7 AAC 100.016 - Verification and documentation

Current through December 2, 2021

(a) The department will verify whether an applicant or recipient meets eligibility requirements.

(b) The department will request in writing that an applicant or recipient provide documentation that the applicant or recipient meets eligibility requirements if the required documentation is not readily available to the department from any alternative source or the information needed cannot be verified from an alternative source readily available to the department. Except as provided in 7 AAC 100.030, an applicant or a recipient who refuses to provide the department with documentation under this section will be determined ineligible for Medicaid by the department.

(c) The department will determine whether the verification and documentation supports a finding of eligibility by evaluating whether

(1) it reasonably proves the fact in question;

(2) it is consistent with all other information contained in the application and record; and

(3) alternative types of verification or documentation, if necessary, are obtainable.

(d) If an applicant who is eligible to receive Medicaid benefits based on the application and all other documents and verification available has not provided all of the documentary evidence needed to verify all eligibility requirements, the department will authorize issuance of benefits only for the month in which the application was received and the following month, and only if the

(1) applicant shows that the applicant

(A) does not possess the necessary documents;

(B) cannot readily obtain the documents;

(C) has requested any custodian of the documents to provide them; and

(D) cannot reasonably be expected to receive the documents within 30 days after requesting them from any custodian;

(2) department has made at least one other contact that supports the applicant's claim that an unverified eligibility requirement is met; and

(3) department does not have evidence that the eligibility requirement is not met.

Notes

7 AAC 100.016

Eff. 7/20/2007, Register 183

Authority:AS 47.05.010

AS 47.07.040