930             THIRD PARTY RESOURCES

An applicantAny individual who completes an application for assistance or recipientAn individual who is receiving a public assistance program. for CAMAChronic and Acute Medical Assistance must help DHCSDivision of Health Care Services identify any health insurance coverage or other third party who may have a responsibility to pay for the applicantAny individual who completes an application for assistance or recipient’s health care. The applicantAny individual who completes an application for assistance must pursue all third party resources for coverage of medical costs as well as identify any potential sources of payment.

CAMAChronic and Acute Medical Assistance may not be approved if the applicantAny individual who completes an application for assistance has a resourceSomething owned by or available to an individual that may provide a means of financial support, and which must be considered when determining eligibility. available to meet the medical need or is living with a legally responsible relative able to provide financial support (see section 940-1).

930-1           AVAILABLE THIRD PARTY RESOURCES

An applicantAny individual who completes an application for assistance must apply for any benefits for which the division believes may be available to meet the individual’s medical need. The caseworker must send written notice to an applicantAny individual who completes an application for assistance describing any benefits for which the applicantAny individual who completes an application for assistance must apply. An applicantAny individual who completes an application for assistance who, without good cause, fails to apply, or pursue a claim within 30 days of mailing of the written notice is not eligible for CAMAChronic and Acute Medical Assistance.

Third party resources available to meet the individual’s medical need include the following:

1. Coverage by a private medical or hospital insurance policy that will pay 100 percent of the cost of medical care. If the insurance coverage will not pay for the entire cost of medical care, CAMAChronic and Acute Medical Assistance eligibility may be found but payment is limited to the amount not covered by the insurance policy and that is otherwise covered under CAMAChronic and Acute Medical Assistance;
   
2. Eligibility to receive medical assistance or coverage, including assistance or coverage from the Veteran's Administration, TRICAREUnited States Department of Defense regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors., U.S.United States Seaman’s Act Program, Handicapped Children’s Program, Office of Vocational Rehabilitation, Division of Mental Health and Developmental Disabilities, MedicaidA needs based program that pays for medical care provided to individuals who are categorically and financially eligible. General eligibility categories include pregnant women; dependent children; individuals needing an institutional level of care; and aged, blind, and disabled individuals., and Medicare;
   

Note:

We must determine the individual's eligibility for Medicaid prior to determining their eligibility for CAMA. A seperate application is not required to make a Medicaid eligibility determination. A CAMA applicant will most likely be eligible for a category of Medicaid.

3. Availability of medical assistance from the Salvation Army, Red Cross, Lion’s International, and other charitable organizations that meets the individual’s medical need;
    
4. Payment for medical bills or medical insurance coverage available through a liable party, including payment for medical claims;
    
5. Payment for medical bills or medical insurance coverage available through an absent parent; and
    
6. A cash contribution received in a previous month from an individual or organization intended to defray medical costs, including medically related transportation, which the applicantAny individual who completes an application for assistance has access to and is sufficient to cover the entire cost of medical care received. If the total contribution will not pay for the entire cost of medical care, CAMAChronic and Acute Medical Assistance eligibility may be found but payment is limited to the amount not covered by the contribution that is otherwise covered under CAMAChronic and Acute Medical Assistance. A charitable cash contribution intended to defray medical costs is not considered a countable resourceSomething owned by or available to an individual that may provide a means of financial support, and which must be considered when determining eligibility..
    

IHSIndian Health Service Beneficiaries: Eligibility to receive assistance from the U. S. Public Health Service through the Indian Health Service (IHSIndian Health Service) is not considered an available resourceSomething owned by or available to an individual that may provide a means of financial support, and which must be considered when determining eligibility. for the purposes of determining eligibility for CAMAChronic and Acute Medical Assistance. This means that an individual who is an IHSIndian Health Service beneficiary and is also eligible for CAMAChronic and Acute Medical Assistance has the freedom to choose which health care providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program. to use. CAMAChronic and Acute Medical Assistance will pay for services provided to an IHSIndian Health Service beneficiary by a non-IHSIndian Health Service providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program., but will NOT pay an IHSIndian Health Service facility for services that the facility renders to an individual who is also eligible for CAMAChronic and Acute Medical Assistance. When discussing CAMAChronic and Acute Medical Assistance coverage for recipients who are eligible to receive services at an IHSIndian Health Service facility, it is important to explain to the applicantAny individual who completes an application for assistance that CAMAChronic and Acute Medical Assistance coverage differs substantially from IHSIndian Health Service coverage.  In choosing to receive services from a CAMAChronic and Acute Medical Assistance providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program., the recipientAn individual who is receiving a public assistance program. may become liable for services that otherwise would have been provided by an IHSIndian Health Service facility at no charge.

930-2           LEGALLY RESPONSIBLE RELATIVES

Under Alaska state law, the relatives of needy individuals are liable for their support while they are living and for their burial upon death. Individuals liable for support in the following order are the spouse, children, parents, grandparents, grandchildren, or siblings of the needy individual who are financially able to provide support.

Note:

This does NOT include a stepparent, stepchild, in-law, cousin, or companion not legally married to the applicantAny individual who completes an application for assistance.

However, the determination of a recipient’s eligibility must not be delayed in an attempt to contact such relatives, nor should assistance be denied because of knowledge of their existence or whereabouts. The statute requires that the legally responsible relative reimburse the state with interest for any relief granted in the event that the relative fails or refuses to support and care for the recipientAn individual who is receiving a public assistance program.. If the caseworker becomes aware of the whereabouts of a recipient’s relatives and their probable ability to provide support, the caseworker must inform the applicantAny individual who completes an application for assistance of this program provision, note the information in the EISEligibility Information System on-line case notes and email DHCSDivision of Health Care Services third-party liability for follow-up at DMATPL@alaska.gov.

The total amount of CAMAChronic and Acute Medical Assistance benefits paid to a recipientAn individual who is receiving a public assistance program. constitutes a claim by the state against a recipient’s estate and can be awarded to the state upon the recipient’s death.

Note:

If the responsible relative receives TATemporary Assistance, APAAdult Public Assistance, or SSISupplemental Security Income benefits, they are not considered to be financially able to provide support.