(a) A child with a
disability who does not qualify for SSI because of parental income or resources
is eligible for Medicaid under
7
AAC 100.002(d) (5) and this section
if
(1) the child is under 19 years of
age;
(2) the Department of Labor
and Workforce Development has made a determination that the child is disabled
according to SSI criteria;
(3) the
child would be eligible for Medicaid under
7
AAC 100.002(d) (4) if the child were
living in a medical institution;
(4) the child is living in the home of the
child's parent or legal guardian;
(5) the department has determined that the
child needs a level of care offered in
(A) an
acute care hospital or long-term care, as determined under
7
AAC 140.505;
(B) an intermediate care facility for the
mentally retarded, as determined under
7
AAC 140.600; or
(C) an inpatient psychiatric hospital, as
determined under (c) of this section;
(6) the department determines that the child
may receive necessary medical care in a setting other than a medical
institution described in (5) of this subsection, and the determination is
recorded in the plan of care approved by the department; and
(7) the department has determined that the
estimated cost of services provided to the child outside the home will cost
less than the cost of institutionalization.
(b) Eligibility under this section does not
authorize home and community-based waiver services under 7 AAC 130. A child
determined eligible under this section who subsequently is separately
determined eligible for home and community-based waiver services must be
converted to an appropriate alternative eligibility category.
(c) For the purpose of determining
eligibility under this section, a child requires a level of care provided in an
inpatient psychiatric hospital if the child
(1) has a mental illness or severe emotional
disturbance that
(A) is diagnosed by a
psychiatrist or mental health professional;
(B) is likely to result in harm to self and
others; and
(C) has persisted six
months and is expected to persist for a total of 12 months or longer;
(2) has at least one of the
following mental health symptoms:
(A)
psychotic symptoms, characterized by defective or lost contact with reality,
hallucinations, or delusions;
(B) a
suicide attempt, in the 90-day period before the date of application;
(C) suicidal thoughts, in the 30-day period
before the date of application, that include a plan for suicide;
(D) violent behavior as the result of an
emotional disturbance, in the 30-day period before the date of application,
characterized by a documented attempt by the child to cause injury to a person
or substantial property damage;
(3) has functional impairments, relative to
expected developmental levels for the child's age and at a level that qualifies
the child to receive inpatient psychiatric hospitalization, in at least three
of the following areas:
(A)
self-care;
(B) interaction with the
community;
(C) social
relationships;
(D) family
relationships;
(E) functioning at
school or work;
(4)
absent appropriate intervention in the home and community, requires psychiatric
hospitalization as documented by a mental health professional; and
(5) can be expected to functionally improve
or can avoid further deterioration if care is provided in the home and
community.
