MEMORANDUM

DATE:             February 18, 1999

TO:                  ALL MEDICAID MANUAL HOLDERS

THROUGH:   Jim Nordlund, Director

                         Division of Public Assistance

FROM:            Bob Labbe, Director

                         Division of Medical Assistance

RE:                  Medicaid Manual Change #21

The primary focus of Medicaid Eligibility Manual Change #21 is Denali KidCare, but it also includes new policy on counting UIB Unemployment Insurance Benefit payments and clarifies Permanent Fund Dividend policy.

In almost all cases, references to poverty level Medicaid and pregnant woman Medicaid are changed to Denali KidCare.  In the manual sections untouched by Manual Change #21, any reference to “poverty level” or pregnant woman Medicaid should be considered a reference to Denali KidCare.

Manual Change #21 does not include implementation policy for the Working Disabled eligibility category or the elimination of the 100-hour rule for Family Medicaid.  These issues will be addressed in the next manual change.  A more complete explanation of the new SLMB categories addressed in the January 20, 1999 broadcast from DMA will also be included in the next manual change.  However, the poverty level related income standards are include for the SLMB expansion and the Working Disabled categories.

The implementation of Denali KidCare has required many changes in case processing procedures and major reprogramming of EIS Eligibility Information System .  Case processing and case transfer procedures will be addressed in a separate Denali KidCare implementation memorandum.   EIS Eligibility Information System changes are being address in training currently being conducted statewide.

Here is a summary of the most substantial changes:

New Cover

The name of this manual is changed from Medicaid Eligibility Manual to the Medical Assistance Eligibility Manual.  This change allows for a generic reference to the manual in Denali KidCare notices and correspondence, recognizing the separate public identity that Denali KidCare will have.

Applications and Reviews -- 5005

This section refers to the new GEN 132 Denali KidCare Application Form Denali KidCare application and GEN 75 Denali KidCare Renewal Application Form Denali KidCare renewal application.  Policy related to the use of the GEN 72 Eligibility Review Form and MRF for Denali KidCare is also discussed.

Continuous Eligibility -- 5007

Numerous changes related to Denali KidCare are made.  New policy is established for families losing Family Medicaid and moving to Post Medicaid ( 4M Four Month Post-Medicaid Eligibility ).   EIS Eligibility Information System programming changes now allow the same case number to be used when parents move to Post Medicaid and the children need to remain on Family Medicaid because of an on going continuous eligibility period.  Section 5007.3 is removed because EIS Eligibility Information System programming changes render that section unnecessary.

Financial Eligibility -- 5020

The revisions here are mostly reformatting and replacing “poverty-level Medicaid” with “Denali KidCare.”  TEFRA Disabled Child at Home is added to paragraph #2 of the list of Family Medicaid policies that do not apply to Under 21 Medicaid or Denali KidCare.

Permanent Fund Dividend -- 5031

Current Medicaid policy on the counting of the Permanent Fund Dividend was explained in an October 8, 1998, memorandum from DPA Division of Public Assistance and DMA policy units.  This section of the manual is updated to reflect that current policy.  A PFD Permanent Fund Dividend or PFD Permanent Fund Dividend Hold Harmless payment is not counted as a resource or income for Denali KidCare.

Alaska Federal Poverty Levels -- 5032

This section has been substantially revised to reflect the two Denali KidCare income standards, the SLMB expansions, and the Working Disabled.  New poverty level standards for 1999 will go into effect April 1, 1999, but were not available in time to be included in this manual change.  A separate broadcast will be issued.

Penal Institutions -- 5035.2

Policy is clarified concerning Medicaid or Denali KidCare eligibility for a child released from a correctional facility and placed directly into another institutional or community setting while remaining in DFYS custody.

Family Medicaid Conversion Guide -- 5105 and Deprivation -- 5125

These changes implement new policy concerning unemployment insurance benefits.  When making a Family Medicaid eligibility determination, UIB Unemployment Insurance Benefit is now countable income for all adults, including the PWE in a two parent household.  A precursor to elimination of the 100-hour, this policy change is being implemented now to facilitate current EIS Eligibility Information System programming enhancements.  Actual elimination of the 100-hour rule is coming soon.  We promise!

Denali KidCare -- 5300

This section is completely rewritten to establish basic eligibility policy for the new Denali KidCare program.  Denali KidCare encompasses all Family Medicaid related poverty level eligibility categories, including pregnant woman.  Pregnant Woman eligibility is expanded up to 200% of the Federal Poverty Level.  Basically, the Healthy Child (HC) and Six-Up (SU) eligibility categories are now rolled into one category that includes all children under the age of 19 with family income at or below 150% FPL.  The income standard is 200% FPL if the child does not have any insurance, and was not terminated from health insurance in the last 12 months.

Under 21 Medicaid -- 5400

Because Denali KidCare will provide coverage to almost all of the children under age 19 who would have otherwise been on Under 21 Medicaid, this section is substantially revised to focus on eligibility for 19 and 20 year olds.

TECHNICAL CHANGES

Vertical lines along the right hand margin indicate where the text has been revised.  Revision lines are not shown for section 5300 since that section was redrafted entirely.  Many revision lines reflect only formatting changes and do not necessarily indicate any change in existing policy.

MANUAL CHANGE INSTRUCTIONS

Remove old pages and replace with new pages as indicated below: