5020            FINANCIAL ELIGIBILITY

Generally speaking, any case involving children is considered Family Medicaid (AFDC Aid to Families with Dependent Children) related, and any case involving an aged, blind, or disabled person is related to SSI Supplemental Security Income/APA .  The only exception is the case of a disabled child, where the SSI Supplemental Security Income or 300% of SSI Supplemental Security Income standard is used to determine eligibility.   In a case where an individual in a household may qualify for Family Medicaid or APA /SSI Supplemental Security Income, the caseworker should explain the differences to the applicant and then must allow the applicant to choose the eligibility category for which they wish to apply.  An individual may be eligible in one category pending an eligibility determination in another category.

5020 A.       PROSPECTIVE DETERMINATION

Eligibility for Medicaid and Denali KidCare is always determined prospectively.

Except as provided for under the continuous eligibility policy (see Section 5007), if the household has income that prospectively exceeds the income limit for Denali KidCare or a Medicaid eligibility category, medical assistance is denied for that month. For an ongoing case, if it appears the reason for the ineligibility will continue, the case is closed (except for children protected by continuous eligibility).   

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.

5020 B.       FAMILY MEDICAID POLICIES THAT DO NOT APPLY TO UNDER 21 AND DENALI KIDCARE

1. The Family Medicaid minor parent deeming policy (section 5160-7) does not apply to Under 21 Medicaid or Denali KidCare.  This means that regardless of the age of the individual, if that individual is living with his or her parent(s) in the same household, the income and resources of the parent(s) is deemed available. However, if that individual is a 19 or 20 year old and has a dependent child in the household, the caseworker should determine if the individual and dependent are eligible for Family Medicaid (rather than Under 21 or DKC Denali Kid Care ), in which case the income and resources of the individual’s parent(s) is not counted.
    

2. An alien sponsor's income and resources are not considered in determining the Medicaid or Denali KidCare eligibility of the alien if the alien entered the U.S. United States before August 22, 1996, or entered under an old affidavit of support before February 19, 1997.  See Sections 5156-6 and 5160-8 for more details.
    

3. The Federal Poverty Guidelines for Alaska are used in place of the Family Medicaid standards when determining eligibility for Denali KidCare (including pregnant women) and Transitional Medicaid (last five month period).
    

4. The Family Medicaid monthly earned income deduction of $150 plus 33 percent of the remaining earned income does not apply to Under 21 or Denali KidCare eligibility determinations.