Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 21. Verification of eligibility criteria

7 AAC 43.021. Verification of eligibility criteria

(a) An applicant must support a claim for assistance with verification and documentation satisfactory to the department that the applicant meets the eligibility requirements of this chapter. An applicant or a recipient who refuses to provide the department with verification and documentation of eligibility as required under this section is not eligible to receive medical assistance benefits.

(b) The department will determine whether the verification and documentation received is satisfactory by considering

(1) its necessity for making an eligibility determination;

(2) whether it reasonably proves the fact that requires verification or documentation;

(3) all other information contained in the application and case file; and

(4) what alternative types of verification or documentation are obtainable.

(c) If an applicant, who is otherwise eligible to receive medical assistance benefits, has not provided all of the documentary evidence needed to verify an eligibility requirement, the department will authorize issuance of benefits only for the month in which the application was received and the following month, and only if the department

(1) determines that the applicant

(A) does not possess the necessary documents;

(B) cannot readily obtain the documents;

(C) has requested any custodian of the documents to provide them; and

(D) cannot reasonably be expected to receive the documents within 30 days after requesting them from any custodian;

(2) has made at least one other contact that supports the applicant's claim that the eligibility requirement is met; and

(3) does not have evidence that the eligibility requirement is not met.

(d) The department will provide additional time for an applicant to submit documentation if the department determines that the applicant is attempting to provide the documentation, but is unable to do so for reasons beyond the applicant's control.

(e) For the purposes of determining medical assistance eligibility under this chapter, the department will consider a child to be living independently of the child's parents if the child has

(1) not lived in the home of the child's parent for at least 30 continuous days immediately preceding the date of application;

(2) left the home of the child's parent to attend an education institution, the National Guard Youth Corps, or another educational or training environment that involves a residential living arrangement lasting 30 continuous days or longer;

(3) left the home of the child's parent to enter a treatment institution in this state that involves a residential living arrangement, and if treatment at the institution has lasted 30 continuous days or longer; the treatment institution must certify that the applicant has resided there for 30 continuous days or longer; a child admitted for less than 30 continuous days will not be considered to be living independently from the child's parents unless the provider also certifies that the child did not go home but has transferred directly to another treatment institution, which results in a total stay of 30 continuous days or longer away from the child's home;

(4) left the home of the child's parent to enter a treatment institution outside this state that involves a residential living arrangement, and if the department gives prior authorization to a 30-day placement outside this state; or

(5) been removed under AS 47.10 or 47.12 from the home of the parent indefinitely or for a period expecting to last at least 30 days.

(f) In this section, "treatment institution" has the meaning given "institution" in 42 C.F.R. 435.1009. For purposes of this subsection, the definition of "institution" in 42 C.F.R. 435.1009, as revised as of October 1, 2002, is adopted by reference.

History: Eff. 3/26/2003, Register 165

Authority: AS 47.05.010

AS 47.07.040