522 MEDICAID EXCEPTIONS TO APA ELIGIBILITY POLICY

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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