STATE OF ALASKA
Department of Health and Social Services
Division of Public Assistance
TRANSMITTAL NUMBER: MC #35
MANUAL: Family Medicaid Eligibility Manual
DATE: September 14, 2007
This manual change implements several policy changes put into effect by the recently adopted State Medicaid regulations. These include new policy that requires use of conversion factors to estimate income. This policy is now aligned with that of the Adult Public Assistance, Food Stamp, and Alaska Temporary Assistance programs. It also allows faxed applications to be accepted, simplifies the deprivation policy, clarifies Retroactive Medicaid, revises the application section in conjunction with changes in other manuals, and provides for automatic newborn eligibility for a child whose birth is covered under Emergency Treatment for Aliens policy.
In addition, there are important policy changes for verifying citizenship
and identity due to issuance of the final federal rules. Staff need
to take the following steps:
Check the Medicaid case file as applications and renewals
are processed to confirm that original or certified copies of documents
for citizenship and identity verification are seen, or that verification
is obtained through the Bureau of Vital Statistics ( BVS ) or
Permanent Fund Dividend ( PFD ) interface.
Ensure that the file copy indicates that an original
or certified copy of the document was seen. A DPA
-contracted fee agent may also note on the file copy when an original
or certified copy was seen.
Confirm that the correct verification code is entered
in EIS .
Request documentation from the applicant or recipient
if verification is not available from BVS
or PFD information, and there is no
indication that an original or certified copy of the document was
seen in the past.
Additional forms of documentation for U.S. citizenship and identification are also allowed, such as a religious record, or the Roll of Alaska Native for citizenship verification, and identity declarations for children under age 18 and disabled individuals in institutional care.
This manual change incorporates the increase in the income standard for uninsured children or pregnant women under Denali KidCare to 175% of the 2007 federal poverty guidelines ( FPG ) for Alaska. This change was previously announced by broadcast. Other technical changes are also made.
Highlights of these policy revisions are described below. If you have any questions, please contact any member of the Policy and Program Development Team at 465-3347 or email dpapolicy@alaska.gov.
OVERVIEW OF CHANGES
MS 5000-5(B) - Circumstances for Which Verification Cannot be Waived
Adds verification of U.S. citizenship and identity cannot be waived unless exempt.
MS 5005 - Application and Review Process
Allows use of faxed applications.
Adds ” DPA -contracted” next to ”fee agent” to clarify that only fee agents who have a contract with DPA Division of Public Assistance can interview the household
MS 5005-2(C) - When is an Application Not Required?
Adds new item (11) to
address when the household is ineligible for the first month but eligible
for the second month.
Rewords Item 8 to emphasize that sufficient information must be in the case file to make a prospective determination.
MS 5005-4(C) - Who can Conduct the Interview?
Adds ”
DPA -contracted” next to ”fee agent” to clarify that
only fee agents who have a contract with DPA
Division of Public Assistance can interview the household.
MS 5005-4(E) - Interviews Conducted at the DPA Office
Clarifies that the office
must schedule an interview if the household contacts the office within
30-daysof the application filing date.
MS 5005-4(F) Changes Reported at the Interview
Clarifies that all applicant households must report all changes at the interview.
MS 5005-5(B) - Information from Data Systems and EIS Interfaces
Clarifies what caseworkers are expected to do when checking interfaces and adds an example.
MS 5005-6(C) - Pending the Application
Removes "attend an interview" from the first sentence. The office is not required to send a notice when an interview is scheduled in person or by telephone.
MS 5008 - Retroactive Medicaid Eligibility
Removes policy allowing
the 3rd and 5th paychecks to be disregarded in the eligibility determination.
Clarifies that actual
resources available each month are used to determine eligibility for
Retroactive Medicaid.
Clarifies that Retroactive
Medicaid is available when there is an unpaid medical bill for services
provided in the month requested in the retroactive period.
Adds clarification for pregnant women.
MS 5011 - U.S. Citizenship and Eligible Alien Status
Removes "Note" about not allowing automatic eligibility for a child born to a non-qualified alien.
MS 5011-2(A) - Acceptable Documentation
Adds all documents must
be either originals or copies certified by the issuing agency or that
verification must be obtained through the Bureau of Vital Statistics
(BVS) or Permanent Fund Dividend (
PFD ) interface.
Adds new items to the lists of acceptable documentation for proof of U.S. citizenship and identity.
MS 5011-2(B) - Citizenship for Certain Children Born Outside the United States
Clarifies that the child must reside in the United States in the legal and physical custody of the United States citizen parent, pursuant to a lawful admission for permanent residence.
MS 5104-7 - Individuals Included in the Household and Whose Income and Resources do Count, but who are not Eligible for Coverage
Adds a mandatory household member found ineligible for Medicaid for failure to provide verification of their own citizenship and identity or immigration status.
MS 5125 - Deprivation
Simplifies policy by
clarifying that deprivation exists when a child does not live with
both parents at the same time or the household has deficient employment.
Changes term from "Deprivation by Unemployment" to "Deprivation by Under-Employment"
MS 5140 - Denial of Benefits to Strikers
Removes section. The striker provision no longer applies to Medicaid eligibility.
MS 5160 - Income
Removes policy throughout
the section that prohibits the use of conversion factors when converted
income causes Medicaid ineligibility.
Aligns policy on conversion
factors with that used by the Adult Public Assistance, Food Stamp
and Temporary Assistance programs.
Removes subsection on disregarding third and fifth payments received in a month.
MS 5300 – MS 5350 - Denali KidCare
Increases the income standard for uninsured children and pregnant women under Denali KidCare to 175% of the 2007 FPG for Alaska and removes references to the prior standard throughout sections.
Removes information about packaging and marketing Denali KidCare as health coverage similar to a private health insurance plan.
Removes exception that prohibits newborn coverage for babies delivered under "Emergency Treatment for Aliens" provisions.
MS 5310 - Pregnant Woman Eligibility
Adds example to clarify when eligibility for Retroactive Medicaid may begin.
MS 5330 - Newborn Child Eligibility
Adds new policy that a baby born to a mother under
the Emergency Treatment for Aliens category is automatically eligible
for newborn coverage.
MS 5600 - Emergency Treatment for Aliens
Removes "Note" that a baby born to a mother under this section is not automatically eligible for newborn Medicaid coverage.
Addendum 1 - Denali KidCare
Updates program standards to reflect the Poverty Guidelines for Alaska effective July 2007.
Addendum 3 – Family Medicaid Subtypes
Removes references to the 175% FPG
being frozen at the 2003 level.
Removes outdated ”IF” subtype.
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