standard. As of September 1, 2010, the Long Term Care income limit again reflects 300% of the prevailing SSI Supplemental Security Income standard, which increases each year.
Nursing Home: An individual who resides in an intermediate care of skilled nursing facility is Medicaid eligible if the individual:
Meets all requirements of the SSI Supplemental Security Income or APA Adult Public Assistance program except for income and the financial eligibility rules in sections 553 - 555 ;
Has gross income equal to or below the Long Term Care Income Standard (no income disregard applies). See Addendum 1 for amount; and
Has resided in the institution for 30 consecutive calendar days. If the individual in the institution dies on or before the 30th day, the deceased individual is considered to have met the 30 day requirement.
Although the individual may not qualify for the Special LTC category until day 30 of institutionalization, their effective date of eligibility is retroactive to the first day of the 30-day period of institutionalization.
HCB Home and Community-Based Waiver: An individual who has been approved by DSDS Division of Senior and Disabilities Services to receive Home and Community Based (HCB) waiver services is Medicaid eligible if the individual:
Meets all requirements of the SSI Supplemental Security Income or APA Adult Public Assistance program except for income, age and the financial eligibility rules in sections 553 - 555 ; and
Has gross income equal to or below the Long Term Care Income Standard (no income disregard applies). See Addendum 1 for amount. When determining eligibility for a disabled child who has a current DDS Disability Determination Service decision on file, the income and resources of the child's parents are not counted, even if the child is living with his or her parents. Individuals who can qualify for Medicaid under regular need standards are not subject to the Long Term Care income eligibility standard.
Because a recipient of HCB Home and Community-Based waiver services lives in his or her own home (or assisted living home), and not in an institution, the 30-day waiting period described above does not apply.
EIS INFORMATION SEPA MERE APMM SUBTYPE ELIG CODE HH TYPE ME-AD Under age 65 IN AS 11 Pregnant Woman NH3 ME-OA 65 and over 24 LTC Long Term Care Institutionalized
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553 PREVENTING SPOUSAL IMPOVERISHMENT
Medicaid has unique "spousal impoverishment" rules designed to keep a spouse who is still living in the community from being impoverished when trying to support a spouse who is in need of long term care in a medical institution, nursing home, or through Home and Community Based ( HCB ) waiver services. Spousal impoverishment rules allow the couple to retain a certain amount of resources and income that are above the APA Adult Public Assistance -related Medicaid financial limits and allocate those resources and income to the community spouse. There are also post-eligibility income allowances for maintaining a community spouse. See Section 570 for policy on post-eligibility and cost-of-care.
553 A. DEFINITIONS
Community Spouse: The spouse of an applicant or recipient of long-term care Medicaid. A community spouse resides outside of an institution and is not receiving HCB Home and Community-Based waiver services.
Continuous Period of Institutionalization: At least 30 consecutive days of residing in a medical institution, nursing home, or receiving HCB Home and Community-Based waiver services.
Community Spouse Income Allowance: The amount of the long-term care spouse’s income that may be allocated to the community spouse in order to raise the community spouse’s gross income up to the Community Spouse Monthly Maintenance Standard. See Addendum 1 .
Community Spouse Resource Allowance: The amount of the long-term care spouse's resources that may be allocated and subsequently transferred to the community spouse, or to another person for the sole benefit of the community spouse, prior to a determination of eligibility for long-term care services. See Addendum 1 .
Long-Term Care ( LTC ) Spouse: A spouse residing or likely to reside in a medical institution or nursing home for a continuous period of institutionalization or who is approved for Medicaid HCB Home and Community-Based waiver services.
Spouse: A person legally married to another under State law.
553 B. OPTIONAL PRELIMINARY RESOURCE ASSESSMENT
At the beginning of a continuous period of institutionalization, either spouse, or a representative acting on behalf of either spouse, may request and receive an assessment of the couple's combined resources. The assessment will calculate the total value of the couple's combined countable resources, owned either jointly or separately, as of the date on which the institutionalization in a medical institution or nursing home began. The assessment will provide the couple with the information necessary for their financial planning. An application for Medicaid is not required in conjunction with the assessment.
Note: This assessment does not apply to HCB Home and Community-Based waiver individuals.
The assessment request is made by the requester by completing a NH8 - Resource Assessment Request form, which is available on the DPA Division of Public Assistance e-forms web site at http://dpaweb.hss.state.ak.us/e-forms/pdf/nh8.pdf . This form asks the requester to complete a list of the couple's resources and their current fair market value and present it to the nearest Public Assistance District Office for assessment.
Upon receipt, the caseworker must review the request and if it is incomplete or ownership and/or value of resources is questionable, request additional documentation or verification. If the requester has provided the information necessary to complete an assessment, the caseworker must compute the total countable value of the couple's resources, complete the Resource Assessment form, and send one copy to each spouse, or their representative. One copy of this form must be retained by the agency for one year.
The Resource Assessment informs the spouses that the assessment calculation is only as accurate as the amounts that they have provided. If these amounts prove to be inaccurate at a later date, the agency is not bound to use them to determine eligibility. The form also states that if they disagree with the assessment determination, they may submit an application and if they are not found eligible, may request a fair hearing.
The assessment should be completed in a timely manner, within 45 days after receipt in the district office of the request or the necessary verification.
553 C. SUBSTANTIAL HOME EQUITY
An individual whose equity interest in a home exceeds the amount listed in Addendum 1 , Excess Home Equity, is NOT eligible for long-term care or home and community-based waiver services. Determine if the individual is eligible for regular Medicaid.
Exception: This limitation does not apply if the community spouse, the individual’s child under age 21, or the individual’s blind or disabled child of any age is residing in the home.
An individual may use a reverse mortgage or home equity loan to reduce the equity interest in the home. If the individual has a reverse mortgage or home equity loan, consider this in determining countable home equity.
If the individual has shared ownership in the home, only the fractional interest of the individual seeking long-term care or home and community-based services is considered. For example, if the home is owned by an applicant and a sibling, one-half of the home’s equity value is used in calculating the equity value for the individual, unless the individual can prove that he or she does not have equal ownership in the property.
Re-evaluation of home equity is required at each review. The appreciation of home equity could result in disqualification of institutional or waiver services if the home equity value exceeds the limit.
553 D. RESOURCE ELIGIBILITY DETERMINATION AND ALLOTMENT OF RESOURCES
All countable resources owned by either spouse, jointly or separately, are pooled together as of the date of institutionalization or potential approval of HCB Home and Community-Based waiver services. Before the eligibility determination is made for the LTC Long Term Care spouse, resources may be allotted to the community spouse, up to the Maximum Community Spouse Resource Allowance. See Addendum 1 - Program Standards. Any amount exceeding this allowance must be considered available to the LTC Long Term Care spouse in the eligibility determination, regardless of which spouse owns the excess.
To determine resource eligibility for the LTC Long Term Care spouse:
Total all resources of the applicant and community spouse.
Deduct from the current combined countable resources the Maximum Community Spouse Resource Allowance (or a higher amount ordered by a court or fair hearing decision - see Subsection F .).
Compare the amount of any remaining resources to the resource eligibility standard for one person. See APA Adult Public Assistance Manual Section 430-2 . If the amount is equal to or below the resource eligibility standard, the LTC Long Term Care spouse is resource-eligible; if the remaining resources exceed the eligibility standard, there is no Medicaid eligibility.
Example 1: A couple's combined countable resources at the time of the institutionalized spouse's Medicaid application are $132,720. The Maximum Community Spouse Resource Allowance is $128,640 (for 2020) and the eligibility resource limit is $2,000. Step 1: Deduct from combined countable resources of $132,720, the Maximum Community Spouse Resource Allowance of $128,640. Step 2: The remaining $4,080 is used to determine the LTC Long Term Care spouse's Medicaid eligibility. This amount exceeds the resource limit, so there is no Medicaid eligibility.
Inform the applicant that he/she is over resource and spend down is necessary. Explain to the applicant what appropriate spend down actions to take in order to avoid a transfer of asset penalty. However, never give advice or tell the applicant what steps to take.
When the resources are equal to or less than the Maximum Community Spousal Resource Allowance, complete the eligibility determination. When approving Medicaid for HCB Home and Community-Based waiver services or Nursing Home care, send the M005 - Notice To Transfer Resources To Spouse. This notice explains that the applicant has one year to transfer all resources into the community spouse’s name.
Example 2: Use Example 1, except the couple's combined resources are $130,250. Step 1: Deduct from combined countable resources of $130,250, the Maximum Community Spousal Resource Allowance of $128,640. Step 2: The remaining $1,610 is used to determine the LTC Long Term Care spouse’s Medicaid eligibility. This amount is less than the APA Adult Public Assistance resource limit of $2,000, so the LTC Long Term Care spouse is resource-eligible.
553 E. REDETERMINATION OF ELIGIBILITY FOR THE LTC Long Term Care SPOUSE
The Maximum Community Spousal Resource Allowance held in the name of the LTC Long Term Care spouse continues until the next regularly scheduled annual review.
When there are changes in the amount of resources following the initial eligibility determination, the caseworker must reevaluate the resource eligibility of the LTC Long Term Care spouse, but the Maximum Community Spousal Resource Allowance remains in effect until the next regularly scheduled annual review. After that time, resources held in each spouse's name are considered available only to the spouse in whose name they are held.
Note: It is important to let both spouses know of this policy in writing, so that they have adequate time to transfer resources to the community spouse’s name.
553 F. TRANSFER OF RESOURCES TO THE COMMUNITY SPOUSE
Once eligibility has been established for the LTC Long Term Care spouse, resources not used to determine eligibility (i.e., resources allotted to the community spouse) must be transferred to the community spouse to assist that spouse in meeting his or her needs in the community. This transfer should be done as soon as it is practicable. This must be done before the first annual review of eligibility for the LTC Long Term Care spouse.
When the first renewal is received, check and ensure that all the resources had been transferred to the community spouse:
If the resources have not been transferred and the M005 was sent, close the Medicaid case due to excess resources.
If the resources have not been transferred but no M005 notice was sent, send a separate notice allowing an additional 30 days to complete the transfer. If the transfer is not completed within 30 days, close the Medicaid case following adverse action notice requirements.
553 G. INCREASES TO MAXIMUM COMMUNITY SPOUSAL RESOURCE ALLOWANCE
The Maximum Community Spousal Resource Allowance may be increased in the following ways:
When the Hearing Authority issues a decision that a higher amount of resources must be retained by the community spouse so that the income generated from those resources is adequate to raise that spouse's income to the minimum amount that may be deducted as a maintenance allowance in the post-eligibility determination (see Section 570 ); or
When either member of the couple alleges that the resource determination was incorrect, and the Hearing Authority concurs; or
A court support order mandates that additional amounts of the LTC Long Term Care spouse’s resources be transferred to the community spouse or other dependents; or
The Division of Public Assistance determines that denial of eligibility would create undue hardship.
Note: The Medicaid Policy Specialist or designee makes this decision on a case-by-case basis.
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554 TRANSFER OF ASSETS
An individual who is institutionalized or receiving home and community based ( HCB ) waiver services and who transfers income or resources for less than fair market value may be subject to a penalty that results in a period of ineligibility for institutional or HCB Home and Community-Based services. In order for a penalty to apply, the transfer must have occurred within the look-back period.
Medicaid transfer of assets rules apply to all individuals eligible under the Special Long Term Care eligibility category and to all individuals receiving HCB Home and Community-Based waiver services, regardless of their eligibility category.
This section explains how to treat a transfer of asset for less than fair market value and includes policies in effect before and after implementation of the Deficit Reduction Act of 2005 provisions.
This section contains the policy and procedures for determining the following:
Who is subject to the transfer of asset penalty;
Which assets are subject to the transfer of asset rules;
The look-back period;
Start date of the penalty period;
When a non-allowable transfer has occurred;
Treatment of purchasing promissory notes, loans, or mortgages;
Treatment of purchasing life estates;
Treatment of annuities;
When to impose a transfer of asset penalty;
How to calculate the penalty period; and
Undue hardship.
554 A. DEFINITION OF TERMS RELATED TO TRANSFER POLICY
Annuity - An annuity is a contract. An individual pays an entity a lump sum of money in return for the right to receive fixed, periodic payments, either for life or for a term of years.
Compensation - Something received as payment for an asset. Payment is usually considered to be cash, but other forms of payment include in-kind income, real or personal property, support and maintenance, services, or assumption of a legal debt.
Community Spouse - The spouse of an applicant or recipient of long-term care Medicaid. A community spouse resides outside of an institution and is not receiving HCB Home and Community-Based Waiver Services.
Equity - The equity of real or personal property is the fair market value (see definition below) less any encumbrances (mortgages, liens, or judgments) on the property.
Fair Market Value - Fair market value is current market value of a resource at the time the resource is transferred. The current market value of a resource is the going price for which it can reasonably be expected to sell on the open market in the geographic area involved.
Legal Representative - A person legally authorized to execute a binding contract for the individual, such as (but not limited to) a legal guardian, parent of a minor child, power of attorney, or trustee managing the individual's assets. Legal authorization requires a legal document or court action except for parents of minor children.
Life Estate - Under a life estate, an individual who owns property transfers ownership of that property to another individual while retaining, for the rest of his or her life (or the life of another person), certain rights to that property. Generally, a life estate entitles the owner of the life estate (the grantor) to possess, use, or profit from the property as long as he or she lives. However, the grantor no longer owns the property.
Look-back Period - The period immediately prior to the date of application or review in which the caseworker will look to see if the applicant transferred an asset.
Medical Institution - An institution certified under state law to provide medical care, including nursing and convalescent c are, such as hospitals, skilled nursing facilities ( SNF ), intermediate care facilities ( ICF ), intermediate care facility for the Intellectually Developmentally Disabled ( ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled ) ; residential psychiatric treatment centers ( RPTC ); and certain assisted living homes providing residential supported living and rehabilitation services, including Alaska Pioneer Homes.
Partial Month Penalty - The penalty period for transferring an asset that produces a fractional monthly amount, resulting in a partial month of ineligibility.
Penalty Period - The period of time in which a client is ineligible for institutional and HCB Home and Community-Based waiver services due to a transfer of asset for less than fair market value. See Subsection 554 L .
Transfer - To change ownership or title from one person(s) to another. A transfer also occurs when an individual takes any action that eliminates his ownership or reduces his control of an asset.
Uncompensated Value - The difference between the equity value of the asset at the time of the transfer and any payment or compensation received. The uncompensated value is the amount upon which the length of a transfer of asset penalty is based.
554 B. VERIFICATION AND DOCUMENTATION
A MED 3 Declaration / Denial of Asset Transfer form , or M723 Transfer of Asset Declaration notice, must be provided and completed for all nursing home or home and community based waiver applicants, including child waivers, when an applicant did not apply with a MED 4 Application for Adults and Children with Long Term Care Needs .
The applicant needs to provide proof of any funds held in financial accounts. If such accounts exist, the applicant can provide the last three bank statements for each account that is owned by the applicant and his or her spouse. Client statement is acceptable for these accounts if the statements are not readily available and the caseworker does not find the information questionable. The caseworker must also obtain this declaration when an APA Adult Public Assistance / SSI Supplemental Security Income /Medicaid or MAGI Modified Adjusted Gross Income Medicaid recipient has started the waiver process.
In addition to the initial application, look for a transfer of asset at the time of review (for the prior 12 months), when a transfer is reported, or when there is a request for a change in institutional or HCB Home and Community-Based services.
When there has been a transfer of assets during the look-back period, obtain the following information:
A description of the asset transferred (the home, other real property, life estate, cash, lump sum, car, stocks, bank account, certificate of deposit, etc.).
The person who transferred the asset (client, spouse, legal representative).
The name of the person(s) to whom the asset was transferred.
The client's relationship to the individual to whom the asset was transferred.
The countable value of the asset at the time of the transfer and the compensation (money or other benefit) received or expected to be received from the transferred asset.
The date the asset was transferred.
Whether the applicant was the sole owner of the asset at the time of the transfer; if not, the name of any co-owners.
If applicable, documentary evidence that the individual intended to dispose of an asset at a fair market value or information from knowledgeable sources to support the value (if any) at which the asset was disposed. See Section 554-F(3) .
Document information in the CANO Case Notes and explain the following transfer of assets rules to the client:
How the penalty is calculated, and
Exceptions to the penalty, and
How to lift or reduce the penalty period.
554 C. TRANSFER OF ASSET RULES APPLY
Transfer of asset rules apply to:
Resources - Any real or personal property, annuity, liquid resource, or funds owned by the individual and his or her spouse that is given away, sold for less than fair market value, or used to purchase a promissory note, loan, mortgage, or life estate.
Income - Any earned or unearned income (including a lump sum) of the individual and his or her spouse that is transferred to another individual in the month of receipt. See APA Manual Section 440-1 for the definition of income.
Note: All real property in Alaska owned by an Alaska Native or American Indian is excluded from being a countable resource or as a potential transfer of asset penalty. This includes land and any structures built on the land. See MS 524-L for more information.
554 D. LOOK-BACK PERIOD
The date on which the look-back period is established is based on the date an individual applies for long term care services, or the date the individual is institutionalized, whichever is later. For example, an individual entered a nursing facility in June and submitted an application during the month of July; the July application date sets the look-back period.
Note: The look-back period should be measured from the date the transfer of property actually occurred, not necessarily when the transfer was officially recorded. An unrecorded conveyance is valid.
The look-back period is 60-months for non-trust transfers of assets for less than fair market value made on or after February 8, 2006.
Take the following steps when determining the look back period:
Evaluate all transfers beginning on or after the look-back date.
Do not consider transfers made prior to this date.
A transfer penalty must be determined for all non-allowable transfers within the look-back period.
Document the findings in the CANO Case Notes .
Although eligibility is determined month-by-month, the look-back period is day specific.
Example 1: Mrs. Korev is institutionalized on May 20, 2026. She applies for Medicaid on May 26, 2026. She has a 60-month look-back period from May 26, 2021 through May 26, 2026.
554 E. PENALTY START DATE
For asset transfers made on or after February 8, 2006, the penalty begins the first day of the month the individual is eligible for Medicaid and would be receiving institutional level of care services, except for the imposition of a transfer of asset penalty.
A transfer of asset penalty cannot start in a retro month, it starts with the application date or the date the individual is institutionalized, whichever is later.
554 F. ASSET TRANSFERS NOT RESULTING IN PENALTY
DO NOT apply a transfer of asset penalty for:
1. Compensated Transfer
Real or personal property or liquid assets that are transferred or exchanged in return for money or other tangible object, service, or benefit that is equal to or greater than the equity of the transferred asset is a compensated transfer. Transfers for services to be provided in the future are not allowable because they have not been compensated.
2. Excluded Asset at the Time of Transfer
An asset that is exempt at APA Manual Section 433-1(B) is an allowable transfer not subject to a transfer of asset penalty.
3. Intent to Dispose of Assets for Fair Market Value or for Other Valuable Consideration
The individual intended to dispose of the assets either at fair market value or for other valuable consideration. The individual must provide written evidence of attempts to dispose of the asset for fair market value, as well as proof to support the value at which the asset was disposed.
Example 2: Ms. Pierce owns rental property with a tax value of $50,000. There are no encumbrances on the property. She lists the property with a realtor for the current market value of $50,000. After several months, Ms. Pierce received a firm offer for $40,000. She accepted the offer. This example documents that Ms. Pierce intended to sell her property at the current market value, but she only received a portion of that amount. Do not apply penalty to the difference between the current market value and the compensation received.
4. Transfer for Other Purposes
For Medicaid, the presumption is that the client or spouse transferred the asset to qualify for Medicaid, continue to qualify for Medicaid, or avoid estate recovery. The client must rebut that presumption by providing convincing evidence of the specific purpose of the transfer. Transferring for gifts, inheritance, avoiding probate, or preservation of an estate does not rebut the presumption that the transfer was to qualify for Medicaid or avoid estate recovery.
5. Transfer Returned
The transferred asset for less than fair market value is returned to the client.
6. Transfer of the Home
Transfer of the home is an allowable transfer only when it is transferred to one of the following:
Legal spouse;
Child under age 21;
Blind/disabled (determined by SSA Social Security Administration ) child of any age;
Sibling who is a co-owner of the home and has been residing in the home for a period of at least one year immediately before the applicant or recipient was institutionalized; or
Adult child who resided in the home for at least two years immediately before the applicant or recipient entered an institution or began receiving home and community based waiver services, and who for the entire two-year period provided care to the disabled parent such that it prevented the need for the parent to enter the institution or to begin receiving HCB Home and Community-Based waiver services.
Note: Verification must be provided that the adult child resided in the home during the two years, and that the adult child provided necessary care.
7. Transfer to a Trust
Income transferred to a Medicaid Qualifying Income Trust, or income and resources transferred to a Special Needs or Pooled Trust established for the sole benefit of an individual under age 65 who is disabled as defined under SSI Supplemental Security Income rules.
8. Transfers to Prevent Spousal Impoverishment
Transfers made under Section 553-F are not subject to penalty.
9. Transfers of Federal Income Tax Returns
Federal income tax returns are not subject to Medicaid transfer of asset penalty provisions for 12 months from the date payments are received. However, payments given away after the end of the exempt period are subject to transfer of asset penalty provisions.
554 G. TRANSFERS TO A SPOUSE, CHILD, OR A DISABLED PERSON
Transferring an asset to the individuals spouse, child, or to a disabled person is not subject to transfer of asset penalty if the asset was transferred:
To the individuals spouse or to another for the sole benefit of the individuals spouse;
From the individuals spouse to another for the sole benefit of the individuals spouse;
To the individuals child, or to a trust established solely for the benefit of the individuals child, provided the child meets the SSI Supplemental Security Income criteria for blindness or disability; or
To a special needs trust established for the sole benefit of a person under age 65 who meets the SSI Supplemental Security Income criteria for disability.
To verify that a transfer of assets is for the sole benefit of an individuals spouse, child, or a disabled person, there must be a written document that legally binds the parties to a specified course of action and identifies who can benefit from the assets.
If there are restrictions placed on transfers that limit the availability of assets to the individual's spouse, child, or a disabled person, email hss.dpa.policy@alaska.gov . Also, please contact the Medicaid Specialist if there are any other indications that the transfer is intended to benefit someone besides the individual's spouse, child, or a disabled person.
554 H. NON-ALLOWABLE TRANSFERS
A non-allowable transfer occurs when any action is taken that causes income or resources of the individual or the individual's spouse to be transferred to another, including:
Irrevocably waiving pension income;
Waiving the right to receive an inheritance;
Not accepting or accessing injury settlements;
Agreeing to a tort settlement that allows the defendant to divert the tort settlement proceeds into a trust, annuity, or similar device to which the plaintiff (who is an applicant or recipient), or the plaintiff's parent or guardian, does not have any access or control. This prohibition does not apply if the proceeds are placed into a recognized Medicaid trust established by the applicant or recipient.
Refusing to take legal action to obtain a court-ordered payment that is not being paid, including child support or alimony; or
Reducing the individual's ownership or control of an asset.
Example 3: Ms. Deluca added her niece's name to her $30,000 savings account in January so either party could access the account independently. This is an "OR" account. (For Medicaid purposes, the entire $30,000 would still be considered available to her and is not subject to a transfer of asset penalty.) However, in April, her niece withdraws the $30,000 from the joint account and puts it into her own account, which eliminates Ms. Deluca's ownership, thus Ms. Deluca is subject to a transfer of asset penalty beginning in May.
Example 4: The same situation as above, but in January the account is changed to an "AND" account. An "and" account requires the signature of both parties to access, thus reducing the clients control of the asset. In this situation, Ms. Deluca is subject to a transfer of asset penalty beginning in February.
Note: It is not a transfer of asset for less than fair market value if the reason for failure to receive an asset is because the individual cannot afford to take the necessary action to obtain the asset or the cost of obtaining the asset is equal to or greater than the assets worth.
554 I. PROMISSORY NOTES, LOANS, OR MORTGAGES
A promissory note, loan, or mortgage is treated as a transfer of asset unless all of the following criteria are met:
The repayment term is actuarially sound (i.e., the beneficiary is expected to live long enough to receive all of the payments); and
Payments are made in equal amounts during the term of the loan with no deferral of payments and no balloon payments; and
The promissory note, loan or mortgage prohibits the cancellation of the balance upon the death of the lender.
Note: Use the period life table published by the Social Security Administration online at http://www.ssa.gov/OACT/STATS/table4c6.html .
554 J. LIFE ESTATES
If an individual has a life estate, the caseworker must investigate whether a transfer of asset for less than fair market value occurred. If the value of the asset transferred by the individual is greater than the value of the life estate, a transfer of asset for less than fair market value has occurred.
The value of the life estate is the amount that it would sell for as of the first moment of the month. This value is determined by multiplying the fair market value of the property by a decimal value based on the life estate holder's life expectancy.
Note: Use the life estate tables published by the Social Security Administration online at https://s044a90.ssa.gov/apps10/poms.nsf/Inx/0501140120 .
If the value of the property exceeds the fair market value of the life estate, the difference between the property value and the life estate value is treated as an asset transfer.
Example 5: Ms. Altman, age 65, owns a house worth $100,000. She deeds the house to her son but retains a life estate in the property. Under the terms of the life estate, Ms. Altman is entitled to live in the house for the rest of her life. To determine the value of Ms. Altman's life estate, the current market value of the property ($100,000) is multiplied by a life estate factor corresponding to Ms. Altman's age in the table (.67970), resulting in a life estate worth $67,970. The penalty is assessed for the difference between the value of the asset transferred ($100,000) and the value of the life estate ($67,790), resulting in $32,030 uncompensated transfer.
554 K. ANNUITIES
The purchase of an annuity by an applicant or a spouse is an allowable transfer when all of the following conditions are met:
It is purchased with proceeds from an employee retirement account or trust, employee pension, or Roth Individual Retirement Account;
OR
It is irrevocable and nonassignable; and
It is actuarially sound (i.e., the beneficiary is expected to live long enough based on the beneficiary's age at the time the annuity is purchased to receive all of the payments); and
It is paid out in equal monthly payments with no deferral and no balloon payments.
In addition, an allowable annuity must name the State as remainder beneficiary
in the first position for the total amount of medical assistance paid on behalf of the individual, including both long-term care services and waiver services, or
in the second position if there is a community spouse, or a minor or disabled child.
Note: Caseworkers must email TPL Third Party Liability at doh.hcs.rec.info@alaska.gov whenever an annuity is approved for a case and the State of Alaska is the beneficiary of that annuity.
To determine if a transfer for less than fair market value has occurred, take the following steps:
Determine the number of years the beneficiary is expected to live based on the beneficiary's gender and age at the time the annuity is purchased.
Note: Use the actuarial tables published by the Social Security Administration online at www.ssa.gov/OACT/STATS/table4c6.html .
Multiply the annual amount scheduled to be paid out by the annuity by the number of years the beneficiary is expected to live. Round to the nearest dollar. This is the amount that the annuity is expected to pay out.
Compare this amount to the purchase price of the annuity.
When the amount that is expected to be paid out during the beneficiary's lifetime is equal to or greater than the purchase price of the annuity, the individual will receive fair market value for his investment. This is an allowable transfer. Do not apply a penalty.
When the purchase price of the annuity is greater than the amount that is expected to be paid out in the beneficiary's lifetime, a penalty should be applied based on the total purchase price of the annuity.
Example 6: Mr. Hollywood, age 65, purchases a $10,000 annuity for himself to be paid out at an annual rate of $1,000 per year over the next ten years. His life expectancy at age 65 is 15.52 years. Since he is expected to live long enough to receive the full value of the annuity, the annuity is an allowable transfer.
Example 7: Mr. Lena, age 85, purchases a $100,000 annuity to be paid out at an annual rate of $1,000 per year over the next ten years. His life expectancy at age 85 is 5.89 years. Since he is not expected to live long enough to receive the full value of the annuity, an uncompensated transfer has occurred and a penalty must be applied. The value of the uncompensated transfer is $100,000.
Note: The allowable transfer of asset policy described above does not apply to revocable and/or assignable annuities. Instead, such annuities are considered as countable resources. If a revocable annuity is cancelled, the funds used to purchase the annuity may be refunded to the purchaser. If the owner or payee may be changed, it means the annuity is "assignable," which in turn means the annuity can be sold on the secondary market. In either case, an annuity that meets one or both of these criteria is a countable resource. If the annuity is revocable, the resource value is the amount that the purchaser would receive if the annuity is cancelled. If the annuity is assignable, the resource value is the amount the annuity can be sold for on the secondary market.
554 L. TRANSFER PENALTY AND PARTIAL MONTHS
Partial months of ineligibility will be imposed when the calculation of the penalty period for transferring an asset produces a remainder amount. This calculation is based on the monthly nursing home rate in the community in which the individual is institutionalized. If unable to determine which community the individual would receive nursing facility services, use the current swing-bed rate as determined by the Division of Health Care Services, Office of Rate Review, and provided by DPA Division of Public Assistance Policy to eligibility workers upon request.
To determine the uncompensated value of a transfer:
Determine and list the date(s) of each non-allowable transfer occurring during the look-back period.
Determine the value of each transferred asset.
Establish the fair market value of the transferred asset at the time of transfer.
Subtract any encumbrances from the fair market value to establish the equity of the asset.
Establish the amount or value received for the transferred asset.
Subtract from the equity the amount received. This is the uncompensated value.
Determine the Penalty Period.
For transfers made on or after February 8, 2006
Add the uncompensated value of each transfer in the look-back period.
Divide the total uncompensated value for all transfers by the average monthly cost to a private patient of nursing home care in the individual's community. If unable to determine in which community the individual would receive nursing facility services, use the current swing-bed rate.
When the calculation of the penalty period produces a remainder, the penalty will include a partial month disqualification.
The result is the number of full and/or partial months for the penalty period.
The period of ineligibility begins once an individual is institutionalized, and eligible for Medicaid. The period runs continuously through the end of the penalty period, even if the individual subsequently stops receiving institutional level of care.
Example 8: Mr. Reed entered a nursing facility in November 2021 and applied for Medicaid on December 5, 2021. He made one transfer during the look-back period. He transferred real property with an equity value of $150,000 on February 20, 2018, receiving no compensation. The average monthly cost to a private patient in a nursing home in his community is $9,630. The uncompensated transfer amount of $150,000 is divided by the average monthly rate of $9,630 and equals 15.58 months. Because Medicaid eligibility begins on the first day of the month, the full 15-month penalty period runs from December 2019 through February 2021, with a partial month penalty calculated for March 2021: $150,000 uncompensated transfer amount ÷ 9,630 monthly rate = 15.58 number of months for penalty period 31 number of days in March 2021 x .58 partial month penalty period = 17.98 number of days for partial month penalty The partial month penalty of 17 days (rounded down) is added to the 15-month penalty period. This means that Medicaid will begin payment for long-term care coverage on March 18, 2021.
Multiple Penalty Periods Overlap.
When assets have been transferred so that multiple penalty periods overlap, combine the uncompensated value of all assets transferred and compute a single penalty period.
Example 9: (For transfers made on or after February 8, 2006) Mr. McFarland entered a nursing facility on July 2, 2021. The average monthly cost to a private patient in a nursing home in his community is $9,630. He applied for Medicaid on August 12, 2021. The look-back period begins August 12, 2021. He made the following transfers during the look-back period: $20,000 on January 20, 2020, another transfer of $15,000 on September 6, 2018, and another transfer of $10,000 on February 10, 2018. The total uncompensated transfer amount of $45,000 is divided by the average monthly rate of $9,630 and equals 4.67 months. This results in giving a partial month penalty. Because Medicaid eligibility begins on the first day of the month, the full four-month penalty period runs from August 2021 through November 2021 with a partial month penalty calculated for December 2021: $45,000 total multiple uncompensated transfer amount ÷ 9,630 monthly rate = 4.67 number of months for penalty period 31 number of days in December 2021 x .67 partial month penalty period = 20.77 number of days for partial months penalty The partial month penalty of 20 days (rounded down) is added to the four-month penalty period. This means that Medicaid will begin payment for long-term care coverage for Mr. McFarland on December 21, 2021.
Both Spouses are Institutionalized or Receiving HCB Home and Community-Based Waiver Services
When both spouses are institutionalized or receiving HCB Home and Community-Based waiver services, divide the penalty period between the spouses. The total penalty imposed on both spouses cannot exceed the number of months of the penalty period.
When one spouse is no longer subject to a penalty (i.e., the spouse no longer receives institutional services or the spouse dies), the remaining penalty period applicable to both spouses must be served by the remaining spouse.
If a community spouse is later institutionalized or receives waiver services and a penalty period is still in effect for the first institutionalized spouse:
Divide the remaining penalty period equally between the spouses.
Do not establish a new look-back period. The client's initial look-back period for the first institutionalized spouse is the same for the former community spouse.
Determine if any additional transfers were made by the former community spouse during the look-back period. Apply the same rules when considering an asset subject to transfer of asset penalty.
A transfer that occurred during the portion of the community spouses look-back period that does not overlap with the look-back period of the first institutionalized care spouse is subject to a transfer penalty. Only the former community spouse is subject to that penalty.
When both spouses are approved at the same time, the extra month is applied to the one with the earlier birth date.
Example 10: (For transfer made on or after February 8, 2006) Mr. Gibson enters a nursing a facility and applies for Medicaid. Mrs. Gibson transfers an asset that results in a 12.64 month penalty against Mr. Gibson. Four months into the penalty period, Mrs. Gibson enters a nursing facility and applies for Medicaid. The penalty period against Mr. Gibson still has 8.64 months to run. Because Mrs. Gibson is now in a nursing facility and a portion of the original penalty period remains, the remaining 8.64 months of penalty is divided between Mr. and Mrs. Gibson. Therefore, Mr. and Mrs. Gibson each have a four month penalty. Because there is a partial month, the extra days are assigned Mr. Gibson. The partial month is given to the spouse who entered the institution or receives waiver approval first.
When both spouses are approved at the same time, the partial month is applied to the one with the earlier birth date.
When a transfer of assets penalty is imposed, immediately notify:
DHCS Division of Health Care Services Systems Unit at dhcs.systems@alaska.gov and t he Division of Senior and Disability Services (DSDS) at longterm.careunit@alaska.gov with the date of Medicaid closure. This is necessary so that DSDS can discontinue issuing Prior Authorizations for HCB Waiver and Nursing Home services.
The following information must be given:
Name and identification number of the client;
Date of penalty start;
Date of penalty end; and
Long term care or waiver services are not to be authorized or paid for until after the penalty end date.
The Division of Health Care Services will enter the penalty end date into the Medicaid Management Information System ( MMIS Medicaid Management Information System ) to prevent long term care or waiver service claims from being paid until the penalty ends.
554 M. UNDUE HARDSHIP
An undue hardship exists when a transfer of asset penalty would deprive the applicant, recipient, or community spouse of:
medical care such that the individual’s life or health would be endangered; or
food, clothing, shelter, or other basic necessities of life.
If a transfer of assets penalty is imposed on an individual, a timely notice of the penalty must be sent. The notice must state that
The penalty will be imposed 10-days after the date of the notice;
An undue hardship exception exists;
The request for an undue hardship exception must be submitted within 30 days of the date the notice was mailed; the individual, or the facility in which the institutionalized individual is residing can request an undue hardship on behalf of the individual with the consent of the individual or the authorized representative of the individual. The facility must have the consent of the individual or the individual’s personal representative. In addition, the facility may present information on behalf of the individual to the Department. The facility may represent the individual throughout the appeals process with the specific written consent of the individual or the individual’s authorized representative;
An undue hardship determination will be made within 30 days of receipt of the request; and
A denial of a hardship determination can be appealed.
The individual or facility acting on behalf of the individual must submit a written statement to the caseworker indicating how the individual or his or her community spouse would be subject to undue hardship and describes:
Why the assets transferred for less than fair market value cannot be returned; and
What efforts the applicant or recipient has made to have the assets returned.
The request should be sent to the Medicaid Specialist at hss.dpa.policy@alaska.gov . The Medicaid Specialist will:
evaluate requests for undue hardship exceptions.
notify the Division of Health Care Service’s (DHCS) Third Party Liability (TPL) Claims Unit of the request. This unit will pend all institutional and HCB Home and Community-Based waiver service claims made within the ten-day notice period, and deny claims after the ten-day notice period. Claims will be pended until ten days after the agency notifies the client of the determination.
email the finding of undue hardship to the eligibility caseworker.
If a finding of undue hardship is made, no penalty applies.
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555 INSTITUTIONAL DEEMING
555 A. COUPLES
A couple who has continuously resided together in the same institution for six months or both lived at home and both received home and community based ( HCB ) waiver services for six months, may have their income and resources considered as a couple or as separate individuals - whichever scenario would most benefit the recipients.
555 B. INDIVIDUALS UNDER 21
For an individual under 21 who is Individualized Supports institutionalized for disability (e.g., a child residing in a nursing home), or who is approved for HCB Home and Community-Based waiver services under the Special Long Term Care category, the eligibility and post-eligibility determination processes are the same as those for an institutionalized adult.
555 C. EIS INFORMATION
EIS INFORMATION Eligibility Code: 11 Pregnant Woman 24 LTC (300%) Institutionalized 54 SSI disabled child, Medicaid only Medicaid Subtype: IN LTC (300% Nursing Home/ HCB Waiver) NH Nursing Home
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560 HOME AND COMMUNITY-BASED (HCB) WAIVER SERVICES
560 A. GENERAL PROVISIONS - HCB Home and Community-Based WAIVER SERVICES
An individual who needs the level of medical care typically provided in a long-term care facility, such as a nursing home, may qualify for special health related services Medicaid normally does not cover. These services are provided in the home or in a community setting and are intended to provide enough additional help that the individual can continue to live in his or her home. These additional services are available only because the federal government has waived regular Medicaid coverage rules.
Administering HCB Home and Community-Based waivers is an interagency effort that involves the following agencies:
Division of Public Assistance (DPA), determines categorical and financial Medicaid eligibility;
Division of Senior and Disability Services (DSDS), also referred to as the waiver managing agency , performs the level-of-care (LOC) assessment with the assistance of private care coordinators and approves or denies all applicants for services under the appropriate HCB waiver; and
Division of Health Care Services (DHCS) processes and pays Medicaid claims submitted by a provider.
560 B. HCB WAIVER TYPES
There are five HCB Home and Community-Based Waivers approved for Alaska, each designed to serve a specific group of individuals:
Children with Complex Medical Conditions (CCMC): This waiver is for a child through age 21 who requires a level of care provided by a hospital or nursing facility.
Individuals with Intellectual and Developmental Disabilities (IDD): This waiver is for a child or adult that requires a level of care provided by an intermediate care facility for those with intellectual and developmental disabilities.
Adults with Physical and Developmental Disabilities (APDD): This waiver is for an individual age 21 and over who is both physically and developmentally disabled, that requires a level of long-term care provided by a nursing facility.
Alaskans Living Independently (ALI) (formerly known as ODA - Older and Disabled Adults) : This waiver is for a disabled adult over 21 that requires a level of long term care provided by a nursing facility or adults age 65 and over that require a level of long term care provided by a nursing facility.
Individualized Supports (IS): This waiver is for a child or adult with intellectual and developmental disabilities that meets an ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled level of care who can be supported safely in a non-residential community setting with less intensive supports than those offered under the IDD Individuals with Intellectual and Developmental Disabilities waiver.
Note: Alaska is also implementing the Community First Choice (CFC) Program. The CFC Community First Choice Program allows Alaska to cover a range of home and community based services under its State Plan, rather than a waiver. CFC Community First Choice services include targeted case management, chore, personal care services, enhanced personal care services, lifeline installation, and lifeline monthly services. To receive CFC Community First Choice services, the individual must qualify for Medicaid as determined by DPA Division of Public Assistance and meet a qualifying level of care as determined by SDS Senior Disability Services . Since CFC Community First Choice services are not waiver services, DPA Division of Public Assistance will not need to utilize special coding in EIS Eligibility Information System to show that an individual is eligible for these additional State Plan services. When SDS Senior Disability Services determines that an individual is eligible for CFC Community First Choice services, DHCS Division of Health Care Services will track eligibility in MMIS Medicaid Management Information System .
Transfer from one waiver classification to another because of age is not automatic (i.e. a CCMC Children with Complex Medical Conditions child turning 22 is not automatically placed under the ALI Alaskans Living Independently) waiver). Program specialists within DSDS Division of Senior and Disabilities Services will work together to make the appropriate transfer and notify DPA Division of Public Assistance of the change.
Note: A child who requires an institutional level of care, but does not receive institutional or special HCB Home and Community-Based waiver services may qualify for Medicaid under the Disabled Child at Home category (also known as TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 ). See MS 533 .
560 C. ELIGIBILITY FOR HCB Home and Community-Based WAIVER SERVICES
Medicaid covers HCB Home and Community-Based waiver services if the individual:
Is eligible for an allowable Medicaid category under the relevant waiver as follows:
CCMC Children with Complex Medical Conditions , IDD Individuals with Intellectual and Developmental Disabilities , and IS -- any eligibility category (e.g., MAGI Modified Adjusted Gross Income , SSI Supplemental Security Income Recipients, Special LTC Long Term Care , TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 , etc.).
APDD Adults with Physical Developmental Disabilities -- any eligibility category (e.g., MAGI Modified Adjusted Gross Income , Breast and Cervical Cancer Medicaid, SSI Supplemental Security Income Recipients, APA Adult Public Assistance Recipients, Special LTC Long Term Care , etc.).
ALI Alaskans Living Independently) -- (formerly known as ODA Older or Disabled Adults ) -- any eligibility category if the recipient is over the age of 21 (e.g., MAGI Modified Adjusted Gross Income , Breast and Cervical Cancer Medicaid, SSI Supplemental Security Income Recipients, APA Adult Public Assistance Recipients, Special LTC Long Term Care , etc.).
Is determined by DSDS Division of Senior and Disabilities Services to meet the appropriate level of care criteria;
I s not under a penalty for transferring assets for less than fair market value; and
Has been identified by DSDS Division of Senior and Disabilities Services as the individual with the highest priority of those who are waiting for services under the relevant HCB Home and Community-Based waiver.
560 D. LIMITATIONS ON THE NUMBER SERVED
Even if an individual qualifies for HCB Home and Community-Based waiver services, the services may not always be available. Each waiver has a limit on how many people it can serve. When the limit is reached, DSDS Division of Senior and Disabilities Services will prioritize the needs of applicants waiting for HCB Home and Community-Based waiver services. When services under a specific waiver become available again, DSDS Division of Senior and Disabilities Services will select the next person with the highest need for services and begin the process of making a level of care determination and developing a Support Plan.
Some applicants may be financially eligible for Medicaid only under the Special Long Term Care (LTC) eligibility category. The applicant needs DSDS Division of Senior and Disabilities Services approval for HCB Home and Community-Based waiver services documenting they meet the categorical requirement of needing an institutional level of care. When an applicant is placed on a DSDS Division of Senior and Disabilities Services prioritized waiting list, determine regular Medicaid eligibility in another eligibility category. This may require making a referral to the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 category or providing the applicant with information about establishing a Medicaid qualifying trust.
If there is no eligibility for an adult in another category of Medicaid, deny the application and notify DSDS Division of Senior and Disabilities Services of the denial.
Some applicants may be accessing non-Medicaid services from DSDS Division of Senior and Disabilities Services , who have never applied for Medicaid. When DSDS Division of Senior and Disabilities Services selects that person from the prioritized waiting list, DSDS Division of Senior and Disabilities Services will instruct the individual to apply for Medicaid and notify DPA Division of Public Assistance that a level of care assessment is beginning.
560 E. HCB WAIVER REFERRALS AND INTERAGENCY COMMUNICATIONS
Refer a Medicaid applicant or recipient to DSDS Division of Senior and Disabilities Services if they are interested in receiving waiver services. When a Medicaid applicant or recipient expresses interest in receiving waiver services and does not have an assigned care coordinator, provide the Aging and Disability Resource Center contact number at 1-877-625-2372 for names of care coordination agencies in the person's community. In most instances, an individual seeking HCB Home and Community-Based services under the CCMC Children with Complex Medical Conditions and IDD Individuals with Intellectual and Developmental Disabilities waivers will already be receiving services from DSDS Division of Senior and Disabilities Services , and DSDS Division of Senior and Disabilities Services will notify the DPA Division of Public Assistance caseworker. If no Medicaid application is on file, email DSDS Division of Senior and Disabilities Services informing them that a Medicaid application is needed.
With the assistance of a care coordinator agency, DSDS Division of Senior and Disabilities Services determines whether the individual meets the requirements for HCB Home and Community-Based waiver services. DSDS will email DPA Division of Public Assistance when an individual is determined eligible for HCB Home and Community-Based services under a specific HCB Home and Community-Based waiver and if that waiver’s limit is reached. When DSDS Division of Senior and Disabilities Services denies a request for HCB Home and Community-Based waiver services, the DPA Division of Public Assistance LTC Long Term Care Unit receives a copy of the denial letter and takes the appropriate case actions.
When an individual is not a Medicaid recipient and requests HCB Home and Community-Based waiver services from DSDS Division of Senior and Disabilities Services , the individual is given a Medicaid application and referred to DPA Division of Public Assistance .
If an individual already has an open Medicaid case (Eligibility Code 11, 20, 24, 50, 51, 52, 54, and 69), there is no need to issue a waiver screening or disability determination screening coupon. Medicaid will pay these expenses without a special screen coupon.
For a Medicaid applicant or an individual receiving Medicaid with a different Eligibility code than listed above, a DE 25 coupon needs to be issued if the individual needs a disability determination and a WD 19 coupon needs to be issued if the individual needs a waiver screening. The screening coupon must be issued on a separate Medicaid case number.
EIS INFORMATION Medicaid Subtype: Eligibility Code: DE Applicant who requires a disability determination ( AD 2 ), 25 WD Applicant who requires waiver determination 19
Note: Copy the client’s care coordinator with all EIS Eligibility Information System notices sent to an HCB Home and Community-Based waiver services applicant or recipient. DPA must have a signed release of information prior to sharing any notices or case information with the Care Coordinator.
560 F. HCB WAIVER SERVICES AND INSTITUTIONAL ELIGIBILITY
For the purpose of determining Medicaid eligibility, an individual receiving HCB Home and Community-Based waiver services is considered to be institutionalized. Policy applicable to institutionalized individuals, such as Preventing Spousal Impoverishment ( Section 553 ), Transfer of Assets ( Section 554 ), and Post-Eligibility ( Section 570 ), also apply to individuals receiving HCB Home and Community-Based waiver services.
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561 EIS HCB Home and Community-Based WAIVER CODES
Use the eligibility code applicable to the individual if not receiving HCB Home and Community-Based waiver services (i.e. 20, 11, 24, 50, 54, etc.). EIS will read that code and the waiver type code, then convert the code into a special waiver eligibility code and enter it on the Medical Resource ( MERE Medical Reference ) screen.
See Addendum 2 for a complete list of Medicaid Subtypes, Eligibility Codes, and Waiver Codes.
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562 PROCESSING HCB Home and Community-Based WAIVER CASES
A recipient in many Medicaid eligibility categories may receive HCB Home and Community-Based waiver services. In most cases, it is appropriate for an applicant of HCB Home and Community-Based waiver services to be referred to the DDS Disability Determination Service for a disability determination. See APA Manual Section 425 and Administrative Procedures Manual Section 115-9 . More liberal income requirements usually apply to disability-related Medicaid eligibility categories. It can work to the recipient’s advantage to have Medicaid eligibility based upon disability. Eligibility for HCB Home and Community-Based waiver services must not be delayed because of a pending disability determination if eligibility for Medicaid can be found in a non-disability eligibility category recognized by the relevant waiver. For example, eligibility for MAGI Modified Adjusted Gross Income Medicaid may work for an individual waiting for the disability determination needed to qualify for HCB Home and Community-Based services under the ALI Alaskans Living Independently) waiver.
562 A. MAGI Modified Adjusted Gross Income WAIVER CASES
For a MAGI Modified Adjusted Gross Income case, for an adult or child that has HCB Home and Community-Based waiver services approved, you can add the waiver code to the MAGI Modified Adjusted Gross Income case. MAGI Modified Adjusted Gross Income cases do not impose cost of care liability. If the MAGI Modified Adjusted Gross Income Medicaid recipient reports that they will be considered disabled for more than 12 months or it is determined that their MAGI Modified Adjusted Gross Income Medicaid eligibility is expected to end within the current certification period, refer the recipient to SSI Supplemental Security Income or DDS Disability Determination Service for a disability decision. If the MAGI Modified Adjusted Gross Income recipient does not pursue this disability determination, their case will continue. If their case closes for other reasons and they do not have a disability decision in place, they will need to reapply for Medicaid.
The LOC Level of Care determination for an HCB Home and Community-Based waiver services recipient must be reviewed every year. The health condition of an HCB Home and Community-Based waiver recipient may improve to the point that may no longer meet an institutional LOC Level of Care . DSDS Division of Senior and Disabilities Services will send a copy of the LOC Level of Care denial letter to the DPA Division of Public Assistance LTC Long Term Care team. When notified of a LOC Level of Care denial and Medicaid eligibility is still approved, end the persons eligibility for HCB Home and Community-Based waiver services by removing the waiver coding on the MERE Medical Reference screen. Send notice M716, Long Term Care Ends-Medicaid coverage will continue. If both the LOC Level of Care is denied and there is no eligibility in a category of Medicaid, send the appropriate notice of the Medicaid and waiver closure.
562 B. APA Adult Public Assistance RELATED MEDICAID OR LTC Long Term Care MEDICAID WAIVER CASES
For ongoing SSI Supplemental Security Income children, TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 and Adults receiving APA Adult Public Assistance -related Medicaid these cases do have a transfer of asset penalty and cost of care liability so the ET will have to send the Medicaid Transfer of Asset Declaration M723 or MED 3 to the recipient for completion, if they haven't already provided verification. When the LOC Level of Care or Support Plan are approved from DSDS Division of Senior and Disabilities Services convert the case to waiver. If a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 child is approved waiver, notify Comagine Health at AKTefra-Waiver@Qualishealth.org that the HCB Home and Community-Based waiver services are approved.
562 C. NEW APPLICANT FOR MEDICAID PENDING DDS Disability Determination Service & WAIVER
Check eligibility under all Medicaid categories. If there is no eligibility under a Medicaid category and if the applicant doesn't have a disability determination, a state only determination will be needed. Complete the financial eligibility determination. This may include informing the applicant of the need to spend down resources, establish a Qualifying Income Trust, etc. Pend the case for the required forms to pursue a DDS Disability Determination Service determination, refer the applicant to DSDS Division of Senior and Disabilities Services for a HCB Home and Community-Based waiver services eligibility determination and care coordinator arrangements. If financial eligibility cannot be established or if the DDS Disability Determination Service determination is a denial of disability, deny the Medicaid application and notify DSDS Division of Senior and Disabilities Services so they can stop processing the request for HCB Home and Community-Based waiver services. If the client requests a fair hearing due to DDS Disability Determination Service denial, notify DSDS Division of Senior and Disabilities Services that the DDS Disability Determination Service denial is being appealed and waiver processing should continue. If financial eligibility is determined and finding a disability is made, (if needed), keep the case in pended status until DSDS Division of Senior and Disabilities Services has approved HCB Home and Community-Based waiver services. If DSDS Division of Senior and Disabilities Services approves HCB Home and Community-Based waiver services, authorized Medicaid. If DSDS Division of Senior and Disabilities Services denies HCB Home and Community-Based waiver services and there is no other category they are eligible for, deny the Medicaid case. Check to see if the client would be eligible for regular APA Adult Public Assistance related Medicaid category with the use of a trust in place.
562 D. HCB Home and Community-Based WAIVER CASES WITH TITLE IV-E ELIGIBLE INDIVIDUALS
When a Title IV-E eligible child in state protective custody is approved for HCB Home and Community-Based waiver services you must notify the OCS Office of Children's Services case worker of the HCB Home and Community-Based waiver approval. Send the MED 1 , MED 2 and MED 3 forms for the OCS Office of Children's Services caseworker to complete. Once the appropriate HCB Home and Community-Based waiver code is added to the MERE Medical Reference screen and CANO Case Notes is done notify the OCS Office of Children's Services caseworker that the case has been updated. The OCS Office of Children's Services caseworker will continue to maintain the case and original case file. Keep track of the review dates for these cases and check after each renewal month to ensure that the child is still eligible for HCB Home and Community-Based waiver and the codes are correct.
562 E. HCB Home and Community-Based WAIVER CASES FOR A PERSON WHO HAS NO OPEN MEDICAID CASE
When notified by DSDS Division of Senior and Disabilities Services that a LOC Level of Care determination is pending and a support plan is in development for a person who has no current Medicaid involvement and that the person will have to apply for Medicaid. Send the application, either GEN 50C or MED 4 and corresponding forms to the person. Add the individual to a tickler file of the other individuals who are in the process of getting LOC Level of Care determination or awaiting completion of a support plan. If the forms are returned, determine eligibility for any category they are eligible for. If the forms are not returned, notify DSDS Division of Senior and Disabilities Services there is no eligibility for Medicaid because they didn't apply.
562 F. HCB Home and Community-Based WAIVER CASES FOR A WOMAN RECEIVING BREAST AND CERVICAL CANCER MEDICAID (LADIES FIRST)
HCB Home and Community-Based waiver services can be added to Breast and Cervical Cancer cases, they do not need a disability determination. For recipients who appear financially eligible for APA Adult Public Assistance -related or LTC Long Term Care Medicaid, the caseworker should recommend, but cannot require, that she pursue a disability determination so that when treatment ends and eligibility has ended under the BCC Breast and Cervical Cancer category, the woman can be transitioned to those Medicaid eligibility categories.
562 G. FAIR HEARINGS
An applicant or recipient of HCB Home and Community-Based waiver services who has been denied LOC Level of Care may request a fair hearing. The Division of Health Care Services represents the state for these hearings.
Previous Section Next Section MC #52 (12/19)
570 POST ELIGIBILITY TREATMENT OF INCOME (COST-OF-CARE)
After being determined eligible for Medicaid, some individuals who are institutionalized, or who is receiving home and community-based (HCB) waiver services may be required to contribute a portion of their income toward the cost-of-care (COC) they receive. The post eligibility process involves determining the exact amount a recipient is obligated to pay to the medical institution, nursing home, or HCB Home and Community-Based waiver services provider. The provider is responsible for collecting from the recipient that recipient’s share of the cost-of-care. Medicaid reduces its payment to a medical institution or nursing home by the amount of the recipient’s cost-of-care liability.
A recipient of HCB Home and Community-Based waiver services who is eligible for Medicaid through the Special Long Term Care (LTC) eligibility category is subject to cost-of-care. Currently, Medicaid does not have a method for equitably reducing its payment to multiple HCB Home and Community-Based service providers. However, an HCB Home and Community-Based waiver service recipient still has a cost-of-care obligation to his or her HCB Home and Community-Based service providers. When a recipient pays a portion of the cost-of-care to a provider, that provider is required to reduce its claim to Medicaid by the amount received from the recipient.
A cost of care obligation is determined by using total gross income minus the allowable deductions and disregards listed below. When a cost of care obligation is determined for a waiver recipient who is utilizing a trust to be eligible for Medicaid, the income used to determine the cost of care is the total gross income before any of it is put into the trust (minus the allowable disregards and deductions listed below).
570 A. DEFINITIONS
Available Income: Income to which a community spouse has access and control.
Community Spouse: The spouse of an applicant or recipient of long-term care Medicaid. A community spouse resides outside of an institution and is not receiving HCB Home and Community-Based Home and Community-Based waiver services.
Continuous Period of Institutionalization: At least 30 consecutive days of institutionalization in a medical institution or nursing facility.
Dependent Children: A couples’ minor children who live with a community spouse and who may be claimed as a dependent by either member of a couple for income tax purposes.
Dependent Parent: A parent of either member of a couple who reside with a community spouse and who may be claimed as a dependent by either spouse for income tax purposes.
Dependent Sibling of a Couple: A brother or sister of either member of a couple (including a half-brother, or a half-sister) who reside with a community spouse and who may be claimed by either member of a married couple for income tax purposes.
Institutionalized Spouse: A spouse who is likely to reside in a medical institution or nursing facility for a continuous period of institutionalization.
Maintenance Needs Standard: Income standard to which community spouse’s and other family member's income is compared for purposes of determining the amount of allowances used in the post-eligibility calculation.
Medical Expense: A medical expense means that a licensed medical practitioner provided or prescribed an item or service to:
Prevent, diagnose, treat, or cure a disease or injury, or
Treat an affected part of the body.
Medical expenses incurred by the recipient that are not subject to payment by Medicaid or other third parties can be used a deductions towards cost of care.
Examples of allowable medical expenses are co-insurance and deductible payments, prescription drugs not covered, Medicare Part B or D premiums, dental services, and medical supplies. Examples of what is not considered allowable medical expenses are care repairs, taxi rides to and from medical appointments, and house repairs. This is not an all-inclusive list.
Medical Institutions or Nursing Facilities: Hospitals, skilled nursing facilities and intermediate care facilities (including ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled s).
Monthly Income Allowances: the amount deducted in the post-eligibility calculation for maintenance needs of a community spouse and other family members.
Remedial Expense: A remedial expense means it helps relieve, remedy, or reduce a medical or health condition.
Swing Bed: A hospital bed that can be used interchangeably to provide acute, skilled, or intermediate care.
Total Gross Income: Income that is used to determine eligibility (including monies deposited in a Medicaid Qualifying Trust) before any deductions or disregards are applied.
Note: Native Dividend income over $2,000 is countable even if deposited to a trust because it is not legally assignable to a trust.
570 B. INDIVIDUALS SUBJECT TO COST-OF-CARE ( COC Cost-of-care )
The following Medicaid recipients are subject to post-eligibility rules and may be required to pay a portion of their medical care cost:
Individuals eligible under any category that are residing in a medical institution or nursing facility unless exempt under Subsection C, who receive institutional long term care services.
Note: It is important to keep the nursing home informed of all changes in COC Cost-of-care obligations, since the majority of the nursing homes will deduct the COC Cost-of-care obligation from the amount that is billed to Medicaid prior to receiving the COC Cost-of-care payment from the recipient. If there is a decrease in a recipient’s COC Cost-of-care obligation, the facility must be notified as it may significantly affect the billing and payment for the recipient’s care.
Example: Mr. Steele is an APA Adult Public Assistance cash and related Medicaid recipient. He recently entered a nursing home and is expected to remain in the nursing home for the duration of his life. He does not have a spouse or dependents. His current income consists of $600 Social Security retirement benefits. The cost-of-care determination is completed for Mr. Steele because he is residing in a nursing facility.
2. HCB Home and Community-Based waiver recipients who are eligible for HCB Home and Community-Based waiver services under the Special Long Term Care eligibility category.
Example: Mr. Kreher receives SSDI Social Security Disability Insurance and is eligible for HCB Home and Community-Based waiver services. He receives waiver approval starting in the month of June. He has a QIT Qualifying Income Trust with $2,000 of income being placed into the trust. Mr. Kreher is Medicaid eligible under the Special LTC Long Term Care eligibility category only and is obligated to pay toward his cost-of-care.
570 C. INDIVIDUALS NOT SUBJECT TO COST-OF-CARE
The following Medicaid recipients are not subject to cost-of-care:
SSI Supplemental Security Income , APA, Adult Public Assistance and Refused Cash Medicaid recipients, unless they are institutionalized. See section 570 B .
A recipient who continues to receive SSI Supplemental Security Income or APA Adult Public Assistance cash benefits because they are temporarily institutionalized for 90 days or less. See APA Manual Section 470-2 .
HCB Home and Community-Based waiver service recipients receiving Medicaid under any eligibility category other than the Special LTC Long Term Care category.
Example: Mrs. Avery receives APA Adult Public Assistance and Medicaid with HCB Home and Community-Based waiver services. In June, she reports to her caseworker that she was in a vehicle accident and anticipates a $6,000 insurance settlement. She expects the settlement payment in July. On July 6, Mrs. Avery reports to her caseworker that she just received the $6,000 check. In this situation, Mrs. Avery is an APA Adult Public Assistance recipient and not living in an institution. Therefore, she does not have a cost-of-care obligation. She remains eligible for APA Adult Public Assistance and Medicaid for July because it is too late to provide a timely notice of adverse action. Note: The caseworker must watch for resource eligibility in August.
Institutionalized recipients in a nursing home who have less than $200 in countable income.
Pregnant Women
Child under 18 receiving waiver services
MAGI Modified Adjusted Gross Income Medicaid recipients
Note: The No Cost of Care Due (M003) notice is only sent to individuals who are subject to cost of care as outlined in MS 570(B) . If the individual is not subject to cost of care, a cost of care notice is not sent.
570 D. INCOME DISREGARDED IN THE COST-OF-CARE DETERMINATION
The following income is not included in the total gross income when making the cost-of-care determination:
1. Payments from the Department of Veteran Affairs for Unusual Medical Expenses ( UME Unusual Medical Expenses ) and Aid and Attendance ( AAA Aid and Attendance ).
Exception: For a recipient residing in a state Veteran’s Home, a VA Department of Veterans Affairs payment that exceeds $200 including UME Unusual Medical Expenses and AAA Aid and Attendance counts as income in the cost-of-care determination. This provision applies only to a veteran without a spouse or child and to a surviving childless spouse of a veteran. At this time, the Alaska Veterans and Pioneer Home is the only designated veteran's home in the state.
2. The withheld portion of an SSA Social Security Administration overpayment.
3. SSI Supplemental Security Income Payments made under 1619(a) or (b) to an institutionalized individual. If a Medicaid recipient receives SSI Supplemental Security Income under the 1619(a) or (b) provisions prior to entering an institution, SSI Supplemental Security Income will continue to pay full SSI Supplemental Security Income benefits up to two months after being institutionalized. The SSI Supplemental Security Income income is disregarded when completing the cost-of-care determination.
4. SSI Supplemental Security Income / APA Adult Public Assistance Payments made to Recipients Living in an Institution. The SSI Supplemental Security Income / APA Adult Public Assistance benefits that are continued at the full community payment rate for up to the first three months after the month of entry into an institution are disregarded in the cost-of-care determination.
5. Income from Interest Bearing Trust Accounts. Interest payments of $4/month or less made to an interest bearing trust account.
570 E. ALLOWABLE DEDUCTIONS FOR COST-OF-CARE DETERMINATIONS
To determine the amount of money the individual must contribute toward his or her cost-of-care ( COC Cost-of-care ), the caseworker must deduct the following allowances from the individual’s total gross income as applicable:
Note: All deductions must be verified before they are allowed as a deduction from the individual's total gross income. The caseworker will determine eligibility without a deduction if the expense is not verified within 30 days of the initial application filing date. If verification is provided at a later date, the change is effective the first day of the month of the agency's receipt of the report of change. See APA MS 480-3(C) .
1. Personal Needs Allowance (PNA)
The personal needs allowance is the amount intended to cover the personal and maintenance needs of the individual. The amount varies depending upon the individuals living situation.
Deduct the following minimum PNA Personal Needs Allowance from total gross income:
$ 200 Institutionalized Individuals in a Nursing Home or Swing Bed Facility. If SSI Supplemental Security Income is the sole income of the individual he or she will receive $30 from SSI Supplemental Security Income and $170 from APA Adult Public Assistance every month to cover the minimum $200 PNA Personal Needs Allowance . $ 200 Veteran in a Nursing Home or Swing Bed Facility . This applies only to a veteran without a spouse or a dependent child who receives a $200 Veterans nursing facility pension. $1,656 Recipient of HCB Home and Community-Based Waiver Services Living at Home. This applies to a recipient of HCB Home and Community-Based waiver services who is living in his or her own home and who is eligible under the Special LTC Long Term Care Income category. This high amount recognizes the fact that unlike a nursing home resident, this individual is still responsible for maintaining their own home. $1,396 Recipients of HCB Home and Community-Based Waiver Services Living in an Assisted Living Home. This applies to a recipient of HCB Home and Community-Based waiver services who is living in an assisted living home, including a Pioneer Home.
Adjustment to the Minimum PNA Personal Needs Allowance :
Taxes: The PNA Personal Needs Allowance may be increased to cover mandatory withholding from earned and unearned income to cover federal, state, and local taxes. The PNA Personal Needs Allowance is also increased to cover the amount of taxes that are not subject to mandatory withholding but are owed and actually paid. This increase does not apply to any tax that is deducted under another provision in the post-eligibility process (e.g. property taxes paid on a home for which a home maintenance allowance is made).
Garnishment for Child Support: The PNA Personal Needs Allowance may be increased to cover the amount of income garnished for child support during the same period covered by the PNA Personal Needs Allowance . This increase does not apply to any amount of garnishment that is deducted under another provision in the post-eligibility process, such as the family member allowance.
Residents of ICF/MR Institutions: The PNA Personal Needs Allowance may be increased by the amount of income needed to fulfill an approved plan for achieving self-support. See APA Manual Section 442-1C .
Guardian and Conservator Fees: The PNA Personal Needs Allowance may be increased by the fee actually charged to the recipient by a court-appointed guardian or conservator, not to exceed $100 per month.
2. Community Spouse Allowance
The community spouse of either an institutionalized or HCB Home and Community-Based waiver recipient may be entitled to a spousal allowance. A spousal allowance is the amount deducted from the recipient’s income that, when combined with all of the community spouse’s own income, can raise the community spouses’ total gross income to the Community Spouse Monthly Maintenance Need Standard. See Addendum 1 . The spousal allowance is deducted from the recipient’s gross income.
Adjustment: The spousal allowance may be increased by a spousal support order or a hearing officer’s decision that a greater monthly amount is needed due to exceptional circumstances resulting in extreme financial duress of the community spouse.
3. Family Member Allowance
The institutionalized or HCB Home and Community-Based waiver recipient is entitled to a dependent allowance for each dependent child, dependent parent, or dependent sibling. A dependent for deeming purposes is the same as a dependent for federal income tax purposes. If a dependent is claimed on the community or institutionalized spouse's personal income tax return, a family member allowance can be considered. The amount deducted from the recipient's income is based on the living arrangement of the dependent.
If the dependent:
Resides with the community spouse
The dependent allowance is equal to the Monthly Need Standard for Additional Household Members, less the dependent's own income ( SSA Social Security Administration , SSI Supplemental Security Income , etc.). See Addendum 1 .
Does not reside with the community spouse
The dependent allowance is equal to the ATAP Alaska Temporary Assistance Program ANI Adult Not Included (Child Only) Need Standard for the number of dependent family members, less the dependent's own income ( SSA Social Security Administration , SSI Supplemental Security Income , etc.) See ATAP Alaska Temporary Assistance Program Addendum 2 .
For example: the ATAP Alaska Temporary Assistance Program ANI Adult Not Included Need Standard for one (Child Only 1) is used for one dependent (in 2026 the Need Standard is $1,048) and the ATAP Alaska Temporary Assistance Program ANI Adult Not Included Need Standard for two (Child Only 2) is used for two dependents (in 2026 the Need Standard is $1,286).
Adjustment: The allowance may be increased by court order or a hearing officer’s decision affirming or establishing that a greater monthly amount is needed due to exceptional circumstances resulting in extreme financial duress of the dependent child, dependent parent or dependent sibling.
4. Insurance Premium Allowance
An allowance for non-reimbursed Medicare and other health insurance premiums paid by the recipient may be deducted from gross income. If this premium is paid by the spouse for the recipient, it can also be deducted; however, if it is a joint premium, only the portion applicable to the institutionalized or HCB Home and Community-Based waiver recipient may be deducted.
5. Unpaid Medical Expense Allowance
An allowance for incurred medical or remedial expenses that are not subject to payment by a third party (Medicaid, Medicare, or any other health insurance) may be deducted from the gross income. This includes unpaid medical expenses that may be outstanding prior to when the person became a Medicaid recipient. Please see ADLTC MS 570(A) for the definitions of medical and remedial expenses.
If the recipient has a very large bill outstanding, make a reasonable effort to carefully document the expense in the deductions on the income credit and in the case notes, as there is no guarantee that the recipient will contribute the deduction toward the unpaid bill. The amount of an unpaid bill may only be deducted once (even though it may take several months to allow the full amount to be deducted). If the recipient does not pay off the bill through income credit deductions allowed for that reason, the bill may not be deducted again.
6. Home Maintenance Allowance
If a Medicaid recipient without a community spouse or a dependent enters a medical institution or nursing facility and a physician has certified that the stay will be six months or less, the recipient can receive a home maintenance allowance deducted from the gross income.
In this situation, the home maintenance allowance is up to or equal, but cannot exceed, the Expanded Refused Cash standard for an individual living independently. See ADLTC Aged, Disabled, and Long Term Care Manual Addendum 1 . This home maintenance allowance can be deducted for a maximum of six months beginning with the 1st of the month after the month of admission to the medical institution or nursing facility.
Take the following steps:
a. Get a physician certification stating the stay will be six months or less and document the receipt of the certification.
b. If the recipient is not expected to leave the institution, end the deduction and send the recipient adequate notice.
c. If the recipient is expected to leave the institution within six months, the home maintenance allowance can continue.
d. Set an alert on the ETAL Eligibility Technician Alerts screen screen for the fifth month to check with the institution and the physician whether the recipient's status of discharge will occur in the sixth month.
e. Get verification of the rent/mortgage and utility costs to determine the amount of home maintenance allowance.
570 F. WHEN A COST-OF-CARE LIABILITY BEGINS AND ENDS
A cost-of-care liability is not incurred in the month of admission, the month of application for Medicaid, or the month of discharge from the facility. This policy is intended to help a recipient make the transition to and from institutional living. A recipient who enters a nursing home after the first of the month will have already incurred community living expenses (e.g., paid rent or mortgage) for that month and a recipient leaving an institution will have to pay new living expenses in the community. Cost-of-care starts the month after HCB Home and Community-Based waiver is approved if the individual is already receiving Medicaid in a different category.
Example: A recipient has an ongoing Medicaid case with a QIT Qualifying Income Trust . The HCB Home and Community-Based waiver is approved with a start date of April 1. The cost of care liability starts the month of May.
A cost-of-care liability is not incurred when a late review is received and there is a break in Medicaid coverage. If a review is received the month after a case is closed for no review, we would still invoke a cost-of-care liability.
Example: A Medicaid case closes February 28 for failure to submit the required review form. If the client reapplies for Medicaid on March 29 and is found eligible, cost-of-care is applied for March. If the client does not reapply for Medicaid until April 2, and is found eligible, there would not be any cost-of-care applied for April.
Note: The monthly cost-of-care liability may not exceed the actual cost-of-care provided in that month.
Once the medical benefit is paid for a benefit month, the liability amount cannot be changed for that month; the change must be done in a future month through use of the adjustment line on the EIS Eligibility Information System COCA Cost of Care screen.
Exception: If only a screening coupon (DE 25 or WD 19) was issued, the caseworker must notify the EIS Eligibility Information System Help Desk to add a cost-of-care liability amount on the EIS Eligibility Information System COCA Cost of Care screen for that month.
570 G. RETROACTIVE COST-OF-CARE ADJUSTMENTS
Retroactive adjustments can be made for an overstated or understated cost-of-care ( COC Cost-of-care ) liability at any time. There is no time limit to correct a COC Cost-of-care error. Retroactive adjustments are treated the same for institutionalized persons and HCB Home and Community-Based waiver recipients. An understated liability occurs when a recipient fails to report income or has a one-time lump sum payment that causes an increase in the COC Cost-of-care . An overstated amount is when a recipient has a previously unreported or a one-time medical expense.
This is especially useful for interest bearing trust accounts in which the monthly interest does not warrant making an adjustment, yet the accumulated amount over several months may result in an increase in COC Cost-of-care obligation. However, in order to avoid a payment error, all adjustments must be made within four months of the change in income. If the adjustments cannot be accomplished in four months, notify Systems Support for a correction of the liability amount.
When making a retroactive adjustment that results in a larger liability, the caseworker must provide timely notice of adverse action taken. Complete a new COCA Cost of Care screen for the following month to ensure that the COC Cost-of-care reverts to the correct amount for the subsequent months. See Addendum 4 - COCA Cost of Care Processing when making retroactive adjustments.
Example 1 - Overstated liability: Mr. Shafaat currently has a monthly COC Cost-of-care of $1,025. In July, he went to the podiatrist and the cost of the visit was $200. He reported this expense on July 21. The caseworker does not have time to send a 10-day adverse action notice to adjust COC Cost-of-care for August.
Step 1: Access the September COCA Cost of Care screen and enter the $200 medical expense; Step 2: Recalculate the COC Cost-of-care for September and send notice M715 - Cost of Care Change; and Step 3: Access the October COC Cost-of-care , remove the $200 medical expense, recalculate COC Cost-of-care , and send a second COC Cost-of-care change notice.
Example 2 - Understated liability: Ms. Martinez currently has a COC Cost-of-care of $300 per month. On August 26, she reports receiving a $5,000 pay out from an old retirement account of her deceased husband and the money was deposited into her Qualifying Income Trust (QIT) account to maintain her eligibility.
Step 1: Access the October COCA Cost of Care screen and enter the $5,000; Step 2: Recalculate October COC Cost-of-care with the $5,000 and send notice M715 - Cost of Care Change; Step 3: Access the November COCA Cost of Care screen, remove the $5,000 and recalculate COC Cost-of-care ; and Step 4: Send a second COC Cost-of-care change notice.
Note: Understated liability can be captured in more than one month for example, when a lump sum or lump sums were reported late. The case worker can increase the cost of care for multiple months when multiple lump sums were received in separate months. Example: Client receives a $5,000 payment for April, July and September, reports it late in October. The case worker should do adjustments in the months following the report, one adjustment for each month if the amount received is too high to capture in one month.
570 H. NURSING HOME EXAMPLES
Example 1: Mr. Webber is an 85 year-old widower who resides in an assisted living home. He receives APA Adult Public Assistance and HCB Home and Community-Based waiver services. His physician has determined that his needs would be better met in a long-term care facility. On October 5, Mr. Webber moves into a nursing home. Mr. Webber’s income includes $1050 Social Security retirement benefits and APA Adult Public Assistance . On October 6, the LTC Long Term Care caseworker is notified by DSDS Division of Senior and Disabilities Services that Mr. Webber’s HCB Home and Community-Based waiver will end due to nursing home placement. The caseworker verifies with the facility that his stay will last longer than 90 days. The APA Adult Public Assistance worker ends Mr. Webber’s APA Adult Public Assistance cash effective October 31, and converts the case to Nursing Home Medicaid. Mr. Webber reports no expenses.
Step 1: Determine the COC Cost-of-care obligation by deducting the personal needs allowance ( PNA Personal Needs Allowance ) from Mr. Webber’s SSA Social Security Administration ; and $1050 - 200 ( PNA Personal Needs Allowance ) $850 (COC obligation) Step 2: Send Mr. Webber notice M120 - Cost-of-Care / LTC Long Term Care Facility, informing him that his COC Cost-of-care obligation will begin November 1, and send a copy to the nursing home and guardian (if applicable).
Example 2: Yusef is married and both he and wife Aiyla each receive a $1050 per month Social Security benefit. Their combined resources are within allowable limits. The couple would be eligible for an APA Adult Public Assistance cash payment but has never applied. Yusef enters a medical institution on March 15 and applies for Medicaid. His countable income in March and subsequent months is $1050.
Step 1: Determine the allowed spousal allowance by deducting Aiyla’s income from the community spousal need standard: $4,066.50 (2026 Community Spouse Monthly Maintenance Need Standard) - 1050 (Social Security benefit) $3,016.50 (allowable spousal deduction) Step 2: Deduct Yusef’s PNA Personal Needs Allowance , and community spouse allowance from his income: $1050 (income of institutional spouse) - 200 ( PNA Personal Needs Allowance ) - 850 (amount allocated to the community spouse*) $ 0 total individual must pay toward cost-of-care * This is the amount that may be allocated to the community spouse because the maximum community spouse allowance of $4,066.50, less community spouse's $1050 income, equals $3,016.50, which is more than the spouse's income, so the community spouse allowance is all of the institutionalized spouse’s income after the PNA Personal Needs Allowance has been deducted.
570 I. COST-OF-CARE FOR RECIPIENTS OF HCB Home and Community-Based WAIVER SERVICES
Recipients of HCB Home and Community-Based waiver services are allowed the same COC Cost-of-care deductions as nursing home recipients. An HCB Home and Community-Based recipient who has a COC Cost-of-care obligation must work with his or her care coordinator in determining what services are subject to a COC Cost-of-care obligation. A recipient’s cost-of-care can only go toward services not covered by regular Medicaid. If a care coordinator or recipient has any questions on what constitutes a covered HCB Home and Community-Based service versus a regular Medicaid service, refer the care coordinator or recipient to DSDS Division of Senior and Disabilities Services for assistance. Adverse action notice is required for COC Cost-of-care obligations.
Step 1:
Send notice M130 - Cost-of-care / Waiver to the recipient, and copy the recipient’s care coordinator and trustee and/or guardian; and
Step 2:
Document the medical expenses used to determine the COC Cost-of-care obligation in the case notes ( CANO Case Notes ).
570 J. HOME AND COMMUNITY-BASED WAIVER CASE EXAMPLES
Example 1 - Applicant: Mrs. Kepner is a 60 year-old applicant for HCB Home and Community-Based waiver services and the level-of-care ( LOC Level of Care ) and Support Plan have been approved by DSDS Division of Senior and Disabilities Services . Her monthly disability and pension income totals $3,822. She has an approved QIT Qualifying Income Trust that has been registered with the court. Mrs. Kepner is married and her husband has earnings of $2,000 per month. Mrs. Kepner lives in her own home with her husband. All children are grown and living on their own. Mrs. Kepner has a $50 health insurance premium expense.
Step 1: Determine the allowed spousal allowance by deducting Mr. Kepner’s gross wages from the allowed spousal allowance; $4,066.50 (2026 Community Spouse Monthly Maintenance Need Standard) - 2,000 (Mr. Kepner’s gross wages) $2,066.50 (spousal allowance) Step 2: Deduct Mrs. Kepner’s PNA Personal Needs Allowance , spousal allowance and health insurance premiums from her gross income; $3,822 - 1,656 ( PNA Personal Needs Allowance ) $2,166 - 2,066.50 (spousal allowance) - 50 (health insurance premium) $ 49.50 ( COC Cost-of-care obligation) Step 3: Approve and authorize Medicaid with HCB Home and Community-Based waiver service; Step 4: Send appropriate approval notice; Step 5: Send notice M130 - Cost of Care / Waiver; and Step 6: Document the medical expense in the case notes.
Example 2 - Recipient: Mr. Shepard is a 70 year-old HCB Home and Community-Based waiver service recipient eligible for Medicaid under the Special LTC Long Term Care income standard of $2,982. He entered a Pioneer Home in August. Mr. Shepard has monthly income of $1,650 from his retirement pensions. Mr. Shepard will incur a cost-of-care obligation.
Step 1: Deduct Mr. Shepard PNA Personal Needs Allowance from his gross income. $1,650 (gross income) - 1,396 ( PNA Personal Needs Allowance for ALH Assisted Living Home ) $ 254 (Medicaid COC Cost-of-care obligation)
Step 2: Check for adverse action notice. Because it is August 25, there is no time for adverse action notice so Mr. Shepard's Medicaid COC Cost-of-care obligation will not begin until October 1. Step 3: Send Mr. Shepard notice M130 - Cost-of-Care / Waiver explaining his Medicaid COC Cost-of-care obligation beginning October 1, and a copy to the care coordinator.
Example 3 - Lump Sum Income: Ms. Obu is an HCB Home and Community-Based waiver service recipient with a COC Cost-of-care obligation of $200 per month. In July, she reports to her caseworker that she is anticipating a $25,000 cash inheritance payment from her deceased grandmother and she is expecting to receive and have the check deposited into her QIT Qualifying Income Trust in August. Because the money is anticipated to be received in August, Ms. Obu's COC Cost-of-care obligation for this month will increase. However, her COC Cost-of-care obligation cannot exceed the actual waiver service expenses she receives in a month.
Step 1: In July, request a copy of Ms. Obu’s current Support Plan from DSDS Division of Senior and Disabilities Services . Step 2: Review the Support Plan for any one-time large sum costs such as environmental modifications and deduct these expenses from the overall Support Plan costs. Step 3: Divide this amount by 12 to determine the monthly Support Plan cost. Step 4: Send Ms. Obu a notice informing her that the COC Cost-of-care obligation for the month of August will be her entire monthly Support Plan cost. In September, her COC Cost-of-care obligation will return to $200 per month.
570 K. COCA NOTICE REQUIREMENTS
In addition to the notice requirements outlined in Admin MS 108 , the cost of care notices must include what income was counted (source and amount, along with the calculation), what allowances were given (or not if any where denied), and any other factor that affected the cost of care obligation.
Previous Section Next Section MC #70 (12/25)
575 ALASKA BREAST AND CERVICAL SCREENING ASSISTANCE PROGRAM (aK B+c)
The Center for Disease Control ( CDC ) and Prevention conducts the National Breast and Cervical Cancer Early Detection Program, which provides funding for breast and cervical cancer screening in all 50 states. To encourage women to seek treatment, Congress passed the Breast and Cervical Cancer Prevention and Treatment Act of 2000. This act authorizes states to provide Medicaid coverage to women who are diagnosed with cancer through participation in a CDC Center for Disease Control and Prevention screening program. Alaska began using this optional Medicaid eligibility category on July 1, 2001.
575 A. BCHC SCREENING
The Division of Public Health ( DPH ) operates and determines eligibility for the Breast and Cervical Health Check ( BCHC ) program to screen individuals in accordance with the national CDC Center for Disease Control and Prevention criteria. This program uses 25 different health care providers in 15 communities throughout the state. There are also three tribal grantees that provide screening services:
Southcentral Foundation;
Southeast Alaska Regional Health Corporation; and
Arctic Slope Regional Health Corporation;
To be eligible for the BCHC Breast and Cervical Health Check program, a woman must:
Be age 18-64;
Be uninsured or have insurance that does not cover preventative screening services; and
Have income below 250% of the Federal Poverty Guideline for Alaska. DPH Division of Public Health determines income eligibility for this program.
575 B. APPLICATION
After a woman has been screened by the BCHC Breast and Cervical Health Check , she may apply for Medicaid by in any of the ways outlined in ADLTC MS 520(A) .
575 C. ELIGIBILITY
To be eligible for this Medicaid category, an applicant must:
Have been screened under the Alaska BCHC Breast and Cervical Health Check , or CDC Center for Disease Control and Prevention National Breast and Cervical Cancer Early Detection program from another state, and determined to need treatment for breast or cervical cancer;
Meet general Medicaid eligibility requirements of residency and assignment of rights;
Be a U.S. United States citizen or qualified alien;
Not be eligible for any other Medicaid category; and
Does not have credible coverage that covers her breast and cervical cancer treatment.
Credible coverage is any of the following:
A group health plan;
Health insurance coverage;
Medicare Part A or part B;
Medicaid;
Uniform Services coverage;
A medical care program of the Indian Health Service or of a tribal organization;
A public health plan; and
A Peace Corps health benefit plan.
The Breast and Cervical Cancer Medicaid category does not have a separate financial eligibility test beyond what was already required for eligibility under the BCHC Breast and Cervical Health Check screening program.
Although men may also get breast cancer, they are not included in the CDC Center for Disease Control and Prevention screening program and, therefore, are not eligible for this Medicaid category.
575 D. COVERAGE
If eligible, AKB+C Alaska Breast & Cervical Screening Assistance should be certified for 12 months. Coverage may end during the certification period for the following reasons:
Other insurance is obtained that covers breast and cervical cancer;
Eligible for another Medicaid category;
No longer an Alaska resident;
Turns 65;
Refuses treatment or does not start treatment; or
Completes active treatment.
When the office receives the form titled: Breast and Cervical Cancer Program Closing Form, close the case with 10 day adverse action and send the M420 notice. In the free-form section of the notice explain to the client that a physician review of the case determined that treatment ended and that the woman should contact her original screening provider to re-enroll in the Breast and Cervical Health check program so she can receive coverage for her surveillance appointments. Send an email TO BE DETERMINED and the appropriate program manager to advise them of the closure.
NOTE: In the notice DO NOT say "Your case manage Jane Doe determined your treatment ended" keep it generic by simply saying "A physician review of your case."
Coverage may include home and community-based services if the recipient meets the requirements of the Adults with Physical Disabilities waiver. See Section 560 . For recipients who appear financially eligible for APA Adult Public Assistance -related or LTC Long Term Care Medicaid, the caseworker should recommend, but cannot require that she pursue a disability determination so that when treatment ends and eligibility has ended under the BCC Breast and Cervical Cancer category, the woman can be transitioned to those Medicaid eligibility categories.
575 E. RENEWALS
At least once each calendar year a recipient must complete a renewal application. The proper form for an annual review application is DPA Division of Public Assistance form GEN 72.
In addition to the completed renewal application, the recipient must also provide any additional DPA Division of Public Assistance forms and any other information/verification that is necessary to correctly redetermine the recipient's eligibility.
575 F. NOTICES
Refer to section 520 H for the policy on notices.
575 G. QUESTIONS
For general questions about screening for breast or cervical cancer or help with finding a screening provider, call the Division of Public Health at 269-8069 (Anchorage) or 1-800-410-6266 (outside Anchorage).
For questions about how to apply for Breast and Cervical Cancer Medicaid or about how this Medicaid category works, please contact the Long Term Care Unit in the Division of Public Assistance toll free at 1-800-478-7778.
Previous Section Next Section MC # 67 (12/24)
576 EMERGENCY TREATMENT FOR ALIENS
Emergency Treatment for Aliens is Individualized Supports a special category of the Medicaid program that provides coverage for aliens who do not meet the Medicaid citizenship requirements. An alien eligible under this special category is not considered to be a regular Medicaid recipient. Coverage is limited to the treatment of emergency medical conditions.
576 A. DEFINITIONS
Alien: For the purposes of Emergency Treatment of Aliens eligibility, an alien is:
a non-qualified alien as defined in MAGI MS 808-5 ; or
a qualified alien as defined in MAGI MS 808-4 who is subject to the five-year bar on Medicaid eligibility.
Covered Dates of Service are the dates in which the alien received treatment for an emergency medical condition and is determined eligible for emergency treatment for aliens.
Emergency Medical Condition means the individual has, after sudden onset, a medical condition, including labor and delivery, manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:
placing the patient's health in serious jeopardy;
serious impairment to bodily functions; or
serious dysfunction of any bodily organ or part.
An emergency medical condition does not include care and services related to either an organ transplant procedure or routine prenatal or postpartum care.
576 B. ELIGIBILITY REQUIREMENTS
Except as provided in Subsection C, an alien must meet the following requirement to be eligible for the Emergency Treatment of Aliens:
Meet the financial and non-financial eligibility requirements for the category of Medicaid appropriate for the individual;
Be a resident of Alaska;
Meet the definition of an alien; and
Have received treatment for an emergency medical condition.
576 C. REGULAR MEDICAID RULES THAT DO NOT APPLY TO EMERGENCY TREATMENT OF ALIENS
The following regular Medicaid rules do not apply to an applicant for Emergency Treatment of Aliens:
Medicaid citizenship requirements;
Development of income;
Alien-sponsor deeming;
Verification of a social security number; or
Verification of immigration/alien status.
576 D. LIMITED AUTHORIZATION
Once eligibility has been established, the caseworker must issue the number of Recipient Identification Cards (coupons) necessary, limiting the authorization to the dates of services identified by the Division of Health Care Services. See section 501 .
A new application is required for each separate occurrence of an emergency medical condition that requires treatment.
576 E. COORDINATION WITH THE DIVISION OF HEALTH CARE SERVICES ( DHCS )
Because Medicaid coverage for this eligibility category is limited to emergency services, most aliens will apply for emergency medical, assistance only after the services have been provided. Hospitals in the state have been instructed to send medical records to the DHCS Division of Health Care Services office in Anchorage for review. However, there may be times a hospital does not automatically send the medical records and the caseworker must assist the individual in obtaining medical documentation to support the emergency medical claim. When assistance is requested, the caseworker should request that the hospital submit medical documentation, including the discharge summary to:
Division of Health Care Services
Operations
Attention: Carrie Crouse
4601 Business Park Blvd., Bldg. K
Anchorage, AK 99503
Fax: (907) 770-1684
The Division of Health Care Services will:
Determine if the services received were of an emergency nature;
Determine the covered dates of service; and
Provide written authorization to the provider who will then provide a copy of this authorization to the alien.
When an alien applies for emergency treatment, they must provide to their caseworker a copy of the written approval from DHCS Division of Health Care Services .
Note: The letter from DHCS Division of Health Care Services stating that an individual received services of an emergent nature and indicating the covered dates of service is not a determination of eligibility. DPA Division of Public Assistance caseworkers must determine eligibility for Emergency Treatment for Aliens based on the criteria outlined in ADLTC 576(B) .
Previous Section Next Section MC #73 (09/26)
ADDENDUM 1
PROGRAM STANDARDS
Refer to APA Adult Public Assistance Addendum 1 for APA Adult Public Assistance Need/Payment Stan dards and Supplemental Security Income Eligibility/Payment Standards.
Year 1/1/2023 1/1/2024 1/1/2025 1/1/2026 Special Long Term Care Income Standard $2,742 $2,829 $2,901 $2,982 Alaska NH Nursing Home Personal Needs Allowance $200 $200 $200 $200 Alaska HCB Personal Needs Allowance $1,656 $1,656 $1,656 $1,656 Alaska ALH Assisted Living Home Personal Needs Allowance $1,396 $1,396 $1,396 $1,396 Maximum Community Spouse Resource Allowance $148,620 $154,140 $157,920 $162,660 Community Spouse Monthly Maintenance Need Standard $3,715.50 $3,853.50 $3,948 $4,066.50 Monthly Need Standard for Additional Household Members $1,238.80 $1,284.50 $1,316 $1,355.50
EXPANDED REFUSED CASH INCOME LIMITS HOUSEHOLD TYPE 1/01/2024 01/01/2025 01/01/2026 A Individual (A1E) $1,751 $1,795 $1,845 B Individual (B1E) $1,751 $1,795 $1,845 ALH Individual (H1E) $1,751 $1,795 $1,845 A Couple, 1 Eligible (A2S) $2,593 $2,658 $2,732 B Couple, 1 Eligible (B2S) $2,593 $2,658 $2,732 ALH Couple, 1 Eligible (H2S) $2,593 $2,658 $2,732 A Couple, Both Eligible (A2C) $2,593 $2,658 $2,732 B Couple, Both Eligible (B2C) $2,593 $2,658 $2,732 ALH Couple, Both Eligible (H2C) $2,593 $2,658 $2,732 Nursing Home Regular (NHR) $1,751 $1,795 $1,845
Effective 4/1/2026 Monthly Federal Poverty Guidelines for Alaska Annual Federal Poverty Guidelines for Alaska HH Size QMB Qualified Medicare Beneficiaries Qualified Medicare Beneficiaries SLMB Specified Low Income Medicare Beneficiaries Special Low Income Medicare Beneficiaries Base SLMB Plus Specified Low Income Medicare Beneficiary Plus QDWI Qualified Disabled and Working Individuals Qualified Disabled and Working Individuals Working Disabled Low-Income Subsidy ( LIS Low Income Subsidy ) 100% 120% 135% 200% 250% 135% 140% 145% 149% 150% 1 $1,663 $1,955 $2,245 $3,325 $4,157 $26,933 $27,930 $28,928 $29,726 $29,925 2 $2,255 $2,705 $3,044 $4,509 $5,636 $36,518 $37,870 $39,223 $40,305 $40,575 3 $7,115 $46,103 $47,810 $49,518 $50,884 $51,225 4 $8,594 $55,688 $57,750 $59,813 $61,463 $61,875 5 $10,073 $65,273 $67,690 $70,108 $72,042 $72,525 6 $11,553 $74,858 $77,630 $80,403 $82,621 $83,175 7 $13,032 $84,443 $87,570 $90,698 $93,200 $93,825 8 $14,511 $94,028 $97,510 $100,993 $103,779 $104,475 Addl. $1,480 $9,585 $9,940 $10,295 $10,579 $10,650
Note: The QMB Qualified Medicare Beneficiaries , SLMB Specified Low Income Medicare Beneficiaries 's, and QDWI Qualified Disabled and Working Individuals eligibility categories follow APA Adult Public Assistance / SSI Supplemental Security Income policy, which recognizes only one and two-person households. The Working Disabled Medicaid Buy-In and the LIS Low Income Subsidy categories use the entire household size to determine the 250% standard.
MEDICARE PART A MONTHLY PREMIUM MEDICARE PART B MONTHLY PREMIUM BEFORE 2023 Year 2024 2025 2026 Year 2021 2022 2023 <30 Qtrs $505 $518 $565 $148.50 $170.10 $164.90 >30 -<39 Qtrs $278 $285 $311 QMB, SLMB, & SLMB+ RESOURCE LIMITS MEDICARE PART B MONTHLY PREMIUM STARTING IN 2023 Year 2024 2025 2026 Year 2024 2025 2026 Individual $9,430 $9,660 $9,950 $174.70 $185.00 $202.90 Couple $14,130 $14,470 $14,910 EXCESS HOME EQUITY MEDICARE PART D MAXIMUM LOW INCOME SUBSIDY AMOUNT FOR ALASKA YEAR 2024 2025 2026 Year 2024 2025 2026 $713,000 $730,000 $752,000 $38.76 $38.85 $0.00
Pickle Amendment Table
If SSI Supplemental Security Income was terminated during this period: Multiply 2026 Social Security income by: If SSI Supplemental Security Income was terminated during this period: Multiply 2026 Social Security income by: If SSI was terminated during this period: Multiply 2026 Social Security income by: May – June 1977 .181 Jan. 1993 – Dec. 1993 .437 Jan. 2009 – Dec. 2011 .678 July 1977 – June 1978 .192 Jan. 1994 – Dec. 1994 .449 Jan. 2012 – Dec. 2012 .703 July 1978 – June 1979 .204 Jan. 1995 – Dec. 1995 .461 Jan. 2013 – Dec. 2013 .715 July 1979 – June 1980 .224 Jan. 1996 – Dec. 1996 .473 Jan. 2014 – Dec. 2014 .726 July 1980 – June 1981 .256 Jan. 1997 – Dec. 1997 .487 Jan. 2015 – Dec. 2016 .738 July 1981 – June 1982 .285 Jan. 1998 – Dec. 1998 .497 Jan. 2017 – Dec. 2017 .740 July 1982 – Dec. 1983 .306 Jan. 1999 – Dec. 1999 .504 Jan. 2018 – Dec. 2018 .755 Jan. 1984 – Dec. 1984 .317 Jan. 2000 – Dec. 2000 .516 Jan. 2019 – Dec. 2019 .776 Jan. 1985 – Dec. 1985 .328 Jan. 2001 – Dec. 2001 .534 Jan. 2020 – Dec. 2020 .788 Jan. 1986 – Dec. 1986 .338 Jan. 2002 – Dec. 2002 .548 Jan. 2021 – Dec. 2021 .799 Jan. 1987 – Dec. 1987 .342 Jan. 2003 – Dec. 2003 .556 Jan. 2022 – Dec. 2022 .846 Jan. 1988 – Dec. 1988 .357 Jan. 2004 – Dec. 2004 .568 Jan. 2023 – Dec. 2023 .920 Jan. 1989 – Dec. 1989 .371 Jan. 2005 – Dec. 2005 .583 Jan. 2024 – Dec. 2024 .949 Jan. 1990 – Dec. 1990 .388 Jan. 2006 – Dec. 2006 .607 Jan. 2025 - Dec. 2025 .973 Jan. 1991 – Dec. 1991 .409 Jan. 2007 – Dec. 2007 .627 Jan. 1992 – Dec. 1992 .425 Jan. 2008 – Dec. 2008 .641
Due to the recession, there was no cost of living adjustment in Social Security or SSI Supplemental Security Income benefits in January 2010 or 2011. The cost of living increased by 3.6% effective January 2012. Because of this history, the Pickle reduction factor is the same for individuals who lost SSI Supplemental Security Income benefits in 2009-2011. Due to there being no increase in the Consumer Price Index during federal fiscal year 2015, there was no COLA Cost of Living Allowance adjustment for January of 2016. The Pickle reduction factor is the same for individuals who lost SSI Supplemental Security Income benefits in 2015-2016.
Note: If the last month in which an applicant received SSI Supplemental Security Income while, or immediately before, receiving Social Security was in any of the periods above, multiply the present year amount of the Social Security by the corresponding years reduction factor.
Previous Section Next Section MC #71 (04/26)
ADDENDUM - 2
APA Adult Public Assistance Related Medicaid Subtypes, Eligibility Codes, and Waiver Codes
Medicaid Subtype Description AS Waivered Assisted Living BB Individual lost SSI Supplemental Security Income / APA Adult Public Assistance eligibility from 1977 SSA Social Security Administration COLA Cost of Living Allowance "Pickle Person" BC Breast and Cervical Cancer (Ladies First) BE Disability exams (blindness), with or without need for HCB Home and Community-Based Waiver Determination. Non-standard coupon. DC Under 18, Receiving SSI Supplemental Security Income DE Applicant who requires an AD Aid to the Disabled -2, and, if needed, an HCB Home and Community-Based Waiver Determination. DK Disabled Kid ( TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 ) DW Working Disabled Medicaid Buy-In GF Individuals eligible for State APA Adult Public Assistance cash program(s) in December 1973 IL Emergency Alien (AD, AB, and OA) – legal alien or ineligible non-immigrant IN Long Term Care (Nursing Home or HCB Home and Community-Based Waiver) NH Nursing Home Nursing Home (eligible for SSI Supplemental Security Income or APA Adult Public Assistance if not institutionalized) NS Ineligible for SSI Supplemental Security Income / APA Adult Public Assistance because of requirements which do not apply to Medicaid (use for SSI Supplemental Security Income eligible individuals who have not applied for SSI Supplemental Security Income ) PM Section 1619(b) eligible individuals. See Manual Section 530-E ;or Disabled Adult Children; or Disabled Widowers who have lost SSI Supplemental Security Income or APA Adult Public Assistance due solely to receipt of title II benefits QD Qualified Disabled and Working Individuals ( QDWI Qualified Disabled and Working Individuals ) QM Qualified Medicare Beneficiaries ( QMB Qualified Medicare Beneficiaries ) RC Eligible for but refusing APA Adult Public Assistance cash payments or has countable income above the APA need/payment standard but below the Expanded Refused Cash Income Limits outlined in ADLTC MS 530(C) SA Ineligible for SSI Supplemental Security Income / APA Adult Public Assistance because of alien sponsor deeming SI Receiving SSI Supplemental Security Income SL Specified Low Income Medicare Beneficiary. ( SLMB Specified Low Income Medicare Beneficiaries ) SS Individuals eligible for SSI Supplemental Security Income or state supplemental payments except for the 20% Social Security Benefit increase ( OASDI Old Age, Survivors, and Disability Insurance (Social Security) I ) in 1972. ST Not receiving SSI Supplemental Security Income UL Emergency Alien (AD, AB, or OA) – undocumented illegal alien only WD Waiver applicant who does not require a disability determination, but does need a waiver determination. Eligibility is for the cost of a Waiver Agency's assessment for Waiver eligibility. Non-standard coupon.
Incarceration Medicaid Subtype Description AI APA Related (AD, AB & OA) BI Breast and Cervical Cancer II Emergency Alien (AD, AB & OA) – legal alien or ineligible non-immigrant IU Emergency Alien (AD, AB, or OA) – undocumented illegal alien only KI Pregnant Woman
The following Medicaid eligibility codes are specific to ADLTC Medicaid unless here is a "*" in the description.
Medicaid Eligibility Code Description 11 Pregnant Woman * 19 Waiver Determination Only 20 No other eligibility codes apply * 24 LTC (300%) Institutionalized 25 Disability/Blind/Waiver Determination 30 Adults with Physical and Developmental Disabilities Waiver – Special LTC 31 Adults with Physical and Developmental Disabilities Waiver * 34 Adults with Physical and Developmental Disabilities – Dual Medicaid/QMB 40 Alaskans Living Independently Waiver – Special LTC 41 Alaskans Living Independently Waiver * 44 Alaskans Living Independently Waiver – Dual Medicaid/QMB 53 Ineligible Alien Emergency coverage (used for everyone except pregnant women) * 54 SSI disabled child 66 Medicare Savings Program – QDWI only 67 Medicare Savings Program – QMB only 68 Medicare Savings Program – SLMB only 69 Medicare Savings Program – Dual Medicaid/QMB 70 Intellectual and Developmental Disabilities Waiver – Special LTC 71 Intellectual and Developmental Disability Waiver * 74 Intellectual and Developmental Disabilities Waiver – Dual Medicaid/QMB 78 Medicare Savings Program – SLMB Plus only 80 Complex Medical Condition Waiver – Special LTC 81 Complex Medical Condition Waiver * 91 Individualized Supports Waiver – Special LTC 92 Individualized Supports Waiver * 93 Individualized Supports Waiver – Pregnant* 94 Individualized Supports Waiver – Dual Medicaid/QMB
Waiver Codes Description MC Complex Medical Condition MD Intellectual and Developmental Disabilities DA Adults with Physical and Developmental Disabilities AG Alaskans Living Independently IS Individualized Supports
Previous Section Next Section MC #67 (12/24)
ADDENDUM 3
Countable and Excluded Income for ADLTC Medicaid
Type of income Countable for ADLTC Adoption payments, subsidized Yes - see APA MS 442-3(F) for additional details Alaska Native/American Indian Real Property Rental Income Yes - see MS 523 (J) for additional details American Indian/Alaska Native payments Yes - see APA MS 442-3(A)(8) for additional details Annuity Payments Yes Alien Sponsor income Yes - see MS 518 for additional details Child Support Yes Census Income Yes Compensatory payments, court ordered Yes Contractual Income, such as monthly payments from sale of house Yes Corporation income from partnerships, estates and S-corporations Yes Crowdfunding See MS 520(M) for additional details Death Benefits Yes - see APA MS 441-2(G) for additional details Disaster and Emergency Assistance provided by states, local governments, or disaster assistance organizations No Earned Income Tax Credit (EITC) No Educational Grants, Awards, Scholarships and Loans issued under any program funded the Title IV of the Higher Education Act or under a Bureau of Indian Affairs student assistance program No Food Stamp Hold Harmless payment No Foster Care, including Therapeutic Foster Care and boarding home payments No - see APA MS 442-3(F) for additional details Gambling and lottery winnings Yes Garnishments Yes - see APA MS 443-1 for additional details Individual Indian Money Accounts No - see MS 523(I) for additional details Inheritances Yes In-kind support and maintenance Yes - see MS 523(H) for additional details Loans, including educational, personal and commercial No Military Entitlements Yes Missionary Income Yes Permanent Fund Dividend No Recoupments Yes Rental income, including room rental Yes retirement/pension income Yes Self-employment income Yes - see APA MS 441-1(E) for additional details Supplemental Security Income ( SSI Supplemental Security Income ) Yes Social Security payments, excluding SSI Supplemental Security Income Yes Spousal Support (Alimony) Yes Tax returns, federal No Title V of the Older Americans Act, such as MASST See APA MS 442-3(A) for additional details Trust income Yes Unemployment benefits ( UIB Unemployment Insurance Benefit ) Yes Veterans' retirement paid by the Department of Defense Finance and Accounting Services (DFAS) Yes Veteran Disability Payments Yes Veterans Survivor benefits Yes Victims of Crime Compensations No Volunteer Payments from the corporation for National and Community Service (CNCS), such as Senior Corps and AmeriCorp No Wages, including salaries, bonuses, commissions, tips, overtime, severance, and gratuities. This includes an SSI recipient's wages Yes Workers' Compensation Yes
This chart is not comprehensive. For questions regarding income types, please email hss.dpa.policy@alaska.gov .
Previous Section Next Section MC #63 (09/23)
ADDENDUM 4
COCA Cost of Care PROCESSING
A. THE COCA Cost of Care SCREEN
The COCA Cost of Care Screen is Individualized Supports used to calculate the amount of money a client is required to pay for the care he or she is receiving.
CF109-I NEW COCA Cost of Care AMT CALCULATED - PRESS ENTER TO CONFIRM - F9 TO CANCEL EIS Eligibility Information System COCA Cost of Care COST OF CARE SCREEN 020204 14:26 WORKER B CASE NAME: DOE, JOHN CASE NUMBER: 00024573 MONTH: 0304 CLIENT: JOHN D CLIENT NO: 0600055441 INCOME EXPENSE SOC SECURITY (SS) : 1200.00 PERSONAL NEEDS : 1656.00 SUPL SECURITY (SI) : INCOME TAXES : SENIOR BENEFITS : CHILD SUPPORT GARNISH : VETERANS ( VA ) : SPOUSAL MAINTENANCE : PENSION PERS Public Employees Retirement System : 1500.00 DEPENDENT MAINTENANCE : ANNUITY : INSURANCE PREMIUM : UNCOVERED MED EXPENSE : 140.00 EARNED INCOME : HOME MAINT (6 MO MAX) : ADULT PUBLIC ASSISTANCE : EXPENSE ADJUSTMENT : INCOME ADJUSTMENT : TOTAL INCOME : 2700.00 TOTAL EXPENSE : 1796.00 Comments: NEW COST OF CARE LIABILITY AMOUNT: 904.00 NEXT-->
B. DESCRIPTION OF FIELDS ON COCA Cost of Care SCREEN
FIELD DESCRIPTION / USE INCOME SOC SECURITY (SS) If the client receives Social Security ( SSA Social Security Administration ) income (RE, DI, etc), input the amount in this field. SUPL SECURITY (SI) If the client receives Supplemental Security Income ( SSI Supplemental Security Income ), input the amount in this field. SENIOR BENEFITS If the client receives Alaska Senior Benefits Program (SBP) payments, input the amount in this field. VETERANS ( VA ) If the client receives payments from the Department of Military and Veterans Affairs, input the amount in this field. PENSION If a client is receiving an employer pension, enter the amount in this field. Open Field by PENSION The field beside Pension opens and allows the caseworker to enter the source of the Pension (i.e. PERS Public Employees Retirement System , Railroad, etc.) ANNUITY If a client is receiving an annuity from a private source, enter the amount in this field. Open Field by ANNUITY The field beside ANNUITY opens and allows the caseworker to enter the source of the annuity (i.e. SBS, Roth IRA, etc.) Open Field between ANNUITY and EARNED INCOME fields Use this field to enter any supplemental or additional income not otherwise specified. EARNED INCOME If a client has wages, enter the amount of gross earnings (including self-employment) in this field. ADULT PUBLIC ASSISTANCE If a client receives APA Adult Public Assistance benefits, enter the total amount of APA Adult Public Assistance benefits in this field. INCOME ADJUSTMENT Enter any amounts of offsetting income. (e.g. when an incorrect amount of income was used in determining the cost of care in a previous month.) TOTAL INCOME This field displays the total amount of countable income. COMMENTS This is a free form field for caseworkers to enter information regarding any of the data entry on the COCA Cost of Care screen. DO NOT DUPLICATE information that is recorded on the online Case Notes ( CANO ).
FIELD DESCRIPTION / USE EXPENSES PERSONAL NEEDS This amount is hard coded and is determined by the Medicaid subtype entered on the MERE Medical Reference s creen . INCOME TAXES If a client pays taxes on any income (e.g. (retirement or annuity), enter the amount paid in this field. CHILD SUPPORT GARNISH If a client has any income garnished for child support during the month, enter the amount of the garnishment in this field. SPOUSAL MAINTENANCE Enter the amount allowed for spousal maintenance in this field. DEPENDENT MAINTENANCE Enter the amount allowed for dependent maintenance in this field. INSURANCE PREMIUM If a client pays an insurance premium for private insurance coverage, enter the amount of premium in this field. UNCOVERED MED EXPENSE Enter the amount for uncovered medical expenses in this field. HOME MAINTENANCE (6 MO MAX) If a client lives in a nursing home and intends to return to his or her private residence, enter the amount of maintaining the private residence in this field. EXPENSE ADJUSTMENT Enter any offsetting expenses in this field. TOTAL EXPENSES The total amount of allowed expenses will display in this field. NEW COST OF CARE LIABILITY AMOUNT Upon <ENTER> this field will display the clients new cost of care amount.
C. COCA PROCESSING EXAMPLES
Example 1: John Doe is currently eligible for Medicaid under the Special Long Term Care category and is receiving HCB Home and Community-Based Waiver Services. He lives in his own home. His monthly income consists of $1200 in SS-RE and $1500 in PERS Public Employees Retirement System retirement for a combined monthly income of $2700. He has a Qualifying Income Trust ( QIT ) that he deposits $1044 each month. He also incurs uncovered medical expenses and this month the total of uncovered medical expenses is $140.
Step 1: Input all demographic and income information. Step 2: On the MERE Medical Reference : " Input" the correct Medicaid Subtype and Eligibility Code. Step 3: On the APA Adult Public Assistance METHOD MEDICAID ONLY AUTHORIZATION ( APMM ) screen: 1. <TAB> to the UNEARNED INCOME field and enter the combined unearned income 2. <ENTER> 3. Input PCN and REVIEW DUE DATE 4. <ENTER>
APMM APA Method Medicaid Only Authorization screen APA Adult Public Assistance METHOD AUTHORIZATION ONLY 020204 13:50 WORKER B CASE NAME: DOE, JOHN CASE NUMBER: 00024573 MONTH: 0304 ADJ GROSS EARNED INCOME : 0.00 HOUSEHOLD TYPE : WAV $65 AND 1/2 WORK INCENT : 0.00 QMB Qualified Medicare Beneficiaries / SLMB HH SIZE : AB Aid to the Blind WORK DEDUCTIONS : 0.00 NET EARNED INCOME : 0.00 APA Adult Public Assistance NEED STANDARD : 1656.00 UNEARNED INCOME : 2700.00 COUNTABLE EARNED INCOME : 2700.00 $20 DISREGARD : 0.00 NET UNEARNED INCOME 2700.00 PENDED? : INFORMATION ONLY AUTHORIZATION : DENIAL/CLOSURE REASON : COUNTABLE RESOURCES : 0.00 INSTITUTIONALIZED? : BENEFIT ISSUANCE : R REVIEW DUE DATE : 0105
Step 4:
Upon <ENTER> the COCA Cost of Care screen will appear. On the COCA Cost of Care screen:
1. In the SOC SECURITY field input the SS-DS payment of $1200
2. <TAB> to the PENSION field, beside the PENSION field enter the source of the pension
3. In the PENSION field input the PERS Public Employees Retirement System pension of $1500.00
4. <TAB> to the UNCOVERED MED EXPENSE and enter the allowed $140 deduction
5. <TAB> to the COMMENTS field and enter any comments (optional step)
6. <ENTER> to calculate the New Cost of Care Liability amount
7. If correct<ENTER> again to confirm
EIS Eligibility Information System COCA Cost of Care COST OF CARE SCREEN 020204 14:03 WORKER B CASE NAME: DOE, JOHN CASE NUMBER: 00024573 MONTH: 0304 CLIENT: JOHN D CLIENT NO: 0600055441 INCOME EXPENSE SOC SECURITY (SS) : 1200.00 PERSONAL NEEDS : 1656.00 SUPL SECURITY (SI) : INCOME TAXES : SENIOR BENEFITS : CHILD SUPPORT GARNISH : VETERANS ( VA ) : SPOUSAL MAINTENANCE : PENSION PERS Public Employees Retirement System : 1500.00 DEPENDENT MAINTENANCE : ANNUITY : INSURANCE PREMIUM : UNCOVERED MED EXPENSE : 140.00 EARNED INCOME : HOME MAINT (6 MO MAX) : ADULT PUBLIC ASSISTANCE : EXPENSE ADJUSTMENT : INCOME ADJUSTMENT : TOTAL INCOME : 2700.00 TOTAL EXPENSE : 1796.00 Comments: NEW COST OF CARE LIABILITY AMOUNT: 904.00 NEXT-->
Example 2: Jane Doe is currently eligible for Medicaid under the Special Long Term Care category and is receiving HCB Home and Community-Based Waiver Services. She lives in an assisted living home. Her monthly income consists of $1200 in SS-RE and $300 from an annuity for a combined monthly income of $1500. She has no expenses.
Step 1:
Input all demographic and income information
Step 2:
On the MERE Medical Reference :
"Input" the correct Medicaid Subtype AS and Eligibility Code
Step 3:
On the APA Adult Public Assistance METHOD MEDICAID ONLY AUTHORIZATION ( APMM ) screen:
1. <TAB> to the UNEARNED INCOME field and enter the combined unearned income
2. <ENTER>
3. Input PCN and REVIEW DUE DATE
4. <ENTER>
Step 4:
Upon <ENTER> the COCA Cost of Care screen will appear. On the COCA Cost of Care screen:
1. In the SOC SECURITY field input the SS-DS payment of $1200
2. <TAB> to the ANNUITY field, beside the ANNUITY field enter the source of the annuity
3. In the ANNUITY field input the $300.00
4. <TAB> to the COMMENTS field and enter any comments (optional step)
5. <ENTER> to calculate the New Cost of Care Liability amount
6. If correct<ENTER> again to confirm
EIS Eligibility Information System COCA Cost of Care COST OF CARE SCREEN 090204 14:03 WORKER B CASE NAME: DOE, JANE CASE NUMBER: 00024573 MONTH: 1004 CLIENT: JANE D CLIENT NO: 0600055441 INCOME EXPENSE SOC SECURITY (SS) : 1200.00 PERSONAL NEEDS : 1396.00 SUPL SECURITY (SI) : INCOME TAXES : SENIOR BENEFITS : CHILD SUPPORT GARNISH : VETERANS ( VA ) : SPOUSAL MAINTENANCE : PENSION PERS Public Employees Retirement System : DEPENDENT MAINTENANCE : ANNUITY : 300.00 INSURANCE PREMIUM : UNCOVERED MED EXPENSE : EARNED INCOME : HOME MAINT (6 MO MAX) : ADULT PUBLIC ASSISTANCE : EXPENSE ADJUSTMENT : INCOME ADJUSTMENT : TOTAL INCOME : 1500.00 TOTAL EXPENSE : 1396.00 Comments: NEW COST OF CARE LIABILITY AMOUNT: 104.00 NEXT-->
D. THE COCB SCREEN
The COCB screen provides a history of the cost of care for the case. This screen displays all months of benefits, including months that have auto-rolled. The only instance where the COCB will not show a benefit month is if a worker accidentally passed through the COCA Cost of Care screen without making any entries. To access the COCB screen:
<NEXT> to the COCB from the COCA Cost of Care or any EIS Eligibility Information System menu
Caseworkers can access a specific COCA Cost of Care screen directly from the COCB screen by:
1. Placing an X in the SEL (select) field by the benefit month
2. Pressing <ENTER>
IE002-I END OF DATA EIS Eligibility Information System COCB COST OF CARE BROWSE 020204 14:06 WORKER B CASE NAME: DOE, JOHN CASE NUMBER 0002457 SEL BEN MONTH COCA Cost of Care AMOUNT INCOME AMOUNT EXPENSE AMOUNT COMMENTS 03/04 904.00 2700.00 1796.00 02/04 844.00 2700.00 1856.00 03/00 712.83 1240.00 527.17 02/00 1713.98 2291.87 577.89 NEXT -->
Note: When the COCA Cost of Care displays from the COCB, the NEXT field will automatically display COCB.
E. MAKING RETROACTIVE COCA Cost of Care ADJUSTMENTS
Example 3: Retroactive Adjustment due to Reported Uncovered Medical Expense It is March 3, 2004 and Mr. Doe has submitted a podiatrist bill for $75 for services received on February 19, 2004.
Step 1:
Access the 0404 COCA Cost of Care screen and input the $75 in the Expense Adjustment field and <ENTER>
Step 2:
Upon <enter> EIS Eligibility Information System will update the COCA Cost of Care liability
Step 3:
Send notice to Mr. Doe explaining that his COC Cost-of-care for 0404 has been reduced due to the uncovered medical expense occurred in 0204.
Step 4:
Access the 0504 COCA Cost of Care screen and remove the $75 from the Expense Adjustment field and <ENTER>
Step 5:
Upon <ENTER> the COCA Cost of Care screen will update the COC Cost-of-care amount
Step 6:
Send a second notice to Mr. Doe explaining that his COC Cost-of-care liability will increase in 0504.
Example 4: Retroactive Adjustment due to Increased Income Mr. Doe receives Social Security Retirement. It is January 10, 2004 and the caseworker has just realized that the COC Cost-of-care was not adjusted with the increase in Social Security due to the cost-of-living adjustment. Mr. Does Social Security increased from $1200 to $1226.
Step 1:
Access the 0204 COCA Cost of Care screen and enter the new SS-RE amount of $1226.00 in the SOC Security field.
Step 2:
Enter the $26 of the missed Social Security for 0104 in the INCOME ADJUSTMENT field and <ENTER>
Step 3:
Send the COC Cost-of-care notice informing Mr. Doe that his 0204 COC Cost-of-care liability has increased due to Social Security adjustment
Step 4:
Access the 0304 COCA Cost of Care screen and delete the $26 from the INCOME ADJUSTMENT field and <ENTER>
Step 5:
Send a second notice explaining what the new COC Cost-of-care liability amount is beginning with 0304 benefits.
F. CONTACTING sYSTEMS SUPPORT
If COC Cost-of-care adjustments cannot be made within a four-month timeframe, contact Systems Support to adjust the COCA Cost of Care for earlier months.
When contacting Systems Support to make a change to the Cost of Care Liability, provide the following information for each month to be corrected:
All income information
All expense information
The corrected liability amount
Systems Support will email Policy to determine if the request is valid and can be approved. If the request is denied, Systems Support will email the ET who requested the correction.
Previous Section Next Section MC #53 (04/20)
Addendum 5
Reserved
Previous Section Next Section MC #68 (04/25)
Addendum 6
Community Residential Centers (CRCs)
Anchorage
Cordova Center
130 Cordova St.
Anchorage, AK 99501
Glennwood Center
835 D St.
Anchorage, AK 99501
Midtown Center
2508 Margies Pl.
Anchorage, AK 99503
OR
2507 Eide St.
Anchorage, AK 99503
Juneau
Glacier Manor (Gastineau Human Services)
5597 Aisek St.
Juneau, AK 99801
OR
5577 Aisek St.
Juneau, AK 99801
Fairbanks
Northstar Center
3022 Park Hwy.
PO Box 80670
Fairbanks, AK 99708
OR
Mile 353.5
George Parks Hwy.
Fairbanks, AK 99709
Nome
Seaside
108 Front St.
PO Box 2129
Nome, AK 99762
Bethel
Tundra Center
680 Ridgecrest Dr.
PO Box 485
Bethel, AK 99559
Previous Section Next Section
ADDENDUM 7
PRESCRIPTION DRUG PLANS AVAILABLE IN ALASKA
Medicare Part D (Prescription Drug Coverage) information can be found at https://health.alaska.gov/dsds/Pages/medicare/prescription.aspx .
Previous Section Next Section MC #53 (04/20)
ADDENDUM 8
WORKING DISABLED MEDICAID BUY-IN PROCEDURES
The Working Disabled Medicaid Buy-in program has experienced significant growth since it began in April 1999. The administration of this program involves two divisions within the Department of Health:
The Division of Public Assistance is responsible for the eligibility determination and ongoing case maintenance, and
The Division of Health Care Services is responsible for the calculation and collection of premiums.
To ensure the integrity and efficiency of the program it is essential the two divisions work closely together. This addendum outlines procedures for:
Case numbering
Case registration, household size, school status, and income documentation
Checking for 1619B status
Process for paying premiums
Processing cases when the recipient is 45 Days past due paying premiums
Processing cases for recipients who are repeatedly late with payments
Communicating with DHCS Division of Health Care Services
I. CASE NUMBERING
The DHCS Division of Health Care Services uses the Working Disabled case number to document all unpaid premium balances. It is important that DPA Division of Public Assistance staff use the following case numbering procedures:
Before registering a Working Disabled case number, conduct a full search of all Medicaid case numbers on the CLPM Client Profile/Maintenance screen.
Register a Working Disabled case on a stand-alone Medicaid number. A regular APA Adult Public Assistance /Medicaid case number should never be converted to a Working Disabled case number and vice versa.
In couple cases where both spouses are disabled, each spouse will have their own Working Disabled Medicaid case. The couples combined unearned income is compared to the Expanded Refused Cash or LTC income standard for an eligible couple in the second unearned income test.
Example 1: Mr. Smith is an APA Adult Public Assistance / ME Medicaid recipient. On May 2, Mr. Smith started a new job that placed him over income for APA Adult Public Assistance cash and Expanded Refused Cash or LTC Medicaid.
Process:
End the APA Adult Public Assistance / ME Medicaid case number effective May 31.
Register a Medicaid-only case number beginning June 1.
Authorize Working Disabled Medicaid on the new case number beginning June 1.
Notify DHCS Division of Health Care Services via email at doh.hcs.rec.info@alaska.gov of the open Working Disabled Medicaid case name and number.
DHCS will review the CASS Case Summary , MERI Medical Resource Information , and WODM Working Disabled Medicaid Authorization screens to calculate the premium amount and send notice M901 - Working Disabled Medicaid-Premiums Due.
Example 2: On August 10, Mr. Smith is laid of from his job and his income is once again within the Expanded Refused Cash or LTC Medicaid income standard.
Process:
End the Working Disabled case number August 31.
Register the former APA Adult Public Assistance / ME Medicaid case number with a benefit start date of September 1, and authorize September Medicaid benefits. The recipient will need to reapply for APA Adult Public Assistance cash.
Notify DHCS Division of Health Care Services at doh.hcs.rec.info@alaska.gov of the closed Working Disabled Medicaid case name and number.
DHCS Division of Health Care Services will calculate the premium amount and send notice M901 - Working Disabled Medicaid-Premiums Due.
Example 3: On December 2, Mr. Smith finds a new job and once again goes over income for APA Adult Public Assistance cash and Expanded Refused Cash or LTC Long Term Care Medicaid.
Process:
End the APA Adult Public Assistance / ME Medicaid case number December 31.
Register the former Working Disabled case number with a benefit start date of January 1, and authorize Working Disabled Medicaid.
Notify DHCS Division of Health Care Services at doh.hcs.rec.info@alaska.gov of the open case name and number.
DHCS Division of Health Care Services will calculate the premium amount and send notice M901 - Working Disabled Medicaid-Premiums Due.
II. CASE REGISTRATION / HOUSEHOLD SIZE / SCHOOL STATUS / INCOME DOCUMENTATION
To ensure the correct calculation of premiums, it is important to accurately document household size, the school status of all 18 and 19 year-old dependents, and the income of every household member in the Working Disabled Medicaid Buy-In case.
Process:
Register the spouse and all dependent household members to the Working Disabled Medicaid case number.
Complete a separate case note regarding the school status of all 18 and 19 year old status. Title the case note School Status .
It is also important to write clear case notes in the CANO Case Notes regarding the household’s income.
Process:
On the CANO Case Notes , breakdown the income of all household members.
Check the case to ensure that the income information is the same as what is documented on the CANO Case Notes , CASS Case Summary , and WODM Working Disabled Medicaid Authorization screens.
III. 1619B ELIGIBILITY
It is important to review the 1619B list on Mobius titled HESDX30 under reports every month. An individual who is 1619B is eligible for regular Medicaid benefits.
Do not code an individual who is 1619B eligible as a Working Disabled Medicaid Buy-In case.
IV. PREMIUM PAYMENTS
When completing an intake interview for the Working Disabled Medicaid Buy-In or when converting an APA Adult Public Assistance Medicaid case, caseworkers must:
Check to see if there is a past Working Disabled case with past due premiums. If there are any outstanding premiums, Medicaid under this category cannot be established until all past premiums are paid.
Discuss the importance of paying all premiums timely with the client to ensure continuing eligibility.
Premiums should only be sent to the DHCS Division of Health Care Services office. A DPA Division of Public Assistance district office should not collect the premiums, but should tell recipients to always mail their premium payments directly to the DHCS Division of Health Care Services office in Anchorage.
V. CASE PROCESSING WHEN PREMIUM PAYMENTS ARE 45 DAYS PAST DUE
When a premium payment is 45 days past due, DHCS Division of Health Care Services sends the recipient notice M904, Working Disabled - Premiums Overdue, and takes adverse action. The M904 is very specific and states that the case will close unless the payment is received by a specified date. A second adverse action notice is not necessary as the M904 is sufficient.
Process:
When the M904 is sent, DHCS Division of Health Care Services e-mails the caseworker and explains that the recipient is 45 days past due and that the M904 was sent.
The caseworker accesses the WODM Working Disabled Medicaid Authorization (Working Disabled Medicaid Authorization) screen for the next month to de-authorize the Medicaid benefits and document the action on CANO Case Notes .
If the recipient pays the premium by the specified date or by the end of the month, DHCS Division of Health Care Services e-mails the caseworker. The caseworker accesses the WODM Working Disabled Medicaid Authorization to re-authorize the Medicaid benefits.
If the premium payment is not paid, the caseworker closes the case and documents the action on CANO Case Notes .
Example 1: Mr. Brown is 45 days overdue on his Buy-In premium. On May 3, DHCS Division of Health Care Services sends Mr. Brown the M904 notice requesting he pay his delinquent premiums by May 16, and emails the caseworker who:
Accesses the June WODM Working Disabled Medicaid Authorization screen and de-authorizes benefits, and
Documents the action taken on CANO Case Notes .
On May 15, Mr. Brown delivers a check covering all delinquent premiums to the DHCS Division of Health Care Services office. DHCS sends an e-mail to the caseworker stating that premiums are now paid. The caseworker:
Accesses June WODM Working Disabled Medicaid Authorization screen and re-authorizes benefits.
Checks to make sure the auto-roll date is set.
Documents the action taken on CANO Case Notes .
Example 2: Mr. Brown is 45 days overdue on his Buy-in premium. On May 3, DHCS Division of Health Care Services sends Mr. Brown the M904 notice requesting he pay his premiums by May 16, and emails the caseworker. The caseworker:
Accesses the WODM Working Disabled Medicaid Authorization screen for benefit month of June and de-authorizes benefits.
Documents the action taken on CANO Case Notes .
Mr. Brown does not send in his premium payment by the due date or by the end of the May. The caseworker closes the case and documents the action on CANO Case Notes .
VI. PROCESSING CASES WHEN PREMIUMS ARE REPEATEDLY PAST DUE
The integrity of the Working Disabled Medicaid Buy-In program is dependent on the collection of premiums and keeping recipients accountable for their premium payments. Occasionally a recipient is repeatedly late and begins to accrue large overdue premium balances. In order to encourage the timely payment of premiums the procedures listed below will be enforced.
First and Second 45-Day Notices: When a premium payment is made at the beginning of the month following the 45-day notice:
The payment is accepted.
Medicaid is reopened.
DHCS Division of Health Care Services sends a reminder to the recipient explaining the importance of paying premiums timely. After the second 45-day notice, a stronger reminder is sent stating that Medicaid coverage will end for failure to pay premiums on time.
Third 45-Day Notice: If the premium payment is not made by the end of the month:
The case remains closed.
The recipient needs to reapply with a new Medicaid application.
VII. REPORTING CHANGES TO DHCS Division of Health Care Services
It is the responsibility of the DPA Division of Public Assistance caseworker to contact DHCS Division of Health Care Services at doh.hcs.rec.info@alaska.gov to report the following changes and information:
All address and phone changes as reported by the client
All income changes after updating the WODM Working Disabled Medicaid Authorization screen
Closures for any reason, including auto-closures for failure to review
Any new Working Disabled Buy-In case name and number
Previous Section MC #67 (12/24)
Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DEPARTMENT OF HEALTH
DIVISION OF PUBLIC ASSISTANCE
STATE OF ALASKA
Department of Health
Division of Public Assistance
TRANSMITTAL NUMBER: MC #73
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 1, 2026
Beginning July 4, 2025 the 2025 Reconciliation Bill (H.R. 1) was signed into law. This law contains several provisions that affect the non citizen requirements of the Medicaid program that are effective October 1, 2026.
Highlights of these and other policy revisions are described below. If you have any questions, contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov
OVERVIEW OF CHANGES
500(A) Applicable Eligibility Categories
Revised section to remove automatic Medicaid eligibility for APA Adult Public Assistance and SSI Supplemental Security Income recipients due to the Medicaid qualified alien requirements effective October 1st, 2026.
Added note to reflect individuals must also meet Medicaid qualified alien requirements effective October 1st, 2026.
501(A) Issuing Medicaid to Eligible Recipients
Revised section to reflect new process and new design of Medicaid cards.
511 B(1) Who is Not Required to Cooperate
Revised postpartum period from 60 days to 12 months to align with postpartum period change.
520(C) Proof of United States Citizenship and Qualified Alien Status
Removed reference to APA Adult Public Assistance MS 421, added reference to MAGI MS 808 , due to the Medicaid qualified alien requirements effective October 1st, 2026.
522 Medicaid Exceptions to APA Adult Public Assistance Eligibility Policy
Added note to reflect individuals must meet Medicaid qualified alien requirements effective October 1st, 2026.
522(A) Special Non-Immigrant Groups
Removed reference to APA Adult Public Assistance MS 421, added reference to MAGI MS 808-2 and MAGI MS 808-4(D) due to the Medicaid qualified alien requirements effective October 1st, 2026.
522(E) Renewal Requirements
Revised section to remove automatic Medicaid eligibility for SSI Supplemental Security Income recipients due to the Medicaid qualified alien requirements effective October 1st, 2026.
530 SSI Supplemental Security Income and APA Adult Public Assistance Related Categories
Revised section to remove automatic Medicaid eligibility for SSI Supplemental Security Income and APA Adult Public Assistance recipients due to the Medicaid qualified alien requirements effective October 1st, 2026.
Added note to reflect SSI Supplemental Security Income and APA Adult Public Assistance recipients and applicants must also meet Medicaid qualified alien requirements effective October 1st, 2026.
532 SSI Supplemental Security Income or APA Adult Public Assistance Ineligible for Reasons that Do Not Apply to Medicaid.
Added note to reflect individuals must also meet Medicaid qualified alien requirements effective October 1st, 2026.
533(A) TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Eligibility
Added note to reflect individuals must also meet Medicaid qualified alien requirements effective October 1st, 2026.
540 Grandfathered Eligibility Categories
Added note to reflect individuals must also meet Medicaid qualified alien requirements effective October 1st, 2026.
550 Eligibility Categories for an Individual Living in an Institution
Added note to reflect individuals must also meet Medicaid qualified alien requirements effective October 1st, 2026.
576(A) Definitions
Removed reference to APA Adult Public Assistance MS 421-6, added reference to MAGI MS 808-5 and MAGI MS 808-4 due to the Medicaid qualified alien requirements effective October 1st, 2026.
580 Medicare Savings Programs
Added note to reflect individuals must also meet Medicaid qualified alien requirements effective October 1st, 2026.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #28
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: January 7, 2013
The resource limit for the Low Income Subsidy Program typically increases each January when Social Security announces their COLA increase. This year, we did not receive the new resource limits for LIS until after the manual was posted. The ADLTC manual has now been updated to reflect the correct resource limits.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 580 D Low-Income Subsidy (LIS) Program
Updated with current resource limits for the Low-Income Subsidy Program
Addendum 6 Medicare Part D Low Income Subsidy Guide
Updated the guide with the 2013 resource limits.
Previous Section Next Section
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #29
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: March 8, 2013
We have updated the Program Standards and Pickle Amendment Chart for 2013. We have also updated the chapter on TEFRA cases to more accurately reflect the current process.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 506 O SOCIAL SECURITY OFFICES
Corrected contact information for the Juneau Social Security Office
MS 533 DISABLED CHILDREN AT HOME ( TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 )
Updated chapter to more accurately reflect the current TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 process.
MS 534 WORKING DISABLED MEDICAID BUY-IN
Updated examples with 2013 FPG Federal Poverty Guidelines amounts and APA Adult Public Assistance Standards.
MS 560 E HCB WAIVER REFERRALS AND INTERAGENCY COMMUNICATIONS
Updated section to clarify DSDS waiver denials are sent to the LTC Unit, not the LTC Coordinator.
MS 575 BREAST AND CERVICAL CANCER MEDICAID
Updated application address to remove Breast and Cervical Cancer Coordinator and replace with LTC Unit as there is no longer a coordinator for this program.
ADDENDUM 1 NEEDS STANDARDS
Updated Needs Standards tables for current FPG Federal Poverty Guidelines
Updated Pickle Amendment table.
Previous Section Next Section
MEMORANDUM
DATE: March 21, 2005
TO: All Adult Public Assistance Manual Holders
FROM: Policy and Program Development Team
Ellie Fitzjarrald, Chief
SUBJECT: Aged, Disabled and Long Term Care Medicaid Manual Change #1
This manual change updates the Income Standards in Addendum 1 with the 2005 Federal Poverty Guidelines for Alaska, and the 2005 Reduction Factors for the Pickle Amendment Table. It also adds the EIS Eligibility Information System Qualified Medicare Beneficiaries ( QMB ) eligibility codes and the assisted living " AS " subtype for use in home and community-based waiver determinations, and the "IC" and "IF" eligibility codes that were inadvertently omitted.
If you have any questions, please contact any member the Policy and Program Development Team at 465-3347 or email us at dpapolicy@health.state.ak.us .
MANUAL CHANGE FILING INSTRUCTIONS
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MEMORANDUM
DATE: September 1, 2005
TO: All Aged, Disabled and Long Term Care Medicaid Manual Holders
FROM: Policy and Program Development Team
Ellie Fitzjarrald, Chief
SUBJECT: Aged, Disabled and Long Term Care Medicaid Manual Change #2
This manual change includes information about the new Medicare Part D prescription drug coverage. It incorporates policy revisions implemented by broadcast announcements, and makes minor technical changes. An index is Individualized Supports added as a result of suggestions received from field staff.
This manual change does not include policy regarding the Medicare low-income subsidy program, and processing the Medicare "extra help" applications. This policy and the EIS Eligibility Information System changes supporting it is under development and will be addressed in the next manual change. In the interim, please refer to the broadcast issued June 9, 2005, regarding guidelines for handling Medicare low-income subsidy applications received in DPA Division of Public Assistance offices.
Highlights of these policy additions and other clarifications are described below.
If you have any questions, please contact any member the Policy and Program Development Team at 465-3347 or email us at dpapolicy@health.state.ak.us.
OVERVIEW OF CHANGES
MS 506(D)(4) - Medicare Part D - Prescription Drug Coverage
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 ( MMA ), adds Part D to Medicare, which makes prescription drug coverage available to all Medicare beneficiaries. Prescription drug plans will be available to help people with Medicare save money on prescription drugs. These prescription drug plans will become known in October 2005.
Starting January 1, 2006, Medicaid will no longer pay for prescription drugs for people who are eligible for Medicare. People with both Medicaid and Medicare, known as "dual eligibles" will automatically be enrolled in a prescription drug plan to ensure there will be no break in coverage.
Medicaid recipients who reside in nursing home or medical institutions who are eligible for Part D Medicare will have no deductible, premiums, and co-payments. All other Medicaid recipients and individuals in buy-in programs will continue to have co-payments.
In November, Centers for Medicare and Medicaid Services will send letters to all recipients with information about their prescription drug plan. Medicaid recipients may choose to opt-out of a prescription drug plan, or enroll in another plan at any time as long as they are eligible for Medicaid. However, if a person chooses to opt-out of a prescription drug plan without enrolling in another plan, Medicaid will not pay for the cost for their prescription drugs. In November, DPA Division of Public Assistance will be sending letters to Medicaid dual eligible recipients explaining this change in Medicaid coverage.
As a reminder, when case reviews, new applications or redeterminations are made, staff need to check EIS Eligibility Information System coding to ensure proper entry of Medicare enrollment on the MERE Medical Reference screen.
MS 524 (F) - Institutional Allotment of Resources
Adds Medicaid exception to APA Adult Public Assistance resource policy for financial responsibility of spouses who no longer live together. This policy does not apply to institutional or waiver applicants.
MS 526 (D) - Payments Made from a QIT Qualifying Income Trust
Federal SSI Supplemental Security Income regulations were amended effective March 9, 2005 to change the definition of income. Previous policy defined income as money that could be used to meet a person’s needs for food, clothing, or shelter. This change removes the term "clothing" from the definition of income. This change was previously issued by broadcast as a pen and ink change on April 19, 2005.
MS 554 - Transfer of Assets
Clarifies the transfer of asset penalty policy when both spouses’ are institutionalized.
MS 561-G - EIS Eligibility Information System HCB Home and Community-Based Waiver Codes
Includes the "PM" subtype for use with home and community-based waiver services.
MS 570 - Post Eligibility and Cost-of-Care
Updates the personal needs allowance ( PNA ) to $1396 as changed by Senate Bill 125 for Medicaid recipients who reside in assisted living homes. Also includes clarification that unpaid medical bills that are not subject to payment by a third party are an allowable cost-of-care deduction.
Addendum 1 - Program Standards
Updates the PNA Personal Needs Allowance to $1396 for individuals who reside in assisted living homes.
Addendum 4 - COCA Cost of Care Processing
Updates the EIS Eligibility Information System cost-of-care ( COCA Cost of Care ) screen with the PNA Personal Needs Allowance $1396 for individuals who reside in assisted living homes.
MANUAL CHANGE FILING INSTRUCTIONS
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MEMORANDUM
DATE: December 1, 2005
TO: All Aged, Disabled and Long Term Care Medicaid Manual Holders
FROM: Policy and Program Development Team
Ellie Fitzjarrald, Chief
SUBJECT: Aged, Disabled and Long Term Care Medicaid Manual Change #3
This manual change includes policies and processing instructions for Medicare’s low-income subsidy ( LIS ) program, and makes other technical changes. It also adds the 2006 Long Term Care community spouse resource and income allowance, and household member standards, and adds two new addendums to describe the low-income subsidy levels and provide information about the Medicare approved drug plans for Alaska. In addition, instructions for advising Medicaid/Medicare recipients about changes in prescription drug coverage are provided below.
Highlights of these policy additions and other clarifications are described below.
If you have any questions, please contact any member the Policy and Program Development Team at 465-3347 or email dpapolicy@health.state.ak.us.
NEW MEDICAID COVERAGE POLICY
Beginning January 1, 2006, Medicaid will no longer pay for prescription drugs for recipients who are eligible for Medicare. On November 18, 2005, current Medicaid/Medicare dual eligible recipients were sent an EIS Eligibility Information System auto-generated notice telling them about this change.
Implementation: A manual notice, M710 - Medicare Drug Coverage Begins is now available in EIS Eligibility Information System . Once a Medicaid recipient becomes eligible for Medicare, he or she will loose prescription drug coverage through Medicaid. Effective with this manual change, the caseworker must send this notice to all new Medicaid recipients as soon as it becomes known that Medicare eligibility exists.
OVERVIEW OF CHANGES
ADLTC MS 505 - Third Party liability ( TPL ) and Recovery
Instructs caseworkers to send an email message to Division of Health Care Services TPL Third Party Liability staff if it appears a minor child has health insurance coverage.
ADLTC MS 554 - Transfer of Resources
Clarifies that a MED 3, Declaration / Denial of Asset Transfer, or notice M723, Transfer of Asset Declaration, must be obtained for all nursing home and home and community based waiver applicants.
ADLTC MS 580-D - Low-Income Subsidy Program
This new section provides information about the Medicare Part D Low-Income Subsidy program.
Addendum 1 - Program Standards
Includes the Annual Federal Poverty Guidelines for Alaska for processing Medicare low-income subsidy applications, and updates the annual community spouse maintenance resource and income standards.
Addendum 6 - Low-Income Subsidy Guide
Shows eligibility criteria for the Medicare Part D Low-Income Subsidy and SeniorCare prescription drug benefit, and describes how this assistance affects the cost of Medicare Part D premiums, deductibles, and co-payments or co-insurance.
Addendum 7 - Medicare Prescription Drug Plans for Alaska
Provides information about the Medicare approved prescription drug plans for Alaska as of October 10, 2005.
MANUAL CHANGE FILING INSTRUCTIONS
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MEMORANDUM
DATE: October 2, 2006
TO: All Aged, Disabled and Long Term Care Medicaid Manual Holders
FROM: Policy and Program Development Team
Carolyn Spalding, Acting Chief
SUBJECT: Aged, Disabled and Long Term Care Medicaid Manual Change #4
This manual change incorporates Medicaid policy that requires United States citizens to provide verification of their U.S. United States citizenship and identity. This requirement is due to a change in federal law under the Deficit Reduction Act of 2005. The policy changes were previously implemented by broadcast announcements. Implementation in Alaska began on August 1, 2006 for Medicaid applications and renewals received on or after that date.
Note: The new law does not change the eligibility or verification rules that apply to non-citizens. Qualified aliens are still required to provide verification of their status when they apply for Medicaid benefits.
Following is the guidance provided to implement the new requirement for applications and renewals received on or after August 1, 2006:
Application Processing:
Applicants for Medicaid who declare they are U.S. United States citizens are asked to provide proof of their citizenship and identity. If the proof is not provided with the application, and the individual is a previous recipient, the caseworker will check the case file to see if the required documents have already been provided. If the verification is not in the file, the application will be pended and notice M307 will be sent requesting the verification. Applicants may be allowed additional time beyond the normal processing time frames if needed due to reasons beyond their control. Applicants may not be found eligible for Medicaid until the necessary verification is provided.
If the household does not provide the necessary proof or does not respond by the date requested, the application must be denied using the M205 notice and entering the "CI" denial reason code in EIS Eligibility Information System .
Note: Coverage for Medicaid is denied only for the individuals who do not provide the requested citizenship and identity verification as required.
Renewal Processing:
As reviews are submitted, caseworkers will check the existing case file for proof of citizenship and identity for Medicaid recipients. If the required documents are not in the file, send the M308 notice requesting the needed verification. If necessary, recipients will remain eligible for Medicaid into the next month to allow time for them to respond to the request. Recipients who provide the requested verification, or state they are trying to get the verification but are unable to provide it at this time, may be found eligible for a new review period. In this situation, documentation will be required at the next redetermination. A new eligibility period must be determined before a child is allowed the 6-month period of continuous eligibility.
If the household does not provide the necessary proof or does not respond by the date requested, the case will be closed with timely adverse action using the M 405 notice, and entering the "CI" closure reason code in EIS Eligibility Information System .
Note: Coverage for Medicaid ends only for the individuals who do not provide the requested citizenship and identity verification as required.
In an effort to comply with the federal law, and make the process as easy as possible for applicants, recipients, and staff, we have:
Created flyers about the new Medicaid citizenship and identity verification requirements, and sent a supply of these to offices and other interested parties to hand out with applications.
Created new EIS Eligibility Information System codes for tracking the level of citizenship and identity verification provided as required by federal regulations.
Successfully matched over 60,000 Alaska residents with Bureau of Vital Statistics ( BVS ) data to verify citizenship. We are continuing to pursue future automated BVS Bureau of Vital Statistics matches.
Developed new Medicaid EIS Eligibility Information System notices for requesting citizenship and identity verification, and for denying or ending eligibility for an individual who does not provide verification.
This manual change also includes other policy clarifications and updates which are described below. If you have any questions, please contact any member the Policy and Program Development Team at 465-3347 or email dpapolicy@health.state.ak.us.
OVERVIEW OF CHANGES
506 - Medicare Buy-In
Adds instructions to send EIS Eligibility Information System notice "M710 - Medicare Drug Coverage Begins" when a Medicaid applicant has Medicare, and when a recipient becomes eligible for Medicare.
514 - Residents of Institutions
Adds exception to policy for an individual age 65 and older who resides in an inpatient psychiatric hospital. Also removed "Emergency Placement" section, as it is now included under "Exceptions."
520 - Eligibility Requirements that Follow APA Adult Public Assistance Policy
Adds Medicaid exception to APA Adult Public Assistance policy on requirement to provide verification of U.S. United States citizenship and identity.
Adds subsection on Loss of Contact.
Adds subsection on Age.
523 - Medicaid Exceptions to APA Adult Public Assistance Policy
Adds clarification that APA Adult Public Assistance policy for in-kind support and maintenance does not apply to eligibility for the Special Long Term Care category.
575 - Breast and Cervical Cancer Medicaid
Updates contact information for the Breast and Cervical Cancer Coordinator.
580 - Medicare Premium Assistance Categories
Updates SLMB Specified Low Income Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries Plus categories with information on Medicare Part D.
Removes instructions to contact DPA Division of Public Assistance Policy and DMA Third Party Liability Unit ( TPL ) when authorizing a SLMB Specified Low Income Medicare Beneficiaries Plus case.
Includes a new eligibility code "78" for use on the MERE Medical Reference screen when authorizing a SLMB Specified Low Income Medicare Beneficiaries Plus case. This instruction was distributed by broadcast on February 17, 2006.
Addendum 1 - Program Standards
Updates the Annual Federal Poverty Guidelines for Alaska effective April 1, 2006, and the Pickle Amendment Table.
MANUAL CHANGE FILING INSTRUCTIONS
Remove Old Pages Insert New Pages Table of Contents Table of Contents B-13 - B-14 B-13 - B-14 C-13 - C-16 C-13 - C-16 D-1 - D-6 D-1 - D-6 E-1 - E-2 E-1 - E-2 O-3 through O-4 O-3 through O-4 P-1 through P-6 P-1 through P-6 Addendum 1 (pages 1 through 2) Addendum 1 (pages 1 through 2)
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
Date: April 20, 2007
Subject: Aged, Disabled and Long Term Care Medicaid Manual Change #5
This manual change includes the 2007 Long Term Care community spouse resource and income allowance and household member standards that became effective January 1, 2007. These new standards were announced by broadcast on November 29, 2006. It also updates the resource limits for the low-income subsidy program, and co-payments for the 2007 Medicare Part D prescription drug coverage.
A description of these changes is included in the overview below.
OVERVIEW OF CHANGES
MS 506-E - Medicare Deductible/Coinsurance
Updates Medicare Part D 2007 coverage information with the new premiums, deductibles and co-payment amounts.
MS 520-B - U.S. United States Citizenship and Eligible Alien Status
Added three additional groups to the list of individuals who are exempt from the requirement to provide proof of citizenship and identity. MS 580-D(3) - Low Income Subsidy ( LIS ) Program
Updates the Medicare LIS Low Income Subsidy Full and Reduced Subsidy levels for 2007. This includes changes in the resource limit, deductible, and co-insurance amounts for determining the amount of the subsidy.
Addendum 1 - Updates the 2007 Long Term Care community spouse resource and income allowance, and household member standards, updates the 2007 Pickle Amendment table, and the Federal Poverty Guidelines for Alaska effective April 1, 2007.
Addendum 5 - Adds the following Medicaid Notices:
M060 - Child Support Cooperation Statement
M061 - Child Support - Good Cause Allowed
M062 - Child Support - Good Cause Not allowed
M100 - Medicaid Approved - One Month Only
M102 - Medicaid Application Approved
M114 - Medicaid Approved 2nd Month
M205 - Medicaid Denied - Citizenship/Identity
M307 - Medicaid Pended - Citizen/ID Needed
M308 - Medicaid - Citizenship/ID Proof Needed
M601 - Medicaid Suspended
M701 - Medicaid Benefits Change
M710 - Medicare Drug Coverage Begins
M801 - Medicaid Review Due
Addendum 6 - Updates the Low-Income Subsidy chart with the 2007 Medicare Part D information.
Addendum 7 - Updates the Medicare Part D 2007 Prescription Drug Plans that are available for dual eligibles in Alaska.
If you have any questions please contact any member of the Policy and Program Development Team at 465-3347 or email dpapolicy@health.state.ak.us.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
Date: July 27, 2007
Subject: Aged, Disabled and Long Term Care Medicaid Manual Change #6
This manual change implements new transfer of asset policies. It also adds a new resource policy for an individual whose equity interest in a home exceeds $500,000. This is Individualized Supports a result from the Deficit Reduction Act ( DRA Deficit Reduction Act of 2005 ) of 2005, which was signed into law February 8, 2006. These policies are effective for all Medicaid applications and reviews received on or after August 1, 2007, and for any new discovery of transfer of assets for less than fair market value. These policy changes affect individuals applying for or receiving Medicaid long term care or home and community based waiver services.
This manual change also implements new policy resulting from a change in state law that increases the resource limit for the Working Disabled Buy-In program to $10,000 for an individual and $15,000 for a couple.
A description of these changes is included in the overview below. If you have any questions, please contact any member of the Policy and Program Development Team at 465-3347 or email dpapolicy@health.state.ak.us
OVERVIEW OF CHANGES
MS 524-G - Institutionalized Individuals with Substantial Home Equity
New subsection. Adds Medicaid exception to APA Adult Public Assistance policy regarding the exemption of an individual’s home for long-term care services.
MS 524-H - Promissory Notes, Loans, and Property Agreements for Institutionalized Individuals
New subsection. For transfer of asset purposes only, adds Medicaid exception to APA Adult Public Assistance policy regarding the treatment of promissory notes, loans, and property agreements for long-term care services.
MS 524-I - Purchase of Life Estates for Institutionalized Individuals
New subsection. For transfer of asset purposes only, adds Medicaid exception to APA Adult Public Assistance policy regarding the treatment of life estates for long-term care services.
MS 524-J - Resource Limit for the Working Disabled Buy-In Category
New subsection. For the Working Disabled Buy-In category only, adds resource exception to the APA Adult Public Assistance policy regarding the resource limit.
MS 534 - Working Disabled Buy-In
Adds new policy that increases the resource limit for the Working Disabled Buy-In program to $10,000 for an individual, or $15,000 for a couple.
MS 553-C Substantial Home Equity
New subsection. Adds new policy that an individual is not eligible for long-term care services if the individual’s equity interest in the individual’s home exceeds $500,000. This policy does not apply if a spouse, child under 21, or disabled child of any age is living in the home.
MS 554 - Transfer of Assets
Updated section with new transfer of asset policies:
Lengthens look-back period from 3 years (36 months) to 5 years (60 months) for individuals applying for long term care services, including home and community-based waivers. The look-back period is lengthened from the 36-months prior to the month of application to 60-months prior to the month of application. This will be phased-in over a 5-year period from the date of enactment, which is February 8, 2006.
Changes the beginning date for a transfer of asset penalty for transfers for less than fair market value after February 8, 2006. The penalty period begins on the date of application or the time of transfer, whichever is later.
Clarifies when the transfer of the home to an adult child will not result in a transfer of asset penalty.
Adds a new subsection on non-allowable transfers.
Adds new policy on when the purchase of promissory notes and loans are not considered a transfer.
Adds new policy on when the purchase of life estates is considered a transfer.
Adds new policy on when the purchase of an annuity is an allowable transfer.
Requires an individual (including the individual’s spouse) to disclose any interest in an annuity.
Adds new policy on partial month penalties and examples showing the calculation for the remainder amount of penalty period.
Adds e-mail contacts for the Division of Senior and Disabilities Services and the Division of Health Care Services and describes information that must be provided to those agencies when a transfer of asset penalty is imposed.
Clarifies policy on undue hardship determinations.
Allows a long term care facility to file an undue hardship request on behalf of the individual with consent of the individual or personal representative.
Addendum 6 - Medicare Part D Low Income Subsidy Guide
Removes SeniorCare Prescription Drug Coverage
UPDATED FORMS
The following forms have been revised to comply with the new transfer of asset requirements:
Med 3 - Declaration Denial of Asset Transfer Form; and
Med 4 - Application for Adults and Children with Long Term Care Needs.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC Manual Change #7
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 14, 2007
This manual change implements important policy changes for verifying citizenship and identity due to issuance of the final federal rules. Staff need to take the following steps:
Check the Medicaid case file as applications and renewals are processed to confirm that original or certified copies of documents for citizenship and identity verification are seen, or that verification is obtained through the Bureau of Vital Statistics ( BVS ) or Permanent Fund Dividend ( PFD ) interface.
Ensure that the file copy indicates that an original or certified copy of the document was seen. A DPA Division of Public Assistance -contracted fee agent may also note on the file copy when an original or certified copy was seen.
Confirm that the correct verification code is entered in EIS Eligibility Information System .
Request documentation from the applicant or recipient if verification is not available from BVS Bureau of Vital Statistics or PFD Permanent Fund Dividend information, and there is no indication that an original or certified copy of the document was seen in the past.
Additional forms of documentation for U.S. United States citizenship and identification are also allowed, such as a religious record, or the Roll of Alaska Native for citizenship verification, and identity declarations for children under age 18 and disabled individuals in institutional care.
This manual change also clarifies Retroactive Medicaid, provides for automatic newborn eligibility for a child whose birth is covered under Emergency Treatment for Aliens policy, and allows faxed applications to be accepted.
Also included is an update to Addendum 2 to reflect the increased resource limit for the Working Disabled Buy-In Medicaid category. Other technical changes are also made.
Highlights of these policy revisions are described below. If you have any questions, please contact any member of the Policy and Program Development Team at 465-3347 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 511 E - Penalty for Failure to Cooperate
Removes guidance asking for voluntary cooperation from APA Adult Public Assistance Adult Public Assistance recipients. As announced by broadcast dated August 1, 2007, caseworkers are now able to code an APA Adult Public Assistance Adult Public Assistance-related Medicaid individual "OU" on the SEPA Setup Participations Setup Participations screen to stop the issuance of a Medicaid coupon to a non-cooperating adult.
MS 516 - Retroactive Medicaid Eligibility
Clarifies that actual resources available as of the first moment of each month are used to determine eligibility for Retroactive Medicaid.
Clarifies that Retroactive Medicaid is available when there is an unpaid medical bill for services provided in the month requested in the retroactive period.
MS 520 B - U.S. United States Citizenship and Eligible Alien Status
Removes "Note" about not allowing automatic eligibility for a child born to a non-qualified alien.
Adds all documents must be either originals or copies certified by the issuing agency or that verification must be obtained through the Bureau of Vital Statistics ( BVS Bureau of Vital Statistics Bureau of Vital Statistics) or Permanent Fund Dividend ( PFD Permanent Fund Dividend Permanent Fund Dividend) interface.
Adds new items to the lists of acceptable documentation for proof of U.S. United States citizenship and identity.
MS 524 E - Transfer of Resources
Clarifies institutional or waiver applicants and recipients have separate transfer of resource policy.
Addendum 2 - APA Adult Public Assistance Adult Public Assistance Related Medicaid Subtypes
Updates the resource limits for the Working Disabled Medicaid Buy-In category.
Addendum 5 - Medicaid EIS Eligibility Information System Eligibility Information System Notices
Adds M709 - Med Benefits Stopped - CSED Child Support Enforcement Division Child Support Services Division Penalty notice.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #8
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 1, 2007
New policy now requires a Medicaid applicant or recipient to apply for Medicare coverage if he or she appears to be eligible. We have also clarified that enrollment in a Medicare Part D prescription drug plan is not required if an individual has other creditable drug coverage. We have updated the following items to reflect annual increases for 2008:
Long Term Care community spouse resource and income allowance, and household member standards
Medicare Part A and B premiums
Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
We have also added references to federal and state laws and regulations governing the Medicaid program. All changes described in this transmittal apply to all applications and reviews processed on or after January 1, 2008.
Highlights of these policy revisions are described below. If you have any questions, please contact the Policy and Program Development Team at 465-3347 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 500 Overview of Aged, Disabled and Long Term Care Medicaid
Adds references to federal and state laws and regulations governing the Medicaid program.
MS 505 Third Party Liability and Recovery
Adds new policy that Medicare enrollment is required to become or remain eligible for Medicaid if an applicant or recipient appears to be Medicare eligible.
MS 506-B Medicare Enrollment
Removes old policy that Medicare enrollment is voluntary and adds new policy that requires Medicare enrollment if an individual appears eligible.
Adds cross-references to Sections 505 and 510.
Adds guidance for caseworkers about how individuals apply for Medicare coverage and how enrollment is verified.
MS 506-D(4) Part D Prescription Drug Coverage
Provides additional information about applicants or recipients who have other creditable prescription drug coverage and the potential impacts of joining a Medicare drug plan.
MS 506-E Medicare Deductible/Coinsurance
Updates Medicare Part D coverage information with the 2008 premiums, deductibles and copayment amounts.
MS 520-B U.S. United States Citizenship and Eligible Alien Status
Clarifies that proof of identity is also required when a data match or interface is used to verify citizenship.
Adds Permanent Fund Dividend interface in Level Two acceptable documentation.
MS 554-B Verification and Documentation
Clarifies that a Med 3 Declaration/Denial of Asset Transfer form, or M723 Transfer of Asset Declaration notice, must be provided and completed for all nursing home or home and community based waiver applicants, including child waivers when an applicant did not apply with a Med 4 Application for Medical Assistance for Adults and Children with Long Term Care Needs .
MS 554-K Annuities
Clarifies that an allowable annuity can be purchased with proceeds from an employee retirement account or trust, employee pension, or Roth Individual Retirement Account, or meet certain other qualifying conditions.
Clarifies that an allowable annuity must name the State as a remainder beneficiary regardless of how it is purchased.
MS 560-E HCB Waiver Referrals and Interagency Communications
Removes use of form GEN 140A Referral to Division of Senior and Disability Services for APD Adults with Physical Disabilities (HCB Waiver) and OA Older Alaskans waiver referrals. When individuals do not have a care coordinator, caseworkers no longer need to send a GEN 140A for waiver referrals. Instead, caseworkers must provide DSDS Division of Senior and Disabilities Services contact numbers so the person or guardian can contact DSDS Division of Senior and Disabilities Services for names of care coordination agencies in the person's community.
MS 580-D Low-Income Subsidy ( LIS ) Program
Updates the number of Medicare Part D plans and coverage information with the 2008 premiums, deductibles and copayment amounts.
Addendum 1 Program Standards
Updates the 2008 Long Term Care community spouse resource and income allowance, and household member standards.
Addendum 2 EIS Subtypes
Removes invalid "IC" subtype
Adds "IP" subtype for Residential Psychiatric Treatment Center Waiver
Addendum 5 Medicaid EIS Eligibility Information System Notices
Adds the following Medicaid Notices:
M008 - Medicare Benefits Available
M125 - RPTC Residential Psychiatric Treatment Center Waiver Approved-Disabled Child
M126 - RPTC Residential Psychiatric Treatment Center Waiver Approved- FM Family Medicaid / DKC Child
M218 - Medicaid Denied - Excess Home Equity
M310 - Medicaid - SLMB Specified Low Income Medicare Beneficiaries Information Needed
M321 - RPTC Residential Psychiatric Treatment Center Waiver: Info Needed- FM Family Medicaid / DKC Child
M418 - Medicaid Closed - Excess Home Equity
M718 - Excess Home Equity - Med Benefits Change
Addendum 6 Medicare Part D Low Income Subsidy Guide
Updates the Low-Income Subsidy chart with the 2008 Medicare Part D information.
Addendum 7 Prescription Drug Plans in Alaska
Updates the Medicare Part D 2008 Prescription Drug Plans that are available for dual eligibles in Alaska.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #9
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: July 15, 2008
We have updated program standards to reflect changes for 2008 and added a new addendum to describe Working Disabled Medicaid Buy-in Procedures. We have also made numerous technical changes.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3347 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 507 Estate Recovery
Removes the name of Public Consulting Group (PCG). This organization no longer helps to administer the Estate Recovery program.
MS 520-D Disability Determinations
Changes the cross reference from Administrative Procedures MS Manual Section 105-12 to MS Manual Section 115-9.
MS 523-D Cost of Care Determination
Clarifies that Senior Benefits Payments are countable in the cost-of-care determination.
MS 533-C Referral and Interagency Communications
MS 533-D Case processing
MS 533-E TEFRA Reviews
Removes Arbitre Consulting as a contracted care coordination agency for disabled child at home ( TEFRA ) determinations. DSDS Division of Senior and Disabilities Services now does the ICAP Inventory for Client and Agency Planning Evaluation evaluations previously done by Arbitre Consulting.
Clarifies the role of the Division’s Long Term Care Coordinator in the administration of TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 cases.
MS 534 Working Disabled Medicaid Buy-In.
Adds a cross reference to new Addendum 8 on Working Disabled Medicaid Buy-in Procedures.
MS 554-K Annuities
Adds a note to clarify that transfer of asset provisions do not apply to revocable and/or assignable annuities.
MS 554-L Transfer Penalty and Partial Months.
Updates the email address for Division of Senior and Disability Services in MS 554-L(7) .
MS 580-D Low-Income Subsidy ( LIS ) Program
Updates this section to reflect 2008 resource limits for low-income subsidy (extra help) categories.
Removes information about LIS Low Income Subsidy subsidy benchmark amounts for Alaska and a cross reference to new table in Addendum 1 that includes this information.
Addendum 1 Program Standards
Updates Federal Poverty Guidelines for Alaska that became effective March 1, 2008.
Adds information about maximum Low Income Subsidy amounts for Alaska.
Updates Pickle Amendment Table for 2008.
Addendum 6 Medicare Part D Low Income Subsidy Guide
Updates Low Income Subsidy resource limits for 2008.
Addendum 8 Working Disabled Medicaid Buy-In Procedures
Provides information about processing procedures for Working Disabled Medicaid Buy-In cases.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #10
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 1, 2008
We have updated the following items to reflect annual cola Cost of Living Allowance increases for 2009:
Long Term Care community spouse resource and income allowance, and household member standards
Medicare Part A and B premiums
Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
We have also changed references to the previous SeniorCare Program to the current Senior Benefits Program and made numerous other technical changes and corrections.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 505 Third Party Liability ( TPL ) and Recovery
Replaces references to specific offices and agencies with the words appropriate office or agency .
MS 506 D (3) Part C: Medicare + Choice
Changes the Note to clarify that there are a few Part C plans in Alaska, but participation has historically been limited.
MS 513 E Residency Guide
Replaces the word capable with incapable in the third box down in the table.
MS 554 E Penalty Start Date
Clarifies that a transfer of asset penalty always starts on the first day of the month..
MS 555 C EIS Information
Removes Medicaid Subtypes IC and IF from table as they are not currently being used.
MS 580 D (2) When DPA Division of Public Assistance Processes the Application
Changes the name of the Alaska Senior Care Program to Alaska Senior Benefits Program.
Addendum 1 Program Standards
Updates LTC Long Term Care standards with the 2009 community spouse resource and income allowance, and household member standards, Medicare premiums, and Low Income Subsidy tables.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #11
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: February 20, 2009
The Low Income Subsidy section has been updated with 2009 standards for resources, deductibles and co-payments. In addition, we have updated the Program Standards, Pickle Amendment Chart, and Medicare Part D Low Income Subsidy Guide for 2009.
Technical changes include changing the name of the former medical services contractor First Health to the new contractor Affiliated Computer Systems.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 554 I Promissory Notes, Loans or Mortgages
Clarifies the subsection by deleting the phrase Purchase of from the title and text.
MS 562 C Processing HCB Home and Community-Based Waiver Cases for SSI Supplemental Security Income Children
Removes references to the DKC Denali KidCare Unit, and revises to indicate that these cases are maintained in the district offices.
MS 570 B Individuals Subject to Cost of Care
Moves Example 1 from subsection B to subsection C because the example is about an individual not subject to cost of care.
MS 570 C Individuals Not Subject to Cost of Care
Moves Example 1 from subsection B to subsection C because the example is about an individual not subject to cost of care.
MS 580 D 3 Subsidy Levels
Updates Low Income Subsidy section with 2009 standards for resources, deductibles, co-payments, etc.
Addendum 1 Program Standards
Updates Federal Poverty Guideline and Pickle People charts to reflect the poverty guideline changes for 2009.
Addendum 4 COCA Cost of Care Processing
Changes all references to Alaska Longevity Bonus to Senior Benefits.
Addendum 6 Medicare Part D Low Income Subsidy Guide
Update Low Income Subsidy Chart with the 2009 Medicare Part D Information
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #12
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
Date: April 1, 2009
Beginning April 1, 2009, all children under the age of 19 who are eligible for Medicaid (except BA Newborn Medicaid , TM Transitional Medicaid , 4M Four Month Post-Medicaid Eligibility , and Retroactive Medicaid categories) remain eligible for those benefits for a continuous 12-month period. This change applies to all actions taken on or after April 1, 2009.
The manual has been updated to change all references to 6-month continuous eligibility to 12 months, and language that no longer applies has been removed.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 515 Continuous Eligibility and Children in SSI Supplemental Security Income -Related Categorie s
• Changes 6 months to 12 months.
• Removes language about review periods that no longer applies.
MS 515 A TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Case Processing
• Changes dates in example to fit new continuous eligibility period ( CEP ) rules.
• Removes unnecessary steps in instructions.
MS 515 B LTC Category with HCB Home and Community-Based Waiver Services Case Processing
• Changes dates in example to fit new CEP continuous eligibility period rules.
• Adds instructions to consider other Medicaid categories if a review is submitted.
MS 515 C Level of Care Denial and DKC Denali KidCare Waiver Case Processing
• Removes section
MS 515 D Level of Care Denial; Medicaid Continues Case Processing
• Changes dates in example to fit new CEP continuous eligibility period rules.
• Removes unnecessary steps in instructions.
• Changes section number to 515 C.
MS 520 A Application and Review Process
• Adds a statement that SSI Supplemental Security Income related categories review annually.
MS 562 L LOC Denial by DSDS Division of Senior and Disabilities Services for On-Going HCB Home and Community-Based Waiver Cases
• Changes 6 months to 12 months regarding CEP continuous eligibility period .
Update Low Income Subsidy Chart with the 2009 Medicare Part D Information
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #13
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
Date: July 1, 2009
Tribal documents such as a tribal enrollment card or a Certificate of Degree of Indian blood may be used to verify both citizenship and identity. This manual change adds this information to the citizenship chapter and includes two other minor changes.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 520 B US Citizenship and Eligible Alien Status
Adds tribal documents to the list of documents which can verify both citizenship and identity
Clarifies instructions regarding the BV code and when a screen print is placed in the case file
MS 554 L When a transfer of assets penalty is imposed, immediately notify:
Replaces Natalia Manfredi's name with that of Douglas Myers in bullet #1
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #14
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
Date: January 4, 2010
Beginning January 1, 2010, Medicaid policies will change as follows:
Low Income Subsidy applications received and processed by the Social Security Administration may act as an application for Medicare Savings Programs ( QMB , SLMB Specified Low Income Medicare Beneficiaries , SLMB Specified Low Income Medicare Beneficiaries Plus, and QDWI Qualified Disabled and Working Individuals ), as well as any other Medicaid categories for which the individual may qualify. In addition, the resource limits for Medicare Savings Programs are raised to match the Low Income Subsidy levels. These amounts, which are listed in a new table in Addendum 1, will be adjusted annually. Any applications received as a result of this provision will be funneled through a single DPA Division of Public Assistance worker in Anchorage.
A data match with Social Security through the State Verification Exchange System ( SVES ), confirming the individual’s citizenship status via their Social Security Number, will be acceptable documentation of citizenship and identity for Medicaid purposes.
In addition, Addendum 6 has been updated with new resource limits for the Low Income Subsidy program. Addendum 7 has also been updated to list new Medicare Part D Prescription Drug Plans for Alaskans and correct existing plan names and phone numbers. Other revisions include technical corrections and policy clarifications suggested by field staff.
Other highlights to policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 500 C Medical Services Received Out-of-State
Changes First Health Services Corporation to Affiliated Computer Systems ( ACS ).
MS 500 D Freedom of Choice Providers
Changes the name of the Medicaid Lock-In Program to Care Management Program.
MS 500 E Freedom of Choice Restriction – Care Management Program
Changes First Health Services Corporation to Affiliated Computer Systems ( ACS ).
Changes ACS Affiliated Computer Systems email contact to Jason Ball.
Changes the name of the Medicaid Lock-In Program to Care Management Program.
MS 506 E Medicare Deductible/Coinsurance
Updates Medicare Part D information with 2010 amounts.
MS 520 B US Citizenship and Eligible Alien Status
Clarifies verification of U.S. United States citizenship and identity are not required for children who are eligible for newborn Medicaid.
Removes policy that requires documentation of US citizenship when newborn Medicaid ends and clarifies that no further documentation is required.
Adds SVES State Verification Exchange System to the data matches under Documenting U.S. United States Citizenship and clarifies that an additional form of identity verification is not required when citizenship is verified through SVES State Verification Exchange System .
Adds SVES State Verification Exchange System to Data Matches and Interfaces and explains the data match process.
Revises the description of tribal documents that are acceptable as level one verification of both citizenship and identity to conform to language specified in federal law.
Adds verification of citizenship status and identity through SVES State Verification Exchange System to level one verification.
MS 534 D Disability Determination Needed
Corrects cross reference from Administrative Procedures MS Manual Section 105-12 to MS 115-9 .
MS 550 C Special Long Term Care Eligibility Category
Clarifies that individuals who can qualify for Medicaid under the regular need standards are not subject to the Long Term Care income eligibility standard.
MS 554 G-4 Transfers to a Spouse, Child, or a Disabled Person
Clarifies that a transfer to a disabled individual who is not a spouse or child must be put into a special needs trust to avoid a transfer of asset penalty.
MS 580 Medicare Premium Assistance Categories
Explains the LIS Low Income Subsidy referral process for Medicare Savings Programs.
MS 580 A Qualified Medicare Beneficiaries ( QMB )
Clarifies that resource limits for QMB Qualified Medicare Beneficiaries cannot exceed the amounts listed in Addendum 1 under QMB Qualified Medicare Beneficiaries , SLMB Specified Low Income Medicare Beneficiaries , SLMB+ , and QDWI Qualified Disabled and Working Individuals Resource Limits.
MS 580 C Qualified Disabled and Working Individuals
Clarifies that resources for QDWI Qualified Disabled and Working Individuals cannot exceed the amounts listed in Addendum 1 under QMB Qualified Medicare Beneficiaries , SLMB Specified Low Income Medicare Beneficiaries , SLMB+ , and QDWI Qualified Disabled and Working Individuals Resource Limits .
MS 580 D Low Income Subsidy ( LIS ) Program
Clarifies the eligibility criteria for reduced subsidies and removes repetitive language under income levels.
Updates subsidy level deductible and co-pay amounts.
Changes the number of organizations that have Medicare Part D plans in Alaska from thirteen to seventeen.
Addendum 1 Program Standards
Adds a table to provide resource limits for Medicare Savings Programs ( QMB , SLMB Specified Low Income Medicare Beneficiaries , SLMB+ , and QDWI Qualified Disabled and Working Individuals ).
Addendum 6 Medicare Part D Low Income Subsidy Guide
Updates addendum with 2010 amounts.
Addendum 7 Medicare Prescription Drug Plans for Alaska
Updates company names, plan names, and phone numbers.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC Manual Change #15
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
Date: April 1, 2010
Beginning December 19, 2009, Afghan and Iraqi special immigrants are treated the same as refugees and are not subject to a five-year bar. Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field.
Highlights to policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov.
OVERVIEW OF CHANGES
MS 514 D Penal Institution
Removes policy that an individual on electronic monitoring is an inmate in a penal institution, and clarifies that such individuals are not considered to be incarcerated.
MS 516 Retroactive Medicaid
Clarifies that the recipient is responsible for the unpaid medical bills until the provider has been given evidence of eligibility and agrees to accept payment by billing Medicaid for the service.
MS 520 B U.S. United States Citizenship and Eligible Alien Status
Clarifies that an authorized member of a tribal health organization may also verify original or certified copies of citizenship and identity documents.
MS 528 D General Trust Provisions
Clarifies the steps a caseworker must take if it appears that a trustee is mismanaging a trust in a way that could cause Medicaid ineligibility.
MS 534 E Premiums May Be Required
Clarifies that a caseworker must make sure a previous Working Disabled Medicaid Buy-In case was not closed for failure to pay premiums. These back premiums must be paid before a new Working Disabled Medicaid Buy-In case is opened.
MS 570 C Individuals Not Subject to Cost of Care
Updates the example to explain that the recipient is still eligible for APA Adult Public Assistance in July because of adverse action notice requirements.
MS 580 C Qualified Disabled and Working Individuals
Corrects the resource limits to be twice the SSI Supplemental Security Income resource limits ($4,000 for individuals and $6,000 for couples). A previous manual change incorrectly applied higher resource limits to this coverage group.
Addendum Addendum 1
Removes QDWI Qualified Disabled and Working Individuals from the resource limit table.
Corrects 2009 maximum community spouse resource allowance.
Updates the 2010 Medicaid part D subsidy amount.
Revises the 2010 Pickle Amendment Table.
Addendum Addendum 2
Updates QM and SL Medicaid subtypes to show the resource limits for 2010.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC Manual Change #16
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
Date: May 1, 2010
A recent change in federal law provides that individuals who claim to be U.S. United States citizens or nationals and who meet all other eligibility factors can receive Medicaid coverage for 90 days while proof of U.S. United States citizenship is Individualized Supports being sought. We no longer need to pend Medicaid applications while we wait for proof of U.S. United States citizenship when that is the only proof needed to determine Medicaid eligibility.
In most cases, proof of citizenship will be available within a few days through the new SVES State Verification Exchange System data match with SSA Social Security Administration . If the SVES State Verification Exchange System data match does not verify the individual's citizenship, and the caseworker determines that proof of citizenship is needed, we will give the household 90 days to provide the necessary proof. If the proof is not received within this 90 day period, the individual’s Medicaid must be ended with a ten-day adverse action notice. This applies even to children who normally would receive 12 months of continuous eligibility.
If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 515 Continuous Eligibility for Children
Adds a note to clarify that children under the age of 19 are not eligible for a 12-month continuous eligibility period if their claim to be a U.S. United States citizen or national is not verified.
MS 520B U.S. United States Citizenship and Eligible Alien Status
Adds new Medicaid policy that individuals who declare they are U.S. United States citizens or nationals must be given a reasonable period (90 days) to provide proof of citizenship, and may not have their Medicaid eligibility denied or delayed if they are otherwise eligible. Also clarifies that Medicaid benefits must be ended if proof of citizenship is not received by the end of this 90-day period. Adds a note to clarify that children under the age of 19 are not eligible for a 12-month continuous eligibility period if their claim to be a U.S. United States citizen or national is not verified. Clarifies that a SVES State Verification Exchange System data match will be initiated for all new Medicaid applications and reviews. For new applications, removes policy that states that verification must be obtained before authorizing benefits. For review applications, removes policy that states the individual must be making a good faith effort to obtain citizenship verification before benefits are authorized.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC Manual Change Manual Change #17
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
Date: October 1, 2010
We are making several changes to incorporate new policy, clarify existing policy, and align policies within our program manuals. This includes:
The Long Term Care income limit will change to 300% of the prevailing SSI Supplemental Security Income standard as of September 1, 2010.
A written request from the recipient is a valid reason to end a child's continuous eligibility period.
Individuals who receive SSDI Social Security Disability Insurance , SSI Supplemental Security Income , or Medicaid are only exempt from verifying their citizenship status if they claim to be a U.S. United States citizen or national. Non-citizens must still verify their alien status.
A new section explains how to handle trust document changes.
The person to contact in Division of Health Care Services ( DHCS Division of Health Care Services ) when a transfer of assets penalty is imposed has changed.
Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 515 Continuous Eligibility for Children
Adds "written request from the recipient requesting case closure" as a reason to end the continuous eligibility period. Clarifies that the continuous eligibility period applies to all individuals under age 19, even if the individual is the Primary Information (PI) person on their own case.
MS 516 Retroactive Medicaid
Clarifies that a client can request retroactive Medicaid at any time, even if they have been denied previously for failing to provide requested verification. The caseworker can determine eligibility for the three months prior to any application for Medicaid. Clarifies that client statement is allowed regarding the value of a resource, unless questionable. Clarifies that the individual requesting retroactive Medicaid must meet all of the requirements for the Medicaid category, both financial and non-financial.
MS 520B U.S. United States Citizenship and Eligible Alien Status
Clarifies that recipients of SSDI Social Security Disability Insurance , SSI Supplemental Security Income , or Medicare are exempt from verifying their U.S. United States citizenship but this exemption only applies to individuals that claim to be U.S. United States citizens or nationals. Non-citizens must still verify their alien status. Clarifies that "individuals that have received a 90-day period to provide proof of U.S. United States citizenship are not entitled to receive this again". No further Medicaid benefits will be authorized for the individuals until verification of their U.S. United States citizenship is received.
MS 528A Initial Case Processing
Clarifies that the trust document should be sent to DHCS Division of Health Care Services / TPL Third Party Liability Unit once policy has approved the trust and the Medicaid case has been approved.
MS 528B Processing APA Adult Public Assistance Related Medicaid Case with Trusts
Clarifies that the trust reporting form that needs to be sent to the TPL Third Party Liability Unit is provided to the Eligibility Technician by policy in an email when the trust is approved.
MS 528G Trust Changes
Adds a new section to explain how to handle changes that occur to trust documents.
MS 550C Special Long Term Care Eligibility Category
Updates the Long Term Care income limit to 300% of the prevailing SSI Supplemental Security Income standard, which increases each year.
MS 554D Look-Back Period
Clarifies that a transfer of property can occur before the transfer is officially recorded. The look-back period is measured from the date the transfer of property actually occurred, not necessarily when the transfer was officially recorded. An unrecorded conveyance is valid.
MS 554L Transfer Penalty and Partial Months
Changes the person to contact in Health Care Services when a transfer of assets penalty is imposed.
MS 580B Special Low Income Medicare Beneficiary ( SLMB Specified Low Income Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries Plus)
Clarifies that policy will notify staff if SLMB Specified Low Income Medicare Beneficiaries Plus reaches its annual spending limit before the end of the calendar year.
Addendum 1
Updates the Long Term Care income limit to 300% of the prevailing SSI Supplemental Security Income standard as of September 1, 2010.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC Manual Change #18
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: January 3, 2011
Beginning January 1, 2011, we are making several changes to incorporate new policy and clarify existing policy. These changes include:
Funds held in a Qualifying Income Trust are not subject to Medicaid transfer of asset penalty provisions. The excess home equity amount increases from $500,000 to $506,000. A personal needs allowance may be increased for fees charged by a court-appointed guardian or conservator.
Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 526-F Funds Held in a Qualifying Income Trust
Changes section title from "Transfer of Asset Situations" to "Funds Held in a Qualifying Income Trust." Clarifies that funds held in a qualifying income trust are not subject to transfer of asset penalty provisions. Adds language that a trustee may make advance payments on the trust obligation to reimburse the state for Medicaid benefits provided to the recipient while the trust is in place.
MS 553-C Substantial Home Equity
Clarifies that on January 1, 2011, the excess home equity amount is indexed to the Consumer Price Index-Urban ( CPIU Consumer Price Index-Urban ), and may change each year.
MS 570-E(1) Personal Needs Allowance
Adds new policy that allows an increase to a recipient's personal needs allowance for monthly fees actually charged the recipient by a court-appointed guardian or conservator, not to exceed $100 per month.
MS 580-A(3) QMB Eligibility Effective Date
Adds examples to show when QMB Qualified Medicare Beneficiaries eligibility begins in annual review situations.
Addendum 1 Program Standards
Updates the year for program standards. Because there was no Social Security COLA Cost of Living Allowance adjustment for 2011, most program standards remain the same. Updates the QMB Qualified Medicare Beneficiaries , SLMB Specified Low Income Medicare Beneficiaries , and SLMB Specified Low Income Medicare Beneficiaries Plus resource limits for 2011. Adds a new table for the excess home equity amount. Beginning January 1, 2011, the excess home equity amount is indexed to the Consumer Price Index-Urban ( CPIU Consumer Price Index-Urban ), and may change each year. In 2011, this amount increased from $500,000 to $506,000.
Addendum 6 Medicare Part D Low Income Subsidy Guide
Updates the resource limits for full and reduced subsidies for 2011.
Addendum 7 Prescription Drug plans in Alaska
Updates the list of Prescription Drug Plans available in Alaska by adding a link to Affiliated Computer Services, Inc. Alaska Medical Assistance web site, which contains the most current listing.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC Manual Change #19
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 1, 2011
Beginning April 1, 2011, we are making several changes to incorporate new policy and clarify existing policy. These changes include:
Clarifying that verification of citizenship includes verification of both citizenship and identity. it is not necessary to verify citizenship and identity again unless it becomes questionable. New policy excluding federal income tax returns as income in the month of receipt and as a resource for 12 months from the date of receipt. They are not subject to Medicaid transfer of asset penalty provisions for 12 months from the date the payments are received and cannot be used to determine the cost of care. New policy exempting any deposits or funds held in Individual Indian Money accounts as income and resources. Clarifying the personal needs amount is determined by the Medicaid subtype entered on the MERE Medical Reference screen.
Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 520-B U.S. Citizenship and Eligible Alien Status
Clarifies that verification of citizenship includes verification of both citizenship and identity. Clarifies that once a person's citizenship and identity is documented and recorded, it is not necessary to verify citizenship and identity again unless it becomes questionable.
MS 523-D Cost-of-Care Determination
Clarifies that federal income tax returns are excluded as income and cannot be used to determine the cost of care for institutionalized individuals or certain individuals eligible for HCB Home and Community-Based services under a waiver.
MS 523-I Individual Indian Money Accounts
Adds new policy that excludes any deposits or funds held in Individual Indian Money ( IIM Individual Indian Money ) accounts from counting as income.
MS 524-E Transfer of Resources
Adds new policy that federal tax returns are not subject Medicaid transfer of asset penalty provisions for 12 months from the date the payments are received.
MS 524-K Individual Indian Money Accounts
Adds new policy that excludes any deposits or funds held in Individual Indian Money ( IIM Individual Indian Money ) accounts from counting as a resource.
MS 554-F(9) Transfers of Federal Income Tax Returns
Adds new policy that federal income tax returns are not subject to Medicaid transfer of asset penalty provisions for 12 months from the date the payments are received.
Addendum 1 Program Standards
Updates Federal Poverty Guideline charts to reflect the poverty guideline changes effective March 2011. Updates Pickle Amendment Table to show reduction factor amounts through December 2010.
Addendum 4 COCA Cost of Care Processing
Revises the description for the personal needs field to state that this amount is hard coded and is determined by the Medicaid subtype entered on the MERE Medical Reference screen. The current language incorrectly indicates the hard coded personal needs amount is determined by the household type entered on the APMM APA Method Medicaid Only Authorization screen or APAS screen.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC Manual Change #20
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: July 1, 2011
Beginning July 1, 2011, new policy increases the personal needs allowance for nursing home residents to $200 per month.
Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 523-E Veterans Affairs Payments
Updates the amount of Veterans Affairs payments that are not counted as income in the post-eligibility computation for residents of state Veteran’s Homes or institutional facilities from $90 to $200 per month.
MS 570-C Individuals Not Subject to Cost-of-Care
Updates the amount of countable income that an institutionalized recipient in a nursing home can receive and not be subject to cost-of-care from $75 to $200 per month.
MS 570-D(1) Income Disregarded in the Cost-of-Care Determination
Updates the amount of Veterans Affairs payments that are excluded from income when making the cost-of-care determination from $90 to $200 per month.
MS 570-E(1) Allowable Deductions for Cost-of-Care Determinations
Updates the personal needs allowance that may be deducted from an individual’s gross income when determining cost-of-care for institutionalized individuals in a nursing home or swing bed facility from $75 to $200 per month. Updates the portion of the personal needs allowance that is paid by APA Adult Public Assistance for individual’s whose sole source of income is SSI Supplemental Security Income and are institutionalized in a nursing home or swing bed facility from $45 to $170 per month. Updates the personal needs allowance that may be deducted from an individual’s gross income when determining cost-of-care for veterans in a nursing home or swing bed facility from $90 to $200 per month.
MS 570-G Retroactive Cost-of-Care Adjustments
Updates the examples from 2005 to 2011.
MS 570-H Nursing Home Examples
Updates the personal needs allowance that may be deducted from an individual’s gross income when determining cost-of-care for institutionalized individuals in a nursing home from $75 to $200 per month. Updates the Community Spouse Monthly Maintenance Need Standard to the 2011 amount of $2,739.00 in example 2.
MS 570-J Home and Community-Based Waiver Case Examples
Updates the Community Spouse Monthly Maintenance Need Standard to the 2011 amount of $2,739.00 in example 1. Updates the Special Long Term Care Income Standard to the 2011 amount of $2,022 in example 2.
Addendum 1 Program Standards
Updates the nursing home personal needs allowance from $75 to $200 per month effective July 1, 2011.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC Manual Change #21
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: August 1, 2011
Beginning August 1, 2011, we are making several changes to incorporate new policy and clarify existing policy. These changes include:
Removing documentation of identity from the U.S. United States citizenship and eligible alien status section and moving it to a new section. This should make it easier for staff to locate this information. Clarifying that the DPA Division of Public Assistance caseworker is Individualized Supports responsible for sending the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 welcome letter (MED 16) to the parent or guardian when an application for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 is received. Updating the Working Disabled Medicaid Income Standards to the 2011 amounts throughout this subsection. Previous manual uses 2004 and 2005 income standards which are outdated.
Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 520-B U.S. United States Citizenship and Eligible Alien Status
Removes some references to identity and moves them to new section 520-C.
MS 520-C Identity
Creates new section for documentation of identity. Moves current sections 520-C through 520-J to 520-D through 520-K. Adds language that clarifies that using the signature for identity on the application form for children under age 16 should be coded 5A. Adds an example that clarifies when a child turns age 16 at review no action is required.
MS 533-A(3) TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Eligibility
Removes the amount of the Special LTC Long Term Care Income Standard and creates a link to Addendum 1 instead since this amount is now subject to change annually.
MS 533-C(4) Referral and Interagency Communications
Clarifies that the DPA caseworker is responsible for sending the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 welcome letter (MED 16) to the parent or guardian when an application for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 is received. Adds a note to indicate that the MED 16 is not the same letter that Qualis Health sends as described in section 533-D(2).
MS 534-K Example of an Eligibility Determination
Updates the Income Standards to the 2011 amounts throughout this subsection. Previous manual uses 2004 and 2005 income standards which are outdated.
MS 534-M Example of an Eligibility Determination with a Medicaid Qualifying Trust
Updates the Income Standards to the 2011 amounts throughout this subsection. Previous manual uses 2004 and 2005 income standards which are outdated.
Addendum 1 Program Standards
Removes the income guidelines for household sizes greater than two for QMB Qualified Medicare Beneficiaries . Since QMB only allows either a one or two person household size this may lead to confusion.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC Manual Change #22
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 1, 2011
We are making several changes to incorporate new policy, clarify existing policy, and align policies within our program policy manuals. These changes include:
Adding policy that allows caseworkers the option to use CourtView to verify that a trust is registered with the Alaska court system. Adding procedures emphasizing that the DPA Division of Public Assistance caseworker is responsible for either approving or denying a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 application within 90 days. Clarifying that there is no time limit to correct a cost-of-care error and that retroactive adjustments to a recipient’s cost-of-care liability are treated the same for institutionalized persons and or HCB Home and Community-Based waiver recipients.
Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 528-A Initial Case Processing
Adds policy that allows caseworkers the option to use CourtView to verify that a trust is registered with the Alaska court system. Provides instructions to staff on how to access and use CourtView information.
MS 533-C(4) Referral and Interagency Communications
Adds procedures that emphasize that the DPA Division of Public Assistance caseworker is responsible for sending the M320 pend notice and either approving or denying a TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 application within 90 days.
MS 570-G Retroactive Cost-of Care Adjustments
Clarifies that there is no time limit to correct a cost-of-care error. Clarifies that retroactive adjustments to a recipient’s cost-of-care liability are treated the same for institutionalized persons and or HCB Home and Community-Based waiver recipients.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #23
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 1, 2011
This year Social Security announced a COLA (Cost of Living Allowance) increase effective 2012. We have updated Addendum 1 , Addendum 2 , and Addendum 6 with the following items to reflect the 3.6% cola Cost of Living Allowance increases for 2012:
An increase to the Long Term Care community spouse resource and income allowance and household member standards; An increase to the Excess Home Equity resources maximum; and An increase to the Special Long Term Care Income Standard Medicare Part A and B premiums Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
Previous Section Next Section
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #24
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: March 1, 2012
We are making several changes to clarify existing policy as a result of suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 516 Retroactive Medicaid
Adds language to indicate that the eligibility criteria for the same category of Medicaid the family is currently receiving or was receiving at the time requested is used in determining eligibility for Retroactive Medicaid.
MS 520-A Application and Review Process
Adds two exceptions to the APA Adult Public Assistance application requirements to clarify that a new application is not required when: (1) an individual is already part of an active public assistance case and the existing case file already includes the information needed to make a prospective Medicaid determination. (2) the individual is already a Medicaid recipient in another eligibility category.
Adds an exception to the APA Adult Public Assistance interview requirements for applicants to clarify that if a client has an active public assistance case, an interview is not required unless the caseworker feels it is necessary to correctly determine eligibility.
MS 528 Processing Cases with Trusts
Revi ses language to throughout this section indicate that a copy of the trust document must be emailed to dpapolicy@alaska.gov for review and approval. The current policy requires trust documents to be faxed to the Medicaid Eligibility Program Officer or designee.
Revises language to indicate throughout this section t hat trust information that is required to be sent to the DHCS Division of Health Care Services TPL Third Party Liability unit must be emailed to dmatpl@alaska.gov . The current policy requires trust documents to be faxed to the DHCS Division of Health Care Services TPL Third Party Liability unit.
Removes three notes in subsections B, C, and D that states to contact the LTC Long Term Care Coordinator to get the MED 21, 22, and 23 brochures. These are now available on eForms so these notes are obsolete.
Removes B(4) and C(5) because this language is now found in A(6) which provides general case processing procedures.
MS 528-D Processing Renewals with Trusts
Adds language to step 6 that requires the M140 notice to be sent in addition to the M144 notice when processing renewals for cases with a QIT Qualifying Income Trust . The M144 notice states that a separate notice will be sent explaining the amount of money that the client may access for living allowance and there is not another notice that currently meets this requirement.
MS 528-G Trust Changes
Adds a note to indicate that caseworkers must request and obtain a copy of the court document showing that the court approved revisions to an irrevocable trust.
MS 533 Disabled Children at Home ( TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 )
Removes AKA acronym from the section title because it is not needed.
Revises language in the first paragraph to indicate that caseworkers in the LTC Long Term Care unit process TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 cases. Previous policy stated that designated caseworkers in each DPA Division of Public Assistance region process TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 cases.
Removes language throughout this section that states that the LTC Long Term Care Coordinator is in Field Services because this position is now in Policy and Program Development, but the information is not necessary.
Replaces “Long Term Care” with the LTC Long Term Care glossary term where appropriate throughout this section.
MS 533-A TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Eligibility
Adds exceptions to the APA Adult Public Assistance income and resource policies for Coverdell funds, 529 plans (also known as a Qualified Tuition Program), and UTMA/UGMA accounts used when determining TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility.
Adds an exception that indicates that only the TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 child’s income and resources are countable for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility.
MS 533-C Referral and Interagency Communications
Adds language in subsection 3 that indicates that if the DDS Disability Determination Service decision is a denial of disability, the DPA Division of Public Assistance LTC Long Term Care Coordinator will issue a closure letter to the parent(s).
Adds language in subsection 4 that indicates that the DPA Division of Public Assistance caseworker is responsible for sending the MED 15 and entering a CANO Case Notes stating that both the MED 15 and MED 16 were sent to the parents or guardian whenever an application is received for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid.
MS 533-E TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Reviews
Revises language to indicate that TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 cases now have a twelve-month continuous eligibility period. Previous policy indicated that TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 cases had a six-month continuous eligibility period.
MS 534-C Income
Adds a note to clarify that an income allocation for an ineligible child is not allowed in the Family Income Test because income allocations are part of the APA Adult Public Assistance spousal deeming process. Includes a link to APA Manual Section 460-5A .
MS 534-K Example of an Eligibility Determination
Updates the Income Standards to the 2012 amounts throughout this subsection.
MS 534-M Example of an Eligibility Determinat ion with a Medicaid Qualifying Trust
Updates the Income Standards to the 2012 amounts throughout this subsection.
MS 553 Preventing Spousal Impoverishment
Updates the Maximum Community Spousal Resource Allowance to the 2012 standard of $113,640 in the examples in subsection D. Previous manual uses 2004 standard of $92,760 which is outdated.
Removes the terms “Long Term Care” and “Home and Community-Based” because they are duplicated by glossary terms and clutter up subsections D, E, F, and G.
MS 554 Transfer of Assets
Removes the language about how to treat a transfer of asset for less than fair market value before implementation of the Deficit Reduction Act of 2005 provisions in subsections D, E, and L. By February 2011, any transfer of assets for less than fair market value will require a 60-month look-back period.
R enumbers remaining examples as 1- 10 throughout this section due to deleted policies.
MS 554-J Life Estates
Updates the link to the current life estate tables published by SSA Social Security Administration at https://s044a90.ssa.gov/apps10/poms.nsf/lnx/0501140120 .
MS 560-B HCB Home and Community-Based Waiver Types
Revises language to indicate that there are five types of HCB Home and Community-Based waivers. Previous policy stated that there were four types of HCB Home and Community-Based waivers.
Adds FASD Fetal Alcohol Spectrum Disorder waivers as a type of HCB Home and Community-Based waiver.
MS 560-C Eligibility for HCB Home and Community-Based Waiver Services
Adds FASD Fetal Alcohol Spectrum Disorder waivers as a type of HCB Home and Community-Based waiver.
MS 560-F HCB Home and Community-Based Waiver Services and Institutional Eligibility
Adds a note that indicates that the Preventing Spousal Impoverishment ( Section 553 ) and Post-Eligibility ( Section 570 ) policies do not apply to FASD Fetal Alcohol Spectrum Disorder waivers.
MS 561-F APD, MRDD, or OA Waivers with APA Cash Assistance
Corrects AO waiver to OA waiver in title.
MS 561-I FASD Fetal Alcohol Spectrum Disorder Waiver
Adds new policy for FASD Fetal Alcohol Spectrum Disorder waiver EIS Eligibility Information System codes.
MS 562 Processing HCB Home and Community-Based Waiver Cases
Revises the policy to state that all HCB Home and Community-Based waiver cases have a twelve-month review period in subsections B, J, and L. This policy changed a while ago, but a few references to a six-month review period were not changed.
MS 562-B Processing HCB Home and Community-Based Waiver Cases When a DDS Determination is Pending
Removes language that states that the LTC Long Term Care Coordinator is in Field Services because this position is now in Policy and Program Development, but the information is not necessary.
MS 562-F Processing HCB Home and Community-Based Waiver Cases for Title IV-E Eligible Individuals
Adds the word “Title” before “IV-E” in step 3 for clarity.
MS 562-K Processing FASD Fetal Alcohol Spectrum Disorder Waiver Cases
Adds new section K that provides processing procedures for FASD Fetal Alcohol Spectrum Disorder waiver cases. Includes information on the benefit start date, a list of notices, and HCB Home and Community-Based waiver policies that do not apply to the FASD Fetal Alcohol Spectrum Disorder waiver type.
Renumbers remaining sections as 562-L to 562-N.
MS 570-F When a Cost-of-Care Liability Begins and Ends
Clarifies that if only a screening coupon is issued for a benefit month, the caseworker must notify the EIS Eligibility Information System Help Desk to add a cost-of-care liability amount on the EIS Eligibility Information System COCA Cost of Care screen for that month.
MS 570-H Nursing Home Examples
Updates the Community Spouse Monthly Maintenance Need Standard to the 2012 amount of $2,841.00 in example 2.
MS 570-J Home and Community-Based Waiver Case Examples
Updates the Community Spouse Monthly Maintenance Need Standard to the 2012 amount of $2,841.00 in example 1.
Updates the Special LTC Long Term Care Income Standard to the 2012 amount of $2,094 in example 2.
Addendum 1 Program Standards
Corrects the 2012 Special Long Term Care Income Standard from $2,095 to $2,094.
Corrects the 2012 Monthly Need Standard for Additional Household Members from $913 to $947.
Updates Federal Poverty Guideline Table for 2012.
Updates Pickle Amendment Table to show new reduction factor amounts through December 2011.
Addendum 5 Medicaid EIS Eligibility Information System Notices
Adds missing notices to the table:
M321 - Pend Waiver Start - Child on DKC Denali KidCare
M724 - Waiver Services Denied – Medicaid Cont.
Corrects number of RPTC Residential Psychiatric Treatment Center Waiver: Info Needed – FM Family Medicaid / DKC Denali KidCare Child notice from M321 to M323 and reorders the table.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #25
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 2, 2012
Due to Federal review, the Department must restructure the current Older Alaskans (coded AG in EIS Eligibility Information System ) and Adults with Physical Disabilities (coded DA in EIS Eligibility Information System ) waivers. In EIS Eligibility Information System , these Medicaid waiver codes are entered on the MERE Medical Reference screen. To eliminate the need for new waiver codes, the Department has decided to keep the current four waiver codes (AG, DA, MC, and MD). We have updated Section 515 , Section 533 , Section 534 , Section 560 , Section 561 , Section 562 , and Addendum 5 with the changes outlined below.
If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
AG Code: Most of the waiver cases previously coded as DA have been changed to the AG waiver code. The AG code now covers adults who meet a nursing level of care. The new name for this waiver is Older and Disabled Adults (ODA). The AG code was previously used for Older Alaskans (OA) and was limited to adults age 65 or older.
DA Code: The DA code now covers Adults with Physical and Developmental Disabilities (APDD waiver). This waiver was previously called the Adults with Physical Disabilities (APD) waiver.
MC Code: No change. This code continues to cover Children with Complex Medical Conditions (CCMC waiver).
MD Code: A name change only. This code continues to cover adults and children with Intellectual and Developmental Disabilities (IDD waiver). This waiver was previously called the Mental Retardation and Developmental Disabilities (MRDD) waiver.
MS 534 M Example of an Eligibility Determination With a Medicaid Qualifying Trust
Example 1 was corrected to properly reflect income that exceeds 250% of the FPG Federal Poverty Guidelines .
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #26
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: August 31, 2012
This manual change consists of several small technical changes or clarifications as a result of suggestions from the field.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 506 B Medicare Enrollment
Adds a note that it is not necessary to delay Medicaid benefits while applicant applies for Medicare part B.
MS 506 L Medicare-In Problems
Corrects the email address for the TPL Third Party Liability Unit.
MS 506 O SSA Offices
Adds a back up fax number for the Anchorage SSA office.
MS 515 A TEFRA Case Processing
Corrects the email address for Qualis Health.
MS 528 G (2) Trust Changes
Adds clarification to note that says we do not have to obtain a copy of the changed trust document unless the original trust document does not have a provision for making changes.
MS 533 B Dual Eligibility
Adds the email address for Qualis Health.
MS 554 A Definitions of Terms Related to Transfer Policy
Revises definition of "Fair Market Value" to align with APA Adult Public Assistance MS 433-1 (A)
Adds definition of "Community Spouse"
MS 554 K Annuities
Adds a note that caseworkers need to email the TPL unit whenever an annuity is approved for a case and the State of Alaska is the beneficiary.
MS 560 B HCB Waiver Types
Clarifies that an individual aged 21-64 must be developmentally and physically disabled in order to qualify for an APDD waiver.
Clarifies the ODA waiver is for individuals over 21 who are disabled and require long-term level of care or who are over 65 and require long-term level of care.
MS 561 EIS HCB Waiver Codes
Updates tables in sections F, G and H to change "Older and Disabled Adult" to "Older or Disabled Adult."
MS 561-I FASD Waiver
Adds language to say " Medicaid only cases using APA Adult Public Assistance Income Need Standards require use of the ST Subtype even though the recipient is not actually receiving APA Adult Public Assistance ".
MS 562 D Processing HCB Waiver Cases for a Disabled Child at Home (TEFRA)
Adds the email address for Qualis Health.
MS 570 A Definitions
Revises definition of Community Spouse to align with definition in 553-A .
MS 570-E (6) Allowable Deductions for Cost of Care Determinations (Home Maintenance Allowance)
Clarifies the home maintenance allowance starts the month after admission since there is no cost of care in the month of admission.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #27
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 1, 2012
This year Social Security announced a COLA (Cost of Living Allowance) increase effective 2013. We have updated Addendum 1 and Addendum 6 with the following items to reflect the 1.7% cola Cost of Living Allowance increases for 2013:
An increase to the Long Term Care community spouse resource and income allowance and household member standards; An increase to the Excess Home Equity resources maximum; and An increase to the Special Long Term Care Income Standard Medicare Part A and B premiums Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
In addition to the COLA change, this manual change consists of several small technical changes or clarifications as a result of suggestions from the field.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 575 E Breast and Cervical Cancer Questions
Replaces "Breast and Cervical Cancer Coordinator" with Long Term Care Unit.
MS 580 B Special Low income Medicare Beneficiary (SLMB and SLMB Plus)
Adds a new subsection to clarify the Benefit Start Date for SLMB coverage.
Addendum 1 Program Standard s
Updated the 2013 standards.
Addendum 6 Medicare Part D Low Income Subsidy Guide
Updated the guide with the 2013 amounts.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #30
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: July 1, 2013
This manual change reflects the updated Fair Hearing regulations regarding how a hearing must be requested and includes a link to the Administrative Manual section 117 for this process. In addition, throughout the manual the HCB Home and Community-Based Waiver name "ODA" (Older and Disabled Adults) has been change to "ALI" (Alaskans Living Independently) and all references to FASD Fetal Alcohol Spectrum Disorder Waivers have been deleted and are no longer valid.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 520 I FAIR HEARINGS
Added reference to Administrative Manual Section 117 to clarify procedures for requests for Fair Hearings, and that Fair Hearing requests must be made in writing.
Addendum 2 APA RELATED MEDICAID SUBTYPES
Adjust resource limits for types QM and SL.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #31
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 30, 2013
We are making several changes to incorporate new policies, clarify existing policies, and align policies with those in the Family Medicaid Manual. Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field. This manual change reflects the updated Medicaid policies, as well as corrects some errors from past manual changes.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 500 OVERVIEW OF AGED, DISABLED AND LONG TERM CARE MEDICAID
Correct the state regulation citations to eliminate references to repealed Medicaid regulations at Title 7 Chapter 43.
MS 501 A ISSUING MEDICAID TO ELIGIBLE RECIPIENTS
Adds information about new Denali and Denali KidCare ID Cards that will be issued to all Medicaid recipients.
MS 513 A DEFINITION OF ALASKA RESIDENCY
Changes the definition of Alaska residency .
MS 520 B PROOF OF UNITED STATES CITIZENSHIP AND QUALIFIED ALIEN STATUS
Combines former manual sections 520-B and 520-C into single manual section at 520-B to coordinate with similar changes in the Family Medicaid manual.
Allows copies of copies of original documents to be accepted as documentary proof.
Presents streamlined documentary verification requirements for U.S. citizenship and identity .
MS 520 C REASONABLE OPPORTUNITY PERIOD
Adds revised policy that Medicaid benefits are available to persons claiming to be U.S. citizens, U.S. nationals, or qualified aliens during a 90-day reasonable opportunity period if their citizenship when status cannot be promptly verified through an electronic data match or documentary proof.
MS 520 H NOTICES
Changes the linked manual section from APA Manual section 481 to Family Medicaid manual section 5006.
MS 560 E HCB WAIVER TYPES
Add to note that before DPA can copy Care Coordinators on all notices, we must have a signed Release of Information.
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #32
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 2, 2013
The resource limit for the Low Income Subsidy Program typically increases each January when Social Security announces their COLA increase. This year, we did not receive the new resource limits for LIS.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 570 H NURSING HOME EXAMPLES
2014 COLA updates changed the amounts used in the examples.
MS 570 J HOME AND COMMUNITY-BASED WAIVER CASE EXAMPLES
2014 COLA updates changed the amounts used in the examples.
ADDENDUM 1
Updated with 2014 COLA changes
ADDENDUM 2
Updated QMB and SLMB resource limits with 2014 COLA changes
ADDENDUM 6
Updated with 2014 COLA changes
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #33
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: March 3, 2014
We have updated the Program Standards and Pickle Amendment Chart for 2014. We have also updated other sections that use Federal Poverty Level guidelines for income eligibility.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
5 00-A APPLICABLE ELIGIBILITY CATEGORIES
Added a note to explain that a disability determination is needed for APA related Medicaid, if no disability has been determined, MAGI needs to be processed.
520-B(5) PROOF OF US CITIZENSHIP ONLY
Removed bullets pertaining to Bureau of Vital Statistics and Permanent Fund Dividend since those two electronic interfaces are both proof of Citizenship and proof of identity.
534-K EXAMPLE OF AN ELIGIBILITY DETERMINATION
Updated examples with 2014 FPL numbers.
534- M EXAMPLE OF AN ELIGIBILITY DETERMINATION WITH A MEDICAID QUALIFYING TRUST
Updated examples with 2014 FPL numbers.
ADDENDUM 1
Updated with 2014 COLA changes
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STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #34
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: June 2, 2014
We have updated the ADLTC manual to include several small changes. Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
52 0- D DEVELOPMENT OF INCOME
Adds a note to explain that if a client is potentially eligible for income from UIB, early retirement or retirement they must pursue it.
554-B VERIFICATION AND DOCUMENTATION
Adds that we can accept client statement for bank accounts unless questionable.
562-A PROCESSING HCB HOME AND COMMUNITY BASED WAIVER CASES FOR A CHILD RECEIVING ANY MAGI MEDICAID
Deleted the reference to DKC, Denali Kidcare, Family Medicaid or Under 21 Medicaid.
562-B PROCESSING HCB WAIVER CASES WHEN A DDS DETERMINATION IS PENDING
Adds a step to send notice N011 requesting a MED3 form.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #35
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: January 2, 2015
We have updated the ADLTC manual to include several small changes. Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 553 D RESOURCES ELIGIBILITY DETERMINATION AND ALLOTMENT OF RESOURCES
Updates the example to use 2015 Maximum Community Spouse Resource Allowance
Deleted the instruction to adjust the start date, as it is Individualized Supports outdated.
MS 554 D Look-Back Period
Updated example dates
MS 570 H NURSING HOME EXAMPLES
2015 COLA Cost of Living Allowance updates changed the amounts used in the examples.
MS 570 J HOME AND COMMUNITY-BASED WAIVER CASE EXAMPLES
2015 COLA updates changed the amounts used in the examples.
ADDENDUM 1
Updated with 2015 COLA changes
ADDENDUM 2
Updated QMB Qualified Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries resource limits with 2015 COLA changes
ADDENDUM 6
Updated with 2015 COLA changes
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #36
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: March 2, 2015
We have updated the Program Standards and Pickle Amendment Chart for 2015. We have also updated other sections that use Federal Poverty Level guidelines for income eligibility.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team by e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
520-C REASONABLE OPPORTUNITY PERIOD
Updated policy, per CMS, to state that an individual can have more than one reasonable opportunity period.
Advised when a fraud referral is appropriate.
Deleted section 3 to remove language indicating only adequate notice is needed. Per CMS clarification adverse action is required.
534-K EXAMPLE OF AN ELIGIBILITY DETERMINATION
Updated examples with 2015 FPL numbers.
534- M EXAMPLE OF AN ELIGIBILITY DETERMINATION WITH A MEDICAID QUALIFYING TRUST
Updated examples with 2015 FPL numbers.
ADDENDUM 1
Updated with 2015 FPL changes.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #37
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: June 1, 2015
We have corrected the reference in the definitions related to trusts section.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team by e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
525A Definitions Related To Trusts
Corrected the reference in this section from 554(I) to 554(K) in the definition of annuity.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #38
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 1, 2015
We have corrected the reference in the definitions related to trusts section.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team by e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
514 D PENAL INSTITUTION
Added clarification that an incarcerated individual may be eligible for Medicaid for hospital stays over 24 hours.
520 E PENAL INSTITUTION
Added clarification that a SSA disability determination trumps a DDS disability determination.
ADDENDUM 2
Added Incarcerated subtypes and corrected QM and SL resource limits.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #39
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 1, 2015
Included in this manual change is the recent clarification from CMS Centers for Medicare & Medicaid Services that Alaska Native and American Indian Real Property is excluded as a resource for Medicaid.
This year Social Security announced that there will be no COLA (Cost of Living Allowance) increase for 2016. Social Security did update the Substantial Gainful Activity (SGA) limit which is added to Addendum 1.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team by e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
524-L ALASKA NATIVE AND AMERICAN INDIAN REAL PROPERTY RESOURCE EXCLUDED
Adds clarification that all real property including land and any structures built on the land, owned by an Alaska Native and American Indian is excluded as a resource.
554-C TRANSFERS OF ASSET RULES APPLY
Adds clarification that all real property owned by an Alaska Native or American Indian is excluded from being a countable resource or as a potential transfer of asset penalty.
ADDENDUM 1 PROGRAM STANDARDS
Updated 2016 standards.
ADDENDUM 6 MEDICARE PART D LOW INCOME SUBSIDY GUIDE
Updated 2016 standards.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #40
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 01, 2016
We are making several changes to clarify existing policy as a result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at dpapolicy@alaska.gov .
MS 505-E Caseworker Actions Related to TPL/TPR
Corrected TPL policy to match Child Support Policy per clarification from CMS.
MS 506-I Initiating the Medicare Buy-In
Updated this section to state that TPL needs to be emailed when initiating a Medicare Buy-In.
MS 534-K Example of an Eligibility Determination
Updated this section to reflect new FPL changes.
MS 534-M Example of an Eligibility Determination with a Medicaid Qualifying Trust
Updated this section to reflect new FPL changes.
MS 562-L LOC denial by DSDS for On-Going HCB Waiver Cases
Clarifies to look at Expansion Medicaid, if there is no Medicare eligibility.
MS 576 Emergency Treatment for Aliens
Deleted note regarding baby born to mother is not covered under Emergency Alien Medicaid, the baby is eligible for Medicaid.
Addendum 1 Update with 2016 COLA changes
Addendum 6 Removed due to being superfluous.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #41
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: August 01, 2016
We are making several changes to clarify existing policy as a result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at dpapolicy@alaska.gov .
MS 506-B Medicare Enrollment
Added a note to email TPL once a client applies for Medicare Part B to start the buy-in process.
MS 520-A Application and Review Process
Added a clarification on when an SSP or FFM application can be used for APA related Medicaid.
MS 570-C Individuals Not Subject To Cost-Of-Care
Added children under 18, pregnant women and MAGI recipients are not subject to cost-of-care.
MS 580-B Specified Low Income Medicare Beneficiary
Renamed the title "Special Low Income Medicare Beneficiary" to "Specified Low Income Medicare Beneficiary" to adhere to federal terminology.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #42
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 01, 2016
This year Social Security announced a COLA (Cost of Living Allowance) increase effective 2017. We have updated Addendum 1 and the examples throughout the manual with the following items to reflect the 0.3% increases for 2017:
An increase to the Long Term Care community spouse resource and income allowance and household member standards; An increase to the Excess Home Equity resources maximum; and An increase to the Special Long Term Care Income Standard Medicare Part A and B premiums Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
In addition to the COLA change, this manual change consists of several small technical changes or clarifications as a result of suggestions from the field. Also, we have replaced all reference to Family Medicaid with MAGI Medicaid and updated the links to the new MAGI Medicaid manual.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
505-E CASEWORKER ACTIONS RELATED TO TPL/TPR
Clarified that termination of TPL Third Party Liability must be verified.
505-H MILITARY FACILITIES
Removed this subsection due to outdated DHCS Division of Health Care Services information.
513 ALASKA RESIDENCY
Revised this section to match MAGI Modified Adjusted Gross Income manual for consistency.
514-D PENAL INSTITUTION
Revised subsection to match MAGI Modified Adjusted Gross Income manual for consistency.
514-G CHILDREN IN TREATMENT
Added new subsection regarding children that have been in residential treatment for more than 30 days that are ineligible for MAGI Modified Adjusted Gross Income Medicaid.
520-L ABLE ACCOUNTS
Added new subsection explaining new ABLE Achieving a Better Life Experience Act accounts with a link to the APA Adult Public Assistance manual section.
560-E HCB WAIVER REFERRALS AND INTERAGENCY COMMUNICATIONS
Replaced DSDS Division of Senior and Disabilities Services with Aged and Disability Resource Center for the care coordinator list per DSDS Division of Senior and Disabilities Services request.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #43
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 03, 2017
We have updated the Program Standards and Pickle Amendment Chart for 2017.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 500 Overview of Aged, Disabled and Long Term Care Medicaid
Replaced Affiliated Computer Systems with Conduent State Healthcare as Xerox changed their business name effective January 3, 2017
MS 514-D Penal Institution
Clarified Medicaid eligibility while in a penal institution
Added examples
MS 514-E Treatment Facilities and Halfway Houses
Clarified Medicaid eligibility at half-way houses
M S 514-F Partial Month Status
Added example
MS 528-E Documentation
Added note indicating that Policy will create a trust approval CANO when the trust review has been completed and it has been found to meet the requirements of a Medicaid Qualifying Trust
MS 534-K Example of an Eligibility Determination
Updated this section to reflect the 2017 Federal Poverty Level changes
MS 534-M Example of an Eligibility Determination with a Medicaid Qualifying Trust
Updated this section to reflect the 2017 Federal Poverty Level changes
Addendum 1 Program Standards
Updated with 2017 Federal Poverty Level changes
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #44
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: July 3, 2017
We are making changes to clarify existing policies and align policies with those in the MAGI Modified Adjusted Gross Income Medicaid Manual. Other changes are either technical in nature, clarifications that are the result of policy questions, or suggestions from the field. This manual change reflects the updated Medicaid policies, as well as corrects some errors from past manual changes.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 505 Third Party Liability and Recovery
Added information regarding FMAP Federal Medicaid Assistance Percentage and the important of using the correct Medicaid category and subtype, and indicating IHS Indian Health Service eligibility
MS 505-C Applicant/Recipient Responsibility
Clarified that verification of TPR/TPL termination is required
MS 528-A Initial Case Processing
Clarified that the Policy & Program Development Unit will enter a case note on the existing Medicaid case number when approving a Medicaid Qualified Trust
Updated instructions regarding how to find a trust in CourtView
MS 554-L 6 Transfer Penalty and Partial Months
Updated DHCS email by replacing Doug Myers to DHCS.Systems@alaska.gov
MS 560-F HCB Waiver Services and Institutional Eligibility
Removed the note referencing the FASD waiver as this is no longer a valid waiver type
ADDENDUM 2
Removed institutionalized from SI description as this is not correct
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #45
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 1, 2017
We are making changes to clarify existing policies and align policies with those in the MAGI Modified Adjusted Gross Income Medicaid Manual whenever possible. Other changes are either technical in nature, clarifications that are the result of policy questions, or suggestions from the field. This manual change reflects the updated Medicaid policies, as well as corrects some errors from past manual changes.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 514-E SUBSTANCE ABUSE TREATMENT FACILITIES AND COMMUNITY RESIDENTIAL CENTERS (HALFWAY HOUSES)
Added a new section regarding Medicaid eligibility at Treatment Facilities and Halfway Houses based on a CMS Centers for Medicare & Medicaid Services clarification.
MS 560-E HCB WAIVER REFERRALS AND INTERAGENCY COMMUNICATIONS
Revised screening coupon section to explain when a screening coupon needs to be issued.
MS 570-F WHEN A COST-OF-CARE LIABILITY BEGINS AND ENDS
Added an example to explain that COCA Cost of Care is applied when a late review is received and there is no lapse in Medicaid coverage and that COCA Cost of Care isn't applied when a late review is received and there is a lapse in Medicaid coverage.
ADDENDUM 6 COMMUNITY RESIDENTIAL CENTERS
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #46
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 1, 2017
This year Social Security announced a COLA (Cost of Living Allowance) increase effective 2018. We have updated Addendum 1 and the examples throughout the manual with the following items to reflect the 2.0% increases for 2018:
An increase to the Long Term Care community spouse resource and income allowance and household member standards;
An increase to the Excess Home Equity resources maximum; and
An increase to the Special Long Term Care Income Standard
Medicare Part A and B premiums
Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
In addition to the COLA change, this manual change consists of several small technical changes or clarifications as a result of suggestions from the field.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
527-B SPECIAL NEEDS TRUST
Clarified that an individual can set up a Special Needs Trust (SNT) due to a law change
533 DISABLED CHILDREN AT HOME (TEFRA)
Replaced terminology "Plan of Care" with "Support Plan" to match Senior & Disabilities Services (SDS) change in terminology as of January 1, 2018
553-D RESOURCE ELIGIBILITY DETERMINATION AND ALLOTMENT OF RESOURCES
Updated example due to COLA change
554-D LOOK BACK PERIOD
Updated example with new year for ease in understanding
560 HOME AND COMMUNITY BASED WAIVER SERVICES
Replaced terminology "Plan of Care" with "Support Plan" to match Senior & Disabilities Services (SDS) change in terminology as of January 1, 2018
560-B HCB WAIVER TYPES
Added new Individualized Supports (IS) Waiver type
Explained new Community First Choice (CFC) services that have been added to the Medicaid State Plan as of January 1, 2018
560-C ELIGIBILITY FOR HCB WAIVER SERVICES
Added new Individualized Supports (IS) Waiver type
562 PROCESSING HCB WAIVER CASES
Replaced terminology "Plan of Care" with "Support Plan" to match Senior & Disabilities Services (SDS) change in terminology as of January 1, 2018
570 POST ELIGIBILITY AND COST-OF-CARE
Replaced terminology "Plan of Care" with "Support Plan" to match Senior & Disabilities Services (SDS) change in terminology as of January 1, 2018
ADDENDUM 1 PROGRAM STANDARDS
Updated due to COLA change
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #47
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 2, 2018
We have updated the Program Standards and Pickle Amendment Chart for 2018. We have also updated other sections that use Federal Poverty Level guidelines for income eligibility.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 520-M Eligibility Requirements That Follow APA
Added crowdfunding accounts definition
MS 528-A Initial Case Processing
Added trust approval forms are now located on e-forms
Added that only Medicaid Qualifying Trust documents need to be sent to Policy
MS 533 Disabled Children at Home ( TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 )
Changed Long Term Care Coordinator to TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 /Specialized Medicaid PAA throughout the chapter
MS 534-K Example of an Eligibility Determination
Updated this section to reflect the 2018 Federal Poverty Level changes
MS 534-M Example of an Eligibility Determination with a Medicaid Qualifying Trust
Updated this section to reflect the 2018 Federal Poverty Level changes
MS 561 EIS HCB Waiver Codes
Added Individualized Supports waiver coding
MS 562 Processing HCB Waiver Cases
Removed process from the entire section which will be relocated to the How We Guide
Addendum 1 Program Standards
Updated with 2018 Federal Poverty Level changes
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #48
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 1, 2018
We have updated the Medicare Premium Assistance Resource Limits.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 553-D Resource Eligibility Determination and Allotment of Resources
Updated Maximum Community Spouse Resource Allowance examples
Addendum 1 Program Standards
Updated the Medicare Premium Assistance Resource Limits
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #49
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 03, 2018
This year Social Security announced a COLA (Cost of Living Allowance) increase effective January 2019. We have updated Addendum 1 and the examples throughout the manual with the following items to reflect the 2.8% increase for 2019:
An increase to the Long Term Care community spouse resource and income allowance and household member standards;
An increase to the Excess Home Equity resources maximum;
An increase to the Special Long Term Care Income Standard;
Changes in Medicare Part A and B premiums; and
Changes in Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
In addition to the COLA Cost of Living Allowance change, this manual change consists of several small technical changes or clarifications as a result of suggestions from the field.
Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 505 B What is a Third Party Resource
Added long term care insurance to the list of third party resources and a note explaining how to notify TPL Third Party Liability if a long term care insurance policy exists.
MS 554 D Look Back Period
Updated example due to COLA Cost of Living Allowance increase
MS 562 A MAGI Modified Adjusted Gross Income Waiver Cases
Removed the statement that MAGI Modified Adjusted Gross Income waiver cases do not impose a transfer of asset penalty. MAGI Modified Adjusted Gross Income waiver cases do impose a transfer of asset penalty.
MS 570 E Allowable Deductions for Cost-Of-Care
Added a note to clarify that deductions must be verified before they are allowed to be used as a deduction.
MS 570 E(3) Family Member Allowance
Updated section to clarify how a Family Member Allowance should be calculated and corrected reference from the MAGI Modified Adjusted Gross Income Medicaid standards to the ATAP Alaska Temporary Assistance Program ANI Adult Not Included standards.
MS 570 H Nursing Home Examples
Updated example due to COLA Cost of Living Allowance increase
MS 570 J Home and Community Based Waiver Case Examples
Updated example due to COLA Cost of Living Allowance increase
Addendum 1
Updated standards due to COLA change
Updated Medicare Part A, Part B and Part D premiums for 2019
Updated 2019 Spousal Impoverishment Standards
Addendum 2
Removed MAGI Medicaid subtypes to eliminate confusion
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #50
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 1, 2019
We have updated the Federal Poverty Level guidelines for income eligibility. We are making several changes to clarify existing policy as a result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 506-C Medicare Card
Updated section with the new Medicare Card that was revised in 2018
MS 520-N Ineligible Spouse Retirement Fund
Added new subsection explaining that an ineligible spouse's retirement fund is an exempt resource
MS 528-A Initial Case Processing
Updated #2 to state Policy will email the specific caseworker who sent in the trust along with their Eligibility Office Manager and Regional Manager when approving or denying trusts
MS 534-K Example of an Eligibility Determination
Updated this section to reflect the 2019 Federal Poverty Level changes
MS 534-M Example of an Eligibility Determination with a Medicaid Qualifying Trust
Updated this section to reflect the 2019 Federal Poverty Level changes
MS 561-F APDD, IDD, or ALI Waivers with APA Cash Assistance
Added eligibility codes 71 & 74 to the 21 and over in the table as the IDD waiver does not have an age limit
MS 562-F HCB Waiver Cases for a Women Receiving Breast and Cervical Cancer Medicaid
Added Ladies First in parenthesis after BCHC in the title of this section as Alaska changed the name of the program in 2018 (The Federal Government has not changed the name of the BCHC program)
MS 570 Post Eligibility and Cost of Care
Clarified that cost of care is determined using total gross income minus allowable deductions and disregards
MS 570-A Definitions
Added to Total Gross Income definition, including money deposited in a Medicaid Qualifying Trust
MS 575 BCHC Screening
Added Ladies First in parenthesis after BCHC in the title of this section as Alaska changed the name of the program in 2018 (The Federal Government has not changed the name of the BCHC program)
Added that Alaska updated the BCHC program to be called "Ladies First" in 2018
MS 575-B Application
Updated LTC office location from suite 410 to 120
Addendum 1
Updated with 2019 FPL Changes
Addendum 2
Added Ladies First to BCHC (Breast and Cervical Health Check)
Updated QM & SL resource limit
Addendum 8 III. 1619B Eligibility
Updated where to find the 1619B list in Luminist due to a program change from Document Direct to Luminist
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #51
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 3, 2019
We have provided updated information regarding how to handle an individual who appears eligible for Medicare benefits, and changed the terminology from Medicare Premium Assistance Categories to Medicare Savings Programs to match the federal language.
This and other policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
MS 506 Medicare
Removed "buy-in" from the title of this section as this was causing confusion for staff.
Rewrote entire section for clarity and linked to MS 580.
MS 523(J) Alaska Native / American Indian Property Rents
Added new subsection clarifying that rental income received from exempt property in Alaska belonging to an Alaska Native / American Indian is exempt. This is true for the Medicaid eligibility decision and determining cost of care.
MS 528(A) Initial Case Processing
Added note explaining that it is a best practice to fund a trust by having all income direct deposited into the trust account.
Revised the process regarding how to communicate trust approvals and denials with the field offices.
MS 528(D) Processing Renewals with Trusts
Added note explaining that is a best practice to fund the trust by having all income direct deposited into the trust account.
MS 533(D) Case Processing
Added note clarifying that there is no eligible for retroactive TEFRA Medicaid due to the level of care requirement not being met.
MS 570 Post Eligibility Treatment of Income (Cost of Care)
Changed title of section from Post Eligibility and Cost of Care to Post Eligibility Treatment of Income (Cost of Care) to match federal terminology.
MS 570(A) Definitions
Added definitions of Medical and Remedial Expenses.
MS 570(E) Unpaid Medical Expense Allowance
Updated section explaining what medical costs are.
MS 570(E)(6) Home Maintenance Allowance
Updated section clarifying that home maintenance expenses must be verified before the allowance is given and that the amount shall be the same as the expenses up to the maximum allowance, which is the APA need standard for an individual living independently.
MS 570(F) When a Cost of Care Liability Begins and Ends
Deleted statement indicating an individual could make advanced payments towards a nursing home facility for future month's cost of care as this does not follow federal regulations. The individual must be legally obligated to pay the bill before payment can be made. Payment of any expense before services are provided or before the individual has received the benefit is not allowed.
MS 580 Medicare Savings Programs
Changed name of section from Medicare Premium Assistance Categories to Medicare Savings Programs to match federal terminology.
Rewrote entire section for clarity.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #52
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 2, 2019
This year Social Security announced a Cost of Living Allowance ( COLA Cost of Living Allowance ) increase effective January 2020. We have updated Addendum 1 and the examples throughout the manual with the following items to reflect the 1.6% increase for 2020:
An increase to the Long Term Care community spouse resource and income allowance and household member standards;
An increase to the Excess Home Equity resources maximum;
An increase to the Special Long Term Care Income Standard;
Changes in Medicare Part A and B premiums; and
Changes in Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
In addition to the COLA Cost of Living Allowance change, we have expanded the use of the Refused Cash ( RC Refused Cash ) Medicaid subtype effective with the benefit month of January 2020 to include individuals who have countable income above the appropriate APA Adult Public Assistance need/payment standard but below the Expanded Refused Cash monthly income limit listed in ADLTC MS 530(C) .
This manual change also consists of several small technical changes or clarifications as a result of suggestions from the field. Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
500(A) Applicable Eligibility Categories
Revised section to include an explanation of "Expanded Refused Cash" Medicaid eligibility
Clarified that QMB, SLMB, SLMB Plus, and QDWI are Medicare Savings Programs that do not offer Medicaid coverage and added a link to ADLTC MS 580
515 TEFRA Case Processing
Changed Qualis name to Comagine throughout the chapter due to company name change and updated to current dates
520(I) Fair Hearings
Added a link to Admin MS 117-2
530(B) APA Recipient
Revised table explanation of the SI and ST Medicaid subtypes for clarity
530(C) SSI or APA Eligible, But Not Receiving Cash Payments
Changed title due to the expanded use of the RC Refused Cash Medicaid subtype
Added the Expanded Refused Cash income limits
Revised table explanation of the RC Refused Cash Medicaid subtype due to a change in policy
533 Disabled Children at Home (TEFRA) whole chapter
Changed Qualis name to Comagine due to company name change
554(D) Look Back Period
Updated example due to COLA Cost of Living Allowance increase
562(B) APA Related Medicaid or LTC Medicaid Waiver Cases
Changed Qualis name to Comagine due to company name change
570(H) Nursing Home Examples
Updated example due to COLA Cost of Living Allowance increase
570(J) Home and Community Based Waiver Case Example
Updated example due to COLA Cost of Living Allowance increase
575(D) Coverage
Changed Qualis name to Comagine due to company name change
Addendum 1
Updated standards due to COLA Cost of Living Allowance change
Updated Medicare Part A, Part B, and Part D premiums for 2020
Updated 2020 Spousal Impoverishment Standards
Updated QMB, SLMB, QI Resource Limits
Updated Pickle Amendment Table
Addendum 2
Revised table explanation of the RC Medicaid subtype due to a change in policy
Revised Table explanation of the SI and ST Medicaid subtypes for clarity
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #53
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 1, 2020
We have updated the 2020 Federal Poverty Level guidelines for income eligibility effective April 1, 2020. We have also updated other sections that use Federal Poverty Level guidelines for income eligibility.
This manual change also consists of several technical changes or clarifications as a result of suggestions from the field. Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
506(A) Medicare Eligibility
Clarified that an individual must be receiving SSDI Social Security Disability Insurance in order to qualify for Medicare benefits
516 Retroactive Medicaid
Revised section for clarity and to align with MAGI Modified Adjusted Gross Income Medicaid
520(A) Application and Review Process
Clarified that an application and interview are required when an individual is moving from a MAGI Modified Adjusted Gross Income Medicaid category to an Old Age/Disability related Medicaid category
520(B) Proof of United States Citizenship and Qualified Alien Status
Replaced Bureau of Vital Statistics (BVS) with Health Analytics & Vital Records (HAVR)
528(A) Initial Case Processing
Clarified that a trust should not be sent to policy for review until the interview has been completed and the application is ready to be approved (other than the trust approval)
528(G) Trust Changes
Clarified that amended trusts and the associated court paperwork must be sent to policy for approval
530(C) Use of the Refused Cash Medicaid Subtype
Removed Expanded Refused Cash income limits and added a link to it on the ADLTC Addendum 1
533(A) TEFRA Eligibility
Clarified that when a TEFRA child is turning 18, they must be referred to apply for SSI
Added that Child Support received on behalf of a TEFRA child is countable income to the child
533(B) TEFRA Conversions
Clarified that if a child's SSI benefit stops, the caseworker must evaluate the child's eligibility for MAGI Medicaid, TEFRA, and a CEP.
533(E) TEFRA Reviews
Clarified that at the time of review, the caseworker must check the child's age. If the child is turning 18 years old, they must be referred to apply for SSI.
534(K) Example of an Eligibility Determination
Updated examples with 2020 Federal Poverty Level Changes and replaced APA Need Standard with Refused Cash standard
534(M) Example of an Eligibility Determination With a Medicaid Qualifying Trust
Updated examples with 2020 Federal Poverty Level Changes and replaced APA Need Standard with Refused Cash standard
554(E) Penalty Start Date
Clarified when a TOA penalty begins
554(L) Transfer Penalty and Partial Months
Updated dates in the examples
Updated DHCS contact email to dhcs.systems@alaska.gov
561 EIS HCB Waiver Codes
Removed charts throughout this section as this process information is not maintained by the policy unit
Move eligibility and waiver codes to Addendum 2
570(E) 6 Home Maintenance Allowance
Updated the amount used for home maintenance allowance as equal to the Expanded Refused Cash Medicaid income limit instead of the APA need/payment standard
570(H) Nursing Home Examples
Updated examples with 2020 Community Spouse Monthly Maintenance Need Standards
570(J) Home and Community-Based Waiver Case Examples
Updated examples with 2020 Community Spouse Monthly Maintenance Need Standards
576(F) EIS Information
Deleted section and added information to Addendum 2
580 Medicare Savings Programs
Updated QMB & SLMB resource limits
Addendum 1
Updated with 2020 Federal Poverty Level Changes
Added 2020 Expanded Refused Cash Income Limits
Updated QMB, SLMB, and SLMB+ Resource Limits
Addendum 2
Added subtypes for Undocumented Illegal Aliens due to CMS reporting requirements
Added a list of eligibility and waiver codes
Addendum 4
Added the Help Desk will contact Policy to determine if the request is valid and can be approved
Addendum 7
Revised information for Medicaid Part D, including a new link to the SDS website
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #54
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 1, 2020
We are making several changes to incorporate new policy, clarifying existing policy, and align policies within our policy manuals. Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions, contact the Policy and Program Development Team at dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
520(B) U.S. United States CITIZENSHIP AND ELIGIBLE ALIEN STATUS
Updated section to align with MAGI Modified Adjusted Gross Income MS 808-6 as the HAVR Health Analytics & Vital Records ( BVS Bureau of Vital Statistics ) data match has ended.
534 WORKING DISABLED MEDICAID BUY-IN
Clarified when calculating the unearned income test, apply APA Adult Public Assistance related methodology or 300% Special Long Term Care income limit depending on what category of Medicaid eligibility is based on.
575 BREAST AND CERVICAL CANCER MEDICAID
Explained what credible coverage means.
Added renewals are required yearly.
580 MEDICARE SAVINGS PROGRAMS
Updated who is eligible section to include MAGI Modified Adjusted Gross Income caretaker category.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #55
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 1, 2020
This year Social Security announced a Cost of Living Allowance ( COLA Cost of Living Allowance ) increase effective January 2021. We have updated Addendum 1 and the examples throughout the manual with the following items to reflect the 1.3% increase for 2021:
An increase to the Long Term Care community spouse resource and income allowance and household member standards;
An increase to the Excess Home Equity resources maximum;
An increase to the Special Long Term Care Income Standard;
Changes in Medicare Part A and B premiums; and
Changes in Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
This manual change also consists of several small technical changes or clarifications as a result of suggestions from the field. Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
517 Fair Hearings
Added a new chapter to match federal regulations that allow a verbal fair hearing request for Medicaid.
518 Alien Sponsor Income
Added a new chapter to clarify Alien Sponsor Income deeming.
520(F) Verification and Documentation
Added a link to APA MS 410-4 for further clarification on verification.
520(I) Reserved
Revised section as reserved due to fair hearing policy is no longer the same as APA. See ADLTC 517 .
523(B) Reserved
Revised to reserved due to information moved Alien Sponsor Income to new chapter ADLTC 518 .
524(A) Reserved
Revised to reserved due to information moved Alien Sponsor Income to new chapter ADLTC 518 .
532(C) Alien Sponsor Deeming
Removed outdated section and moved Alien Sponsor Income to new chapter ADLTC 518 .
Renumbered section.
554(D) Look Back Period
Updated example due to COLA Cost of Living Allowance increase.
570(A) Definitions
Added note clarifying that Native Dividend income over $2,000 is countable, even if deposited to a trust.
570(C) Individuals Not Subject to Cost of Care
Clarified that SSI and APA recipients are not responsible for cost of care.
570(H) Nursing Home Examples
Updated example due to COLA Cost of Living Allowance increase.
570(J) Home and Community Based Waiver Case Example
Updated example due to COLA Cost of Living Allowance increase.
580 Medicare Savings Programs
Added a note that incarcerated individuals are not eligible for Medicare Savings Programs.
Updated the QMB Qualified Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries resource limits.
Updated LIS resource limits and coverage information.
Addendum 1
Updated standards due to COLA Cost of Living Allowance change
Updated Medicare Part A, Part B, and Part D premiums for 2021
Updated 2021 Spousal Impoverishment Standards
Updated QMB Qualified Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries resource limits
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #56
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 1, 2021
We have updated the 2021 Federal Poverty Level guidelines for income eligibility effective April 1, 2021. We have also updated other sections that use Federal Poverty Level guidelines for income eligibility.
This manual change also consists of several technical changes or clarifications as a result of suggestions from the field. Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
514(D) Penal Institutions
Removed verbiage indicating applications for adults in DOC Department of Corrections or BOP Federal Bureau of Prisions custody will be processed by Field Services as this is no longer the case
520(A) Application and Review Process
Added language regarding signature requirements
Clarified that a NFAP Native Family Assistance Program application can be used as an application and recertification
520(B) Proof of United States Citizenship and Qualified Aliens
Removed subsection C regarding use of the PFD Permanent Fund Dividend interface as verification of US Citizenship as this no longer meets policy requirements
522(A) Special Non-Immigrant Groups
Due to a change in law effective December 27, 2020, clarified that non-immigrants from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau who are legally residing in the United States are eligible for Medicaid benefits and are not subject to the 5-year waiting period
524(M) Dingell Act Lands
Added a new subsection regarding the Dingell Act Lands received by Native Veterans
530(A) SSI Recipient
Clarified that Medicaid eligibility does not depend on APA Adult Public Assistance eligibility
534(K) Example of an Eligibility Determination
Updated examples with 2021 Federal Poverty Level Changes and replaced APA Need Standard with Refused Cash standard
534(M) Example of an Eligibility Determination With a Medicaid Qualifying Trust
Updated examples with 2021 Federal Poverty Level Changes and replaced APA Need Standard with Refused Cash standard
Addendum 1
Updated with 2021 Federal Poverty Level Changes
Updated Pickle Chart
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #57
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 1, 2021
We are making several changes to incorporate new policy, clarifying existing policy, and align policies within our policy manuals. Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions, contact the Policy and Program Development Team at dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
520 A APPLICATION AND REVIEW PROCESS
Clarified that an SSP Self Service Portal / FFM Federally Facilitated Marketplace is the only acceptable application that doesn't need a "wet" signature
550 B INDIVIDUAL ELIGIBLE FOR SSI Supplemental Security Income OR APA Adult Public Assistance CASH ASSISTANCE IF NOT IN AN INSTITUTION
Clarified that the Refused Cash category is also included.
554 K ANNUITIES
Clarified how a TOA Transfer of Assets should be calculated with an annuity that has caused a penalty.
576 E COORDINATION WITH DIVISION OF HEALTH CARE SERVICES (DHCS)
Added a note clarifying that the letter from DHCS Division of Health Care Services indicating an individual received services of an emergent nature and indicating the covered dates of services is not a determination of eligibility.
580 D LOW-INCOME SUBSIDY (LIS) PROGRAM
Added a link to the LIS business process at Administrative MS 126-3 .
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #58
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 1, 2021
This year Social Security announced a Cost of Living Allowance ( COLA Cost of Living Allowance ) increase effective January 2022. We have updated Addendum 1 and the examples throughout the manual with the following items to reflect the 5.9% increase for 2022:
An increase to the Long Term Care community spouse resource and income allowance and household member standards;
An increase to the Excess Home Equity resources maximum;
An increase to the Special Long Term Care Income Standard;
Changes in Medicare Part A and B premiums; and
Changes in Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
This manual change also consists of several small technical changes or clarifications as a result of suggestions from the field. Highlights of these revisions are described below. If you have any questions please contact the Policy and Program Development Team at e-mail dpapolicy@alaska.gov .
OVERVIEW OF CHANGES
512 SOCIAL SECURITY ENUMERATION
Renamed section to align with MAGI Modified Adjusted Gross Income Medicaid Manual
Added link to new Addendum 9 for the notice template when they must request a SSN Social Security Number from the SSA Social Security Administration
520 A APPLICATION AND REVIEW PROCESS
Revised section for clarity
Clarified that telephonically recorded application signatures are accepted through the Virtual Call Center (VCC)
Revised note to clarify that for paper applications, the signature must either be telephonically recorded by a caseworker through the VCC Virtual Call Center or a "wet signature"
522 A SPECIAL NON-IMMIGRANT GROUPS
Clarified that although a COFA Compact of Free Association migrant is exempt from the five-year waiting period, if their status changes to a qualified alien as outlined in APA MS 421-2, the five-year waiting period will apply unless they meet an exemption listed in APA MS 421-4(D).
554 D LOOK BACK PERIOD
Updated example due to COLA Cost of Living Allowance change
570 C INDIVIDUALS NOT SUBJECT TO COST-OF-CARE
Clarified that individuals receiving Medicaid in the Refused Cash category are not responsible for cost-of-care
570 E INDIVIDUALS NOT SUBJECT TO COST-OF-CARE
Updated ATAP Alaska Temporary Assistance Program ANI Adult Not Included standard due to COLA Cost of Living Allowance change
570 H NURSING HOME EXAMPLES
Updated example due to COLA Cost of Living Allowance change
570 J HOME AND COMMUNITY BASED WAIVER CASE EXAMPLES
Updated example due to COLA Cost of Living Allowance change
580 MEDICARE SAVINGS PROGRAMS
Updated QMB Qualified Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries resource limits
ADDENDUM 1
Updated standards due to COLA Cost of Living Allowance change
Updated Medicare Part A, Part B, and Part D premiums for 2022
Updated 2022 Spousal Impoverishment Standards
ADDENDUM 2
Changed terminology to "ineligible non-immigrants" for Medicaid Subtypes IL and II due to COFA Compact of Free Association migrants
ADDENDUM 9
Added a new addendum for the social security enumeration request letter template
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #59
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 1, 2022
We have updated the 2022 Federal Poverty Level guidelines for income eligibility effective April 1, 2022. We have also updated other sections that use Federal Poverty Level guidelines for income eligibility.
This manual change also consists of several technical changes or clarifications as a result of suggestions from the field. Highlights of these revisions are described below. If you have any questions please contact the Policy & Program Development Team at e-mail hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
514(G) Children in Treatment
Clarified that although an individual may not qualify for the Special LTC category until 30th day of institutionalization, the individual's effective date of eligibility is retroactive to the first day of the 30-day period of institutionalization.
520(A) Application and Review Process
Clarified that we can accept online application through the FFM and SSP for disability related Medicaid but additional information will be needed from the household.
534(K) Example of an Eligibility Determination
Updated examples with 2022 Federal Poverty Level Changes
534(M) Example of an Eligibility Determination With a Medicaid Qualifying Trust
Updated examples with 2022 Federal Poverty Level Changes
550(C) Special Long Term Eligibility
Clarified that although an individual may not qualify for the Special LTC category until day 30 of institutionalization, the individual effective date of eligibility is retroactive to the first day of the 30-day period of institutionalization.
575(B) Application
Updated LTC office address to 3901 Old Seward Highway Suite 131, Anchorage, AK 99503
580 Medicare Savings Program
Updated QMB and SLMB resource limits
Addendum 1
Updated with 2022 Federal Poverty Level Changes
Updated QMB and SLMB resource limits
Updated Pickle Chart
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #60
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 1, 2022
We are making several changes to incorporate new policy, clarifying existing policy, and align policies within our policy manuals. Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions, contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
528 A INITIAL CASE PROCESSING
Revised the trust communication process now that the division has electronic document management.
530 C USE OF THE REFUSED CASH MEDICAID SUBTYPE
Added a note clarifying that the Refused Cash category should not be used for individuals residing in a LTC Long Term Care facility or receiving HCB Home and Community-Based Waiver services.
554 TRANSFER OF ASSETS
Revised section to clarify that a caseworker must review for a possible TOA penalty at every renewal to ensure that the individual did not make a non-allowable transfer in the prior 12 months.
570 C INDIVIDUALS NOT SUBJECT TO COST OF CARE
Clarified that individuals residing in a LTC facility are not exempt from cost of care and added a link to 570(B).
ADDENDUM 3 COUNTABLE AND EXCLUDED INCOME FOR ADLTC MEDICAID
Added new Addendum outlining basic countable and excluded income for ADLTC Medicaid.
ADDENDUM 9 SOCIAL SECURITY ENUMERATION REQUEST LETTER TEMPLATE
Revised signature line by removing "Eligibility Technician" as the Social Security Administration will not accept the form if it isn't signed by a member of management. Also, updated phone number to the VCC.
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #61
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 1, 2022
This year Social Security announced a Cost of Living Allowance ( COLA Cost of Living Allowance ) increase effective January 2023. We have updated Addendum 1 and the examples throughout the manual with the following items to reflect the 8.7% increase for 2023:
An increase to the Long Term Care community spouse resource and income allowance and household member standards;
An increase to the Excess Home Equity resources maximum;
An increase to the Special Long Term Care Income Standard;
Changes in Medicare Part A and B premiums; and
Changes in Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
We have made several changes to clarify existing policy as a result of policy questions or suggestions from the field. An overview of the changes are listed below.
If you have any questions, please contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
ENTIRE MANUAL
Changed all references from DHSS Department of Health and Social Services to DOH Department of Health
520 B When an Application is Required
Added new subsection to clarify when an application is required
Renumbered section
520 C When an Application is Not Required
Added new subsection to clarify when an application is not required
Renumbered section
520 D Proof of Qualified Alien Status
Removed link to NCOSC website that no longer provides the information needed in this section. Updated to USCIS website.
521 Coordination with the FFM Federally Facilitated Marketplace
Added new section regarding coordination with the FFM Federally Facilitated Marketplace
Clarified when an individual is found ineligible for Medicaid (denial or closure), their information must be electronically transferred to the FFM Federally Facilitated Marketplace . So they can determine their eligibility for a Qualified Health Plan (QHP). Individuals who are found ineligible for Medicaid due e to procedural reasons and those who do not attest to U.S. citizenship or lawfully present non-citizen status should not be referred to the FFM Federally Facilitated Marketplace .
533 D Case Processing
Removed note indicating retroactive Medicaid is not available for TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248
554 D Look Back Period
Updated example due to COLA Cost of Living Allowance change
570 E Individuals not Subject to Cost of Care
Updated ATAP Alaska Temporary Assistance Program ANI Adult Not Included standard due to COLA Cost of Living Allowance change
Revised section to clarify that the caseworker will determine eligibility without a deduction if the expense is not verified within 30 days of the initial application filing date. If verification is provided at a later date, the change is effective the first day of the month of the agency's receipt of the report of change
Added link to APA MS 480-3(C)
570 H Nursing Home Examples
Updated example due to COLA Cost of Living Allowance change
570 J Home and Community Based Waiver Case Examples
Updated example due to COLA Cost of Living Allowance change
580 D Low Income Subsidy (LIS) Program
Updated subsidy information
ADDENDUM 1
Updated standards due to COLA Cost of Living Allowance change
Updated Medicare Part A, Part B, and Part D premiums for 2023
Updated 2023 Spousal Impoverishment Standards
STATE OF ALASKA
Department of Health
Division of Public Assistance
TRANSMITTAL NUMBER: MC #62
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 3, 2023
We have updated the 2023 Federal Poverty Level guidelines for income eligibility effective April 1, 2023. We have also updated other sections that use Federal Poverty Level guidelines for income eligibility.
This manual change also consists of several technical changes or clarifications as a result of suggestions from the field. Highlights of these revisions are described below.
If you have any questions, please contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
500 Overview of Aged, Disabled and Long Term Care Medicaid
Changed Alaska's fiscal agent from Conduent to Health Management Systems.
501(A)(4) Manual Benefit Issuance
Changed Alaska's fiscal agent from Conduent to Health Management Systems.
513(B) Temporary Absence and Residents Residing Out of State
Changed Alaska's fiscal agent from Conduent to Health Management Systems.
514(G) Children in Treatment
Changed Alaska's fiscal agent from Conduent to Health Management Systems.
520(A) Application and Review Process
Removed reference to application processing time frame of 30 days.
522(B) Actions taken on the Application
Added new subsection regarding actions taken on the application.
Changed section title from Medicaid Exception to APA Adult Public Assistance citizenship Requirements to Medicaid Exceptions to APA Adult Public Assistance Eligibility Policy.
534(K) Example of an Eligibility Determination
Updated examples with 2023 Federal Poverty Level Changes.
534(M) Example of an Eligibility Determination With a Medicaid Qualifying Trust
Updated examples with 2023 Federal Poverty Level Changes.
570 Post Eligibility Treatment of Income (Cost of Care)
Added new subsection regarding notice requirements.
580 Medicare Savings Program
Updated QMB Qualified Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries resource limits.
Addendum 1
Updated with 2023 Federal Poverty Level Changes.
Updated QMB Qualified Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries resource limits.
Updated Pickle Chart.
STATE OF ALASKA
Department of Health
Division of Public Assistance
TRANSMITTAL NUMBER: MC #63
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 1, 2023
We are making several changes to incorporate new policy, clarifying existing policy, and align policies within our policy manuals. Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions, contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
521(A) APPLICATION SUBMITTED THROUGH THE FEDERALLY FACILITATED MARKETPLACE
Revised note to clarify that the FFM Federally Facilitated Marketplace referral must be made by sending the M070 as EIS Eligibility Information System cannot transfer client information electronically.
521(B) APPLICATION SUBMITTED THROUGH DPA Division of Public Assistance
Revised note to clarify that the FFM Federally Facilitated Marketplace referral must be made by sending the M070 as EIS Eligibility Information System cannot transfer client information electronically.
524(L) ALASKA NATIVE AND AMERICAN INDIAN REAL PROPERTY RESOURCE EXCLUDED
Added noted clarifying that Alaska Native property remains exempt if it passes from AN/AI to one or more relatives, such as a spouse or child, even if the relative is not AN/AI.
ADDENDUM 3 COUNTABLE AND EXCLUDED INCOME FOR ADLTC MEDICAID
Added VA Disability as countable income
STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #64
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 1, 2023
This year Social Security announced a Cost of Living Allowance ( COLA Cost of Living Allowance ) increase effective January 2024. We have updated Addendum 1 and the examples throughout the manual with the following items to reflect the 3.2% increase for 2024:
An increase to the Long Term Care community spouse resource and income allowance and household member standards;
An increase to the Excess Home Equity resources maximum;
An increase to the Special Long Term Care Income Standard;
Changes in Medicare Part A and B premiums; and
Changes in Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
We have made several changes to clarify existing policy as a result of policy questions or suggestions from the field. An overview of the changes are listed below.
If you have any questions, please contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
512 Social Security Enumeration
Removed reference to Addendum 9 and replaced with reference to new location of the Social Security Enumeration Letter Template.
514 D Penal Institution
Clarified that we cannot deny or terminate Medicaid benefits solely because an individual is incarcerated.
515 Continuous Eligibility and Children in SSI Supplemental Security Income Related Categories
Removed incarceration in a penal institution as a reason to end the continuous eligibility period.
554 D Look Back Period
Updated example due to COLA Cost of Living Allowance change.
554 F Transfer of Assets
Clarified transfer of asset presumption policy for Medicaid.
570 C Individuals not Subject to Cost of Care
Added note to clarify when it is appropriate to mail the M003 notice.
570 E Allowable deduction for Cost of Care determinations
Updated example of ATAP Alaska Temporary Assistance Program ANI Adult Not Included standard due to COLA Cost of Living Allowance change.
570 H Nursing Home Examples
Updated example due to COLA Cost of Living Allowance change.
570 J Home and Community Based Waiver Case Examples
Updated example due to COLA Cost of Living Allowance change.
580 D Low Income Subsidy (LIS) Program
Updated resource limit and subsidy information.
ADDENDUM 1
Updated standards due to COLA Cost of Living Allowance change.
Updated Medicare Part A, Part B, and Part D premiums for 2024.
Updated 2024 Spousal Impoverishment Standards.
ADDENDUM 9 SOCIAL SECURITY ENUMERATION REQUEST LETTER TEMPLATE
Removed addendum so this letter template is not available to the public.
STATE OF ALASKA
Department of Health
Division of Public Assistance
TRANSMITTAL NUMBER: MC #65
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 1, 2024
We have updated the 2024 Federal Poverty Level guidelines for income eligibility effective April 1, 2024. We have also updated other sections that use Federal Poverty Level guidelines for income eligibility.
This manual change also consists of several technical changes or clarifications as a result of suggestions from the field. Highlights of these revisions are described below.
If you have any questions, please contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
512 Social Security Enumeration
Removed SharePoint reference.
534(K) Example of an Eligibility Determination
Updated examples with 2024 Federal Poverty Level Changes.
534(M) Example of an Eligibility Determination With a Medicaid Qualifying Trust
Updated examples with 2024 Federal Poverty Level Changes.
575 Breast and Cervical Cancer
Changed name to Alaska Breast and Cervical Screening Assistance Program (AK B+C).
Changed the staff contact at DHCS.
580 Medicare Savings Program
Updated QMB Qualified Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries resource limits.
Addendum 1
Updated with 2024 Federal Poverty Level Changes.
Updated QMB Qualified Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries resource limits.
Updated Pickle Chart.
STATE OF ALASKA
Department of Health
Division of Public Assistance
TRANSMITTAL NUMBER: MC #67
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 2, 2024
This year Social Security announced a Cost of Living Allowance ( COLA Cost of Living Allowance ) increase effective January 2025. We have updated Addendum 1 and the examples throughout the manual with the following items to reflect the 2.5% increase for 2025:
An increase to the Long Term Care community spouse resource and income allowance and household member standards;
An increase to the Excess Home Equity resource maximum;
An increase to the Special Long Term Care Income Standard;
Changes in Medicare Part A and B premiums; and
Changes in Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
We have also made several changes to clarify existing policy as a result of policy questions or suggestions from the field. An overview of the changes are listed below.
If you have any questions, please contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
506 Medicare
Revised section to clarify that SSI Supplemental Security Income recipients are categorically eligible for Medicaid.
520(A) Application Process
Revised policy to allow for digital and handwritten signatures created on an electronic device (finder/stylus to screen) effective October 1, 2024.
Clarified that a request to add other programs to an existing Medicaid application must be done timely or a new application is required.
Revised note to clarify that FFM Federally Facilitated Marketplace and SSP Self Service Portal applications are valid for any category of Medicaid but additional information is needed from the household for ADLTC Aged, Disabled, and Long Term Care Medicaid categories.
520(C) Proof of United States Citizenship and Qualified Alien Status
Removed reference to a parent, guardian, or caretaker relative attesting to the identity of a child under the age of 16 by signing an identity declaration (the application) as this is not allowed without a wet signature.
526(D) Payments made from a QIT
Due to a federal regulation change effective September 30, 2024, removed food from in-kind support and maintenance ( ISM In-Kind Support and Maintenance ) calculations.
528(A) Initial Case Processing
Updated section to clarify that the MED 20 is not completed unless the Medicaid Qualifying Trust is used to establish or maintain Medicaid eligibility.
554(D) Look Back Period
Updated example due to the COLA Cost of Living Allowance change.
570(D) Income Disregarded in the Cost of Care Determination
Changed Palmer Pioneer Home to Alaska Veterans and Pioneers Home due to a name change.
570(E) Allowable Deductions for Cost of Care Determinations
Updated example of ATAP Alaska Temporary Assistance Program ANI Adult Not Included standard due to the COLA Cost of Living Allowance change.
570(H) Nursing Home Examples
Updated example due to the COLA Cost of Living Allowance change.
570(J) Home and Community Based Waiver Case Examples
Updated example due to the COLA Cost of Living Allowance change.
575(B) Application
Revised section to include other application methods.
580 Medicare Savings Programs
Due to a federal regulation change effective October 1, 2024, revise section to indicate that if an SSI Supplemental Security Income recipient is approved for Medicaid, we must automatically enroll them in QMB Qualified Medicare Beneficiaries starting the month following the Medicaid approval.
Updated QMB Qualified Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries resource limits.
580(A) Qualified Medicare Beneficiaries
Revised section to indicate that SSI Supplemental Security Income recipients are automatically eligible for QMB Qualified Medicare Beneficiaries . Non- SSI Supplemental Security Income recipients must have countable income equal to or less than 100% of the FPG.
580(D) Low Income Subsidy Program
Updated resource limits.
Addendum 1 Program Standards
Updated standards due to the COLA Cost of Living Allowance change.
Updated Medicare Part A, Part B, and Part D premiums for 2025.
Updated Spousal Impoverishment standards for 2025.
Addendum 2 APA Related Medicaid Subtypes, Eligibility Codes, and Waiver Codes
Removed invalid RPTC Residential Psychiatric Treatment Center Medicaid Subtype.
Addendum 5 Medicaid EIS Notices
Updated notice listing.
Addendum 8 Working Disabled Medicaid Buy-In Procedures
Revised to include Expanded Refused Cash and LTC Long Term Care Medicaid.
Revised to include other application methods.
Changed 1619B report system from Luminist to Mobius.
STATE OF ALASKA
Department of Health
Division of Public Assistance
TRANSMITTAL NUMBER: MC #68
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 1, 2025
We have updated the 2025 Federal Poverty Level guidelines for income eligibility effective April 1, 2025. We have also updated other sections that use Federal Poverty Level guidelines for income eligibility.
This manual change also consists of several technical changes or clarifications as a result of suggestions from the field. Highlights of these revisions are described below.
If you have any questions, please contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
505 Third Party Liability (TPL) and Recovery
Changed Child Support Services Division (CSSD) to Child Support Enforcement Division (CSED).
506(B) Medicare Enrollment
Removed instructions to refer an individual who is found to be ineligible for Medicare Savings Plan to the Social Security Office to apply for Medicare as DHCS Division of Health Care Services confirmed that this is an unnecessary step.
506(J) Social Security Offices
Removed the Ketchikan office as it is closed and updated fax and phone numbers for Anchorage, Juneau, and Fairbanks offices.
511 Child Support Cooperation
Changed Child Support Services Division (CSSD) to Child Support Enforcement Division (CSED).
513 Alaska Residency
Added note clarifying when caseworkers should consider Alaska residency questionable.
516 Retroactive Medicaid
Clarified that retroactive Medicaid uses actual income.
520(D) Reserved
Due to a federal rule change, removed the requirement to apply for other benefits as a condition of Medicaid eligibility.
522(B)5 Actions Taken on the Application
Clarified that Medicaid application withdrawal requests can be done with a recorded signature the VCC Virtual Call Center .
530(D) SSI Supplemental Security Income Disabled Adult Children
Clarified how to verify SSI Supplemental Security Income Disabled Adult Children eligibility.
534(K) Example of an Eligibility Determination
Updated examples with 2025 Federal Poverty Level Changes.
534(M) Example of an Eligibility Determination with a Medicaid Qualifying trust
Updated examples with 2025 Federal Poverty Level Changes.
580 Medicare Savings Programs
Clarified that SSI Supplemental Security Income recipients who are eligible for Medicare are automatically eligible for QMB Qualified Medicare Beneficiaries and must be enrolled the first of the month after Medicaid eligibility is determined.
Clarified that SLMB Specified Low Income Medicare Beneficiaries can be authorized for up to 3 months prior to the QMB Qualified Medicare Beneficiaries start date.
Addendum 1
Updated with 2025 Federal Poverty Level Changes
Updated Pickle chart
Addendum 5
Removed as an EIS Eligibility Information System notice listing exists in the Admin Manual.
STATE OF ALASKA
Department of Health
Division of Public Assistance
TRANSMITTAL NUMBER: MC #69
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: September 2, 2025
We are making several changes to incorporate new policy, clarifying existing policy, and align policies within our policy manuals. Other changes are either technical in nature or clarifications that are the result of policy questions or suggestions from the field.
Highlights of these policy revisions are described below. If you have any questions, contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
ENTIRE MANUAL
Changed DHCS Division of Health Care Services TPL Third Party Liability Email to doh.hcs.rec.info@alaska.gov
Changed System operations and Help desk to Systems support
506(B) Medicare Enrollment
Clarified that an individual who appears to be eligible must apply for and pursue Medicare coverage.
Added note clarifying that if an individual applies for Medicare and is denied Part A because they would only be eligible if they pay for part A, Medicaid continues, and they would not be eligible for QMB Qualified Medicare Beneficiaries .
520(C) Proof of United States Citizenship and Qualified Alien Status
Added note clarifying that the only states to issue Enhanced Driver's License (EDL/EID) are Washington, Michigan, Minnesota, New York, and Vermont.
520(E) Disability Determination
Added note to clarify that Social Security non-pay status does not necessarily mean that the individual is no longer disabled. An individual in non-pay status may still be eligible for Medicaid, providing they meet all other factors of eligibility.
522(E) Renewal Requirements
Added information regarding the ex parte process.
Added that federal regulations do not allow us to send a renewal form to the household unless we are unable to determine continued eligibility using the ex parte process.
Clarified that individuals who have no income counted on their case and no income is found when checking data sources can only be approved using the ex parte process if we received an application or renewal form attesting to zero income within the last 3 years. This means that the maximum number of ex parte renewals that can be approved for an individual who has no income counted on their case and no income is found when checking data sources is 3. After this time frame, a renewal form must be sent to the household for completion to attest to their income.
523(B) Reasonable Compatibility
Added note clarifying that the earned income exclusions are to be used before the comparison on both the client statement of earnings and DOL Department of Labor and Workforce Development verification.
524(L) Alaska Native and American Indian Real Property Resource Excluded
Clarified when property owned by an Alaska Native or American is sold, the proceeds are no longer exempt.
Linked to APA MS 440-3(C) .
533 Disabled Children at Home ( TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 )
Changed DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Specialized Medicaid PAA Public Assistance Analyst to DPA Division of Public Assistance TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Project Assistant throughout the chapter.
533-C(4) DPA Division of Public Assistance is Responsible For
Clarified what type of coupons need to be issued and matched language to ADLTC 560 .
533-E(2) TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Reviews
Clarified that the caseworker are responsible for approving an LOC Level of Care extension request during the renewal process.
Clarified DDS Disability Determination Service denial procedure clarifying that the caseworker must send a copy of the DDS Disability Determination Service denial letter to policy email for required notice to go out.
570(F) When a Cost-of-Care Begins and Ends
Clarified Caseworkers must automatically enroll SSI Supplemental Security Income recipients who are receiving Medicare part A in the QMB Qualified Medicare Beneficiaries program the first of the month after Medicaid eligibility is determined.
580 Medicare Savings Programs
Clarified Caseworkers must automatically enroll SSI Supplemental Security Income recipients who are receiving Medicare part A in the QMB Qualified Medicare Beneficiaries program the first of the month after Medicaid eligibility is determined.
STATE OF ALASKA
Department of Health
Division of Public Assistance
TRANSMITTAL NUMBER: MC #70
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: December 1, 2025
This year Social Security announced a Cost of Living Allowance ( COLA Cost of Living Allowance ) increase effective January 2026. We have updated Addendum 1 and the examples throughout the manual with the following items to reflect the 2.8% increase for 2026:
An increase to the Long Term Care community spouse resource and income allowance and household member standards;
An increase to the Excess Home Equity resource maximum;
An increase to the Special Long Term Care Income Standard;
Changes in Medicare Part A and B premiums; and
Changes in Medicare Part D premium and coverage information, including changes to the Low-Income Subsidy program
We have also made several changes to clarify existing policy as a result of policy questions or suggestions from the field. An overview of the changes are listed below.
If you have any questions, please contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
506(A) Medicare Enrollment
Revised the note clarifying if an individual applies for Medicare and is denied Part A because they would only be eligible if they pay for part A, Medicaid continues, and the caseworker must make the QMB Qualified Medicare Beneficiaries determination.
520(D) Alaska Native Claims Settlement Act (ANCSA) Payments and Assets
Due to a new bill HR 42 revised section to include:
All ANCSA Alaska Native Claims Settlement Act distributions, including distributions from ANCSA Alaska Native Claims Settlement Act Settlement trusts, received from 7/7/25 - 7/6/30 are excluded as income in the month of receipt and as a resource if retained for aged 65 or older, blind, or disabled individuals.
These distributions are excluded as income in Cost of Care determinations for Special Long Term Care Waiver and institutional cases for the above listed individuals.
523(B) Reasonable Compatibility
Added note clarifying that "interface" should be used as verification in EIS Eligibility Information System for reasonable compatibility as client statement is not allowed for earned income.
523(K ) Development of Income
Added subsection to clarify development of income requirements no longer apply to Medicaid.
525(E) Hardship Exceptions
Clarified that a transfer of asset is the only hardship exception that can be allowed.
528(G) Trust Changes
Clarified the process for trustee changes.
Court paperwork assigning new trustee must be sent to policy for approval.
The Med 20 with new trustee information must be sent to DHCS Division of Health Care Services .
If the original trust is amended it must be sent to policy for review and approval.
554(D) Look Back Period
Updated example due to COLA Cost of Living Allowance change.
570(E)3 Allowable Deduction for Cost of Care Determinations
Updated example of ATAP Alaska Temporary Assistance Program ANI Adult Not Included standard due to COLA Cost of Living Allowance change.
570(G) Retroactive Cost of Care Adjustments
Clarified COCA Cost of Care understated liabilities can be captured in more than one month, such as when lump sum or sums were reported late.
You can increase the cost of care for multiple months when multiple lump sums were received in separate months.
570(H) Nursing Home Examples
Updated example due to COLA Cost of Living Allowance change.
570(J) Home and Community Based Waiver Case Examples
Updated example due to COLA Cost of Living Allowance change.
580(D) Low Income Subsidy (LIS) Program
Updated example due to COLA Cost of Living Allowance change.
Addendum 1 Program Standards
Updated example due to COLA Cost of Living Allowance change.
Updated Medicare Part A, Part B, and Part D premiums for 2026.
Updated 2026 Spousal Impoverishment Standards.
STATE OF ALASKA
Department of Health
Division of Public Assistance
TRANSMITTAL NUMBER: MC #71
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: April 1, 2026
We have updated the 2026 Federal Poverty Level guidelines for income eligibility effective April 1, 2026. We have also updated other sections that use Federal Poverty Level guidelines for income eligibility.
This manual change also consists of several technical changes or clarifications as a result of suggestions from the field. Highlights of these revisions are described below.
If you have any questions, please contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
520(B) When an Application is Required
Added a note to clarify that we do not have to have an application when someone is transitioning from Expansion Medicaid to ADLTC Aged, Disabled, and Long Term Care Medicaid either for being 65 or having a disability determination.
533(E) TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 Reviews
Added to send notice M315 when child is turning 18.
534(K) Example of an Eligibility Determination
Updated examples with 2026 Federal Poverty Level Changes.
534(M) Example of an Eligibility Determination with a Medicaid Qualifying Trust
Updated examples with 2026 Federal Poverty Level Changes.
580 Medicare Savings Programs
Updated QMB Qualified Medicare Beneficiaries and SLMB Specified Low Income Medicare Beneficiaries resource limits.
Addendum 1
Updated with 2026 Federal Poverty Level Changes.
Updated Pickle chart.
STATE OF ALASKA
Department of Health
Division of Public Assistance
TRANSMITTAL NUMBER: MC Manual Change #72
MANUAL: Aged, Disabled and Long Term Care Medicaid Eligibility Manual
DATE: July 1, 2026
We have made several changes to clarify existing policy as a result of policy questions or suggestions from the field. An overview of the changes are listed below.
If you have any questions, please contact the Policy & Program Development Team at hss.dpa.policy@alaska.gov .
OVERVIEW OF CHANGES
522(B)(3) Pending the Application
Replaced 10 day pend with 15 day pend for requested information.
522(B)(5) Withdrawing the Application
Replaced 10 day pend with 15 day pend for requested information.