816               MAGIModified Adjusted Gross Income MEDICAID CATEGORIES

Along with meeting all other factors of eligibility, to be eligible for MAGIModified Adjusted Gross Income Medicaid, an individual must meet eligibility criteria for one of the following categories. Individuals may meet the eligibility criteria for more than one category. The categories below are listed in the order that should be used when determining which category of MAGIModified Adjusted Gross Income Medicaid to authorize.

• Newborn
• Pregnant Women
• Children Under 19 years old
• Parent/Caretaker Relatives
• Under 21
• Former Foster Care
• Expansion Group

Note:

Effective January 1, 2023, if we have verification that an individual is eligible for the FFCFormer Foster Care category but do not have the verification needed for another category higher on the hierarchy list, we should authorize benefits in the FFCFormer Foster Care category without asking the individual to provide any information needed make an eligibility decision in another category.

Example:

Leafaina is a 25 year old pregnant woman, has no other dependents, and no income. She also aged out of Alaska foster care. Her eligibility is determined using the Pregnant Women Category. When she reports that her baby was born and after her post-partum period ends, her Medicaid eligibility is determined using the Parent/Caretaker Relative category. A few months later Leafaina gets a new job and is now over-income for Medicaid in the Parent/Caretaker relative category. She now becomes eligible in the Former Foster Care category as there is no income limit for this category of Medicaid. When she turns 26 and is no longer eligible for the Former Foster Care category, she may be eligible for the remaining months of Transitional Medicaid.

816 A. INDIVIDUALS THAT MAY MEET ELIGIBILITY FACTORS FOR BOTH MAGIModified Adjusted Gross Income MEDICAID AND ADLTCAdult Disabled and Long Term Care MEDICAID

Federal regulations require that individuals who are eligible for both MAGIModified Adjusted Gross Income Medicaid and ADLTCAdult Disabled and Long Term Care Medicaid be allowed to choose the Medicaid category for which they wish to apply. Since Alaska does not have a difference in benefit package between MAGIModified Adjusted Gross Income Medicaid and ADLTCAdult Disabled and Long Term Care Medicaid, applications should be triaged based on the following guidance:

• If an individual already has a disability determination, the caseworker should determine their eligibility for disability related Medicaid and only determine their eligibility for MAGIModified Adjusted Gross Income Medicaid if they are found to be ineligible for disability related Medicaid.

• If the individual does not yet have a disability determination but states they are seeking a determination, the caseworker should determine their eligibility for MAGIModified Adjusted Gross Income Medicaid since it may take a while until the individual receives a disability determination. 

An individual may be eligible in one category pending an eligibility determination in another category. The individual should be sent a notice about the choice of categories (see section 802-3).

There are some exceptions when an individual may meet all eligibility factors for both MAGIModified Adjusted Gross Income Medicaid and ADLTCAdult Disabled and Long Term Care categories, but is not given a choice of category. These exceptions are SSISupplemental Security Income recipients and disabled children, where the SSISupplemental Security Income or 300% of SSISupplemental Security Income standard is used to determine eligibility. These individuals will be determined eligible in the ADLTCAdult Disabled and Long Term Care category.