Sec. 7 AAC 100.002 - Medicaid eligibility categories recognized in the state

ยง 7 AAC 100.002. Medicaid eligibility categories recognized in the state

(a) Except as provided in (b) of this section, the specific mandatory eligibility categories required under AS 47.07.020(a) for individuals, children, and families are

(1) households that

(A) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(i)(I) and 42 U.S.C. 1396u-1; and

(B) are eligible for Family Medicaid under 7 AAC 100.100 - 7 AAC 100.199;

(2) individuals who lose eligibility under (a)(1) of this section due to earnings and who

(A) meet the requirements of 42 U.S.C. 1396r-6; and

(B) are eligible under 7 AAC 100.200 - 7 AAC 100.209;

(3) individuals who lose eligibility under (a)(1) of this section due to increased income from collection of child or spousal support and who are eligible under 7 AAC 100.210;

(4) pregnant women who are

(A) qualified pregnant women as described in 42 U.S.C. 1396 a(a)(10)(A)(i)(III) or poverty-level pregnant women as described in 42 U.S.C. 1396 a(a)(10)(A)(i)(IV); or

(B) eligible under 7 AAC 100.300 - 7 AAC 100.306;

(5) newborns who meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(i)(IV) and are eligible under 7 AAC 100.300 - 7 AAC 100.306;

(6) poverty-level children at least one year of age and under six years of age who meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(i)(VI) and are eligible under 7 AAC 100.310 - 7 AAC 100.312;

(7) poverty-level children at least six years of age and under 19 years of age who meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(i)(VII) and are eligible under 7 AAC 100.310 - 7 AAC 100.314;

(8) children receiving Title IV-E foster care assistance, adoption assistance, or relative guardianship assistance who meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(i)(I) and are eligible under 7 AAC 100.270; and

(9) individuals described in 42 C.F.R. 435.114, revised as of October 1, 2005 and adopted by reference, who would have been eligible for Aid to Families with Dependent Children (AFDC) under former AS 47.25.301-47.25.470 had the increase in OASDI under P.L. 92-336 not raised their income over the limit allowed under AFDC.

(b) The specific Medicaid eligibility categories required under AS 47.07.020(a) for individuals with a disability or who are 65 years of age or older are

(1) individuals who are receiving or considered to be recipients of SSI who

(A) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(i)(II); and

(B) are eligible under 7 AAC 100.410;

(2) individuals who are deemed to be SSI recipients under 42 U.S.C. 1396 a(a)(10)(A)(i)(I) or 42 U.S.C. 1396 a(a)(10)(A)(i)(II) as determined under 42 C.F.R. 435.120, revised as of October 1, 2005, and adopted by reference; individuals in the eligibility category described in this paragraph include

(A) an individual with a disability who would be eligible under (b)(1) of this section except the individual's earnings exceed the SSI substantial gainful activity level in accordance with 42 U.S.C. 1382 h(a);

(B) subject to the restriction under 7 AAC 100.412, a blind or disabled individual who would be eligible under (b)(1) of this section except the individual's earnings are too high to receive SSI benefits in accordance with 42 U.S.C. 1382 h(b); and

(C) a qualified severely impaired individual who would be eligible under (b)(1) of this section except the individual's earnings are too high to receive SSI benefits in accordance with 42 U.S.C. 1396 d(q);

(3) individuals ineligible for SSI or APA because of requirements that do not apply to Medicaid who are eligible under 7 AAC 100.414;

(4) individuals who would be eligible for SSI or APA if the individual had not received the annual cost-of-living increase to that individual's OASDI benefits and who

(A) meet the requirements of 42 C.F.R. 435.135, revised as of October 1, 2005 and adopted by reference;

(B) meet the requirements set out in sec. 503, P.L. 94-566; and

(C) are eligible under 7 AAC 100.416;

(5) disabled widows or widowers described in 42 C.F.R. 435.137, revised as of October 1, 2005, and adopted by reference, who would be eligible for SSI or APA except for the elimination of the additional reduction factors for disabled widows and widowers who are deemed to be receiving SSI for Medicaid purposes in accordance with 42 U.S.C. 1383 c(b);

(6) blind or disabled individuals deemed to be receiving SSI for Medicaid purposes in accordance with 42 U.S.C. 1383 c(c) and who are eligible under 7 AAC 100.420;

(7) disabled widows or widowers described in 42 C.F.R. 435.138, revised as of October 1, 2005, and adopted by reference, who would be eligible for SSI except for receipt of early social security disability benefits according to the provisions of 42 U.S.C. 1383 c(d);

(8) individuals who

(A) would have been eligible for SSI or APA had the increase in OASDI under P.L. 92-336 not raised their income over the limit allowed under SSI or APA; and

(B) are eligible under 7 AAC 100.422(a);

(9) institutionalized individuals who

(A) were eligible for Medicaid in December 1973; and

(B) are eligible under 7 AAC 100.422(b);

(10) blind or disabled individuals who

(A) were eligible for Medicaid in December 1973; and

(B) are eligible under 7 AAC 100.422(c);

(11) individuals who

(A) were entitled to a mandatory state supplement in December 1973 by meeting the requirements of P.L. 93-66 and P.L. 93-233; and

(B) are eligible under 7 AAC 100.422(d); and

(12) children who

(A) were receiving SSI on August 22, 1996;

(B) lost SSI because of the amendment to the definition in 42 U.S.C. 1382 c(a)(3) of "childhood disability" by sec. 201(a), P.L. 104-193 (Personal Responsibility and Work Opportunity Reconciliation Act of 1996); and

(C) are eligible under 7 AAC 100.422(e).

(c) Except as provided in (d) of this section, the specific optional eligibility categories under AS 47.07.020(b) for children and families are

(1) under AS 47.07.020(b)(1), households that meet

(A) the income and resource requirements of Family Medicaid under 7 AAC 100.100 - 7 AAC 100.199, but who are not receiving Family Medicaid benefits under (a)(1) of this section; and

(B) the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(I);

(2) under AS 47.07.020(b)(8), individuals under 21 years of age who

(A) would be eligible for Family Medicaid under 7 AAC 100.100 - 7 AAC 100.199, except that they have the care and support of both parents;

(B) are not covered under (a) of this section;

(C) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(I) and 42 U.S.C. 1396 d(a)(i); and

(D) are eligible under 7 AAC 100.250 - 7 AAC 100.252;

(3) under AS 47.07.020(b)(5), individuals under 21 years of age who

(A) are in an institution designated as an intermediate care facility for the mentally retarded;

(B) are financially eligible for Family Medicaid under 7 AAC 100.100 - 7 AAC 100.199, or would be eligible if not living in a medical institution;

(C) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(IV); and

(D) are eligible under 7 AAC 100.252;

(4) under AS 47.07.020(b)(7), individuals under 21 years of age, except as provided in (g) of this section, who

(A) are receiving active treatment in an inpatient psychiatric hospital or residential psychiatric treatment center;

(B) are financially eligible for Family Medicaid under 7 AAC 100.100 - 7 AAC 100.199, or would be eligible if not receiving active treatment in an inpatient psychiatric hospital or residential psychiatric treatment center;

(C) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(IV); and

(D) are eligible under 7 AAC 100.252;

(5) under AS 47.07.020(b)(3), individuals under 21 years of age who

(A) are under the protective custody or supervision of the department, for whom maintenance is being paid in whole or in part from public funds, and who are in foster homes or private child-care institutions;

(B) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(I) and 42 U.S.C. 1396 d(a)(i); and

(C) are eligible under 7 AAC 100.254;

(6) under AS 47.07.020(b)(10), individuals under 21 years of age who

(A) are receiving state-only adoption subsidies under 7 AAC 53.227;

(B) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(VIII); and

(C) are eligible under 7 AAC 100.256;

(7) under AS 47.07.020(b)(9), pregnant women who

(A) are not covered under (a) of this section;

(B) meet the income and resource requirements of Family Medicaid under 7 AAC 100.100 - 7 AAC 100.199;

(C) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(I); and

(D) are eligible under 7 AAC 100.300 - 7 AAC 100.302;

(8) under AS 47.07.020(b)(13), individuals under 19 years of age who

(A) are not covered under (a) of this section;

(B) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(XIV); and

(C) are eligible under 7 AAC 100.310 - 7 AAC 100.314; and

(9) under AS 47.07.020(b)(14), pregnant women who

(A) are not covered under (a) of this section;

(B) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(IX); and

(C) are eligible under 7 AAC 100.300 - 7 AAC 100.302.

(d) The specific optional eligibility categories under AS 47.07.020(b) for individuals with a disability or who are 65 years of age or older are

(1) under AS 47.07.020(b)(4), individuals who

(A) are not receiving SSI, but who are eligible for and receiving only the optional state supplementary payment under the APA program;

(B) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(XI);

(C) meet the requirements of 42 C.F.R. 435.232, revised as of October 1, 2005, and adopted by reference; and

(D) are eligible under 7 AAC 100.410(b);

(2) under AS 47.07.020(b)(2), individuals who

(A) would be eligible for APA payments if they were not residing in a general hospital, skilled nursing facility, or intermediate care facility;

(B) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(IV);

(C) meet the requirements of 42 C.F.R. 435.211, revised as of October 1, 2005, and adopted by reference; and

(D) are eligible under 7 AAC 100.500(1);

(3) under AS 47.07.020(b)(1), individuals who

(A) are eligible for but who have chosen not to receive SSI or APA;

(B) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(I);

(C) meet the requirements of 42 C.F.R. 435.210, revised as of October 1, 2005, and adopted by reference; and

(D) are eligible under 7 AAC 100.410(c);

(4) under AS 47.07.020(b)(6), individuals who

(A) are residing in a medical institution, other than an assisted living home;

(B) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(V);

(C) meet the requirements of 42 C.F.R. 435.236(a)(1) - (2), revised as of October 1, 2005, and adopted by reference; and

(D) are eligible under 7 AAC 100.500(2);

(5) under AS 47.07.020(b)(11), children with a disability living at home who meet the requirements of 42 U.S.C. 1396 a(e)(3) and who are eligible under 7 AAC 100.424;

(6) under AS 47.07.020(b)(12), individuals with a disability who

(A) are ineligible for cash assistance due to earnings and who gain access to Medicaid through the payment of premiums;

(B) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(XIII); and

(C) are eligible under 7 AAC 100.426;

(7) under AS 47.07.020(b)(15), women diagnosed with breast and cervical cancer who meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(XVIII) and are eligible under 7 AAC 100.710;

(8) under AS 47.07.020(b)(6), individuals who

(A) would be eligible for Medicaid under (a)(4) of this section if they were institutionalized and who, but for the provision of home and community-based waiver services, would require institutionalization;

(B) meet the requirements of 42 U.S.C. 1396 a(a)(10)(A)(ii)(VI);

(C) meet the requirements of 42 C.F.R. 435.217, revised as of October 1, 2005, and adopted by reference; and

(D) are eligible under 7 AAC 100.502.

(e) The specific mandatory Medicare cost-sharing eligibility categories for individuals with a disability or who are 65 years of age or older required under AS 47.07.020(a) are

(1) qualified Medicare beneficiaries, for individuals who meet the requirements of 42 U.S.C. 1396 a(a)(10)(E)(i) and are eligible under 7 AAC 100.750 and 7 AAC 100.752;

(2) qualified disabled and working individuals, for individuals who meet the requirements of 42 U.S.C. 1396 a(a)(10)(E)(ii) and are eligible under 7 AAC 100.750 and 7 AAC 100.758;

(3) specified low-income Medicare beneficiaries, for individuals who meet the requirements of 42 U.S.C. 1396 a(a)(10)(E)(iii) and are eligible under 7 AAC 100.750 and 7 AAC 100.754; and

(4) qualified individuals, for individuals who meet the requirements of 42 U.S.C. 1396 a(a)(10)(E)(iv) and are eligible under 7 AAC 100.750 and 7 AAC 100.756.

(f) A mandatory eligibility category for individuals who do not meet United States citizenship requirements for Medicaid is required under AS 47 07.020(a) which provides limited coverage for the treatment of an emergency medical condition. This eligibility category is available to individuals who

(1) meet the requirements of 42 U.S.C. 1396 b(v); and

(2) are eligible under 7 AAC 100.700.

(g) A recipient eligible for Medicaid under (c)(4) of this section may continue to receive inpatient psychiatric services while under 22 years of age if the recipient

(1) meets the requirements of 42 C.F.R. 435.1008, revised as of October 1, 2005 and adopted by reference; and

(2) has continuously resided in an inpatient psychiatric hospital or residential psychiatric treatment center since being determined eligible for Medicaid under (c)(4) of this section.

(Eff. 7/20/2007, Register 183; am 1/1/2011, Register 196; am 4/13/2011, Register 198)

Authority:AS 47.05.010

AS 47.07.020

AS 47.07.040

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