(a) Except as
provided in (h) of this section, at least once every 12 months, the department
will require a recipient who is eligible for Medicaid to submit a review
application on a form provided by the department and furnish the documentation
requested by the department to support continued eligibility.
(b) Repealed 10/1/2009.
(c) Repealed 4/1/2009.
(d) The department will notify a recipient or
a known person acting on the recipient's behalf that a review of the
recipient's eligibility is required and the date on or before which the
recipient must submit the recipient's review application. In the notice, the
department will state that failure to submit a review application on or before
the date stated in the notice will result in the recipient's loss of
eligibility under (e) of this section.
(e) Except as provided in
AAC 100.070 and (f) of this section, if a recipient
fails to submit a review application on or before the date indicated in the
notice under (d) of this section, the recipient will lose Medicaid
(f) If a recipient is
receiving SSI, the department will continue that recipient's Medicaid
eligibility until the department receives verification that the recipient has
ceased getting SSI or has moved out of the state, even if the recipient fails
to submit the recipient's review application.
(g) The department may set a recipient's
review period of less than the duration set in (a) of this section to establish
a review date that coincides with a level of care review date, home and
community-based waiver services review date, or other significant date related
to that recipient's continued eligibility for Medicaid or other programs
administered by the department.
Notwithstanding the review periods established in (a) - (g) of this section,
upon receipt of information from any source that indicates that a change in
circumstances affecting a recipient's continued eligibility may have occurred,
the department will investigate and may require that a review application be
(i) If additional
verification or documentation is necessary to support continued eligibility
under this section, the department will act in accordance with
In this section,
(1) "review date" means the date marking the
end of a review period and the end of a recipient's Medicaid eligibility for or
authorization for services if the department does not redetermine the
recipient's eligibility under this chapter;
(2) "review period" means the period of time
a recipient is eligible for Medicaid without the department redetermining the
recipient's Medicaid eligibility.