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STATE OF ALASKA by wulinqing

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									                             STATE OF ALASKA
                   Department of Health and Social Services
                        Division of Public Assistance


TRANSMITTAL NUMBER: MC #35

MANUAL:         Family Medicaid Eligibility Manual

DATE:           September 14, 2007

This manual change implements several policy changes put into effect by the
recently adopted State Medicaid regulations. These include new policy that
requires use of conversion factors to estimate income. This policy is now aligned
with that of the Adult Public Assistance, Food Stamp, and Alaska Temporary
Assistance programs. It also allows faxed applications to be accepted, simplifies
the deprivation policy, clarifies Retroactive Medicaid, revises the application
section in conjunction with changes in other manuals, and provides for automatic
newborn eligibility for a child whose birth is covered under Emergency Treatment
for Aliens policy.

In addition, there are important policy changes for verifying citizenship and
identity due to issuance of the final federal rules. Staff need to take the following
steps:

      Check the Medicaid case file as applications and renewals are processed
       to confirm that original or certified copies of documents for citizenship and
       identity verification are seen, or that verification is obtained through the
       Bureau of Vital Statistics (BVS) or Permanent Fund Dividend (PFD)
       interface.

      Ensure that the file copy indicates that an original or certified copy of the
       document was seen. A DPA-contracted fee agent may also note on the
       file copy when an original or certified copy was seen.

      Confirm that the correct verification code is entered in EIS.

      Request documentation from the applicant or recipient if verification is not
       available from BVS or PFD information, and there is no indication that an
       original or certified copy of the document was seen in the past.

Additional forms of documentation for U.S. citizenship and identification are also
allowed, such as a religious record, or the Roll of Alaska Native for citizenship
verification, and identity declarations for children under age 18 and disabled
individuals in institutional care.
This manual change incorporates the increase in the income standard for
uninsured children or pregnant women under Denali KidCare to 175% of the
2007 federal poverty guidelines (FPG) for Alaska. This change was previously
announced by broadcast. Other technical changes are also included.

Highlights of these policy revisions are described below. If you have any
questions, please contact any member of the Policy and Program Development
Team at 465-3347 or email dpapolicy@alaska.gov.


OVERVIEW OF CHANGES

MS 5000-5(B) - Circumstances for Which Verification Cannot be Waived
   Adds verification of U.S. citizenship and identity cannot be waived unless
     exempt.

MS 5005 - Application and Review Process
   Allows use of faxed applications.

      Adds “DPA-contracted” next to “fee agent” to clarify that only fee agents
       who have a contract with DPA Division of Public Assistance can interview
       the household

MS 5005-2(C) - When is an Application Not Required?
   Adds new item (11) to address when the household is ineligible for the first
     month but eligible for the second month.

      Rewords Item 8 to emphasize that sufficient information must be in the
       case file to make a prospective determination.

MS 5005-4(C) - Who can Conduct the Interview?
   Adds “DPA-contracted” next to “fee agent” to clarify that only fee agents
     who have a contract with DPA Division of Public Assistance can interview
     the household.

MS 5005-4(E) - Interviews Conducted at the DPA Office
   Clarifies that the office must schedule an interview if the household
     contacts the office within 30-daysof teh application filing date.

MS 5005-4(F) Changes Reported at the Interview
   Clarifies that all applicant households must report all changes at the
     interview.

MS 5005-5(B) - Information from Data Systems and EIS Interfaces
   Clarifies what caseworkers are expected to do when checking interfaces
     and adds an example.
MS 5005-6(C) - Pending the Application
   Removes "attend an interview" from the first sentence. The office is not
     required to send a notice when an interview is scheduled in person or by
     telephone.

MS 5008 - Retroactive Medicaid Eligibility
   Removes policy allowing the 3rd and 5th paychecks to be disregarded in
     the eligibility determination.

      Clarifies that actual resources available each month are used to determine
       eligibility for Retroactive Medicaid.

      Clarifies that Retroactive Medicaid is available when there is an unpaid
       medical bill for services provided in the month requested in the retroactive
       period.

      Adds clarification for pregnant women.

MS 5011 - U.S. Citizenship and Eligible Alien Status
   Removes "Note" about not allowing automatic eligibility for a child born to
     a non-qualified alien.

MS 5011-2(A) - Acceptable Documentation
   Adds all documents must be either originals or copies certified by the
     issuing agency or that verification must be obtained through the Bureau of
     Vital Statistics (BVS) or Permanent Fund Dividend (PFD) interface.

      Adds new items to the lists of acceptable documentation for proof of U.S.
       citizenship and identity, such as a religious record, or the Roll of Alaska
       Native for citizenship verification, and identity declarations for children
       under age 18 and disabled individuals in institutional care.

MS 5011-2(B) - Citizenship for Certain Children Born Outside the United
States
    Clarifies that the child must reside in the United States in the legal and
      physical custody of the United States citizen parent, pursuant to a lawful
      admission for permanent residence.

MS 5104-7 - Individuals Included in the Household and Whose Income and
Resources do Count, but who are not Eligible for Coverage
   Adds a mandatory household member found ineligible for Medicaid for
     failure to provide verification of their own citizenship and identity or
     immigration status.
MS 5125 - Deprivation
   Simplifies policy by clarifying that deprivation exists when a child does not
     live with both parents at the same time or the household has deficient
     employment.

      Changes term from "Deprivation by Unemployment" to "Deprivation by
       Under-Employment"

MS 5140 - Denial of Benefits to Strikers
   Removes section. The striker provision no longer applies to Medicaid
     eligibility.

MS 5160 - Income
   Removes policy throughout the section that prohibits the use of
     conversion factors when converted income causes Medicaid ineligibility.

      Aligns policy on conversion factors with that used by the Adult Public
       Assistance, Food Stamp and Temporary Assistance programs.

      Removes subsection on disregarding third and fifth payments received in
       a month.

MS 5300 – MS 5350 - Denali KidCare
   Increases the income standard for uninsured children and pregnant
     women under Denali KidCare to 175% of the 2007 FPG for Alaska and
     removes references to the prior standard throughout sections.

      Removes information about packaging and marketing Denali KidCare as
       health coverage similar to a private health insurance plan.

      Removes exception that prohibits newborn coverage for babies delivered
       under "Emergency Treatment for Aliens" provisions.

MS 5310 - Pregnant Woman Eligibility
   Adds example to clarify when eligibility for Retroactive Medicaid may
     begin.

MS 5330 - Newborn Child Eligibility
   Adds new policy that a baby born to a mother under the Emergency
     Treatment for Aliens category is automatically eligible for newborn
     coverage.

MS 5600 - Emergency Treatment for Aliens
   Removes "Note" that a baby born to a mother under this section is not
     automatically eligible for newborn Medicaid coverage.
Addendum 1 - Denali KidCare
   Updates program standards to reflect the Poverty Guidelines for Alaska
     effective July 2007.

Addendum 3 – Family Medicaid Subtypes
   Removes references to the 175% FPG being frozen at the 2003 level.

      Removes outdated “IF” subtype.
5000-5 Incomplete Verification
5000-5   INCOMPLETE VERIFICATION

5000-5 A. CIRCUMSTANCES FOR WHICH VERIFICATION MAY BE WAIVED

         Eligibility may be found for the first two calendar months without
         complete verification if all of the following conditions are met and
         documented in the case file:

            1. The eligibility factor that is not fully verified requires
               documentary evidence;

            2. The necessary documents are not in the possession of the
               applicant and he or she cannot easily obtain them;

            3. The documents have been requested and cannot be
               reasonably expected to be received within the 30 days allowed
               for the caseworker to make a final eligibility decision;

            4. At least one collateral contact has been made, which verifies
               the factor of eligibility is met;

            5. There is no reason to doubt the applicant’s statement about
               the factor in question;

            6. The caseworker requested a supervisory review of the case
               situation and the supervisor approves a temporary finding of
               eligibility; and

            7. The case is placed in a suspense system to assure that the
               documents are received and the factor is fully verified at least
               10 days before the end of the second month.

5000-5 B. CIRCUMSTANCES FOR WHICH VERIFICATION CANNOT BE
          WAIVED

         Social Security Enumeration: Verification requirements for Social
         Security enumeration applications cannot be waived with the
         exception of Newborn Coverage (see Section 5330). Applicants
         must have a Social Security Number or apply for one as a condition
         of eligibility for Medicaid. (For more information on applying for a
         Social Security number, see Section 5014 and the Administrative
         Procedures Manual.)
U.S. Citizenship and Eligible Alien Status: Verification of US.
citizenship and identity cannot be waived unless exempt. See
Section 5011 for exceptions to this requirement.

Caretaker Relationship: If the caseworker is unable to verify the
child’s relationship to his or her possible specified relative, the child
will not be considered a household member for Family Medicaid
purposes. See Section 5120-1.
5005 Application And Review Process
5005   APPLICATION AND REVIEW PROCESS

       In order for the Division of Public Assistance (DPA) to determine a
       household’s eligibility, the household must:

             Submit an identifiable application;

             Complete and sign an approved application form;

             Attend an interview with a DPA caseworker, DPA-contracted
              fee agent, or Native Family Assistance Program (NFAP)
              agency staff person, if an interview is required; and,

             Provide documentation and verification, including required
              forms, needed to determine program eligibility.

       An application form must be given to the individual the same day
       DPA or the fee agent receives a request for an application. All
       households must be advised that they may file an application the
       same day they contact the office in order to establish their benefit
       start date. Individuals requesting an application by phone will be sent
       one the same day the telephone request is made.

       Fee agents help individuals who live in communities that do not have
       a local DPA office apply for public assistance. DPA provides fee
       agents with applications and other forms individuals need to apply for
       assistance. Individuals are not required to go to a fee agent, and may
       send the application directly to the nearest DPA office.

       An application is considered filed when a DPA office receives an
       acceptable application form containing the applicant's name, address,
       and signature. Faxed applications are accepted.

       Applicants must be advised that eligibility cannot be determined until
       a member of the household completes an application form and
       participates in an interview with a caseworker, fee agent, or Native
       Family Assistance Program agency, if an interview is required.

       The receipt of an identifiable application in a DPA district office
       establishes the application filing date. The caseworker has 30 days
       following the application filing date to process the application. When
       the applicant asks to apply for another program prior to the eligibility
determination, use the original filing date and benefits start date for
all programs.


    Note:

    If an individual appears to be eligible under more than
    one Medicaid eligibility category, the individual may
    select the category.
5005-2 The Application Form

5005-2    THE APPLICATION FORM

5005-2 A. What is an Acceptable Application Form?

          The Gen 50B, Application for Services form, is the initial
          application form that is used to apply for any public assistance
          program, except the Heating Assistance Program. To apply for
          Heating Assistance, a Heating Assistance Program application must
          be completed.

          The Gen 72, Eligibility Review Form, is the review application form
          that is used to determine continued eligibility for Adult Public
          Assistance, Food Stamps, Medicaid, and Temporary Assistance.

                If received in the month following the end of the review period,
                 the Gen 72 form can be used as an initial application form.

                If received after the month following the end of the review
                 period, a Gen 50B application form is required. The Gen 72
                 form will be accepted to protect the benefit start date;
                 however, it cannot be used as the initial application form.

          The Native Family Assistance Program (NFAP) TANF application
          form is an acceptable application form for Adult Public Assistance,
          Food Stamps, Medicaid, and Temporary Assistance.

          The following specialized application forms are also available and
          their use is encouraged when appropriate:

          The Gen 132, Denali KidCare Application, used for all poverty level
          children, pregnant women, and all children applying for or receiving
          SSI;

          The Gen 33, Application for Medicaid and Title IV-E Foster Care
          for a child in DHSS Custody, used by the Office of Children’s
          Services (OCS) to apply for children in state custody, Title IV-E foster
          care and adoption assistance agreements, and state-only adoption
          assistance agreements;

          The Gen 35, Application for Medicaid for a child in DHSS
          Custody, used by youth corrections staff and specialized/Title IV-E
          caseworkers.
5005-2 B. When is an Application Required?

             1. Upon the individual's first application for a program, except if
                the individual is already a recipient of another DPA assistance
                program.

             2. Upon application from a denied, withdrawn, or closed status,
                unless the denial or closure was the result of an administrative
                error.

             3. Any time the caseworker believes the individual’s
                circumstances have changed sufficiently to justify conducting a
                special redetermination of eligibility, including when an office
                conducts a special review project for all or part of its caseload.

5005-2 C. When is an Application Not Required?

             1. To reopen a closed case as a result of an individual's timely
                request for a fair hearing, or to open or reopen a case as the
                result of a fair hearing decision.

             2. To reopen a case that had been closed incorrectly.

             3. To redetermine eligibility after the initial application is denied
                for failing to provide verification and the household provides
                the verification within 30 days from the application filing date.

             4. To redetermine eligibility after the application is denied for
                failing to attend an interview and the household contacts the
                office to reschedule the interview within 30 days from the
                application filing date.

             5. When there is a change in “payee”, “in care of” addressee, or
                mailing address.

             6. When the individual is already a Medicaid recipient in another
                eligibility category.


              Example:

              An 18-year old individual is removed from the Family
              Medicaid or Denali KidCare case because of age. If the
              18 year old meets all the financial and non-financial
              criteria of the Medicaid program that individual may be
              moved to the Under 21 Medicaid eligibility category
              without a new application.


             7. When an applicant is being added to an ongoing Medicaid
                case. All additional forms and documentation needed for that
                individual (i.e., a 1603, verification of citizenship, etc.) must be
                obtained before eligibility can be determined.


              Example:

              A cousin moves into the home of a family already
              receiving Family Medicaid.


             8. When an individual is already part of an active public
                assistance case and the existing case file already includes the
                information needed to make a prospective Medicaid
                determination. The caseworker must carefully document the
                source of information used to make the eligibility
                determination. TPL or any other missing information should
                be requested separately.

             9. When a family moves from FM to Transitional Medicaid, or
                from Transitional Medicaid to FM or Denali KidCare.

             10. When an applicant originally applied for TEFRA, but at the
                 time of application was only found eligible for FM or Denali
                 KidCare. The recipient is not required to file a new application
                 at the time the recipient does move to TEFRA.

             11. When a household is ineligible for the first month, but eligible
                 for the second month. See Section 5005-6A.

5005-2 D. What is an Identifiable Application?

          An identifiable application is an acceptable application form
          containing the applicant’s name, address, and signature (or
          witnessed mark) of the individual seeking assistance or of the
          individual's authorized representative. Each DPA office must accept
          and date the identifiable application when it is presented.

          An individual who contacts a DPA office and who shows interest in
          the program or a desire to apply shall be advised of his or her right to
          submit an identifiable application on the date of the contact in order to
          establish the benefit start date. The individual may file an identifiable
         application on an acceptable application form as described at Section
         5005-2.

5005-2 E. Who Can Sign the Application Form?

                 An adult household member

                 A minor parent

                 An authorized representative

                 An individual who has legal authority to act on the applicant’s
                  behalf (i.e., Office of Public Advocacy, legal guardian)

                 An individual with appropriate power of attorney.

                 A responsible person, if the individual filing the application is
                  incapable of applying and of appointing an authorized
                  representative in writing.

                 If a child is living with more than one caretaker relative, either
                  of the relatives may be an eligible signer of the DKC
                  application.

                 The parent, guardian, or the child may sign the Denali KidCare
                  or Under 21 Medicaid application when the caseworker
                  determines it is appropriate.


                Note:

                Any person has a right to submit an application for
                Medicaid or Denali KidCare and to sign the application
                form, either for themselves or on behalf of another
                person.


         The signer must certify, under penalty of perjury, the truth of the
         information contained in the application.

         The appropriate individual to sign a Medicaid or Denali KidCare
         application is a specified relative of a dependent child, the authorized
         representative of a specified relative, or, if the specified relative is
         incompetent or incapacitated, a responsible individual acting on
         behalf of the specified relative. If a child is living with more than one
         specified relative, either of the relatives may be an eligible signer.
          When both parents are included in the case, both parents must sign
          the application.

5005-2 F. Who can be an Authorized Representative?

          A responsible adult, 18 years or older, may be designated by the
          applicant in writing as authorized representative. If the applicant is
          illiterate, his/her mark must be witnessed by two individuals who must
          each sign their names and date the document. No special form is
          required.

          Authorized representatives may sign the application and act on
          behalf of a household. A household member should prepare or
          review the application, if possible, even though the authorized
          representative will be filing the application and/or attending the
          interview.

5005-2 G. Completing the Application Form

          In addition to making an identifiable application and having it signed
          by an eligible individual, the applicant must answer all of the
          questions on the application form.

          If the individual requests help in completing the application form, the
          caseworker will offer assistance.

          If the application form is not completed, the caseworker will allow the
          household an opportunity to complete the form. In this case, written
          notification will be sent to the household listing the items that need to
          be completed. See Section 5005-6(C), Pending the Application.
5005-4 The Interview

5005-4    THE INTERVIEW

5005-4 A. When is an Interview Required?

          Interviews are mandatory for all initial applicants. A face-to-face
          interview is required at the time of initial application unless the face-
          to-face interview is waived. See Section 5005-4(D) for policy on
          when an interview can be waived.


              Exception:

              Interviews are not required for Denali KidCare
              applications.


5005-4 B. Who Must Attend the Interview?

          A member of the applicant household who can sign the application
          form or an individual authorized by the household must attend the
          interview.

5005-4 C. Who Can Conduct the Interview?

             1. DPA Caseworker: Most individuals will be interviewed by a
                DPA caseworker in the DPA office or by telephone.

             2. DPA-contracted Fee Agent: In communities where there is
                no DPA Office, the fee agent conducts the interview for
                individuals who want to apply for public assistance. The fee
                agent will complete a Fee Agent Interview Report form (FA #1)
                and submit it with each application.

             3. Native Family Assistance Program (NFAP) Agency: We
                will accept the NFAP interview, if one is conducted, and not
                require the individual to be interviewed again. If the NFAP
                interview notes are not provided with the application, the
                caseworker should obtain them from the NFAP agency.


              Note:

              Regardless of who conducts the interview, if additional
              information or verification is needed to process the
              application, the caseworker will contact the applicant to
              get this information.


5005-4 D. When Can the Face-to-Face Interview be Waived?

          Face-to-face interviews can be waived when the applicant is unable
          to attend the interview for reasons including:

             1. Illness or disability;

             2. Transportation difficulties;

             3. Prolonged severe weather;

             4. Needed to care for a family member;

             5. Living in a location not served by a DPA office; or

             6. Work or training hours that preclude an in-office interview
                during office hours.

          The caseworker shall document the reasons a face-to-face interview
          is waived. A household whose face-to-face interview is waived shall
          be interviewed by telephone or through correspondence.

5005-4 E. Interviews Conducted at the DPA Office

          Interviews must be scheduled for applicants who cannot be
          interviewed on the day they submit an application.

          The interview must be scheduled timely to ensure eligible households
          have an opportunity to participate within 30 days after the application
          is filed.

          Applicants may bring anyone they choose to the interview. During
          the interview, applicants must be informed of their rights and
          responsibilities and basic program procedures.

          When the applicant fails to appear from a scheduled interview and
          does not reschedule, the application is denied. If the household
          contacts the office within 30 days of the application filing date, the
          office must schedule an interview. If the household is determined
          eligible, the original application is used and benefits start based on
          the date the application was filed.
              Note:

              If an application is registered on EIS as a request for
              service, EIS will automatically deny the application on the
              30th day from the date the application was filed. The
              household is notified via a system-generated notice.


5005-4 F. Changes Reported at the Interview

          Applicant households must report all changes affecting their eligibility
          or benefits at the interview.

          Changes reported after the interview, but before a case decision is
          made, will be considered in the initial eligibility determination.

          When the household reports a new household member before a case
          decision is made, the new member is considered part of the
          household. The benefit start date is used to determine the benefits
          for the household, including the new member. See Section 5002-3
          for policy under the one day-one month principle.

          The individual must be in the home at least one day of the month to
          be included in that month. However, when the household reports
          prior to the eligibility determination that a person moved out, that
          person is not considered part of the household for any month.


              Example # 1:

              A household applies May 27. At the interview on June 5,
              the individual reports her spouse moved in on May 30.
               The spouse is considered part of the household and the
              household’s benefit start date is May 1. If the spouse
              moved in on June 3, the spouse is included in the
              household effective June 1.


              Example #2:

              A household applies on July 28th and is interviewed
              August 9th. During the interview, the individual reports
              that her husband moved out on August 4th and is not
              expected to return. The husband is not considered part
              of the household for either July or August, and
              verification of his income and resources are not needed.
 Income and resources available to the household must
still be considered.
5005-5 Verification

5005-5    VERIFICATION

          See Section 5000-4 for policy on verification.

5005-5 A. Verification Required Prior to Allowing Deductions

          Caseworkers must obtain verification of allowable expenses when the
          expenses result in a deduction of countable income. Households
          must be given an opportunity to provide the verification before the
          eligibility determination is made. If the household does not provide
          verification of the following expenses, the application is processed
          without the deduction.

                  Dependent care expenses.

                  Deductible child support payments.

5005-5 B. Information from Data Systems and EIS Interfaces

          Several data systems and computer interfaces are available through
          the Internet and on-line EIS access. Caseworkers must check these
          systems for each household member at each application and review
          as part of the verification process.

          In some situations, the information will be from the source and can be
          used as verification. In other situations, the caseworker must follow-
          up on the information.


                 Example:

                 The caseworker checks the interfaces and data systems
                 for the two members of an applicant household. The
                 Department of Labor system shows one is currently
                 receiving unemployment benefits of $120 weekly. This
                 information is used as income verification since the
                 information is directly from the source of the income. The
                 caseworker also finds that the other applicant had
                 earnings listed for the prior quarter. The caseworker
                 contacts the household to determine if the person is still
                 working or if there is any change in health insurance and,
                 if so, requests verification.
Direct Data Systems             Information Verified
INGENS Public Information       Ownership of resources
Database                        including vehicles, real estate,
                                fishing permits, mining claims,
                                boats
NSTAR or NFIN State of          Child Support collections Child
Alaska Child Support Services   support disbursements Legal
Division                        obligation to pay child support
State of Alaska Department of   Unemployment Insurance
Labor (DOL)                     Benefits
Automated Status Verification   Qualified alien status of
System (ASVS)                   household members who are
                                not U.S. citizens

EIS Interfaces (using the       Information Verified
INME menu)
BENDEX Social Security          SSA payments
Administration
SDX Social Security             SSI payments
Administration
State of Alaska Department of   Employment history through
Labor (DOL)                     quarterly wage match
State of Alaska Permanent       PFD payments
Fund Dividend Division
Senior Benefits Program         Senior Benefits Program
                                payments
State Verification Exchange     SSA and SSI payments
System (SVES)
5005-6 Actions On Application

5005-6    ACTIONS TAKEN ON THE APPLICATION

          Every applicant must be provided with adequate written notice of the
          action taken on the application. Adequate notice means that the
          individual is informed of the action taken, the reasons for the action,
          and the manual sections from the appropriate program policy manual
          that supports the action.

          5005-6 A. Approving the Application

          An approval notice must be sent to the household following a
          determination of eligibility. Except when the application is delayed as
          described below, approved households must receive benefits no later
          than 30 days after the application filing date. To meet this
          requirement, the caseworker must authorize the benefits by the 28th
          calendar day following the application filing date. See Section 5005-
          6(F) for policy on when an application is delayed.

          Eligible First Month/Ineligible Second Month: A household may
          be eligible for the month of application and ineligible in the
          subsequent month. In this case, the household should be approved
          only for the month of application.

          Ineligible First Month/Eligible Second Month: A household may
          be ineligible for the month of application but eligible in the
          subsequent month. Even though denied for the month of application,
          the household does not have to reapply. The same application is
          used for the first month denial and the determination of eligibility for
          the subsequent month.

5005-6 B. Benefit Start Date

          The benefit start date determines the date from which benefits begin.
           It is the date a household initially requests benefits and files an
          identifiable application:

                At the DPA office: The benefit start date is the date the DPA
                 office receives the application form; or

                With a Native Family Assistance Program (NFAP) Agency:
                  The benefit start date is the date the NFAP agency receives
                 the application form.
5005-6 C. Pending the Application

          When the office needs the applicant to submit a complete application
          form, or provide information needed to determine eligibility, the
          application is pended, and a notice is sent. The notice clearly informs
          the applicant what is needed to complete the application. Applicants
          will be given at least 10 days, but no more than 30 days, from the
          date of this notice to provide the verification. The same verification
          pend time frames will be consistently applied to all applicants within
          each office.

             1. Applicants failing to provide all necessary verification at the
                interview will be sent a pend notice no later than 30 days after
                the application filing date requesting the required verification.

             2. Applicants contacting the agency within the pend period
                expressing difficulty in obtaining required verification will be
                offered assistance. The caseworker should extend the pend
                period if additional time is needed to obtain the information. A
                new pend notice should be sent.

             3. If the applicant does not complete the application process, the
                application is denied at the end of the period provided in the
                notice.

5005-6 D. Denying the Application

          A denial notice must be sent to the applicant explaining the reason
          for the denial. This notice should be sent as soon as possible
          following the determination of ineligibility, but no later than 30 days
          following the application filing date.

          Applicants denied for failing to provide needed verification by the end
          of the pend period will be sent a notice of denial at the end of the
          pend period. If the applicant provides the verification after the pend
          period but within 30 days of the application filing date, the caseworker
          must accept the verification and make an eligibility determination
          without requiring a new application. If the household is found eligible,
          the caseworker will use the original benefit start date.


              Note:

              When the deadline for processing an application or
              providing verification does not fall on a workday, it will be
              extended to the next workday.
          See Section 5005-4(E) for policy on denying applicants for failing to
          attend an interview.

5005-6 E. Withdrawing an Application

          The applicant may voluntarily withdraw the application at any time
          before the eligibility determination is made. A written or verbal
          request to withdraw is acceptable. The reason for withdrawal (if
          known) shall be documented in the case file. The applicant shall be
          advised of his or her right to reapply at any time by submitting a new
          application. A notice shall be sent to the individual denying the
          withdrawn application.

          If the individual wants to apply again once an application has been
          withdrawn, he or she must complete a new application.

5005-6 F. When the Application is Delayed

          If a household's eligibility has not been determined or benefits have
          not been authorized to an eligible household by the 30th day
          following the application filing date, the application is delayed. The
          caseworker will determine the cause for the delay and take
          appropriate action:

          1. Agency-caused delays

          include cases where the application was not approved, denied or
          pended within the allowable time limits.

          If an eligibility determination cannot be made by the 30th day from
          the application filing date because of action required by the agency,
          the case is left in a pending status. The household must be sent a
          pend notice by the 30th day.

          2. Household-caused delays

          include situations where the office cannot take further action on the
          application without an action from the household.

          If the household fails to submit a complete application form or attend
          an interview by the 30th day from the application filing date the
          application is denied.
5008   RETROACTIVE MEDICAID ELIGIBILITY

       Retroactive Medicaid eligibility may be available to a Medicaid
       applicant who did not apply for assistance until after they received
       care, either because they were unaware of Medicaid or because the
       nature of their illness prevented the filing of an application.

       Retroactive eligibility is available when there is an unpaid medical bill
       for a service provided for three full months immediately before the
       month of application providing the individual meets all the eligibility
       criteria. An applicant does not need to be eligible in the month of
       application (or current month) to be eligible for one or more months of
       retroactive Medicaid.

       Retroactive Medicaid may also be available to an individual who is
       added to a case (e.g., child returns home). See Sections 5005-2(B)
       and (C) to determine if a new application is required.

       The date of application, rather than the date of the eligibility
       determination, establishes the beginning of the three-month
       retroactive period. Eligibility for a retroactive month cannot be
       assumed based on current month eligibility. Determine eligibility for
       each month separately using the eligibility rules in effect for that
       month.

       The caseworker must inform each applicant of the availability of
       retroactive Medicaid coverage.

             Ask the applicant if he or anyone in the household needs help
              paying for an unpaid medical bill during the retroactive period.

             Accept and document the applicant’s statement of medical
              need.

       Retroactive Medicaid is determined using:

             Actual income received in each month;

             Adjusted gross income for self-employment based on the
              appropriate type (monthly, seasonal or annual) of self-
              employment. (see Section 5164-1(C) for definitions and
              Section 5164-2 for budgeting methods); and

             Actual resources that were available in each month.
    Example:

    An individual applies for Medicaid coverage in June. The
    caseworker determines that the individual was eligible for
    retroactive Medicaid coverage in March and April, but not
    in May. Any services covered by Medicaid that the
    individual received in March and April that have not been
    paid for can be covered by Medicaid.


Deceased Applicants -- Application for retroactive Medicaid
coverage may be made on behalf of a deceased person. Payment
will be made for covered services rendered to the deceased person
during each month the person was eligible for Medicaid during the
three month period, however, Medicaid does not pay transportation
expenses for recipients who are deceased.

Medicaid Coverage During Retroactive Period -- Individuals
eligible for retroactive Medicaid are eligible for the same amount and
scope of Medicaid services as was available to other Medicaid
recipients during that time period. Coverage of services that normally
require prior authorization are not automatically denied due to lack of
approval prior to receipt of services during the retroactive eligibility
period.

Inform the recipient to give a copy of the retroactive Medicaid
approval notice to the health care provider to assure that any
retroactive claim is processed appropriately. The provider can then
attach a copy to the claim before submitting it for payment.

Only Unpaid Medical Bills --Medicaid will only pay enrolled
providers for unpaid medical claims for covered Medicaid services
during the three-month retroactive period. Medicaid will not
reimburse a recipient for medical services received during the
retroactive period that have already been paid.

Pregnant Woman Medicaid -- Eligibility may be granted
retroactively. The retro-month determines the first month of eligibility
and continues forward throughout the pregnancy. See Section 5310-
B.

Postpartum Medicaid -- Eligibility may not be granted retroactively.
The woman must be receiving Medicaid on the date that her
pregnancy terminates in order to receive postpartum coverage.
State Residency Required -- If an applicant has recently moved to
Alaska, and did not reside in the state during the three-month
retroactive period, the responsibility for medical coverage rests with
the previous state of residence. Application may be made in Alaska
for any month (during the three-month period) in which the individual
did reside in the state, as long as that person was not receiving
benefits from another state during the same time period.

Transitional Medicaid -- For the purposes of determining
Transitional Medicaid eligibility, retroactive Medicaid can be used to
determine whether a current Medicaid recipient in another eligibility
category or a new applicant would have been eligible for Family
Medicaid in three of the last six months. For more details see Section
5220.
5011 U.S. Citizenship And Eligible Alien Status

5011 U.S. Citizenship And Eligible Alien Status

5011          U.S. CITIZENSHIP AND ELIGIBLE ALIEN STATUS

             To be eligible for Medicaid, including Denali KidCare, an individual
             must be a U.S. citizen or a qualified alien.

             U.S. citizens must provide verification of their U.S. citizenship and
             identity to be eligible for Medicaid benefits.

             Qualified aliens must provide verification of their satisfactory
             immigration status when they apply for Medicaid benefits.


                    Note:

                    Verification of satisfactory immigration status is not
                    required for an alien applying for treatment of an
                    emergency medical condition. See Section 5600.


             Verification of U.S. citizenship and identity is not required for:

                     A current Supplemental Security Income (SSI) recipient;


                    Note:

                    A screen-print of the State Data Exchange (SDX)
                    interface may be used to verify and document a former
                    SSI recipient’s citizenship. An SSI recipient’s citizenship
                    status can be found in the Alien Indicator Code at
                    position 578 on the SDX.


                     A current Medicare recipient;

                     An individual receiving Social Security Disability Insurance
                      (SSDI) benefits;

                     Children in state foster care or Title IV-E adoption assistance;

                     A newborn child, including a baby whose mother is a non-
                      qualified alien and is determined eligible under “Emergency
                      Treatment for Aliens” for the labor and delivery of the child.
        Documentation of U.S. citizenship would be required when
       the child turns age one. receiving newborn coverage through
       the end of his or her first birthday.

Verification of U.S. citizenship or immigration status is needed only
for the individuals who will receive benefits, not for individuals
applying for or renewing Medicaid or Denali KidCare on behalf of
someone else.


    Note:

    If an individual who is a mandatory household member is
    found ineligible for Medicaid for failure to provide
    verification of their own citizenship and identity, or
    immigration status, that individual’s needs, income, and
    resources continue to be included in the financial
    eligibility determination for the household.
5011-2 Documenting United States Citizenship


5011-2           DOCUMENTING UNITED STATES CITIZENSHIP

5011-2 A. ACCEPTABLE DOCUMENTATION

                Verification of citizenship and identity must be obtained from original
                documents or certified copies from the issuing agency, unless
                verification is obtained through the Bureau of Vital Statistics (BVS) or
                Permanent Fund Dividend (PFD) interface as described below. An
                agency staff member or out-stationed staff will make a photocopy of
                the documents for the case file and stamp or note on the copy that an
                original or a certified copy was seen. A DPA-contracted fee agent
                may also verify and note on the photocopy that an original or certified
                copy was seen. Uncertified copies, including notarized copies are
                not acceptable.

                Although some documents contain a statement, “DO NOT COPY”,
                DPA staff may copy and file these documents in the case file for the
                official purpose of establishing Medicaid eligibility.

                Once a person’s citizenship is documented and recorded, it is not
                necessary to get proof again unless that person’s citizenship
                becomes questionable.

                Data Matches and Interfaces:

                For citizenship, verification may be obtained from a data match or
                online access with the Bureau of Vital Statistics (BVS), or from
                information on the PFD interface.

                When birth information is verified through an automated data match
                with BVS, the EIS HERC screen will be coded with "BV" and will
                override any prior code.

                The PFD interface may be used for individuals who applied for a PFD
                for the first time in 1989 or after and claim U.S. citizenship. The PFD
                Division requires that an original or certified copy of a birth certificate,
                certificate of naturalization or other acceptable document be
                submitted. When a birth certificate is received, the state of birth is
                recorded in the PFD data with a two letter state identifier. The PFD
                interface can be accepted as verification of citizenship when all of the
                following information appears on the screen:

                         US Citizenship (CITIZEN FLAG) is Y
      Place of birth (BIRTH STATE) is two digit state code

      Year of first application (FIRST APP YEAR) is 1989 or later

When the birth state field shows “//”, other verification of citizenship is
required as this code means the individual was born in another
country, for example when someone is a naturalized citizen.

If information obtained from the client, is not consistent with
information from the PFD interface, additional documentation must be
obtained from the client to verify citizenship.

When birth information is verified through the online BVS access look
up, or the PFD interface, enter code “IN” in the verification field on the
EIS HERC screen. A screen print of the information must be placed
in case file. For BVS, the screen print must be marked “For DPA Use
Only”. These screen prints should not be copied.

If verification is not available through the BVS or PFD interface, and
there is no record that an original or certified copy was seen, this
documentation must be requested from the applicant or recipient.

      For Applications:

  Verification must be obtained prior to authorizing benefits for an
  application. If verification is not available through BVS or the PFD
  interface, it must be requested.

      For Reviews:

  The individual must be making a good faith effort to obtain
  verification of U.S. citizenship and identity before benefits are
  authorized.

Levels of Acceptable Documents:

The list below provides allowable documentation for verifying U.S.
citizenship and identity. There are four levels of verification listed in
order of preference. If a higher level document is not available, a
lower level may be used.

Level One: Acceptable for Both Proof of Citizenship and Identity

      State Data Exchange (SDX) interface for a former SSI
       recipient;
      A U.S. Passport;

      A Certificate of Naturalization (Forms N-550 or N-570); or

      A Certificate of U.S. Citizenship (Forms N-560 or N-561).

Level Two: Acceptable for Proof of Citizenship: (Must have an
additional form of identity verification.)

      Verification of birth through a Bureau of Vital Statistics (BVS)
       online access or an electronic BVS data match;

      A U.S. birth certificate showing birth in one of the 50 States,
       the District of Columbia, Puerto Rico (if born on or after
       January 13, 1941), Guam (on or after April 10, 1899), the
       Virgin Islands of the U.S. (on or after January 17, 1917),
       American Samoa, Swain’s Island, or the Northern Mariana
       Islands (after November 4, 1986) recorded before 5 years of
       age;

      A Certification of Report of Birth (Forms FS-545 or DS-1350);

      A Report of Birth Abroad of a U.S. Citizen (Form FS-240);

      A U.S. Citizen I.D. Card (Forms I-179 or I-197);

      An American Indian Card (I-872) issued by the Department of
       Homeland Security with the classification code “KIC”;

      A Northern Mariana Identification Card (Form I-873);

      A final adoption decree showing the child’s name and U.S.
       place of birth;

      Evidence of U.S. Civil Service employment before June 1,
       1976;

      U.S. Military Record showing a U.S. place of birth, such as a
       DD-214, or similar official document that shows a U.S. place of
       birth; or

      Evidence of meeting the automatic criteria for U.S. citizenship
       under the Child Citizenship Act of 2000. See subsection
       5011-2 B.
Level Three: (Must have an additional form of identity verification.)

Level three documents are allowed when both primary and
secondary verification is not available and include:

        For individuals who are age 16 or older, an extract of a
         hospital birth record on hospital letterhead established at the
         time of the person’s birth that was created five years before
         the initial application date and that indicates a U.S. place of
         birth. This may also include medical records of post-natal
         care. For children under age 16, the document must have
         been created near the time of birth or five years before the
         date of application;


       Note:

       A souvenir birth certificate issued by a hospital is not
       acceptable verification


        Life, health, or other insurance record showing a U.S. place of
         birth that was created at least five years before the initial
         application date and that indicates a U.S. place of birth. For
         children under age 16, the document must have been created
         near the time of birth or five years before the date of
         application;

        Religious record recorded in the U.S. within three months of
         birth showing the birth occurred in the U.S. and showing either
         the date of the birth or the individual's age at the time the
         record was made. The record must be an official record, such
         as a baptismal certificate that is recorded with the religious
         organization. This does not include entries in a family bible; or

        Early school record showing a U.S. place of birth. The school
         record must show the name of the child, the date of admission
         to the school, the date of birth, a U.S. place of birth, and the
         names(s) and place(s) of birth of the applicant's parents.

Level Four: (Must have an additional form of identity verification.)

Level four documents are allowed when first, second and third level
verification is not available and include:

        One of the following documents that shows a U.S. place of
         birth and was created at least five years before the application
       for Medicaid For children under 16, the document must have
       been created near the time or birth or 5 years before the date
       of application:

          Seneca Indian tribal census record;

          Bureau of Indian Affairs tribal census records of the Navajo
            Indians;

          U.S. State Vital Statistics official notification of birth
            registration;

          A delayed U.S. public birth record that is recorded more than
            five years after the person’s birth;

          Statement signed by the physician or midwife who was in
            attendance at the time of birth;

          Medical (clinic, doctor, or hospital) record created at least
            five years before the initial application date that indicates a
            U.S. place of birth.

      Federal or State census record showing U.S. citizenship or a
       U.S. place of birth;

      The Roll of Alaska Natives maintained by the Bureau of Indian
       Affairs. The Roll only contains information of individuals who
       were born prior to December 18, 1971. Using a release of
       information, staff may contact the Bureau of Indian Affairs to
       request information and documentation on the individual from
       the Roll;

      Institutional admission papers from a nursing facility, skilled
       care facility or other institution created at least 5 years before
       the initial application date that indicates a U.S. place of birth;
       or

As a Last Resort:

      A written declaration made by at least two individuals of whom
       one is not related to the applicant/recipient and who have
       personal knowledge of the event(s) establishing the applicant’s
       or recipient’s claim of citizenship. If known, the declaration
       should also explain why documentary evidence establishing
       the applicant’s claim of citizenship does not exist or cannot be
       readily obtained. The person(s) making the declaration must
       be able to provide proof of his/her own citizenship and identity
       for the declaration to be accepted.

       A separate declaration is needed from the applicant or
       recipient, or other knowledgeable individual (guardian or
       representative) explaining why the evidence does not exist or
       cannot be obtained. The declarations must be signed under
       penalty of perjury.

Acceptable Proof of Identity: (Must have an additional verification
of citizenship.)

      A driver’s license issued by a state or territory with a
       photograph of the individual or other identifying information
       such as name, age, sex, race, height, weight, or eye color. A
        voter's registration card or Canadian driver's licenses are not
       acceptable verification;

      Identification card issued by the federal, state, or local
       government with the same information included on driver’s
       licenses listed above;

      Certificate of Degree of Indian Blood, or other U.S. American
       Indian/Alaska Native Tribal document with a photograph or
       other personal identifying information relating to the individual;

      School identification card with a photograph of the individual;

      U.S. military card or draft record;

      Military dependent’s identification card;

      U.S. Coast Guard Merchant Mariner card; or

When no Other Identity Document is Available:

      Three or more documents that together reasonably confirm the
       identity of an individual, such as employer identification cards,
       high school and college diplomas from accredited institutions
       (including general education and high school equivalency
       diplomas), marriage certificates, divorce decrees and property
       deeds/titles. The documents must list the individual's name,
       plus any additional information establishing the individual's
       identity and must have consistent identifying information. This
       form of identity may not be used when U.S. citizenship is
                 documented under level four.

        Identity for Children Under age 16:

                Clinic, doctor or hospital record;

                School records, which may include nursery or daycare record
                 and report cards. Verification of these records must be made
                 with the issuing school; or

                A Medicaid application, or a declaration that states the date
                 and place of the child’s birth that is signed by a parent,
                 guardian, or caretaker relative under penalty of perjury. The
                 Medicaid application or an identity declaration may be used for
                 children under age 18 in limited circumstances, such as
                 when school ID cards and drivers' licenses are not available to
                 the individual in their locality.

        Identity for Disabled Individuals in Institutional Care:

                A declaration signed under penalty of perjury by a residential
                 care facility director or administrator on behalf of the individual
                 in the facility when the individual does not have or cannot get
                 any of the documentation listed above.


               Note:

               A declaration for identity may not be accepted if a
               declaration for citizenship was provided.


5011-2 B. CITIZENSHIP FOR CERTAIN CHILDREN BORN OUTSIDE THE
          UNITED STATES

        Effective February 27, 2001, the Child Citizenship Act of 2000 allows
        a child born outside of the United States to acquire citizenship of the
        United States automatically when all of the following conditions have
        been fulfilled:

           1. At least one parent of the child is a citizen of the United States,
              whether by birth or naturalization;

           2. The child is under the age of eighteen years; and

           3. The child is residing in the United States in the legal and
              physical custody of the United States citizen parent; pursuant
               to a lawful admission for permanent residence.


            Note:

            Because proof of citizenship is not automatically issued
            to eligible children, parents must provide proof of the
            child’s relationship (such as a birth certificate) to their
            U.S. citizen parent and proof that the child is lawfully
            admitted into the U.S. Parents of a foreign born child
            who meet the conditions of the new law should be
            encouraged to apply for a certificate of citizenship for
            their child with the USCIS and/or for a passport for their
            child with the Department of State.


5011-2 C. FOREIGN BORN CHILDREN ADOPTED BY U.S. CITIZENS

        Under the Child Citizenship Act of 2000, a foreign born child under
        age 18 who has been legally adopted by at least one U.S. citizen
        parent automatically becomes a U.S. citizen when the legal adoption
        is finalized. Most of the time, a parent will be able to verify the U.S.
        citizenship of their child by producing a U.S. birth certificate.

        Once a U.S. citizen, the five-year bar no longer applies. However,
        until the legal adoption is finalized, a foreign born child who arrives
        after 8/22/96 is subject to the 5 year bar.

        Effective January 1, 2004, a new entrant (IR-3) program was
        implemented, which focuses on newly entering orphans with full and
        final adoptions abroad. Under this new program, these children will
        automatically receive a Certificate of Citizenship within 45 days of
        entry into the U.S.
5104-7    INDIVIDUALS INCLUDED IN THE HOUSEHOLD AND WHOSE
         INCOME AND RESOURCES DO COUNT, BUT WHO ARE NOT
         ELIGIBLE FOR COVERAGE

         Parents living in the same home as a dependent child may have their
         needs included in the household, even though they are disqualified
         for Medicaid coverage for themselves. These parents are kept in the
         household so that the child is not penalized for the disqualifying
         actions of the parent. The disqualified parent’s resources and
         income do count in determining financial eligibility. These individuals
         include:

            1. The parent of a dependent child, when the parent is
               disqualified from Medicaid eligibility for failure to cooperate
               with CSSD;

            2. The parent fails to provide or verify information under Section
               5000-4;

            3. The parent of a dependent child, when the parent is ineligible
               because of income deemed from a spouse who is only a
               stepparent to the dependent child.

            4. The parent of a dependent child, when the parent is
               disqualified from Medicaid eligibility because the parent is a
               qualified alien subject to the 5-year bar or is a non-qualified
               alien. This also includes any siblings that are non-qualified
               aliens. See Section 5011-5.

            5. A mandatory household member found ineligible for Medicaid
               for failure to provide verification of their own citizenship and
               identity or immigration status. See Section 5011.
5125 Deprivation
5125        DEPRIVATION

         To be eligible for Family Medicaid, a dependent child must be
         deprived of the parental support and care of one or both of the child's
         parents. Deprivation occurs when a parent does not continue to live
         in the home of the child, except for a temporary absence allowed at
         Section 5120-5, or because of under-employment of the parents.

         Deprivation is based upon the condition of the parents, not the
         condition of the child or of another relative. Deprivation must always
         be verified and documented.

         There are three causes of deprivation recognized in Alaska:

                 Deprivation by Death (See Section 5125-1)

                 Deprivation by Under-Employment (See Section 5125-2)

                 Deprivation by Continued Absence (See Section 5125-3)


                Historical Note:

                Historically, when one or both natural or adoptive parents
                were incapacitated by a physical or mental defect, illness,
                or disability, the child was considered deprived of
                parental support and care. While this form of deprivation
                is recognized under federal law, it no longer has a
                practical application in Alaska. Effective July 1, 1997,
                Alaska Medicaid policy on deprivation by unemployment
                was expanded, such that all two parent households who
                would have had to rely on deprivation by parental
                incapacity to qualify for Family Medicaid will meet the
                requirements for deprivation by unemployment.
5125-1   DEPRIVATION BY DEATH

         When one or both natural or adoptive parents of a child are
         deceased, the child is deprived of parental support and care.
         5125-2 Deprivation By Unemployment
5125-2    DEPRIVATION BY UNDER-EMPLOYMENT


         5125-2 A. DEFINITION OF UNDER-EMPLOYMENT

                 A child living in a two-parent home is deprived of parental support
                 and care because of under-employment when the household income
                 does not exceed the Family Medicaid need standard for the
                 household size.

         5125-2 B. PREGNANT WOMEN IN THIRD TRIMESTER

                 A pregnant woman with no other Family Medicaid eligible children
                 who is in her last 90 days of pregnancy may qualify for Family
                 Medicaid based upon deprivation by under-employment if the ALL of
                 following criteria are met:

                    1. The father of the unborn child is living in the home.


                     Note:

                     If she is legally married, the pregnant woman’s spouse is
                     presumed under state law to be the father of the child,
                     unless a court determines otherwise.


                    2. If not married to the pregnant woman, the father of the unborn
                       child must acknowledge paternity by signing a Bureau of Vital
                       Statistics Affidavit of Paternity (BVS Form 16).

                    3. All other Family Medicaid financial and non-financial eligibility
                       criteria are met.

                 During the third trimester, only the pregnant woman may receive
                 Medicaid coverage. While the needs of the unborn child and the
                 child’s father are included in the eligibility determination, neither is
                 eligible for Medicaid coverage until the baby is born. Once the child
                 is born, the child and the father may be added to the Family Medicaid
                 case. Until the father is actually a Medicaid recipient, the father is not
                 required to pursue development of income.
5125-3 Deprivation By Continued Absence
5125-3      DEPRIVATION BY CONTINUED ABSENCE

5125-3 A. DEFINITIONS

         In deciding whether deprivation by continued absence exists, the
         caseworker will use the following definitions:

         Maintenance means providing regular, predictable, and frequent
         contributions of cash, which are for a child’s basic needs and are
         significant in value. Sporadic gifts once a month or less frequently is
         not the same as maintenance.

         Physical care includes activities such as providing clean clothing,
         washing, dressing, preparing meals, feeding, putting to bed, or
         assisting with other personal care needs. Substantial amounts of
         physical care must be provided on a regular, frequent, and
         predictable basis in order for the caseworker to find that a parent is
         providing physical care for a child.

         Guidance includes activities such as accompanying the child to the
         doctor, providing transportation, attending school activities and
         conferences, assisting with school work or extra curricular activities,
         monitoring activities or play, providing discipline, and participating in
         decisions concerning the child's well-being. Substantial guidance
         must be provided on a regular, frequent, and predictable basis in
         order for the caseworker to find that a parent is providing guidance to
         a child.

5125-3 B. CIRCUMSTANCES IN WHICH A CONTINUED ABSENCE
          CONSTITUTES DEPRIVATION.

         A child is deprived of parental support and care when a parent does
         not continue to live in the home of the child, except for a temporary
         absence. See Section 5120-5 B.

         The child is deprived of parental support and care, even if a divorced,
         separated, unmarried, hospitalized, or institutionalized parent, with
         whom the child does not live, has some contact with the child.

5125-3 C. DURATION OF CONTINUED ABSENCE

         There are no minimum time limit requirements on how long a
         continued absence must have lasted or be expected to last. It is
         never acceptable to hold an application in order to verify that
         deprivation exists. For recent absence cases, the caseworker must
        answer the following two questions before reaching an eligibility
        decision about deprivation:

           1. Is one of the parents absent from the home now?

           2. Is that absence such that the conditions of section 5125-3 B
              above are met, and it appears reasonable to predict that the
              conditions of 5125-3 B above will be met?

        If the answer to either or both of these questions is "no", then
        deprivation does not exist. If the answer to both of the questions is
        "yes", then deprivation exists.

5125-3 D. DETERMINING DEPRIVATION WHEN THE ABSENT PARENT
          HAS CONTACT WITH THE CHILD

        Occasionally a divorced, separated, or unwed parent may have
        contact with the child, visiting the child in the child’s home, having the
        child visit in his or her home, picking the child up from school or home
        and taking the child to activities, etc. If such visits occur they do not
        automatically lead to the finding, that deprivation does not exist. All of
        the available circumstances of the visits must be gathered and
        examined to see if the criteria of Section 5125-3 B are met. Whatever
        the cause of the alleged absence of the parent from the home of the
        child, cases in which there is frequent contact of the child with the
        absent parent will be treated as follows:

        1. Obtaining Absent Parent Residence Information

          The caseworker must determine if the allegedly absent parent is in
          fact absent, which means not living in the child's home. Absence
          exists if the parent maintains a residence elsewhere that is not
          temporary, and actually uses that residence as his or her primary
          home, as shown by keeping regularly-used personal possessions
          and clothing there, regularly receiving telephone calls and mail
          there, reporting that residence to others as his or her address, etc.
          The caseworker must evaluate items of proof which tend to show
          where the absent parent lives. Each item of proof must be
          evaluated along with the other items so that the caseworker can
          decide whether the home of the child and the absent parent are the
          same.

          The caseworker must allow for the fact that domestic relations may
          appear cordial and open with respect to the child and visitation.
          However, circumstances may exist otherwise that make it
          impossible for the applying caretaker relative to present or obtain
  proof concerning the absent parent's actual residence. Benefits will
  not be denied because the caretaker relative cannot provide this
  proof. The caseworker must, where necessary, obtain residence
  information from the absent parent and/or from collateral contacts.

2. Complaints

  Frequent contact cases, particularly those involving a history of
  custody disputes or those involving some sort of Child Support
  Enforcement recovery, are often subject to complaints from
  relatives, neighbors, or one of the parents, or made anonymously.
  The most frequent source of such complaints involves the question
  of where the allegedly absent parent really resides. While all such
  complaints must be documented and at least examined, no finding
  on deprivation can be made without a full investigation. Complaints
  from any source, anonymous or otherwise, must be examined
  carefully and weighed in light of the possible motives of the
  complainant. Documents showing residence or mailing address
  must be weighed according to how recent they are and who
  provided the information they show.

3. Examples of Proof

  Following are examples of proof, which may be relevant to deciding
  where someone lives:

        Where the person keeps the majority of his/her personal
         belongings;

        The amount of time spent at one address as opposed to
         another;

        Housing records, e.g., lease, rent receipts;

        Unemployment Insurance Benefit records;

        Child support records;

        Correctional, police, or probation records;

        Tax records;

        Employer or union records;

        School registration;
                Mailing address for government benefits which require
                 mailing to the current address;

                Address used for credit;

                Address given to utilities or creditors as a current address;

                Vehicle registration, driver's license, or post office address
                 that has changed since the absence started;

                Information about the frequency, type, and length of the
                  absences;

                Collateral contacts with landlords, neighbors, or other
                 reliable persons.

5125-3 E. EXAMPLES OF PARENTAL ABSENCE

        1. Planned Absence

          Short, planned absences for such activities as vacations, visiting
          relatives, National Guard summer camp, or seeking/securing
          employment may temporarily disrupt the household unit and
          reduce the amount of support, care, or guidance the absent parent
          is able to provide. However, planned absences do not result in a
          finding of deprivation unless the test set out in Section 5125-3B is
          met. Deprivation cannot be denied simply because the separation
          began as a planned absence. The current situation must be
          examined to determine if deprivation now exists.

        2. Divorce

          Divorce is a judicial termination of a marriage by written decree of a
          court. Deprivation may exist if a child's natural or adoptive parents
          are divorced and one or both parents are out of the child's home.


            Verification:

            Verify with a copy of the divorce decree and by collateral
            contacts on the actual living situation.


          When a divorce has been granted that also involves a child
          custody order, it is possible that the actual location of the child and
          the parent who is actually the caretaker may be very different from
          what is specified in the custody order. The specified terms may
  bear no relationship at all to who actually has custody of the child
  or when visitation occurs. Thus, an order providing for joint or
  shared custody does not by itself demonstrate that deprivation
  does not exist. The caseworker must examine the actual situation
  to determine if the criteria in Section 5125-3 B are met.

3. Legal Separation

  Legal separation occurs when a court issues a written decree
  establishing the right of married parties to live apart without actually
  terminating their marital bonds. Deprivation exists if the couple is
  not living together.


    Verification:

    Verify with a copy of the separation order and by
    collateral contacts on the actual living situation.


4. Separation Without a Court Decree

  Deprivation may exist when the natural or adoptive parents are not
  living together and desertion has not occurred.


    Verification:

    Verify with collateral contacts on the actual living
    situation.
5. Desertion

  Desertion occurs when either or both parents willfully abandon the
  home, leaving it without the necessities of life and with no
  indication of any plan to return.


    Verification:

    Verify with collateral contacts.


6. Unwed Parents

  Birth out of wedlock may be considered as a condition depriving
  the child of parental support and care if one or both of the unwed
  parents are absent from in the home of the child and the other
  aspects of deprivation exist.
  Unrelated male living in home. In the circumstance where an
  applicant household consists of a parent, child, and an unrelated
  male, there is a possibility that the unrelated male is the father of
  the child.

  Deprivation by reason of continued absence will not exist if:

        The unrelated male is determined to be the father of the
         child by a court decision; or

        A birth certificate is issued listing the unrelated male as the
         child's father. Normally, the Alaska Birth Certificate of a child
         born out of wedlock will not list any father, unless the father
         has signed a Vital Statistics Affidavit of Paternity; or

        The unrelated male acknowledges paternity using the DPA
         GEN #7.

  If a caseworker believes that an unrelated male in the household
  may be the father, he must complete the Division of Public
  Assistance Statement of Relationship form (GEN #7). If none of the
  three conditions above exists, and the person indicates on this
  form that he is not the father, deprivation exists.

7. Hospitalization

  Deprivation may exist if the absent parent is hospitalized or
  institutionalized for prolonged treatment of physical or mental
  illness. In order for deprivation to exist, the severity and duration of
  the illness must be such that the role of the sick parent in providing
  support and care for the child is interrupted or terminated.


    Verification:

    Verify by obtaining a statement from a medical provider
    that confirms institutionalization and gives an assessment
    of the duration and severity of the illness.


8. Deportation

  Deprivation of parental support or care due to continued absence
  of the parent exists when a parent has been deported from the
  United States. There are no requirements concerning how long the
  parent must be gone.
     Verification:

     Verify by obtaining by court documents or Immigration
     and Naturalization Service documents ordering
     deportation.


 9. Imprisonment/Work Release

   Deprivation of parental support or care due to continued absence
   of the parent will be found to exist when a parent has been
   sentenced to a correctional institution or is being held in a
   correctional institution to await legal proceedings.

   Work Release. Deprivation may be found to exist in the instance
   when the parent is on a work-release program and living at home,
   providing the following conditions are met:

          A parent has been convicted of an offense and is under
           sentence of a court, and

          The sentence requires, and the parent is performing, unpaid
           public or community services during working hours.


     Verification:

     Verify by obtaining a statement from an official of the
     custodial institution.


10. Single Parent Adoption

   Deprivation exists if there is evidence of a court-approved single
   parent adoption.


     Verification:

     Verify by viewing the court order of adoption. Document
     that this court order was seen; do not place a copy in the
     case file.


11. Military Service
If the absent parent is in the military or other uniformed service
(including Coast Guard or Public Health Service), deprivation may
exist if the absence is not solely due to military service. If the
military parent is away from home on an assigned duty or tour
elsewhere, this is a planned absence and not deprivation.
 Deprivation exists only if the parent is absent from the home and
the extent of his involvement in providing support and care
immediately before and during the assignment constitutes
deprivation.


  Verification:

  Verify absence and deprivation with military authorities
  and other collateral contacts.
5160 Income
5160   INCOME

       A household's eligibility is determined on a calendar month basis.
        Income eligibility is determined by considering all the countable
       income that the household already received and can expect to
       receive during the calendar month.
5160-1   DETERMINING THE HOUSEHOLD’S MONTHLY INCOME

         A household’s eligibility is determined by estimating the income the
         household already received and can reasonably expect to receive.
          Income is estimated by making a reasonable guess based on the
         information available from the household and source of income. The
         caseworker reviews the income received in the past and current
         months from the available information and considers, with input from
         the household and source of the income, what income is likely to be
         received during the remainder of the current month and in the
         subsequent month.

         Income is not counted if the amount of the income cannot be
         estimated or it cannot be reasonably anticipated when the income will
         be received. This type of income may come from sources such as
         bingo or pull-tabs, or may be earned or unearned income that is
         unpredictable and cannot reasonably be anticipated to recur.

         To determine the household’s estimated monthly income, the
         caseworker must know:

               Which household members receive income?

               What is the source of the income?

               What is the amount of each payment?

               How often the payments are received - monthly, twice a
                month, every two weeks, once a week?

               When the payments are received and, if payments have not
                yet begun, when is the first payment expected?

         The estimated income amount used will be considered correct if:

               It is reasonable;

               It is based on all available information;

               The caseworker applied correct policy; and

               The estimate is documented.

         Once the caseworker estimates a household’s monthly income,
         adjustments to the income estimate are made when a change is
reported that affects the amount of income the individual expects to
receive.

In most cases, the caseworker will estimate the monthly income by
calculating an average payment based on recent payments and
multiplying this average by the number of payments expected in the
month.
5160-2   CALCULATING AN AVERAGE PAYMENT

         A caseworker will calculate an average payment when there are
         known payment amounts from a source, the payment amounts vary,
         and the frequency of payment is expected to remain about the same.
          To calculate an average payment amount, add together recent
         payments from the same source and divide this total by the number
         of payments. To do this calculation, use recent payments that
         represent what is likely to be received, including actual payments
         already received in the month. Payments that do not represent a
         regular payment may be excluded in the calculation, for example,
         one-time overtime or an increase or decrease in hours that is not
         expected to continue.


             Example:

             Debra is employed as a housecleaner at a motel, and
             works varying hours depending on how many rooms
             were rented the previous night. She is paid twice a
             month and provides her last three pay stubs, showing
             gross earnings of $600 on March 20th, $585 on April 5th,
             and $660 on April 20th. Neither Debra nor her employer
             is able to predict how many hours she will work in a
             coming pay period, but both agree that her expected
             income will be about the same as her past earnings.
              Calculate an average payment by adding the pay
             amounts together and dividing by three ($600 + 585 +
             660 = $1845 divided by 3 pay periods = $615).
5160-3    CONVERSION FACTORS

         1. Conversion factors are used to convert income to monthly
            amounts when the individual is paid on a weekly or bi-weekly basis
            and the individual received or expects to receive a full month’s
            income.

                     Weekly Income – Conversion Factor 4.3

           When payments are received on a weekly basis, the individual will
           receive a fifth payment every third month. Using the conversion
           factor of 4.3 takes into account this fifth payment.

           If income is received weekly, multiply the payment by the
           conversion factor 4.3 to determine the monthly income. If the
           weekly payment amount varies, calculate an average payment and
           multiply this average payment by the conversion factor 4.3 to
           estimate the monthly income.

                    Bi-weekly Income – Conversion Factor 2.15

           When payments are received every two weeks (bi-weekly), the
           individual will receive a third payment every sixth month. Using the
           conversion factor of 2.15 takes into account this third payment.

           If income is received every two weeks, multiply the payment by the
           conversion factor 2.15 to determine the monthly income. If the bi-
           weekly payment amount varies, calculate an average payment and
           multiply this average payment by the conversion factor 2.15 to
           estimate the monthly income.

           2. Conversion factors are not used:

           When estimating a partial month’s income. See Section 5160-6,
           Estimating Partial Month’s Income.

           3. Conversion factors are not needed when the individual is paid
              in a single monthly payment or twice a month.

                     If income is received in a single monthly payment, no
                      conversion is necessary since it is already a monthly
                      amount. If the monthly payment amount varies, calculate an
                      average payment and use this average as the estimated
                      monthly income.
   If income is received twice a month, multiply the payment by
    two to determine the monthly income. If the payment
    amount varies, calculate an average payment and multiply
    this average by two to estimate the monthly income.
5160-4   RESERVED
5160-5 Estimating A Full Month's Income
5160-5    ESTIMATING A FULL MONTH’S INCOME

5160-5 A. Payment Amounts Do Not Vary

         When the individual receives or expects to receive a full month’s
         income from a source and the payment amount does not vary,
         estimate the monthly income by multiplying the payment amount by
         the number of payments expected in the month.


             Example #1:

             Jim applies on April 4 and is interviewed on April 7. His
             only income is unemployment benefits of $200 every two
             weeks. For April, he’ll get two payments on April 8 and
             April 22. He’ll receive a full month’s income in April and
             expects a full month’s income in May. Estimate April’s
             income by multiplying his bi-weekly payment of $200 by
             the bi-weekly conversion factor of 2.15 ($200 x 2.15 =
             $430) and count $430 for April and subsequent months.


             Example #2:

             Joan applies on March 28th and is interviewed on April
             2nd. She receives weekly worker’s compensation
             checks of $250, and provides verification of her March
             payments received on the 1st, 8th, 15th, 22nd, and 29th.
              Her next check will be received on April 5th. She
             received a full month’s income in March and expects a
             full month’s income in April. Estimate the income by
             multiplying the weekly payment by the weekly conversion
             factor 4.3 ($250 x 4.3 = $1075.) Count $1075 income for
             March, April, and subsequent months.


5160-5 B. Payment Amounts Vary

         When the individual will receive or expects to receive a full month’s
         income from the source and the payment amounts vary, calculate an
         average payment amount by adding together payments from the
         same source and dividing this total by the number of payments.
          Then estimate the monthly income by multiplying the average
         payment amount by the number of payments expected in the month.


             Example #1:

             Ron applies on May 7 and is interviewed on May 10.
              Ron has been working a part-time job since February
             and gets paid every other Friday. He’ll receive two
             checks in May - on May 14 and May 28. He provides
             three pay stubs showing he grossed $350 April 2, $325
             April 16, and $360 April 30. Estimate May’s income by
             calculating an average paycheck. ($350 + $325 + $360
             = $1035 divided by 3 = $345) Multiply this average
             check by the bi-weekly conversion factor 2.15, since he
             gets paid every two weeks ($345 x 2.15 = $741.75).
              Count $741.75 monthly income from this job for May and
             for subsequent months.


             Example #2:

             Carolyn applies on September 15th and is interviewed on
             September 19th. She works at the video store about 20
             hours a week at $8.00 an hour. She gets paid on the 5th
             and 20th of each month. Her August 5th check was
             $320, her August 20th check was $336, and her
             September 5th check was $352. Estimate September’s
             income by calculating an average paycheck. ($320 +
             $336 + $352 = $1008 divided by 3 = $336) Multiply this
             average check by 2, since she is paid twice a month.
               ($336 x 2 = $672) Count $672 for September and for
             subsequent months.


5160-5 C. Estimating New Earned income

         When an individual starts a new job and will receive a full month’s
         income, initially estimate the monthly income by using the individual’s
         anticipated work schedule and hourly rate of pay. Multiply the hourly
         rate of pay by the number of hours the individual is expected to work
         per week. Multiply this estimated weekly wage by the weekly
         conversion factor 4.3 to get an estimated monthly amount.

         At review, determine a new income estimate by calculating an
         average payment using recent payments.
             Example:

             Kathy applies on July 10th. She started a new job on
             July 5th, and will get her first paycheck on July 20th. She
             gets paid by the hour and paydays are on the 5th and
             20th. The employer verifies that she will work an
             average of 30 hours per week at $7 per hour. She will
             receive a partial month’s income in July, and a full
             month’s income beginning August. For July, use the
             income she is expected to receive in July based on
             scheduled hours, pay period end dates, and pay dates.
              For August and subsequent months, estimate the
             income by calculating a weekly wage (30 hours x $7 =
             $210) and applying the weekly conversion factor of 4.3
             ($210 x 4.3 = $903).


5160-5 D. Estimating Earned Income that has Changed

         When the individual will receive a full month’s income and the rate of
         pay has changed but the number of hours is expected to remain
         about the same, estimate the monthly income by calculating the
         average number of hours per pay period using paychecks already
         received and multiplying this average number of hours by the new
         hourly rate.


             Example:

             Terri reports she got a raise to $10 an hour starting July
             1. She gets paid twice a month, and provides her last
             three pay stubs that show 45 hours for pay period ending
             May 31, 36 hours for pay period ending June 15, and 42
             hours for pay period ending June 30. Average the
             number of hours by adding them together and dividing by
             three (45 + 36 + 42 = 123 divided by 3 = 41). Multiply
             this average number of hours by the new rate of pay to
             get an average payment per pay period (41 hours x
             $10/hour = $410).


5160-5 E. Change in Income Occurs During the Month

         When a change occurs during a month and the individual will get a
         full month’s income, calculate an average payment using the
         amounts received and expected to be received in the month. Then,
          multiply this average payment by the number of payments expected
          in the month to get an estimated monthly income for this month.


              Example:

              Yvonne applies for assistance on June 17th. She started
              a job on May 16th, works 40 hours a week, and is paid
              every other Friday. She was paid a training wage of
              $8.00/hour for the first two weeks. Since May 28th, she
              is now being paid $12.00/hour. Her first check received
              June 10th for pay period ending May 27th was 40 hours x
              2 weeks x $8.00/hour = $640. Her June 24th check for
              pay period ending June 10th will be 40 hours x 2 weeks x
              $12.00/hour = $960.

              Since June income will include pay at two different rates,
              June’s income is estimated by calculating an average
              payment using the $640 received June 10, and the $960
              expected on the June 24th check, $640 + $960 = $1600
              divided by 2 = $800. Multiply this average payment by
              the appropriate conversion factor, $800 x 2.15 =$1720.
               For July, estimate the income using only the higher rate
              of pay, $960 x 2.15 = $2064.


5160-5 F. Estimating Salary Income

          When an individual receives a salary and will receive a full month’s
          income, estimate the monthly income based on the monthly salary
          the individual expects to receive.


              Example:

              Jon works for the State of Alaska and receives a salary of
              $1,000 twice a month. Calculate his monthly earnings by
              multiplying his salary by two ($1,000 x 2 = $2,000) and
              count $2,000 gross earned income from this job.
5160-6 Estimating A Partial Month's Income
5160-6   ESTIMATING A PARTIAL MONTH’S INCOME

         When a household's income from a source begins or ends, it may be
         necessary to estimate a partial month’s income. For these situations,
         do not use conversion factors to estimate the income.

         If the household receives or expects to receive a partial month’s
         income from a source in a month, estimate the income by totaling the
         actual income received and the income the household expects to
         receive in the month.

         1.   Beginning Income in Month of Application:


              Example:

              Maria applies on June 25. She just began receiving
              weekly unemployment benefits of $100 and will receive a
              $200 check every two weeks. She received her first
              check of $200 on June 18. Her next check will be
              received July 2. Count $200 unemployment benefits for
              the month of June. Since she will receive a full month’s
              income in July, estimate July’s and subsequent months
              income using the 2.15 bi-weekly conversion factor ($200
              x 2.15 = $430) and count $430 for July and subsequent
              months.


         2.   Beginning Income in Ongoing Case:


              Example:

              Char reports on February 7th that she will start receiving
              bi-weekly payments from an annuity. She will receive her
              first payment March 18th. This will be the only check
              received in March. Determine eligibility for March
              counting the one payment she will receive on March
              18th. Since she will receive a full month’s income in
              April, estimate April’s and subsequent months income by
              multiplying the bi-weekly payment by the 2.15 conversion
              factor.
3.   Ending Income in Month of Application:


     Example:

     Clarissa applies on August 13 and is interviewed the
     same day. She received her last unemployment benefit
     check of $200 on August 6. Count $200 income for
     August. Since she will no longer receive benefits, no
     unemployment income is counted for September.


4.   Ending Income in Ongoing Case:


     Example:

     Kevin reports on September 3 that his seasonal job will
     end in September. The final check from this source will
     be received in October. The anticipated actual amount of
     the final check is estimated for October.


5.   Income Changing During the Month:


     Example:

     Venietia applies for assistance on June 16, and reports
     that she has a job that pays twice a month. She provides
     paychecks showing that she was paid $500 on May 10
     and $600 on May 25. However, during the last half of
     May, she had to take some time off without pay due to an
     illness in the family and so did not receive a paycheck on
     June 10. She returned to work on June 1 at her regular
     pay and expects to be paid $550 on June 25.

     Since Venietia will not receive a full month’s pay during
     June, this is considered to be a partial month’s income.
      The income for June is estimated by calculating the
     amount that she will receive on the June 25 paycheck.
      Income for July will be estimated based on a full month's
     income.
5300   DENALI KIDCARE

       The Balanced Budget Act of 1997 established the Child Health
       Insurance Program in Title 21 of the Social Security Act. This
       program provides Alaska with enhanced federal matching money to
       expand Medicaid eligibility to more children. At the same time,
       eligibility was also expanded for pregnant women. Beginning March
       1, 1999, children under age 19 and pregnant women qualified for
       health care coverage if their household income was at or below 200
       percent of the federal poverty guideline (FPG) for Alaska.

       On September 1, 2003, the eligibility standard for children without
       insurance and pregnant women was reduced from 200 percent to
       175 percent of the 2003 federal poverty guideline for Alaska. This
       175 % FPG standard was frozen at the 2003 level and did not
       increase each year as it did historically.

       Effective July 1, 2007, the eligibility standard for children without
       insurance and pregnant women was increased to 175 percent of the
       2007 federal poverty guideline for Alaska due to a change in law.
        This standard will increase each year along with the annual
       increases in the federal poverty guidelines.

       Denali KidCare is an expansion of Medicaid, using the same basic
       infrastructure and benefit package. The Denali KidCare name
       encompasses the Medicaid eligibility categories of pregnant woman
       (PR), newborn (BA), healthy child (HC), and six-up (SU), although
       these Medicaid subtypes continue to be used for federal financial
       claiming purposes. Application intake and processing occur in the
       specialized Denali KidCare office.
5310 Pregnant Woman Eligibility

5310      PREGNANT WOMAN ELIGIBILITY

5310 A.   GENERAL ELIGIBILITY CRITERIA

          A pregnant woman whose household income does not exceed 175%
          of the Federal Poverty Guideline for Alaska for her household size,
          who meets the Family Medicaid non-financial criteria, and whose
          pregnancy has been medically verified is eligible for Denali KidCare.
           There is no resource requirement or insurance restriction for this
          coverage. See Addendum – 1.

          To determine income eligibility, take into consideration the needs and
          income of all household members who must be included in a Family
          Medicaid household. These include:

                  The spouse of the pregnant woman;

                  Her children;

                  The parents of the Under 21 pregnant woman; and,

                  The needs of the unborn (or unborns if multiple births have
                   been verified) must be included as though the child were born.


                 Note:

                 The needs and income of the father of the unborn child
                 are not included in this determination unless he is the
                 spouse of the pregnant woman.


          Countable income is determined by following Family Medicaid rules
          except for income or disregards that are prohibited from being
          counted under Section 5020. A pregnant woman is eligible if the
          countable income of the household (including the unborn) does not
          exceed the income eligibility standards for her household size.

          Once determined eligible, a pregnant woman is covered throughout
          her pregnancy, including the 60-day postpartum period, without
          regard to changes in her household income. Thus, the woman will
          remain eligible during her pregnancy and postpartum period even if
          her income later exceeds the income standard. See Addendum - 1.
           However, she must remain an Alaska resident and notify the agency
at the end of her pregnancy. A pregnant woman is not required to
cooperate with CSSD in establishing paternity or pursuing medical
support orders until after her postpartum period ends. See Section
5320.


    Example 1:

    The household consists of a pregnant mother, her
    husband, and their two children. To determine eligibility,
    the caseworker would consider the needs and income of
    the mother, father, the unborn, and the two children. If
    the household's countable income as determined by
    Family Medicaid rules does not exceed the poverty level
    standard for a 5 person household, the mother is eligible
    for Denali KidCare as a pregnant woman. The children, if
    age 18 or under, may also be eligible for Denali KidCare
    using a 4-person household size as the needs of an
    unborn child are included only in determining eligibility for
    the pregnant woman.


    Example 2:

    The household consists of a mother and her pregnant 17-
    year-old daughter. To determine eligibility, consider the
    needs and income of the adult mother, her daughter, and
    the unborn child. Since Denali KidCare considers
    parental responsibility to continue until a child is 21, the
    adult mother's income is considered available to her
    minor daughter. If the pregnant minor’s income and the
    income of the adult mother, after allowable deductions,
    do not exceed the income standard for a household size
    of 3, the daughter is eligible for Denali KidCare as a
    pregnant woman.


    Example 3:

    The household consists of a pregnant woman, a child,
    and the father of the children, both born and unborn, who
    is not married to the pregnant woman. To determine
    eligibility, consider the needs of the pregnant woman and
    her children, including the unborn, and the income of the
    pregnant woman only. The needs and income of the
    children's father are not included because he is not the
              spouse of the pregnant woman. However, any income
              he contributes directly to the pregnant woman must be
              considered as income to her. If the mother's countable
              income does not exceed the standard for a household
              size of 3, the woman is eligible for Denali KidCare as a
              pregnant woman. The child, if age 18 or under, may
              have his or her eligibility determined; the household size
              is 3 and the father's income would count in that
              determination since a parent's income is considered
              available to a born child.


5310 B.   RETROACTIVE ELIGIBILITY FOR PREGNANT WOMEN

          Pregnant Woman eligibility may extend three months retroactively if
          the applicant was pregnant during that period and meets all other
          Denali KidCare eligibility requirements. Even if a woman is not
          eligible in the application month or month following the application
          month, but is eligible in Alaska in one of the three retroactive months
          before the application month, she is considered eligible for Denali
          KidCare from that month throughout her pregnancy, regardless of
          changes in her household income.


              Example:

              Aina applies for Pregnant Woman Medicaid in September
              and requested Retroactive Medicaid for the month of
              July. The caseworker determines that Aina is eligible for
              Retroactive Medicaid in July. The caseworker does not
              make any further eligibility determinations. Aina is
              eligible for Pregnant Woman Medicaid beginning July
              and eligibility continues from that month forward through
              the month of her estimated due date.


5310 C.   CONTINUATION OF ASSISTANCE FROM OTHER TYPES OF
          MEDICAID

          A pregnant woman eligible under any Medicaid eligibility category
          who loses eligibility for that Medicaid category because of a change
          in her household's income or due to a requirement that is not a
          criterion of Denali KidCare may remain eligible for health care
          coverage under Denali KidCare throughout her pregnancy and
          postpartum period.
    Example:

    A pregnant woman's Family Medicaid case is closed due
    to excess unearned income. Although ineligible for
    Family Medicaid, she continues to receive health care
    coverage under Denali KidCare.


                       EIS INFORMATION
MEDICAID SUBTYPE:
PR Pregnant Woman with income less than <133% FPG
PX Pregnant Woman with income >133%FPG =<175%FPG
     (EIS will apply the poverty level need standard to the
     budget when the Med subtype "PR" or “PX” has been
     entered on the MERE screen.
ELIGIBILITY CODE:
11 Pregnant Woman (poverty level)

On EIS, the “thru month” should be the expected last month of the
woman's pregnancy.

A pregnant woman is issued a Medicaid Recipient Identification Card
(coupon) with peel off labels, not the Denali KidCare card.
5320   PREGNANT WOMAN POSTPARTUM ELIGIBILITY

       A pregnant woman who applied for and was receiving Medicaid or
       Denali KidCare coverage on or before the date of termination of the
       pregnancy (either by delivery, miscarriage, or Medicaid funded
       abortion) will automatically receive 60 days of postpartum coverage.
        Coverage begins on the day the pregnancy ends through the last
       day of the month in which the 60 days end.

       Termination of the pregnancy must be verified in order to calculate
       the postpartum eligibility. The date of pregnancy termination and
       name of the child may be verified by a statement (written or oral) from
       the mother, hospital records, birth certificate, or any other contact the
       caseworker determines to be a reasonable verification.

       Postpartum eligibility may not be granted retroactively. However, if
       the woman applies for Medicaid or Denali KidCare before the date of
       termination of the pregnancy and is subsequently found eligible for
       either coverage (even if the eligibility determination is not made until
       after the date of pregnancy termination), the woman can be
       considered to be "receiving" Medicaid or Denali KidCare for purposes
       of postpartum eligibility since her Medicaid or Denali KidCare is
       effective back to the 1st day of the application month.

       The only conditions of eligibility for postpartum coverage are Alaska
       residency and cooperation with establishment of TPL. Cooperation
       with CSSD is not required during the postpartum period.

       If an APA recipient loses eligibility for a cash benefit during the
       postpartum period, her Medicaid eligibility continues under
       postpartum coverage throughout her 60-day postpartum period.

       Because of the "one day-one month" Medicaid and Denali KidCare
       principle, the woman may receive more than 60 days of coverage as
       coverage extends through the last day of the month in which her 60-
       day period ends.


           Example:

           The household consists of a woman and her newborn
           child. The woman was receiving Denali KidCare
           coverage on the date of delivery, which was June 5th.
            The woman is guaranteed Medicaid or Denali KidCare
           coverage until the 4th of August (60 days of postpartum
           coverage). However, because of the "one day-one
    month" principle, the woman remains eligible through
    August 31st. The coverage continues regardless of the
    woman's circumstances.


                  EIS INFORMATION
MEDICAID SUBTYPE:
 PB Postpartum income less than <133% FPG
 PC Postpartum income >133% FPG =<175% FPG
ELIGIBILITY CODE:
 11 Pregnant Woman (poverty level)

The Medicaid eligibility code remains “11” through the end of the
postpartum period. If the woman receives Medicaid under an
eligibility category not based on pregnancy, such as FM or APA , her
eligibility code should be returned to the proper one for the eligibility
category she fits (e.g., 20, 50, etc.) effective the first day of the month
after postpartum coverage ends.


    Note:

    If a woman receiving Family Medicaid or APA eligibility
    category loses eligibility during her 60-day postpartum
    period, she should be put on an ME AF case and coded
    “PB” or “PC” and “11”.
5330   NEWBORN CHILD ELIGIBILITY

       A child born to a woman eligible for or receiving Medicaid or Denali
       KidCare in the month of delivery is automatically eligible for Denali
       KidCare without application. This includes a child born to an alien
        under the "Emergency Treatment for Aliens" category. See Section
       5600.

       Eligibility continues until the end of the month in which the child turns
       one year old if the child remains in the mother's household and both
       mother and child remain residents of Alaska. The newborn's eligibility
       is not dependent on the continuation of the mother's eligibility. This
       period of automatic Denali KidCare eligibility for the newborn
       continues through the last day of the month of the child's first
       birthday.


           EXCEPTION:

           If the child is receiving inpatient services on the date that
           he or she becomes ineligible for this coverage due to
           reaching the age of one, Denali KidCare eligibility
           continues until the end of the inpatient stay. To be
           considered an inpatient, the child must be hospitalized or
           residing in a long-term care facility as approved by the
           Division of Health Care Services.



       A mother is not required to submit an application for Medicaid or
       Denali KidCare for herself before delivery, but in order to have the
       birth month covered, the woman must apply within the three-month
       retroactive period and be determined eligible for the month of birth.

       Neither the Citizenship Status Declaration (CSD) nor enumeration is
       required for this coverage because all Denali KidCare requirements
       are considered met by the mother.

       The newborn child's medical bills cannot be paid until the newborn
       has been assigned a Medicaid ID number. Therefore, it is very
       important that the birth of the child be verified as soon as possible.
        The birth may be verified by a statement (written or oral) from the
       mother, hospital, doctor, or any other contact the caseworker
       determines to be a reasonable verification. Some hospitals will notify
       district offices of births in order to facilitate their billing process.
        Hospital verification of birth is acceptable as long as the caseworker
       has no reason to doubt the information provided.
When the newborn's eligibility ends, a new application or a request
for an addition to an existing case must be filed in order to establish
continued Denali KidCare eligibility.


    Example 1:

    The household consists of a mother, her spouse, and a
    newborn infant. The mother received Denali KidCare
    pregnant woman coverage throughout her pregnancy
    and was covered on the date of delivery, making her
    automatically eligible for postpartum coverage and the
    child automatically eligible for newborn Denali KidCare
    coverage. After the postpartum period, the mother is
    determined ineligible for Family Medicaid. Denali
    KidCare newborn eligibility automatically continues until
    the end of the month in which the child turns one year
    old.


    Example 2:

    The household consists of a mother and her 6-month-old
    child. The mother received Family Medicaid for herself
    and her child when the child was born but the Family
    Medicaid case closes due to excess resources. Since
    the mother received Medicaid when the child was born,
    the child remains automatically eligible for newborn
    Denali KidCare coverage through the month of his or her
    first birthday.


                     EIS INFORMATION
MEDICAID SUBTYPE:
BA Baby/Newborn
ELIGIBILITY CODE:
50 Child under 21, not in state custody (including subsidized
     adoptions, both Title IV-E and state-only)
5340 Children Under Age 19

5340      CHILDREN UNDER AGE 19

5340 A.   GENERAL ELIGIBILITY

          A child may fall into one of two groups of children eligible for Denali
          KidCare depending upon the amount of household income and the
          presence of health insurance coverage.

          An insured child under the age of 19 who meets the Family Medicaid
          nonfinancial eligibility criteria (except deprivation) is eligible for Denali
          KidCare if the household’s income does not exceed 150% of the
          federal poverty level for Alaska. See Addendum - 1.

          An uninsured child under the age of 19 who meets the Family
          Medicaid non-financial eligibility criteria (except deprivation) is eligible
          for Denali KidCare if the household’s income is greater than 150%,
          but does not exceed 175% of the federal poverty level for Alaska and

             1. Is not currently covered by health insurance as described in
                paragraph C below; and

             2. Did not have private or employer-sponsored health insurance
                coverage end less than 12 months before the determination of
                eligibility, unless the division determines there is good cause
                for ending coverage; see good cause under Section 5350.

          A child who is in the custody of the State may also be determined
          eligible for Denali KidCare.

5340 B.   FINANCIAL ELIGIBILITY CRITERIA

          Denali KidCare does not count resources.

          To determine income eligibility, take into consideration the needs and
          income of the child and members of the child's household who are his
          or her parents and/or siblings. If the income of a stepparent or sibling
          causes the household to exceed the income limit, the needs and
          income of the sibling and/or stepparent are removed and eligibility is
          redetermined. Countable income is determined by following Family
          Medicaid rules except for income or disregards that may not be
          included in a Denali KidCare determination (see Section 5020).
          Any siblings or stepparents removed from a household to avoid
          attributing their income to another sibling or stepchild must have their
          eligibility for Denali KidCare determined separately.


              Example:

              The household consists of mom, mom's two children
              ages 10 and 19, mom's husband, and mom and
              husband's 6-year old common child. Household applies
              for Denali KidCare for the 10 and 6-year-old children.
               Mom, dad, and 19-year old all receive income and the
              initial determination shows their total income exceeds the
              poverty limit for a household size of five. The following
              redeterminations may be made for the 6-year old and 10-
              year old:

              (1) An eligibility determination is made for the 6-year old
              and 10-year old excluding the needs and income of the
              19-year old and using the income of the child's parents.
               If mom, husband, 6-year old and 10-year old combined
              income does not exceed the poverty level standard for a
              4person family, the 6-year old and 10-year old is eligible.

              (2) If no eligibility exists in example (1), a separate
              determination is made for the 10-year old excluding the
              needs and income of the 6-year old and 19-year old and
              using the income of the 10-year olds parent (see
              stepparent deeming rules in Section 5104-5). If mom
              and 10-year olds combined income does not exceed the
              poverty level standard for a 2person family, the 10-year
              old is eligible.

              A referral for Under 21 Medicaid should be made to the
              appropriate district office for an eligibility determination
              for the 19-year old.


5340 C.   HEALTH INSURANCE COVERAGE

          To determine whether a child with household income greater than
          150% FPG has health insurance coverage and, therefore, is not
          eligible for Denali KidCare, the following definitions apply:

          1. Health insurance coverage includes:
                  A group health plan (including a governmental or church
                   plan);

                  A group or individual health insurance;

                  Medicare;

                  Medicaid;

                  A military-sponsored health care program such as
                   TRICARE;

                  A state high risk insurance pool;

                  The Federal Employees Health Benefit Program;

                  Public health plan established or maintained by a state or
                   local government; and

                  A health benefit plan provided for Peace Corps members.

            A child is considered insured even if the health plan or coverage
            requires a co-payment or deductible (regardless of amount) or
            does not cover a particular illness or procedure the child needs.

          2. Health insurance coverage does NOT include:

                  Coverage limited to a specific service (e.g. dental care or
                   vision care);

                  Tribal/IHS health services;

                  Worker’s Compensation;

                  Auto, homeowner, or general liability insurance.

5340 D.   PERIOD OF ELIGIBILITY

          Denali KidCare is available to children through the month in which
          they turn age 19. The continuous 6-month eligibility period described
          in Section 5007 applies to all children eligible for Denali KidCare.
           Coverage may extend three months before the month of application
          if eligibility exists during that period (see Section 5080).
              EXCEPTION:

              If a child is receiving inpatient services at the end of the
              month in which the child turns 19, Denali KidCare
              eligibility continues until the end of the inpatient stay as
              long the child continues to meet the other eligibility
              criteria. To be considered an inpatient, the child must be
              hospitalized or residing in a long-term care facility
              approved by the Division of Health Care Services.


5340 E.   EIS INFORMATION

          Denali KidCare is essentially one eligibility category that
          encompasses existing Medicaid eligibility categories for children and
          adds additional children up through the highest income standard at
          175% FPG. However, because of complex federal financial claiming
          requirements and the unique Denali KidCare insurance limitations for
          children with income above 150% FPG, it is necessary to use the
          appropriate subtype for each individual depending upon age, income
          level, and insurance status.

          The following matrix shows the subtypes EIS will assign depending
          on information that is entered about depending upon the age, income
          level, and insurance status of the child:

          EIS INFORMATION
          MEDICAID SUBTYPE:
          INCOME                            AGE
          Greater than equal to or          Ages 0-5          Ages 6-18
                       less than
          ---          100%                 HC                SU
          100%         133%                 HC                S1
                                                              (w/insurance)
          100%            133%              HC                S2 (w/out ins)
          133%            150%              H1                H1
                                            (w/insurance)     (w/insurance)

          133%          150%            H2 (w/out ins) H2 (w/out ins)
          150%          175% FPG        CP                CP
          ELIGIBILITY CODE:
          50            Child under age 21, not in state custody
                        (including
                        subsidized adoptions, both Title IV-E and state-
                        only)
51   Child under age 21, in state custody (including
     Title IV-
     E foster care)
5350   GOOD CAUSE FOR TERMINATION OF INSURANCE

       Children whose household income is greater than 150%, but does
       not exceed 175% of the FPG for Alaska, are not eligible for Denali
       KidCare if the child was terminated from health insurance coverage
       less than 12 months before the determination of eligibility, unless it is
       determined that there was “good cause” for termination of that
       insurance.

       Good Cause for termination of insurance is limited to the following
       circumstances:

          1. Death of the dependent’s insured parent;

          2. Expiration of coverage under a COBRA continuation provision
             (42 U.S.C. 300gg-91);

          3. Involuntary termination of health benefits due to long-term
             disability or other medical condition;

          4. Changing to a new employer who does not provide an option
             for dependent coverage; or

          5. The cost of continuing coverage would have caused a severe
             economic hardship on an employee or self-employed
             individual.

       A caseworker may make a good cause determination for
       circumstances (1) through (4) above, as long as the caseworker can
       verify the circumstances. The caseworker’s determination must be
       documented on the EIS Case Notes (CANO) screen.

       The Medicaid Policy Specialist makes the determination of a severe
       economic hardship (good cause circumstance #5). The household
       must submit, through their caseworker, a list of the household’s
       actual monthly gross income and expenses. E-mail any economic
       hardship requests to dpapolicy@alaska.gov.
5600 Emergency Treatment For Aliens

5600        EMERGENCY TREATMENT FOR ALIENS

           Emergency Treatment for Aliens is a special category of the Medicaid
           program that provides coverage for aliens who do not meet the
           Medicaid citizenship requirements. An alien eligible under this
           special category is not considered to be a regular Medicaid recipient.
            Coverage is limited to the treatment of emergency medical
           conditions.

5600 A.    DEFINITIONS

               1. Alien: For the purposes of Emergency Treatment for Aliens
                  eligibility, an alien is

                       a non-qualified alien as defined in Section 5011-8; or

                       a qualified alien as defined in Section 5011-3 who is
                        subject to the five-year bar on Medicaid eligibility.

               2. Covered Dates of Service are the dates in which the alien
                  received treatment for an emergency medical condition and is
                  determined eligible for emergency treatment for aliens.

               3. Emergency Medical Condition means the individual has,
                  after sudden onset, a medical condition, including labor and
                  delivery, manifesting itself by acute symptoms of sufficient
                  severity (including severe pain) such that the absence of
                  immediate medical attention could reasonably be expected to
                  result in:

                       placing the patient's health in serious jeopardy;

                       serious impairment to bodily functions; or

                       serious dysfunction of any bodily organ or part.

           An emergency medical condition does not include care and services
           related to either an organ transplant procedure or routine prenatal or
           postpartum care.

5600 B.    ELIGIBILITY REQUIREMENTS

           Except as provided in Subsection C, an alien must meet the following
           requirements to be eligible for the Emergency Treatment for Aliens:
             1. Meet the financial and non-financial eligibility requirements for
                the category of Medicaid appropriate for the individual;

             2. Be a resident of Alaska;

             3. Meet the definition of an alien; and

             4. Have received treatment for an emergency medical condition.

5600 C.   REGULAR MEDICAID RULES THAT DO NOT APPLY TO
          EMERGENCY TREATMENT OF ALIENS

          The following regular Medicaid rules do not apply to an applicant for
          Emergency Treatment of Aliens:

             1. Medicaid citizenship requirements;

             2. Development of income;

             3. Alien-sponsor deeming;

             4. Verification of a social security number; or

             5. Verification of immigration/alien status.

5600 D.   LIMITED AUTHORIZATION

          Once eligibility has been established, the caseworker must issue the
          number of Recipient Identification Cards (coupons) necessary,
          limiting the authorization to the dates of services identified by the
          Division of Health Care Services. See Section 5075.

          A new application is required for each separate occurrence of an
          emergency medical condition that requires treatment.

5600 E.   COORDINATION WITH THE DIVISION OF HEALTH CARE
          SERVICES (DHCS)

          Because Medicaid coverage for this eligibility category is limited to
          emergency services, most aliens will apply for emergency medical
          assistance only after the services have been provided. Hospitals in
          the state have been instructed to send medical records to the DHCS
          office in Anchorage for review. However, there may be times a
          hospital does not automatically send the medical records and the
          caseworker must assist the individual in obtaining medical
          documentation to support the emergency medical claim. When
          assistance is requested, the caseworker should request that the
          hospital submit medical documentation, including the discharge
          summary to:

          Division of Health Care Services
          Attention: Physician Program Manager
          4501 Business Park Blvd., Ste 24
          Anchorage, AK 99503-7167

          The Division of Health Care Services will:

             1. Determine if the services received were of an emergency
                nature;

             2. Determine the covered dates of service; and

             3. Provide written authorization to the provider who will then
                provide a copy of this authorization to the alien.

          When an alien applies for emergency treatment, they must provide to
          their caseworker a copy of the written approval from DHCS.

5600 F.   EIS INFORMATION

            EIS INFORMATION: EMERGENCY
                       TREATMENT
          MEDICAID SUBTYPE:
          AL      Ineligible alien (FM related)
          IL      Ineligible alien (SSI/APA
                  related)
          ELIGIBILITY CODE:
          11      Pregnant Woman
          53       Ineligible alien emergency
                  coverage (used for every one
                  except pregnant women)
                     ADDENDUM- 1

        DENALI KIDCARE INCOME STANDARDS
                 Effective July 2007

 Denali KidCare is based upon the Federal Poverty Guidelines (FPG)
 for Alaska as set each year by the U.S. Department of Health and
 Human Services.

Household Size    Denali KidCare         Denali KidCare
                 (with insurance)   (without insurance) and
                                        Pregnant Women
                   150% FPG                175% FPG
                  Monthly Income         Monthly Income
1                     1,597                   1,863
2                     2,140                   2,497
3                     2,684                   3,132
4                     3,228                   3,766
5                     3,772                   4,400
6                     4,315                   5,035
7                     4,859                   5,669
8                     5,403                   6,303
Addl.                  544                     635
                  ADDENDUM - 3

           FAMILY MEDICAID SUBTYPES


Medicaid
                             Description
Subtype
  4M       Post-Medicaid due to excess child support
  AF       Family Medicaid (Section 1931 AFDC related)
  AL       Emergency coverage for illegal alien
           Newborn Baby -- through month of 1st birthday
  BA       (child born to a woman who was eligible for
           Medicaid in the month of delivery)
  CP       CHIP (151% to 175% FPL). Title 21 funding
  EO       Eligible for FM if not Institutionalized
  FC       Title IV-E Foster Care child in State custody
           >133%-150%, all ages, with Insurance. Title 19
  H1
           funding
           CHIP (>133% to 150%, all ages), no insurance.
  H2
            Title 21 funding
           Healthy Child (133% or less, age 0 - 5) Title 19
  HC
           funding
           Under 21 child in State custody – In-Patient
   IP
           Psychiatric
  IV       Title IV-E Subsidized Adoption
  JC       Juvenile Court Ordered Child in State custody
           Postpartum Coverage for women whose income is
  PB
           less than <133% FPL
           Postpartum coverage for women whose income is
  PC       >133% - <=175% FPL regardless of insurance.
            Title 19 funding.
  PD       Pregnancy Determination (FM 3rd trimester)
           Pregnant Woman Coverage whose income is less
  PR
           than <133% FPL
           Pregnant Woman >133% - <=175% FPL. Title 19
  PX
           funding
           >100%-133% ages 6-18 with Insurance. Title 19
  S1
           funding
           CHIP (>100% to 133%, ages 6-18). Title 21
  S2
           funding
           State-only (not IV-E) subsidized adoption (State
  SO
           custody)
  SU       Six Up. Title 19 funding
  T1       Transitional Medicaid (1st 6 months)
T2   Transitional Medicaid (2nd 6 months)
TO   Under 21
VO   Child in voluntary state custody

								
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