Title 7 . Health and Social Services

Chapter 23 . Embalming and Other Post-Mortem Services

Section 180. Determination of financial eligibility and participation amount

7 AAC 23.180. Determination of financial eligibility and participation amount

(a) The department will not pay a cost under the handicapped children's program unless, in addition to exhausting alternate resources, the child and the child's family agree to pay costs of treatment during each year that the child participates in the handicapped children's program in an amount determined by use of the table in (1) of this subsection, and adjusted as provided in (2) - (5) of this subsection, as follows:

STATE OF ALASKA

HANDICAPPED CHILDREN'S PROGRAM

FAMILY PARTICIPATION AMOUNT GUIDE FOR

TREATMENT SERVICES

YEARLY Family Size ADJUSTED INCOME 1 2 3 4 5 6 7 8 9 10 11 12 -0- - 9,000 -0- 9,001 - 10,200 60 -0- 10,201 - 11,400 150 80 -0- 11,401 - 12,600 190 170 100 -0- 12,601 - 13,800 220 190 170 140 -0- 13,801 - 15,000 260 230 200 180 160 -0- 15,001 - 16,200 300 270 240 210 180 160 -0- 16,201 - 17,400 340 310 280 250 220 190 160 -0- 17,401 - 18,600 380 350 320 290 260 230 200 170 -0- 18,601 - 19,800 420 390 360 330 300 270 240 210 180 -0- 19,801 - 21,000 470 440 410 380 350 320 290 260 230 200 -0- 21,001 - 22,200 520 480 450 420 380 350 320 280 250 220 180 -0- 22,201 - 23,400 570 530 500 460 430 400 360 330 290 260 220 190 23,401 - 24,600 620 590 550 510 480 440 410 370 340 300 270 230 24,601 - 25,800 680 640 600 570 530 490 460 420 380 350 310 270 25,801 - 27,000 730 700 660 620 580 540 510 470 430 390 360 320 27,001 - 28,200 790 750 710 680 640 600 560 520 480 440 400 370 28,201 - 29,400 850 810 770 730 690 650 610 580 540 500 460 420 29,401 - 30,600 920 880 830 790 750 710 670 630 590 550 510 470 30,601 - 31,800 980 940 900 860 810 770 730 690 650 610 560 520 31,801 - 33,000 1050 1010 960 920 880 830 790 750 710 660 620 580 33,001 - 34,200 1120 1070 1030 990 940 900 850 810 770 720 680 640 34,201 - 35,400 1190 1140 1100 1050 1010 960 920 880 830 790 740 700 35,401 - 36,600 1260 1220 1170 1130 1080 1030 990 940 900 850 800 760 36,601 - 37,800 1340 1290 1240 1200 1150 1100 1060 1010 960 920 870 820

(2) The department will adjust the family participation amount determined under (1) of this subsection according to the election district in which the custodial parent or guardian of the child has his or her residence for voting purposes. The department will multiply the family participation amount by the following factors:

Residence in Election District Factor District 1 1.45 2 1.15 3 1.40 4 1.40 5 1.40 6 1.15 7 - 15 1.50 16 1.40 17 1.20 18 - 21 1.40 22 1.00 23 1.05 24 1.00 25 1.10 26 1.05 27 1.25

(3) If family size exceeds 12 members, the department will calculate the yearly participation amount by reducing adjusted income by $1,200 for each additional member and using the participation amount for a family of 12 with the reduced adjusted income.

(4) If adjusted income exceeds $37,800, the department will calculate the yearly participation amount as follows:

(A) for a household with one member, by multiplying the adjusted income of the family by

(i) four percent for adjusted incomes that exceed $37,800 but that do not exceed $50,000;

(ii) an additional two percent for each $5,000 in excess of $45,001;

(B) for a household of more than one, by subtracting $1,200 from the adjusted income of the family for each additional member of the household and multiplying the remainder as described in (A) of this paragraph; however, if application of this formula produces an income of $37,800 or less, family income amount will be calculated from the chart at (1) of this subsection rather than by multiplication as described in (A) of this paragraph;

(5) If more than one child in a family is eligible for services under this chapter, the family participation amount is the same as it would be if there were only one eligible child.

(b) The department will determine a family's yearly adjusted income by

(1) counting all income for the 12-month period ending with the date of application, whether earned or unearned, from any source, including the fair market value of in-kind payments, but excluding payments made under the Alaska Native Claims Settlement Act;

(2) subtracting all of the family's unreimbursed expenditures for medical and dental services, and medical insurance, including necessary transportation and temporary housing;

(3) subtracting child support and alimony payments made by a member of the family, unless those payments were paid to or for another family member;

(4) subtracting child care payments that were necessary to permit a parent to work or to meet the specialized needs of a handicapped child, unless those payments are made to another family member;

(5) subtracting housing and travel expenses of the child and of one other person that were incidental to securing medical care; and

(6) subtracting any losses of tangible personal property by the family due to fire, automobile accident, or other casualty in excess of $5,000 in value for the 12-month period.

(c) In determining a family's yearly adjusted income, and in determining if alternative resources have been exhausted, the department will consider the income and resources of

(1) the child;

(2) each of the child's parents;

(3) the spouse of a custodial parent if that person claims or has claimed, in the last year, the child as a dependent for state or federal income tax purposes; and

(4) any other person that is financially responsible for the child's care.

(d) Upon request of the child, of a parent of the child, or of an applicant, and in its discretion, the department will disregard the income resources and expenses of a parent if it finds that the parent cannot be located or has abandoned the child, or has refused to contribute to the support of the child. However, the department reserves the right to recover from the parent who abandoned the child or who has refused to contribute, any and all amounts paid as a result of the operation of this subsection, together with any costs and interest allowed by law.

(e) The department will consider a payment by a child or the child's family to be a payment of all or part of the family's participation amount only if the cost paid was for a service that meets the requirements of 7 AAC 23.150. Except as otherwise provided in this subsection, the department will pay a cost only after the applying family has paid the entire applicable family participation amount. In the discretion of the department, and if the applicant agrees to a plan of financial participation, the department will pay costs before the entire participation amount is paid. A plan of financial participation must provide for payment by the applying family of the entire yearly participation during the current enrollment period of the child and must demonstrate by clear and convincing evidence that the applying family will meet its obligations under the plan.

(f) The department will reduce or waive the participation amount calculated in this section if the department, based on clear and convincing evidence, finds that the child would otherwise die or suffer permanent, severe disability, or that the family would suffer extreme and life-threatening privation if it met the prescribed participation amount. The department reserves the right to recover from the child, or the child's parent or parents, the amount of any and all benefits paid as a result of the operation of this subsection, together with any costs and interest prescribed by law.

(g) The department will recalculate the family participation amount annually, and at any time that

(1) the family's adjusted income for a calendar quarter, determined as described in (b)(1) - (b)(6) of this section, varies by more than 25 percent from that of the same calendar quarter of the previous year; or

(2) the department requests that a new financial report form be completed.

History: Eff. 6/28/85, Register 94

Authority: AS 18.05.010

AS 18.05.030

AS 18.05.040