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(a) A person who requires a level of medical or rehabilitative care that could appropriately be provided in a skilled nursing facility or an intermediate care facility may apply to the department for waiver of any or all of the following standards of and requirements for eligibility for General Relief Medical assistance:
(1) the need standards of 7 AAC 47.150;
(2) the resource requirements of 7 AAC 47.160; and
(3) the service limitations of 7 AAC 47.200.
(b) A person who applies for a waiver of 7 AAC 47.150 or 7 AAC 47.160 must demonstrate by clear and convincing evidence, that
(1) he or she meets all requirements and standards for General Relief Medical assistance other than those standards and requirements for which he or she seeks a waiver; and
(2) unusual circumstances exist that prevent the eligibility criteria that would be waived from accurately reflecting his or her financial need.
(c) As a condition of a waiver of 7 AAC 47.150, the needy person receiving the waiver must participate in paying the cost of services for which the department will pay under the waiver, by expending, for his or her care, all of his or her total monthly income in excess of the personal needs allowance specified in 7 AAC 40.390. If the person has a spouse living at home, the department will allow the person to retain an additional amount for maintenance of the spouse which is equal to the appropriate individual need standard specified in 7 AAC 40.310. If the person has dependent children, as defined in AS 47.25.410 (3), the department will allow the person to retain, for support of the dependent children, an amount equal to the appropriate need standard specified in AS 47.25.320 .
(d) As a condition of a waiver of 7 AAC 47.160, the person receiving the waiver agrees
(1) to apply for any prior resources for which he or she may be eligible, and to expend any such resources for the cost of services provided through the department; and
(2) to expend, either directly or through voluntary assignment of his or her interest to the state, all of his or her personal resources, including equity in land, buildings, including his or her home, businesses, or vehicles, for the cost of his or her care.
(e) Under a voluntary assignment of the person's home to the state under (d)(2) of this section, a spouse or a minor or disabled child of a person receiving a waiver, who is living in the home will be permitted to remain living in the home until the spouse dies, the disabled child dies, or until the minor child reaches the age of majority, whichever occurs latest.
(f) As a condition of a waiver of 7 AAC 47.150 or 7 AAC 47.160, the department will require
(1) each person liable for the support of a person receiving a waiver to do either or both of the following:
(A) apply for any insurance benefits or assistance available to the person that may pay for the services to the person receiving the waiver; or
(B) submit an application that includes all of the financial information required of an applicant for General Relief Medical assistance.
(2) the spouse of the person receiving the waiver to expend, either directly or through voluntary assignment of his or her interest to the state, all of his or her personal resources, including equity in land, buildings, including his or her home, businesses, or vehicles, for the cost of his or her spouse's care.
(g) A person liable for the support of a person receiving a waiver under this section is considered by the department to be able to provide all or part of the necessary care and support of the person receiving a waiver, if the liable person does not meet the financial need standards of 7 AAC 40.230.
(h) A person who applies for a waiver of 7 AAC 47.200 must demonstrate by clear and convincing evidence that
(1) he or she is eligible for General Relief Medical assistance or Medicaid assistance, or that he or she meets the requirements of this section;
(2) he or she requires the level of care that would appropriately be provided in a skilled or intermediate care facility; and
(3) the total monthly cost to the department of all services to the person that the department will purchase from general fund appropriations
(A) will not increase after the department grants the waiver; or
(B) for a person who previously did not receive services through the department, will not exceed the state's share of the Medicaid average cost of caring for a person in a long-term care facility in the state for the same period.
(i) In his or her discretion, and based on the amount appropriated for General Relief assistance, and on his or her estimates of the expected demand for General Relief assistance during the state fiscal year, the commissioner will grant a waiver for a period of up to one year. In his or her discretion, and based on the same factors, the commissioner will
(1) deny a request for a waiver;
(2) limit the duration of a waiver to less than one year;
(3) require as a condition of a waiver, that the person receive services at a designated facility inside or outside the state; or
(4) limit the total amount, the monthly amount, or both the total amount and monthly amount of General Relief Medical assistance that may be paid as a result of the waiver.
(j) The commissioner will, in his or her discretion, terminate a waiver under this section at any time if he or she believes that sufficient money has not been appropriated to meet demand for General Relief Medical assistance, or any other assistance included in the same appropriation for the same fiscal year.
(k) The commissioner will, in his or her discretion, renew a waiver under this section for a period of up to one year. An applicant for renewal of a waiver must meet all of the requirements for a waiver. The department will consider all pending applications for renewal of existing waivers before considering any applications for new waivers.
( l ) An applicant for a waiver, and all persons liable for the support of the applicant shall provide any and all evidence of their financial condition that the department requests. The department will deny an application for a waiver or terminate a waiver if an applicant, or a person liable for the support of an applicant fails, without good cause, to cooperate with the department in the department's investigation of the physical condition of the applicant or the financial condition of the applicant and of persons liable for the support of the applicant. For the purposes of this subsection,"good cause" for failure to cooperate includes the inability of an applicant to locate a person liable for support of the applicant after reasonable efforts, and also includes good cause as determined by the commissioner.
(m) The department will consider an application complete upon receipt of all evidence of physical and financial conditions that it has requested, including a statement from a physician. Within 60 days after the department receives a completed application for a waiver or renewal for a waiver under this section, the commissioner will notify the applicant that
(1) the commissioner approves the waiver subject to conditions he or she has established; or
(2) the commissioner denies the waiver.
(n) Notwithstanding (a) - (m) of this section, the commissioner will not grant a general relief medical waiver under this section at any time on or after October 1, 1995.
History: Eff. 12/24/85, Register 96; am 11/20/94, Register 132
Authority: AS 47.05.010
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Last modified 7/05/2006