Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-25 - MEDICAID ELIGIBILITY
Section 560-X-25-.15 - Parents And Other Caretaker Relatives And Transitional Medical Assistance
Universal Citation: AL Admin Code R 560-X-25-.15
Current through Register Vol. 42, No. 11, August 30, 2024
(1) Parents and Other Caretaker Relatives (POCR)
(a) Parents and Other Caretaker Relatives is
a Medicaid eligibility coverage group available to parents and other caretaker
relatives of dependent children with household income at or below 13% of the
federal poverty level (FPL). POCR also includes qualified pregnant women
without other children whose family income falls within the standards for POCR.
A standard income disregard of 5% of the federal poverty level is applied if
the individual is not eligible for coverage due to excess income.
(b) The POCR must be related to the dependent
child by blood, adoption, or marriage, with whom the dependent child lives, and
who has primary responsibility for the dependent child's care. An all-inclusive
list of POCR relationships includes:
1. The
dependent child's father, mother, grandfather, grandmother, brother, sister,
stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin,
nephew or niece;
2. The spouse of
such POCR, even after the marriage ends due to divorce or death.
(c) A "dependent child" is defined
as a child who is under the age of 19.
(d) Self-attestation must be accepted to
verify the POCR relationship for caretaker relatives unless there is
information that is not reasonably compatible with such attestation. In such
cases, the following documents are acceptable to verify POCR relationship:
1. Primary sources: Birth record, school
records, sworn, notarized or witnessed statement of applicant/recipient,
affidavit of paternity, hospital birth record, court orders signed by the judge
where the relationship is acknowledged as claimed and there is no evidence to
the contrary. If there are no primary sources to verify the POCR relationship,
then the combination of both a Declaration of Natural Relationship Form made by
the applicant/recipient or other persons with knowledge of the relationship and
a secondary source to verify the POCR relationship
2. Secondary sources: Insurance policy, other
agency records, (example Red Cross, SSA, Census records, VA, Department of
Senior Services records, Department of Human Resources), bible records, income
tax records, official records, (example school report card, juvenile court),
other hospital records, clinic or Health Department records, church records,
military records, statement from a minister, priest or rabbi, baptismal
certificate or other.
(e) Technical Requirements:
1. The dependent child must be living in the
home of the POCR.
2. The dependent
child must be under age 19.
3. The
dependent child must be a U.S. citizen or an alien in satisfactory immigration
status.
4. The POCR caretaker must
cooperate with the Department of Human Resources and Alabama Medicaid Agency in
Medical Support Enforcement Activities and in Third Party Medical Liability
Activities unless good cause for not cooperating is determined.
5. When application is made for a dependent
child the POCR who cares for the dependent child automatically assigns to the
State all medical insurance or medical support benefits to the extent medical
assistance is provided to both the dependent child and the POCR.
6. The POCR must furnish all Social Security
numbers for everyone in the household or apply for a Social Security number for
anyone who does not have a number and furnish the number upon receipt. (These
numbers will be used in addition to any other means of identification in the
administration of the program as provided for in Section 402(a) (25) of the
Social Security Act). The number provided will be used in computer matches,
program reviews and audits. Eligibility and income information will be
requested regularly from the Internal Revenue Service, Social Security
Administration, Alabama Department of Industrial Relations and other public and
private organizations.
7. The POCR
must apply for any other benefits for which they or other members of the
household appear to be eligible, such as Veteran Benefits, Social Security,
Unemployment Compensation, etc.
(f) The Agency uses less restrictive income
and resource methodologies than those in effect as of July 16, 1996, as
follows:
1. Resources are excluded.
2. Gifts and inheritance are considered
excluded income.
(2) Transitional Medical Assistance (TMA.)
(a) When a household loses
eligibility for Medicaid benefits under the POCR coverage group due wholly or
partly to the collection of increased earnings or hours of employment, the
household is entitled to twelve (12) continuance months of Transitional Medical
Assistance (TMA), provided that:
1. Medicaid
benefits under the POCR coverage group were terminated due wholly or partly to
the POCR's increased earnings or hours of employment;
2. The household correctly received Medicaid
benefits under the POCR coverage group in Alabama for at least three (3) of the
six (6) months immediately prior to the first month of ineligibility;
and
3. There is a child under 19 in
the home.
(b) When a
household loses eligibility for Medicaid benefits under the POCR coverage group
due wholly or partly to the collection or increased collection of spousal
support, the household is entitled to four (4) continuous months (and children
are eligible for twelve (12) continuous months) of Extended Medicaid coverage,
provided that both:
1. Medicaid benefits
under the POCR coverage group were terminated due wholly or partly to the
POCR's collection or increased collection of spousal support; and
2. The household (or any member of the
household) correctly received Medicaid benefits under the POCR coverage group
in Alabama for at least three (3) of the six (6) months immediately prior to
the first month of ineligibility.
Author: Denise Banks, Associate Director, Policy and Training, Beneficiary Services Division
Statutory Authority: Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
Disclaimer: These regulations may not be the most recent version. Alabama may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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