7 AAC 100.426 - Working disabled Medicaid buy-in

(a) An individual with a disability who is ineligible for APA under 7 AAC 40 or APA-related Medicaid under 7 AAC 100.400 - 7 AAC 100.424 because of earned income that is either the individual's own income or the income of the individual's spouse, is eligible for Medicaid under 7 AAC 100.002(d) (6) and this section if
(1) the family monthly net income as determined under (b) of this section is less than 250 percent of the federal poverty guidelines for this state, adopted by reference under 7 AAC 100.980;
(2) excluding all earned income, including any deemed earned income as determined under (c) of this section, the disabled individual's remaining unearned income is equal to or less than the monthly need standard identified in 7 AAC 40.310;
(3) the Department of Labor and Workforce Development or the United States Social Security Administration determines that the individual is disabled according to SSI criteria;
(4) the individual's nonexcludable resources do not exceed $10,000 for the individual or, if the individual is living with a spouse, the nonexcludable resources of the individual and individual's spouse do not exceed $15,000;
(5) the individual meets all other nonfinancial eligibility criteria for APA; and
(6) the individual pays a monthly premium as required under this section.
(b) The department will determine net family income by combining all nonexcluded income of each family member and then, using APA methodology applicable under 7 AAC 100.400, subtracting all disregards and exclusions, including impairment-related work expense exclusions under 7 AAC 40.320(a) (21). The spousal deeming provisions of 7 AAC 40.240 do not apply.
(c) When determining the unearned income of a disabled individual, the department will count the unearned income of a spouse.
(d) A disabled individual eligible under this section must pay a premium to the state as determined by the department. Premiums will be assessed on a sliding fee schedule based on the family's annual net income, and calculated using the formula set out in sec. 10, ch. 130, SLA 1998. An individual is not subject to a premium if the annual family income is below 100 percent of the federal poverty guidelines for this state, adopted by reference under 7 AAC 100.980. An individual's monthly premium may not exceed 10 percent of the disabled individual's net family income. Eligibility for Medicaid under this section will be terminated if an individual is 60 days delinquent in paying a premium.
(e) A Medicaid qualifying income trust under 7 AAC 100.610 may be used to reduce income under this section. Net family income must include any payment made from a trust to the disabled individual. A payment from a trust is unearned income. If a trust pays an individual's premium under this chapter, the payment is not income if the payment is made by the trust directly to the department.
(f) An individual may be eligible for Medicaid under this section even if the individual has not actually received APA or APA-related Medicaid under 7 AAC 100.400 - 7 AAC 100.424 before.
(g) In this section, "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 more than 50 percent of the time in a month. In this subsection, "dependent child" means an individual who
(1) is the child of either the eligible or ineligible spouse;
(2) is not married;
(3) is not the head of the household;
(4) lives in the same household with the applicant; and
(5) is under
(A) 18 years of age; or
(B) 22 years of age and attending a school, college, university, or course of vocational school or technical training to prepare for gainful employment.


7 AAC 100.426
Eff. 7/20/2007, Register 183

Authority:AS 47.05.010

AS 47.07.020

AS 47.07.040

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