STATE OF ALASKA

Department of Health and Social Services

Division of Public Assistance

TRANSMITTAL NUMBER:  MC #58

MANUAL:  Family Medicaid Eligibility Manual

DATE:  December 2, 2013

This manual change reflects changes in policy due to the Affordable Care Act.  We have also updated income limits based on COLA changes effective January 1, 2014.

Other changes are either technical in nature or clarifications that are the results of policy questions or suggestions from the field.

Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov

OVERVIEW OF CHANGES

5000-1            HISTORY OF MEDICAID

• Added an explanation of Medicaid changes resulting from the Affordable Care Act (ACA).

5005-2            THE APPLICATION FORM

• Added information about the methods by which a person may apply for MAGI based Medicaid categories (i.e., online, paper, in person, by telephone).
• Added information about coordination with the Federally Facilitated Marketplace (FFM).

5005-4 A.       WHEN IS AN INTERVIEW REQUIRED

• Updated information to reflect that an interview is not required for MAGI based Medicaid categories.

5005-6 A.       APPROVING THE APPLICATION

• Added information about forwarding the application to the FFM.
• Added an example.

5005-6 B.       BENEFIT START DATE

• Added language regarding the different ways that an identifiable application can be received.

5005-6 D.       DENYING THE APPLICATION

• Added language about denying an application for Family Medicaid between 10/13 through 12/13 and determining MAGI Medicaid Eligibility.
• Removed information referring to 5005-4 (E) regarding denying applicants for interview requirements.

5005-6 E.       WITHDRAWING AN APPLICATION

• Replaced case file with case note in regards to the reason for withdrawing the application.
• Removed both scenarios regarding the "opt-out" box that was previously on page six of the GEN50 b.
• Removed the need for a new application if the client wants to reapply.
• Added that the original application date applies if the client wants to reapply within 90 days after withdrawing their application.

5005-7            RENEWALS (PREVIOUSLY CASE REVIEWS)

• Added information about the renewal process for MAGI based Medicaid categories, including:

• Pre-populated renewal forms.
• Changes affecting eligibility result in a new 12-month renewal period.
• 90-day grace period to submit renewal information from the date eligibility terminated; a new application is not required.
• Eligibility is redetermined without a renewal form if agency has adequate information from other sources.

5006               ADEQUATE NOTICE

• Changed wording from “mail” to “sent”.

5006-3            TIMELY NOTICE REQUIREMENT

• Updated the example with "mailed" and replaced "brought to the post office."

5006-4            OTHER NOTICE REQUIREMENTS

• Added a new section regarding the applicant appearing eligible for non-MAGI based Medicaid, what additional information is needed, and what information is included in approval notices.
• Added a note and link to Administrative Procedures MS 100-6 about helping persons with limited English proficiency or disabilities understand notices.

5011-6            PROOF OF UNITED STATES CITIZENSHIP AND QUALIFIED ALIEN STATUS

• Explained how U.S. citizenship and alien status will be verified electronically through the “hub” for MAGI based Medicaid.

• Allowed copies of original documents to be accepted as documentary proof. Presents streamlined documentary verification requirements for U.S. citizenship and identity.

5011-7            REASONABLE OPPORTUNITY PERIOD

• Medicaid benefits are available to persons claiming to be U.S. citizens, U.S. nationals, or qualified aliens during a 90-day reasonable opportunity period if their citizenship and alien status cannot be promptly verified through the “hub” or through other electronic interfaces.

5012               ALASKA RESIDENCY

• Changed the definition of Alaska residency.

5050               RIGHT TO FAIR HEARING

• Added language regarding receiving a request through the FFM.

5075               Medicaid Recipient Identification Card

• Added information about new Denali Care and Denali KidCare ID Cards.

5700               MAGI Medicaid CATEGORIES

• Provided a brief introduction to MAGI based Medicaid categories along with a list showing each category.

5701               PARENTS AND OTHER CARETAKER RELATIVES

• Provided more detailed policy for the Parents and Other Caretakers category.
• Gave the new definition of a caretaker relative.
• Gave the definition of a dependent child.
• Explained that the caretaker’s household must have countable income below the applicable income limit.

5702               PREGNANT WOMEN ELIGIBILITY

• Explained that we can accept self-attestation of pregnancy and the number of infants expected.
• Explained how we determine household size for the pregnant woman.
• Explained how we determine household size for other members included in the pregnant woman’s household.
• Explained that the pregnant woman’s household must have countable income below the applicable income limit.

5703               CHILDREN UNDER THE AGE OF 19

• Explained the age limit for this Medicaid category.
• Explained the interaction between this category and Newborn coverage.
• Referenced Continuous Eligibility Period (CEP) for Children policy and explains how it affects children in this category.
• Explained that the child’s household must have countable income below the applicable income limit.

5704               FORMER FOSTER CARE CHILDREN

• Explained the eligibility criteria for this category.
• Explained how to determine if individual is eligible for any other Medicaid category
• Explained how to obtain proof of foster care and Medicaid receipt when the individual aged out of foster care.
• Explained that income is not an eligibility factor for this category.

5705               UNDER 21 MEDICAID

• Provided more detailed policy for the Under 21 Medicaid category.
• Added information about the new MAGI income standards that apply to Under 21 Medicaid beginning January 1, 2014.

5707               CONTINUED MEDICAID COVERAGE DURING MAGI TRANSITION  PERIOD

• Provided more detailed policy on individuals who are ineligible for MAGI-based categories, but can still qualify for Medicaid under pre-MAGI policies.
• Described how the continuous eligibility period (CEP) for children policy will affect the child’s continued Medicaid coverage under MAGI rules.

5710               MAGI Medicaid Household Composition

• Explained household composition rules for MAGI based Medicaid categories.

5715               MAGI BUDGETING METHODS

• Explained how income is counted for MAGI based Medicaid.  This includes the treatment of:

• 5% of FPL Disregard
• Self-employment
• Spousal support
• Lump sum income
• PFD
• Reasonably predictable income
• Child support
• Educational Scholarships and awards
• American Indian/Alaska Native exceptions

5720               VERIFICATION AND DOCUMENTATION

• Explained what verification is needed for MAGI based categories and how it is obtained.

5725               MAGI BASED MEDICAID CHANGE REPORTING REQUIREMENTS

• Listed items that must be reported for MAGI based Medicaid.

5730               Coordination with THE Federally Facilitated Marketplace

• Described how the Federally Facilitated Marketplace (FFM) and DPA will process applications for medical assistance that are received by either agency.

ADDENDUM-5

• Added MAGI based income standards for the following Medicaid categories:
• Parents and Other Caretakers
• Pregnant Woman
• Children Under Age 19
• Under 21 Medicaid
• Childless Adults (The State of Alaska has not chosen this option at this time.
• Added a table to show the amount of the 5% FPL Disregard according to household size.

ADDENDUM-6

• Adds IRS Tax Filing Income Threshold Tables.