521 COORDINATION WITH FEDERALLY FACILITATED MARKETPLACE

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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