Alaska Administrative Code
Title 7 - Health and Social Services
Part 7 - Medicaid Assistance Eligibility
Chapter 100 - Medicaid Eligibility
Article 14 - Recipient Rights and Responsibilities, and Program Integrity
7 AAC 100.905 - Special reviews

Universal Citation: 7 AK Admin Code 100.905

Current through August 30, 2024

(a) In addition to the Medicaid eligibility review under 7 AAC 100.020, the department may conduct a special review of the eligibility of a recipient or recipient's household in the same manner that the department determines the eligibility of a new applicant if the department has reason to question the information on file or the eligibility of the recipient under (b) of this section. As part of a special review, the department may include requiring

(1) that a new application be completed and signed;

(2) an in-person interview;

(3) documentation of all eligibility factors, including those not subject to change; and

(4) a review of any other factor or matter relevant to the recipient's eligibility.

(b) If a recipient fails to comply with the applicable provisions of this section, the department may terminate Medicaid eligibility in accordance with this chapter and 7 AAC 49.

(c) The department may conduct a special review for any reason, including

(1) a recipient's failure, without good cause, to cooperate with an inquiry that the department conducts to verify information provided to the department under this chapter;

(2) the department's discovery of a change that the recipient did not report to the department;

(3) the department's receipt of a report of several contemporaneous changes that may affect a recipient's eligibility and that the department must verify;

(4) a change in federal or state law that may affect a recipient's Medicaid eligibility;

(5) a recipient's physical move to a new location in the state;

(6) reevaluation of whether a recipient continues to be disabled;

(7) reevaluation of a recipient's absence from the home or state residency;

(8) reevaluation of whether deprivation continues to exist under 7 AAC 100.106; and

(9) a recommendation for review from the office of the department handling matters of fraud.

Authority:AS 47.05.010

AS 47.07.020

AS 47.07.040

Disclaimer: These regulations may not be the most recent version. Alaska 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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