5120-6        NONTEMPORARY ABSENCES

If a child or specified relative is absent for any reason not allowed in Section 5120-5, that individual may not be included in the household for Family Medicaid.  However, the caseworker should determine that child’s eligibility for Denali KidCare or Under 21 Medicaid.

When determining the child’s eligibility for Denali KidCare or Under-21 Medicaid, the child is considered to be living independently of his or her parents when the child has

1. not lived in the home of the child’s parent(s) for at least 30 days immediately preceding the date of application; or
    

2. left the home to attend an educational institution, National Guard Youth Corps, or other educational, training, or treatment environment that involves a residential living arrangement; or
    

3. left the home to enter a medical institution or treatment facility in Alaska that involves a residential living arrangement and that treatment has lasted 30 days or longer.

Verification Required:

The medical institution or treatment facility must certify that the applicant has resided there for 30 days or longer.  

A child admitted for less than 30 days is not considered to be living separately from his or her parents, unless the caseworker verifies that the child did not go home, was transferred directly to another institutional or treatment setting, and the result is a total of 30 days or longer stay away from the child’s home.  Follow case processing guideline below; or
 

4. left the home to enter an out of state medical institution or treatment program that involves a residential living arrangement and a 30 day out-of-state placement is prior authorized by First Health.  Contact DPAPolicy@health.state.ak.us for special case processing instructions.

Case Processing: If a child admitted to a medical institution or treatment facility in Alaska has lived in the home of his or her parent(s) on any day within the 30 days immediately preceding the date of application, the caseworker must determine Medicaid/DKC eligibility using the parent's income and resources.  If the child is not eligible using the parent's income and resources, the application must be pended until the caseworker can verify that the child has been in the medical institution or treatment facility for 30 days or more and is, therefore, living separately from his or her parent(s). After pending the case, if the caseworker finds that the child was not in a medical institution or treatment facility for 30 continuous days or more, the income and the resources of the child's parent's must be used to determine eligibility.

Transportation:  Occasionally, a child is in need of transportation from his or her home to an in-state medical institution or treatment facility and no other resources are available to pay for that transportation.  Upon application, a caseworker may consider the child to be applying for TEFRA (See Aged, Disabled and Long Term Care Medicaid Eligibility Manual Section 533), as the need for institutional level of care is an indication of possible TEFRA eligibility.   A non-standard restricted Medicaid coupon (DE-25) may be issued (see Section 5075-2) to cover the cost of transportation to obtain a preliminary disability examination if needed.