Alaska Administrative Code
Title 7 - Health and Social Services
Part 7 - Medicaid Assistance Eligibility
Chapter 100 - Medicaid Eligibility
Article 1 - Common Medicaid Eligibility Requirements
7 AAC 100.002 - Medicaid eligibility categories recognized in the state
Universal Citation: 7 AK Admin Code 100.002
Current through November 28, 2024
(a) Except as provided in (b) of this section, the specific mandatory eligibility categories required under AS 47.07.020(a) for individuals, children, and families are
(1)
households that
(A) meet the requirements of
42 U.S.C.
1396 a(a)(10)(A)(i)(I) and
42 U.S.C.
1396u-1; and
(B) are eligible for Family Medicaid under
7
AAC 100.100 -
7
AAC 100.199;
(2) individuals who lose eligibility under
(a)(1) of this section due to earnings and who
(A) meet the requirements of
42 U.S.C.
1396r-6; and
(B) are eligible under
7
AAC 100.200 -
7
AAC 100.209;
(3) individuals who lose eligibility under
(a)(1) of this section due to increased income from collection of child or
spousal support and who are eligible under
7
AAC 100.210;
(4) pregnant women who are
(A) qualified pregnant women as described in
42 U.S.C.
1396 a(a)(10)(A)(i)(III) or poverty-level
pregnant women as described in
42 U.S.C.
1396 a(a)(10)(A)(i)(IV); or
(B) eligible under
7
AAC 100.300 -
7
AAC 100.306;
(5) newborns who meet the requirements of
42 U.S.C.
1396 a(a)(10)(A)(i)(IV) and are eligible
under 7 AAC 100.300 -
7
AAC 100.306;
(6) poverty-level children at least one year
of age and under six years of age who meet the requirements of
42 U.S.C.
1396 a(a)(10)(A)(i)(VI) and are eligible
under 7 AAC 100.310 -
7
AAC 100.312;
(7) poverty-level children at least six years
of age and under 19 years of age who meet the requirements of
42 U.S.C.
1396 a(a)(10)(A)(i)(VII) and are eligible
under 7 AAC 100.310 -
7
AAC 100.314;
(8) children receiving Title IV-E foster care
assistance, adoption assistance, or relative guardianship assistance who meet
the requirements of 42
U.S.C. 1396 a(a)(10)(A)(i)(I) and are
eligible under
7
AAC 100.270; and
(9) individuals described in 42 C.F.R.
435.114, revised as of October 1, 2005 and adopted by reference, who would have
been eligible for Aid to Families with Dependent Children (AFDC) under former
AS
47.25.301-47.25.470 had the increase in
OASDI under P.L. 92-336 not raised their income over the limit allowed under
AFDC.
(b) The specific Medicaid eligibility categories required under AS 47.07.020(a) for individuals with a disability or who are 65 years of age or older are
(1) individuals who are receiving or
considered to be recipients of SSI who
(A)
meet the requirements of 42
U.S.C. 1396 a(a)(10)(A)(i)(II); and
(B) are eligible under
7
AAC 100.410;
(2) individuals who are deemed to be SSI
recipients under 42 U.S.C.
1396 a(a)(10)(A)(i)(I) or
42 U.S.C.
1396 a(a)(10)(A)(i)(II) as determined under
42 C.F.R.
435.120, revised as of October 1, 2005, and
adopted by reference; individuals in the eligibility category described in this
paragraph include
(A) an individual with a
disability who would be eligible under (b)(1) of this section except the
individual's earnings exceed the SSI substantial gainful activity level in
accordance with 42 U.S.C.
1382 h(a);
(B) subject to the restriction under
7
AAC 100.412, a blind or disabled individual who would
be eligible under (b)(1) of this section except the individual's earnings are
too high to receive SSI benefits in accordance with
42 U.S.C.
1382 h(b); and
(C) a qualified severely impaired individual
who would be eligible under (b)(1) of this section except the individual's
earnings are too high to receive SSI benefits in accordance with
42 U.S.C.
1396 d(q);
(3) individuals ineligible for SSI or APA
because of requirements that do not apply to Medicaid who are eligible under
7
AAC 100.414;
(4) individuals who would be eligible for SSI
or APA if the individual had not received the annual cost-of-living increase to
that individual's OASDI benefits and who
(A)
meet the requirements of 42
C.F.R. 435.135, revised as of October 1, 2005
and adopted by reference;
(B) meet
the requirements set out in sec. 503, P.L. 94-566; and
(C) are eligible under
7
AAC 100.416;
(5) disabled widows or widowers described in
42 C.F.R.
435.137, revised as of October 1, 2005, and
adopted by reference, who would be eligible for SSI or APA except for the
elimination of the additional reduction factors for disabled widows and
widowers who are deemed to be receiving SSI for Medicaid purposes in accordance
with 42 U.S.C.
1383 c(b);
(6) blind or disabled individuals deemed to
be receiving SSI for Medicaid purposes in accordance with
42 U.S.C.
1383 c(c) and who are eligible under
7
AAC 100.420;
(7) disabled widows or widowers described in
42 C.F.R.
435.138, revised as of October 1, 2005, and
adopted by reference, who would be eligible for SSI except for receipt of early
social security disability benefits according to the provisions of
42 U.S.C.
1383 c(d);
(8) individuals who
(A) would have been eligible for SSI or APA
had the increase in OASDI under P.L. 92-336 not raised their income over the
limit allowed under SSI or APA; and
(B) are eligible under
7
AAC 100.422(a);
(9) institutionalized individuals who
(A) were eligible for Medicaid in December
1973; and
(B) are eligible under
7
AAC 100.422(b);
(10) blind or disabled individuals who
(A) were eligible for Medicaid in December
1973; and
(B) are eligible under
7
AAC 100.422(c);
(11) individuals who
(A) were entitled to a mandatory state
supplement in December 1973 by meeting the requirements of P.L. 93-66 and P.L.
93-233; and
(B) are eligible under
7
AAC 100.422(d); and
(12) children who
(A) were receiving SSI on August 22,
1996;
(B) lost SSI because of the
amendment to the definition in
42 U.S.C.
1382 c(a)(3) of "childhood disability" by
sec. 201(a), P.L.
104-193 (Personal Responsibility and Work
Opportunity Reconciliation Act of 1996); and
(C) are eligible under
7
AAC 100.422(e).
(c) Except as provided in (d) of this section, the specific optional eligibility categories under AS 47.07.020(b) for children and families are
(1) under
AS
47.07.020(b)(1), households
that meet
(A) the income and resource
requirements of Family Medicaid under
7
AAC 100.100 -
7
AAC 100.199, but who are not receiving Family Medicaid
benefits under (a)(1) of this section; and
(B) the requirements of
42 U.S.C.
1396 a(a)(10)(A)(ii)(I);
(2) under
AS
47.07.020(b)(8), individuals
under 21 years of age who
(A) would be
eligible for Family Medicaid under
7
AAC 100.100 -
7
AAC 100.199, except that they have the care and
support of both parents;
(B) are
not covered under (a) of this section;
(C) meet the requirements of
42 U.S.C.
1396 a(a)(10)(A)(ii)(I) and
42 U.S.C.
1396 d(a)(i); and
(D) are eligible under
7
AAC 100.250 -
7
AAC 100.252;
(3) under
AS
47.07.020(b)(5), individuals
under 21 years of age who
(A) are in an
institution designated as an intermediate care facility for the mentally
retarded;
(B) are financially
eligible for Family Medicaid under
7
AAC 100.100 -
7
AAC 100.199, or would be eligible if not living in a
medical institution;
(C) meet the
requirements of 42 U.S.C.
1396 a(a)(10)(A)(ii)(IV); and
(D) are eligible under
7
AAC 100.252;
(4) under
AS
47.07.020(b)(7), individuals
under 21 years of age, except as provided in (g) of this section, who
(A) are receiving active treatment in an
inpatient psychiatric hospital or residential psychiatric treatment
center;
(B) are financially
eligible for Family Medicaid under
7
AAC 100.100 -
7
AAC 100.199, or would be eligible if not receiving
active treatment in an inpatient psychiatric hospital or residential
psychiatric treatment center;
(C)
meet the requirements of 42
U.S.C. 1396 a(a)(10)(A)(ii)(IV);
and
(D) are eligible under
7
AAC 100.252;
(5) under
AS
47.07.020(b)(3), individuals
under 21 years of age who
(A) are under the
protective custody or supervision of the department, for whom maintenance is
being paid in whole or in part from public funds, and who are in foster homes
or private child-care institutions;
(B) meet the requirements of
42 U.S.C.
1396 a(a)(10)(A)(ii)(I) and
42 U.S.C.
1396 d(a)(i); and
(C) are eligible under
7
AAC 100.254;
(6) under
AS
47.07.020(b)(10),
individuals under 21 years of age who
(A) are
receiving state-only adoption subsidies under
7
AAC 53.227;
(B) meet the requirements of
42 U.S.C.
1396 a(a)(10)(A)(ii)(VIII); and
(C) are eligible under
7
AAC 100.256;
(7) under
AS
47.07.020(b)(9), pregnant
women who
(A) are not covered under (a) of
this section;
(B) meet the income
and resource requirements of Family Medicaid under
7
AAC 100.100 -
7
AAC 100.199;
(C) meet the requirements of
42 U.S.C.
1396 a(a)(10)(A)(ii)(I); and
(D) are eligible under
7
AAC 100.300 -
7
AAC 100.302;
(8) under
AS
47.07.020(b)(13),
individuals under 19 years of age who
(A) are
not covered under (a) of this section;
(B) meet the requirements of
42 U.S.C.
1396 a(a)(10)(A)(ii)(XIV); and
(C) are eligible under
7
AAC 100.310 -
7
AAC 100.314; and
(9) under
AS
47.07.020(b)(14), pregnant
women who
(A) are not covered under (a) of
this section;
(B) meet the
requirements of 42 U.S.C.
1396 a(a)(10)(A)(ii)(IX); and
(C) are eligible under
7
AAC 100.300 -
7
AAC 100.302.
(d) The specific optional eligibility categories under AS 47.07.020(b) for individuals with a disability or who are 65 years of age or older are
(1) under
AS
47.07.020(b)(4), individuals
who
(A) are not receiving SSI, but who are
eligible for and receiving only the optional state supplementary payment under
the APA program;
(B) meet the
requirements of 42 U.S.C.
1396 a(a)(10)(A)(ii)(XI);
(C) meet the requirements of
42 C.F.R.
435.232, revised as of October 1, 2005, and
adopted by reference; and
(D) are
eligible under
7
AAC 100.410(b);
(2) under
AS
47.07.020(b)(2), individuals
who
(A) would be eligible for APA payments if
they were not residing in a general hospital, skilled nursing facility, or
intermediate care facility;
(B)
meet the requirements of 42
U.S.C. 1396 a(a)(10)(A)(ii)(IV);
(C) meet the requirements of
42 C.F.R.
435.211, revised as of October 1, 2005, and
adopted by reference; and
(D) are
eligible under
7
AAC 100.500(1);
(3) under
AS
47.07.020(b)(1), individuals
who
(A) are eligible for but who have chosen
not to receive SSI or APA;
(B) meet
the requirements of 42
U.S.C. 1396 a(a)(10)(A)(ii)(I);
(C) meet the requirements of
42 C.F.R.
435.210, revised as of October 1, 2005, and
adopted by reference; and
(D) are
eligible under
7
AAC 100.410(c);
(4) under
AS
47.07.020(b)(6), individuals
who
(A) are residing in a medical institution,
other than an assisted living home;
(B) meet the requirements of
42 U.S.C.
1396 a(a)(10)(A)(ii)(V);
(C) meet the requirements of
42 C.F.R.
435.236(a)(1) - (2), revised
as of October 1, 2005, and adopted by reference; and
(D) are eligible under
7
AAC 100.500(2);
(5) under
AS
47.07.020(b)(11), children
with a disability living at home who meet the requirements of
42 U.S.C.
1396 a(e)(3) and who are eligible under
7
AAC 100.424;
(6) under
AS
47.07.020(b)(12),
individuals with a disability who
(A) are
ineligible for cash assistance due to earnings and who gain access to Medicaid
through the payment of premiums;
(B) meet the requirements of
42 U.S.C.
1396 a(a)(10)(A)(ii)(XIII); and
(C) are eligible under
7
AAC 100.426;
(7) under
AS
47.07.020(b)(15), women
diagnosed with breast and cervical cancer who meet the requirements of
42 U.S.C.
1396 a(a)(10)(A)(ii)(XVIII) and are eligible
under 7 AAC 100.710;
(8) under
AS
47.07.020(b)(6), individuals
who
(A) would be eligible for Medicaid under
(a)(4) of this section if they were institutionalized and who, but for the
provision of home and community-based waiver services, would require
institutionalization;
(B) meet the
requirements of 42 U.S.C.
1396 a(a)(10)(A)(ii)(VI);
(C) meet the requirements of
42 C.F.R.
435.217, revised as of October 1, 2005, and
adopted by reference; and
(D) are
eligible under
7
AAC 100.502.
(e) The specific mandatory Medicare cost-sharing eligibility categories for individuals with a disability or who are 65 years of age or older required under AS 47.07.020(a) are
(1) qualified Medicare beneficiaries, for
individuals who meet the requirements of
42 U.S.C.
1396 a(a)(10)(E)(i) and are eligible under
7
AAC 100.750 and
7
AAC 100.752;
(2) qualified disabled and working
individuals, for individuals who meet the requirements of
42 U.S.C.
1396 a(a)(10)(E)(ii) and are eligible under
7
AAC 100.750 and
7
AAC 100.758;
(3) specified low-income Medicare
beneficiaries, for individuals who meet the requirements of
42 U.S.C.
1396 a(a)(10)(E)(iii) and are eligible under
7
AAC 100.750 and
7
AAC 100.754; and
(4) qualified individuals, for individuals
who meet the requirements of 42 U.S.C. 1396 a(a)(10)(E)(iv) and
are eligible under
7
AAC 100.750 and
7
AAC 100.756.
(f) A mandatory eligibility category for individuals who do not meet United States citizenship requirements for Medicaid is required under AS 47 07.020(a) which provides limited coverage for the treatment of an emergency medical condition. This eligibility category is available to individuals who
(1) meet the
requirements of 42 U.S.C.
1396 b(v); and
(2) are eligible under
7
AAC 100.700.
(g) A recipient eligible for Medicaid under (c)(4) of this section may continue to receive inpatient psychiatric services while under 22 years of age if the recipient
(1) meets the requirements of
42 C.F.R.
435.1008, revised as of October 1, 2005 and
adopted by reference; and
(2) has
continuously resided in an inpatient psychiatric hospital or residential
psychiatric treatment center since being determined eligible for Medicaid under
(c)(4) of this section.
Authority:AS 47.05.010
AS 47.07.020
AS 47.07.040
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