515           CONTINUOUS ELIGIBILITY AND CHILDREN IN SSISupplemental Security Income-RELATED CATEGORIES

All children under the age of 19 who are eligible for Medicaid (except Retroactive Medicaid) remain eligible for those benefits for a continuous 12-month period.  During this 12-month period, a child continues to be eligible regardless of changes in income, resources, family status, or household composition.  

The continuous period of eligibility ends when one of the following occur, whichever occurs first:

1. at the end of the twelfth month of continuous eligibility;
    

2. at the end of the month the child reaches age 19;
    

3. at the end of the month the child is incarcerated in a penal institution;
    

4. with the death of the child;
    

5. when a case is closed due to loss of contact with the client (i.e., coupon is returned in mail with no forwarding address);
    

6. when the child loses Alaska residency; or

7. written request from the recipient requesting case closure.

Note:

Continuous eligibility applies to all individuals under age 19, even if the individual is the Primary Information (PI) person on their own case.

Note:

Children under the age of 19 are not eligible for a 12-month continuous eligibility period if their claim to be a U.S. citizen or national is not verified. See Section 520 B.

515 A.       TEFRA CASE PROCESSING

Example:

Joanie is a TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 child who has the following review dates: DPADivision of Public Assistance renewal month - 12/19, LOCLevel of Care renewal month - 2/20, disability CDRContinuing Disability Review - 7/20.  Joanie’s mother submits the DPADivision of Public Assistance renewal timely and the caseworker approves TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 with a new renewal month of 12/19.  On 2/05/20, the caseworker receives an email from Comagine Health stating that Joanie no longer meets LOCLevel of Care.  

Step 1:

Check for 12-month continuous eligibility (1/20 through 12/20).  Since this is February, Joanie is currently in her continuous eligibility period (CEP ).  

Step 2:

Send closure notice stating that TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 will end 12/31/20 due to denied LOCLevel of Care.

Step 3:

Email Comagine Health at AKTefra-Waiver@Qualishealth.org, reporting that TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid for Joanie will end 12/31/20.

515 B.       LTC CATEGORY WITH HCBHome and Community-Based WAIVER SERVICES CASE PROCESSING

Example:

Jeff is a child eligible through the LTCLong Term Care category that is receiving CCMCChildren with Complex Medical Conditions waiver services and has the following review dates:  DPADivision of Public Assistance renewal month - 03/19, LOCLevel of Care renewal month - 02/20, disability CDRContinuing Disability Review - 01/20.  The DPADivision of Public Assistance renewal is submitted timely and approved.  In 11/19, the caseworker sends and subsequently receives all paperwork for a DDSDisability Determination Service review.  The DDSDisability Determination Service packet is forwarded to DDSDisability Determination Service on 12/03/20.  On 3/03/20, the DDSDisability Determination Service packet is returned stating continuing disability for Jeff is denied.  

Step 1:

Check for 12-month CEPcontinuous eligibility period (4/19 through 3/20). Since this is March of 2020, Jeff has already completed his 12-month CEPcontinuous eligibility period.

Step 2:

Because the 12-month CEPcontinuous eligibility period is finished, if no review is turned in, close the Medicaid case effective 03/31/20 and send notice of adverse action explaining that Medicaid will end due to the loss of Jeff’s disability status.  If a review is submitted, determine eligibility for any other Medicaid categories.

Step 3:

Email the DSDSDivision of Senior and Disabilities Services Program Specialist and care coordinator (if known) informing them of the Medicaid closure due to loss of Jeff’s disability status.  

515 C.      LEVEL OF CARE DENIAL - MEDICAID CONTINUES CASE PROCESSING

Example:

Katie is a child eligible through the LTCLong Term Care category who is receiving IDDIndividuals with Intellectual and Developmental Disabilities waiver services and has the following review dates:  DPADivision of Public Assistance renewal month - 12/19, LOCLevel of Care renewal month - 01/20, disability CDRContinuing Disability Review - 5/20.  Katie’s father submits the DPADivision of Public Assistance renewal timely and the caseworker approves LTCLong Term Care Medicaid (including HCBHome and Community-Based services) with a new renewal month of 12/20.  On 2/10/20, the caseworker receives notification from DSDSDivision of Senior and Disabilities Services that Katie no longer meets LOCLevel of Care for IDDIndividuals with Intellectual and Developmental Disabilities waiver services.  

Step 1:

Check for 12-month CEPcontinuous eligibility period (1/20 through 12/20).  Since this is February, Katie is currently in her CEPcontinuous eligibility period for regular Medicaid services.  

Step 2:

Go to the 03/20 MEREMedical Reference screen and remove the waiver coding effective 03/01/20.

Step3:

Send a notice explaining that HCBHome and Community-Based waiver services for Katie will end effective 02/28/20; however, due to continuous eligibility, regular Medicaid coverage will continue until 12/31/20.

Step 4:

Email the DSDSDivision of Senior and Disabilities Services program specialist informing him or her that Medicaid with HCBHome and Community-Based services will end 2/28/20; however, Katie will continue with regular Medicaid coverage through 12/31/20.

Step 5:

When Katie's case comes up for annual review in 12/20, determine her eligibility for any other Medicaid category.

Note:

For the above examples, the TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 , SSISupplemental Security Income /APAAdult Public Assistance, and LTCLong Term Care categories of Medicaid are interchangeable and the case examples apply to all three categories.