Individuals included in the MAGI household must apply for benefits from other programs if they appear eligible, even if they are not requesting Medicaid benefits for themselves.
For the purposes of this requirement, a benefit is anything that
1. Requires an application or similar action;
2. Has conditions for eligibility; and
3. Provides regular, intermittent, or one-time payments.
Apply for means the individual must take all appropriate steps to pursue eligibility for the benefit, including
1. Applying for the benefit;
2. Providing the benefit source with the necessary information to determine eligibility or the amount of the benefit;
3. Agreeing to receive the other benefit; and
4. Taking steps to continue receiving benefit payments.
813 A. BENEFIT PROGRAMS FOR WHICH aN APPLICATION MUST BE MADE
The benefit programs for which application must be made include, but are not limited to
1. Social Security (SSA) benefits (such as disability, retirement, early retirement, or survivor's benefits);
2. Department of Veterans Affairs benefits except for Veteran's Disability income;
3. Governmental or employer's private disability programs, and, if the individual is of retirement age, governmental or private employer's retirement programs; and
4. Unemployment Insurance benefits (UIB).
813 B. BENEFIT PROGRAMS FOR WHICH AN APPLICATION IS NOT REQUIRED
Application is not required for
1. Supplemental Security Income (SSI);
2. Bureau of Indian Affairs (BIA) General Assistance;
3. Any Division of Public Assistance program;
4. Veteran's Disability income; or
5. Worker's Compensation income.
Note:
Workers Compensation is still a potential third party resource (TPR) and must be pursued for that purpose only. See section 814 for more information about TPR/TPL.
813 C. APPLYING FOR UNEMPLOYMENT INSURANCE BENEFITS
All individuals must apply for, pursue, and accept any Unemployment Insurance Benefits (UIB) they appear eligible to receive, unless specifically exempt. Pursuit includes complying with all of the UIB program requirements, including being available to accept employment according to Department of Labor’s determination of availability.
Before referring an individual to the Department of Labor (DOL) to apply for UIB, the caseworker must first determine if the individual qualifies for any of the exemptions listed below. If the individual does not qualify for an exemption, the caseworker must determine if the individual appears to meet the financial criteria for UIB. Refer to Administrative Procedures Manual Section 123 for information on use of the UIB interface.
813 D. EXEMPTIONS FOR APPLYING FOR UIB
To qualify for UIB, an individual must be available to accept employment. DPA considers the following individuals generally not available to accept employment and, therefore, they are not required to apply for UIB:
Caretaker Of Baby: This is a parent/caretaker relative with one or more children under the age three.
Note:
This exemption is only available to families with a single caretaker relative or two-parent family where at least one parent is physically or mentally incapable of performing gainful activity. It is not available to two-parent families in which both adults are physically and mentally able to perform gainful activity.
Caretaker Of Disabled Child: This is a parent/caretaker relative who is providing home care for a child with a disability. This exemption must be documented by a physician or other licensed medical professional.
Caretaker Of Disabled Adult: This is a parent/caretaker relative who is providing home care to a related disabled person requiring 24 hour care. This exemption must be documented by a physician or other licensed medical professional.
Medical Reason: This is an individual who is unable to work for medical reasons, as evidenced by (a) being a recipient of SSI, APA, or SSDI; or (b) a physician or other licensed medical professional has documented that the individual is unable to work or pursue employment for medical reasons. The caseworker may waive the medical verification and accept client statement if the caseworker believes
1. There is other evidence to indicate the person would not be able to work for medical reasons; and
2. The individual lives in a remote location and is not likely to have access to a physician or other licensed medical professional within 30 days after receipt of the individual’s identifiable application.
Inappropriate Child Care: This applies when a parent/caretaker relative who lives at home with a child under the age of six demonstrates an inability to find necessary child care because appropriate child care is not available.
Child care is considered appropriate when:
1. A provider who is willing to take care of the parent/caretaker relative’s child appears to have the ability to care for children of the same age and development level as the caretaker relative’s children; and
2. The provider’s location is within 30 minutes travel time by public or private transportation from the parent/caretaker relative’s home or work site.
Child care is considered available when:
1. It is located in the family’s community; and
2. The family has sufficient income, or access to a child care subsidy program, to pay the cost.
If necessary, contact the child care local administrator or resource and referral agency for assistance with this determination.
Under Age 16: A child under age 16 is exempt from applying for UIB.
Full-Time Student: This is an individual who is
1. Age 16 or older and attending, full-time, an elementary or secondary school, vocational or technical training program which leads to a high school diploma or GED; school includes a correspondence study or GED program, or
2. A student in a post-secondary vocational school, technical school, college, or university who attends full-time as defined by that educational institution.
Pregnant Woman: This is a woman in the second or third trimester of a medically verified pregnancy as verified by a physician, physician assistant, or advanced nurse practitioner, public health nurse, or community health aid or is in the 12 month postpartum recuperation period.
Self-Employed: An individual who is already self-employed may be exempt. To qualify for an exemption, the individual must be:
1. Working a monthly average of 30 hours or more per week;
2. Receiving monthly adjusted gross self-employment income that is equal to or greater than the State of Alaska's minimum wage; and
3. Receiving monthly adjusted gross self-employment income at least once per month.
For self-employed individuals, adjusted gross self-employment earnings actually received, or expected to be received, in a month are used to determine the self-employed individual’s hourly rate of pay.
Note:
The minimum wage standards can be found at: http://labor.alaska.gov/lss/whact.htm
The individual's adjusted gross self-employment income must meet or exceed these income standards to be exempt from the pursuit of unemployment income. See section 821 for additional information on self-employment income.
Part Time Employment: The same weekly income standard of 30 hours per week at the State of Alaska’s minimum wage can be applied to individuals who are working for an employer on a part-time basis and receiving regular earnings.
Vista Volunteer: This is an individual who is a full-time VISTA volunteer.
813 E. WRITTEN NOTICE OF REQUIREMENT TO APPLY
It is the caseworker’s responsibility to identify these prior resources. If an individual is potentially eligible for benefits from another program, the individual must be given written notice of the requirement to apply.
Pend Notice for UIB: If an individual appears financially eligible for UIB, they must be given 10 days to apply for and demonstrate pursuit of UIB. As outlined in Admin MS 104-4(B), caseworkers should allow 15 days for households residing in rural areas to accommodate delays in mail delivery.
30-Day Notice for Other Benefits: If an individual appears eligible for benefits other than UIB, the individual must be given 30 days from the date they are notified in writing to apply for and demonstrate pursuit. Applications and benefits will not be delayed during this time period.
For each individual who is required to and who does apply for a benefit program, the caseworker may presume that the requirement for pursuit of benefits is being complied with unless there is evidence to the contrary. If the caseworker discovers that an individual has not actively pursued benefits for which he or she has applied, the caseworker must investigate to see if there is good cause for this failure. Prudent judgment is used in determining if good cause exists. One or more of the exemptions for not applying listed in section 813 D may constitute good cause.
813 G. PENALTY FOR FAILURE TO APPLY
If anyone who must be included in the tax filing household fails, without good cause, to apply for and actively pursue other benefits for themselves or a dependent child, that individual is ineligible for Medicaid following timely notice. If it appears there is good cause for the individual’s failure to apply, the caseworker may give the individual more time to apply for benefits.
Example 1:
Karen and Amir are married and both Expansion Group Medicaid recipients. Amir loses his job and is given notice to apply for UIB. Amir does not apply for benefits by the requested date. Amir's Medicaid closes with 10 day notice of adverse action.
Example 2:
Summer and her 2 children are applying for Medicaid. The father of the children is deceased. The household meets all eligibility factors except for developing their income, as it appears the children are eligible for Social Security Survivor's benefits. The Medicaid benefits are authorized and Summer is given notice to apply for Social Security Survivor's benefits. Summer does not apply for benefits within the 30 day notice. Summer's Medicaid closes with 10 day notice of adverse action.
Example 3:
Kristina and Kacie are married and have 3 children. Kacie lost her job recently so the household applied for MAGI Medicaid. The household meets all eligibility factors except for developing income, as Kacie may be eligible for UIB. Kacie tells the ET that she doesn't want to apply for benefits. However, Kacie must be given the opportunity to apply for benefits in writing. The application is pended for 10 days. Kacie decides not to apply for UIB. At the end of the 10 day pend period, the ET authorized MAGI Medicaid for Kristina and the 3 children. Kacie is penalized and her benefits are denied.
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