960              CASE MAINTENANCE

This section provides information on situations and changes that the caseworker must act on to determine ongoing eligibility.

960-1           PERIOD OF ELIGIBILITY

CAMAChronic and Acute Medical Assistance eligibility is issued one month at a time, but may be authorized for up to six months.  CAMAChronic and Acute Medical Assistance eligibility is not available for the month of application.

960-2           REVIEWS

For eligibility to continue the recipient must reapply by completing a CAMAChronic and Acute Medical Assistance review application (MED 33 ) or new GEN 50c application, and an interview, which is required at least every six months.  Verification of both financial and medical eligibility factors is required.  A new MED 11 form must be completed by the physician, physician assistant, or advanced nurse practitioner for verification that the recipient still has a qualifying chronic condition, cancer, or terminal illness.

• If received in the month following case closure for any reason, the MED 33 form can be used as an initial application form.
   
• If received after the month following case closure for any reason, a GEN 50c application form is required.  The MED 33 form will be accepted to protect the benefit start date; however, it cannot be used as the initial application form.
   

If a review application is received late (i.e. any date after eligibility has lapsed), the applicant is not eligible in the month that the review application is received.

960-3           REPORT OF CHANGE

Any change must be documented in the EISEligibility Information System online case notes and acted upon promptly by the caseworker and, if necessary, eligibility redetermined.

960-4           CARE MANAGEMENT PROGRAM

The Care Management Program (CMP) is a program within Alaska Medicaid that has been set up to help selected recipients establish a primary care provider for their health care services and medication needs. The CMPCare Management Program selects recipients that have used services in an amount or at a frequency that is not medically necessary.

More information regarding the Care Management Program can be found in the Alaska Medicaid Recipient Handbook (Click Here)

960-5           NOTICES

The division must render an eligibility decision for each identifiable application and send a written notice of finding to the applicant within 30 days from the date of the receipt of the application in the District Office.  

The caseworker is required to provide adequate notice of any action taken on an application for assistance including a finding of eligibility and a denial of assistance.

Adequate notice means the notice must be in writing and include the reasons for the action, specific manual sections supporting the action, and an explanation of the individual’s right to request a hearing.

960-6           FAIR HEARINGS

Any individual whose application is not acted upon within 30 days after its receipt in the DPA district office, or whose application is denied or assistance is discontinued, will, upon presentation of a written request to any employee of the division, be granted the opportunity for a fair hearing before a representative of the Department of Health.  This hearing will be conducted under the procedure established in the Administrative Procedures Manual Section 117.

The hearing authority may deny a hearing request if:

• the sole issue is a change in state law or regulations requiring automatic adjustment in eligibility or coverage affecting groups of recipients or all recipients and the issue is not one of incorrect benefit determination; or
   
• eligibility or coverage was denied because the applicant has requested a service that is not covered.