Sec. 7 AAC 100.032 - Development of income

ยง 7 AAC 100.032. Development of income

(a) Except as otherwise provided in this section, to be eligible for Medicaid, a member of a household who may be eligible for benefits under one or more of the following programs must apply for and, if eligible, accept benefits from that program:

(1) workers' compensation under AS 23.30;

(2) social security disability, old-age, or survivor's benefits under 42 U.S.C. 401 - 434;

(3) United States Department of Veterans Affairs benefits under 38 U.S.C. 101 - 8528;

(4) civil service disability and retirement under 5 U.S.C. 8101 - 9009;

(5) railroad disability and retirement under 45 U.S.C. 231 - 231 e;

(6) government or private retirement programs;

(7) unemployment insurance benefits under AS 23.20.330-23.20.405.

(b) An applicant or recipient is not required to apply for benefits from the following programs to be eligible for Medicaid:

(1) supplemental security income (SSI) under 42 U.S.C. 1381 - 1383 f;

(2) United States Department of Interior, Bureau of Indian Affairs general assistance under 25 U.S.C. 13d-1 - 13d-3;

(3) any other assistance program administered by the department.

(c) The department will screen each applicant's or recipient's application for potential eligibility for one or more of the programs identified in (a) of this section and, if potential eligibility is identified, notify the applicant or recipient that the applicant or recipient must apply for that program. In the notice, the department will inform the applicant or recipient that if the applicant or recipient fails to apply for and, if found eligible, accept a benefit from that program within the time frame identified in (d) or (e) of this section, whichever is applicable,

(1) the entire household will become ineligible for Medicaid benefits if the applicant or recipient is a mandatory member of the household under 7 AAC 100.104; or

(2) the applicant or recipient, and the applicant's or recipient's spouse, will become ineligible for Medicaid benefits if the applicant or recipient is not a mandatory member of the household.

(d) Except as provided in (e) of this section for unemployment insurance benefits, if, after receiving a notice under (c) of this section, and without good cause under (h) of this section, an applicant or recipient fails to apply for or, if eligible, accept any benefits from a program listed in (a) of this section within 30 days after the date on the notice, the department will take action under (f) of this section.

(e) If, after receiving a notice under (c) of this section, and without good cause under (h) of this section, an applicant or recipient fails to apply for or, if eligible, accept any unemployment insurance benefits within 10 days after the date on the notice, the department will take action under (f) of this section.

(f) If, after the time period specified in (d) or (e) of this section, and without good cause under (h) of this section, an applicant or recipient has failed to apply for or, if eligible, accept a benefit described in (a) of this section, the department will notify the applicant or recipient that Medicaid benefits will be discontinued. An applicant or recipient has 10 days after the date notice is sent under this subsection to comply with the requirements of this section or provide evidence of good cause for failure to comply with those requirements.

(g) For the purposes of Medicaid eligibility under this chapter, the following individuals are considered unavailable to accept employment and are not required to apply for unemployment insurance benefits:

(1) a parent or caretaker relative who is providing care at home to a

(A) child under the age of three;

(B) child with a disabling condition documented by a physician, physician assistant, or advanced nurse practitioner; or

(C) related adult with a disabling condition who requires 24-hour care; the disabling condition must be documented by a physician, physician assistant, or advanced nurse practitioner;

(2) an individual who has a medical reason for being unable to work or pursue employment; to establish that a medical reason exists, the recipient must

(A) be a recipient of SSI, APA, or SSDI;

(B) have the medical reason verified by a physician, physician assistant, or advanced nurse practitioner; or

(C) submit other information satisfactory to the department of a medical reason, if the applicant lives in a remote location and is unlikely to have access to a physician, physician assistant, or advanced nurse practitioner who can verify a medical reason under (B) of this paragraph within 30 days after the department's receipt of an identifiable Medicaid application;

(3) a parent or caretaker relative who

(A) lives at home with a child under six years of age; and

(B) demonstrates that the parent or caretaker's household does not have

(i) sufficient income to pay for appropriate child care; or

(ii) access to child care assistance under 7 AAC 41;

(4) a child under 16 years of age;

(5) a full-time student attending elementary school, secondary school, post-secondary school, vocational or technical school, or another program that leads to a high school diploma, general education development (GED) credential, or post-secondary diploma; in this paragraph "full-time" has the same meaning used by the education institution being attended;

(6) a woman in her second or third trimester of pregnancy, as verified in accordance with 7 AAC 100.124, or who is in the 60-day postpartum recuperation period;

(7) a self-employed individual who is working at least a monthly average of 30 hours per week and who is receiving monetary compensation equal to or greater than the minimum wage established under AS 23.10.065 at least once per month for the work performed;

(8) a volunteer in the Volunteers in Service to America (VISTA) program under 42 U.S.C. 4951 - 4995.

(h) Good cause is determined by the department and includes

(1) a weather condition that causes a mail delay;

(2) an applicant's or recipient's lack of transportation;

(3) an illness of the applicant, the recipient, or a member of the applicant's or recipient's family;

(4) an emergency in the applicant's or recipient's family, including death in the family; and

(5) another circumstance beyond the applicant's or recipient's control that prevents the applicant or recipient from applying for or, if eligible, accepting a benefit described in (a) of this section.

(i) In this section,

(1) "apply for" means to actively pursue the benefits of an assistance program by complying with all application and program requirements;

(2) "appropriate child care" means a provider

(A) who is willing to take care of the child and who appears to have the ability to care for children of the same age and developmental level as the parent's or caretaker relative's child; and

(B) whose location is within 30 minutes' travel time by public or private transportation from the parent's or caretaker relative's home or work site;

(3) "disabling condition" means a condition that prevents an individual from caring for that individual's own daily health care needs or managing that individual's own daily affairs.

(Eff. 7/20/2007, Register 183)

Authority:AS 47.05.010

AS 47.07.040

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