STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #1
MANUAL: MAGI Medicaid program
DATE: December 1, 2016
Beginning January 1, 2014, due to the Affordable Care Act, MAGI Medicaid replaced Family Medicaid. This manual change encompasses the new policy that is used for MAGI Medicaid eligibility determinations. Historical Family Medicaid policy and procedures have been removed.
Highlights of the further policy changes are described below.
If you have any questions please contact the Policy and Program Development Team at dpapolicy@alaska.gov.
OVERVIEW OF CHANGES
806-1 B. An Application is Required
Corrected policy by removing the 90-day timeframe to reinstate a withdrawn application. This no longer applies since Alaska became a determination state.
806-2 F. Delayed Application
Added clarification for actions taken on applications more than 30 days old.
806-3 Renewal Requirements
Clarified that renewals must be processed within 30 days of receipt by DPA.
Clarified that if a renewal form is not received, DPA must attempt to renew the case within 30 days of the previously authorized certification period.
808-6 Proof of United States Citizenship and Qualified Alien Status
Updated section to match federal regulations.
808-6 A. Clarified that individuals entitled to or receiving any Medicare benefits are exempt from providing proof of their U.S. citizenship.
808-6 E. Clarified that BVS documents are not sufficient to verify citizenship on their own. An approved identification document must also be provided.
808-7 B. Medicaid Eligibility During the Reasonable Opportunity Period
Clarified in the Note section that Pregnant Women Medicaid coverage will end if U.S. citizenship or qualified alien status is not verified by the end of the reasonable opportunity period.
809 F. Out of State Individual Moves to Alaska
Clarified that for individuals moving to Alaska to receive Alaska Medicaid in a month that they already received Medicaid benefits in another state, as long as case closure in the other state has been verified, client statement is sufficient verification that benefits were not used in the other state.
812 B. Who is not Required to Cooperate
Clarified a non-parent/caretaker relative is not required to cooperate with child support requirements.
Removed exemption that applicants under the age of 21 are not required to cooperate with CSSD as this is old Family Medicaid policy.
812-1 Informing Applicants and Recipients about Medical Support Orders and Requirements
Added that if all other eligibility requirements are met except for statement of cooperation, non-cooperation, or good cause, the child(ren)’s Medicaid can be authorized and the parent/caretaker must be sent notification of the requirements. Also, if otherwise eligible, the child(ren)’s benefits should be authorized while waiting for the parent/caretaker to cooperate with CSSD.
Clarified that the Child Support Information form is no longer sent to CSSD. This form is used by DPA to collect whether a client agrees to cooperate, is requesting good cause, and information about the non-custodial parent. The individual will work directly with CSSD for choosing to opt out of cash enforcement support, keeping information confidential, etc.
812-4 E. Penalty for Failure to Cooperate
Removed situation that an adult under 21 is not penalized for failure to cooperate with CSSD. A parent or guardian (over 18 years old), unless exempt, must cooperate with CSSD.
813 Development of Income
Clarified that if a person is part of the tax filing unit with household members requesting Medicaid, the individual needs to develop their income if applicable.
813 D. Exemptions for Applying for UIB
Corrected terminology from post-graduate to post-secondary in exemption.
813 G. Penalty for Failure to Apply
Clarified that if a household member fails to develop income the other household members will not be penalized.
814 E. (1) ET Actions Related to TPL/TPR
Corrected TPL policy to match Child Support Policy per clarification from CMS. The Medicaid benefit must be authorized while we are waiting for TPL details.
Clarified that termination of TPL must be verified.
814 G. Cooperation with TPL/TPR and Individuals Under 18
Changed the age to 18 from 21 years old to match MAGI policy requirements.
815-1 Children in Residential Treatment Centers over 30 Days
Removed information for children in residential treatment centers eligible in the Non-MAGI category and added a link to the Residential Treatment Center section of the ADLTC manual.
816-1 B. Pregnant Women
Per federal regulations, removed verification requirement for multiple expected births. Client statement is acceptable.
816-1 C. Continuous Eligibility for Children
Clarified that in a renewal situation, the new CEP begins the first of the month after a renewal is worked, not the first of the month after the previously approved CEP ended.
816-1 D. Parent/Caretaker Relative
Corrected the policy that a parent who has had their legal and financial ties to a child severed by adoption cannot be considered parent/caretaker relative for that child. Per CMS, the parent/caretaker relative must have legal rights over the child to be considered a parent/caretaker relative for Medicaid purposes.
817-1 Construct a MAGI Household for Each Individual
Corrected tax dependent household size as the tax dependent’s spouse’s income is countable if they are filing taxes jointly or living together.
820 B. Prospective Determination
Removed Family Medicaid policy “However, if it appears that the household will again be prospectively eligible in the following month, the ongoing case and benefit may be suspended for a month and then reinstated without a new application.”
821-1 Budgeting Self Employment Income
Rewrote section and updated policy. Self-employment will be annualized, or divided by 12 months, regardless of whether or not the employment is seasonal.
823 A. The Following Factors of Eligibility Require Proof:
Added clarification that TPL termination requires verification.
824 MAGI Medicaid Change Reporting Requirements
Updated required reports of change that affect eligibility. Removed change of address as this does not affect eligibility. Added changes of tax filing status, marriage, and divorce.
824-1 Acting on Reported Changes
Added exception to clarify that information received on an HPE application is not considered a report of change.
826 Home and community Based Waiver Services
Added waiver service information as it is applicable to MAGI Medicaid
Adding Aging and Disability Resource Center as another entity involved with administering waivers.
828 Transitional Medicaid
Rewrote section for clarity
Removed adverse action to correct policy.
Corrected example to clarify that a married couple living together are considered joint tax filers.
829 Title IV-E Foster Care and Adoption Assistance
Added Tlingit and Haida as an approved tribal entity that can approve Title IV-E eligibility.
831 Emergency Treatment for Aliens
Clarified that applicants can apply for retroactive Medicaid per CFR 435.117 c.
Added clarification when a new application is needed and when it is not.
Addendum 1 MAGI Income Standards
Removed the annualization standards as they are no longer applicable under the Affordable Care Act regulations.
Addendum 3 Countable and Excluded Income for MAGI Medicaid
Excluded AmeriCorps Award if paid to an educational institution.
Added as countable income: state tax refunds, contractual income, Veteran Survivor’s benefits, AmeriCorps awards and stipends if paid in cash.
Added example about earned and unearned in-kind income for clarification.
Added income of a tax dependent if the amount is under the tax filing threshold.
Addendum 4 MAGI Income Deductions
Removed the sentence “The person must have earnings in the year to qualify for the deduction” to avoid confusion.
Addendum 5 Military Leave and Earnings Statement
Updated to match the Affordable Care Act regulations
Breast and Cervical Cancer Medicaid
Removed section as this type of coverage is explained in the ADLTC manual.