825 Coordination with Federally Facilitated Marketplace
Applications for MAGI Medicaid may be submitted any time to DPA or through the Federally Facilitated Marketplace (FFM). Applications for qualified health plans through the FFM are only accepted during the annual open enrollment period and special enrollment periods.
The special enrollment period allows some individuals to enroll in a qualified health plan through the FFM after the open enrollment period ends. There are three reasons listed that relate to Medicaid.
1. Medicaid/CHIP to Marketplace Transfer
Someone is eligible for special enrollment if they were found ineligible for Medicaid and their application was not transferred between the State and the FFM in time for the individual to enroll in a plan during open enrollment. This includes those who applied with the Division of Public Assistance and were found ineligible for Medicaid and referred to the FFM as well as people who applied for health care through the FFM, were assessed eligible for Medicaid by the FFM and were subsequently found ineligible for Medicaid and referred back to the FFM.
2. Unresolved Casework
This refers to applications pended for more information where the pend period did not end before the end of the open enrollment period.
3. Life changes.
If an individual reports a life change such as a loss of income or divorce.
An individual who receives a special enrollment period for being “in line” prior to the end of open enrollment and selects coverage will be able to claim a hardship exemption from responsibility for payments for the months prior to the effective date of their coverage. In other words, they will not be charged a financial penalty for failing to enroll before the end of open enrollment.
825 A. Applications Submitted through the Federally Facilitated marketplace
When an individual submits an application to the FFM and is assessed for Medicaid eligibility, the application information is transferred to ARIES via account transfer. The account will contain all of the information the individual provided on the application as well as indication as to whether information was verified through the HUB. The FFM uses different data sources as verification, but we must accept any finding relating to a criterion of eligibility made by the FFM, without further verification. The account transfer will also identify individuals who should be screened for eligibility on a basis other than MAGI and whether an individual has requested a full eligibility determination by Alaska.
Determined Eligible: As of November 1, 2015, Alaska entered into an agreement with the FFM that gave them the authority to make a final determination of MAGI-based Medicaid. Per the agreement, MAGI-based eligibility determinations made by the FFM are accepted as final. The FFM will send the correspondence notifying the individual/household of their eligibility.
Undetermined: If the FFM determines a full formal Medicaid determination is needed or an application for Non-MAGI or Emergency Treatment for Aliens is received, DPA must make an eligibility determination using our normal process. DPA cannot pend for information already given to the FFM.
Potentially Eligible: If the FFM determines that the individual appears likely to be eligible for Medicaid, but they have identified an inconsistency between information on the application and information obtained through the HUB, the application is transferred to ARIES for resolution and a final eligibility determination.
Partially Eligible: In some situations, the FFM may be able to verify eligibility for some household members but not others. In these situations, for household members determined eligible, DPA will use the information transferred from the FFM to issue Medicaid benefits. For those that the FFM could not determine eligible, then DPA must make a full determination.
Note:
If we determine an individual ineligible for Medicaid (denial or termination), their information must be electronically transferred to the FFM so that they can determine their eligibility for QHP.
Individuals who are found ineligible for Medicaid due to procedural reasons and those who do not attest to U.S. citizenship or eligible alien status should not be referred to the FFM.
A procedural denial or termination is one based on something other than a confirmation of ineligibility. Examples are failure to provide information needed to determine eligibility (including failure to verify eligible alien status after a reasonable opportunity period), failure to comply with assignment of rights or medical child support cooperation requirements, and failure to apply for other benefits for which the individual may be eligible.
825 B. Applications Submitted through DPA
Medicaid eligibility will be determined for each application for medical assistance submitted to DPA. If the household is not eligible for any category of Medicaid, the application will be denied and household information will be transferred to the FFM by entering the information into ARIES. The FFM will then determine the household’s eligibility for the APTC and provide information to the household about QHP they may purchase.
Note:
If we determine an individual ineligible for Medicaid (denial or termination), their information must be electronically transferred to the FFM so that o they can determine their eligibility for QHP.
Individuals who are found ineligible for Medicaid due to procedural reasons and those who do not attest to U.S. citizenship or eligible alien status should not be referred to the FFM.
A procedural denial or termination is one based on something other than a confirmation of ineligibility. Examples are failure to provide information needed to determine eligibility (including failure to verify eligible alien status after a reasonable opportunity period), failure to comply with assignment of rights or medical child support cooperation requirements, and failure to apply for other benefits for which the individual may be eligible.
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