Ala. Admin. Code r. 660-2-5-.01

Current through Register Vol. 43, No. 1, October 31, 2024

Section 660-2-5-.01 - Administrative Responsibilities

The Department determines eligibility for Medicaid in accordance with the provisions of Title XIX of the Social Security Act. The Department determines the individual's eligibility for AR in accordance with the provisions of Title IV-A of the Act and the non-SSI individual's eligibility for supplementation in accordance with Title XVI of the Act, and certifies the Alabama Medicaid Agency individuals in the following groups and court rulings.

(a) All individuals receiving assistance under the State's approved plan for Title IV-E of the Act or the Medicaid for Low Income Families Program or Aid to Refugees Program (AR) or who were terminated due wholly or partly to increased earnings or hours of employment of the grantee relative or due wholly or partly to expiration of the one-third or $30 earned income disregard or due to the principal wage earner no longer meeting the definition of unemployed in relation to the 100 hour rule or due to child support collected by the State. To be eligible for this extended coverage, an individual or assistance group must have been eligible for and receiving assistance under Title XIX in Alabama for at least three of the six calendar months immediately preceding the month in which such individual or assistance group became ineligible for medical assistance because of increased earnings from employment of the grantee relative, expiration of the one-third or $30 disregard, the principal wage earner no longer meeting the definition of unemployed in relation to the 100 hour rule or collection of child support by the State. In addition, sanctioned individuals who would have otherwise been members of the assistance unit that became ineligible due to increased earnings of the grantee, expiration of the one-third or $30 disregard, or the principal wage earner no longer meeting the definition of unemployed in relation to the 100 hour rule are eligible. The extended period of coverage may not exceed four calendar months for terminations due to collection of child support or twelve calendar months for terminations due to the increased earnings or hours worked of the grantee relative, due to expiration of the one-third or $30 disregard or due to the principal wage earner no longer meeting the definition of unemployed in relation to the 100 hour rule;

(b) All individuals receiving mandatory state supplementary benefits, as required by P.L. 93-66 ;

(c) Any individual(s) who, for the month of August 1972, was eligible for and received financial assistance under the State's plan for ADC, OAP, AB, or APTD and who was also entitled to monthly insurance benefits under the Title II program and who, except for the increase in monthly insurance benefits under Title II resulting from enactment of P.L. 92-355, would have been eligible for financial assistance for the current month;

(d) Aged, blind, or disabled persons who receive an approved state supplementary payment and who, except for the level of their income, would be eligible for benefits under Title XVI of the Act. The individual's gross income may not exceed established limits and net income may not exceed the established level of supplementation;

(e) All individuals who, in the month of December 1973, were eligible as inpatients or residents in Title XIX institutions and would have been, except for being an impatient or resident, eligible to receive assistance under the State's plan for OAP, AB, or APTD;

(f) All financially eligible children under 21 years of age not otherwise eligible under a plan, for whom public agencies are assuming full or partial financial responsibility and who are in foster homes or private child caring institutions;

(g) Any individual who, for the month of April 1977 or thereafter, was eligible for and receiving financial assistance under the State's plan for OAP, APTD, and AB and who was also entitled to monthly insurance benefits under the Title II program and who except for the increase(s) in monthly insurance benefits under Title II resulting from enactment of P.L. 94-566 would be eligible for State Supplementation for the current month;

(h) Certain categorically related coverage groups as follows:

1. Denied or deceased applicants for AR, and State SUP, provided all conditions of eligibility were met as outlined in 660-2-2, except 660-2-4, and 660-2-5 and they received medical services in that period of a type covered under the Title XIX State Plan.

2. Approved, denied, or deceased applicants for Medicaid and State SUP are entitled to three-month retroactive Medicaid from the date of application if they have received medical services of a type covered under the Title XIX State Plan during any or all of the three-months prior to an application for assistance and met the eligibility requirements of the categorical assistance programand for Medicaid during the month(s) for which retroactive Medicaid eligibility is determined.

3. Individuals State Supplementation because of stepparent or alien sponsor deeming.

(i) Recipients of Aid to Refugee (AR) Program and medically needy refugees who are not eligible for a money payment under AR because they have income/resources sufficient to meet their medical needs as well. Eligibility is limited to the first 12 months;

(j) Reserved for future use.

Author: Melody Armstrong

Ala. Admin. Code r. 660-2-5-.01

Effective June 28, 1983. Emergency amendment effective October 1, 1984. Permanent amendment effective December 10, 1984. Succedent emergency amendment effective May 16, 1985. Succedent emergency amendment effective August 1, 1985. Succedent permanent amendment effective September 9, 1985. Succedent permanent amendment effective October 9, 1985. Succedent emergency amendment effective September 30, 1985. Succedent permanent amendment effective January 9, 1986. Succedent emergency amendment effective July 1, 1986. Succedent permanent amendment effective September 17, 1986. Succedent emergency amendment effective February 10, 1987. Succedent permanent amendment effective May 21, 1987. Succedent emergency amendment effective April 28, 1987. Succedent permanent amendment effective August 11, 1987. Succedent emergency amendment effective July 1, 1988. Succedent permanent amendment effective October 18, 1988. Succedent emergency amendment effective January 26, 1989. Succedent permanent amendment effective April 11, 1989. Succedent emergency amendment effective February 5, 1990. Succedent permanent amendment effective May 9, 1990. Succedent emergency amendment effective April 1, 1990. Succedent permanent amendment effective July 11, 1990. Succedent emergency amendment effective October 10, 1990. Succedent permanent amendment effective January 9, 1991. Succedent emergency amendments effective April 11, 1991 and April 18, 1991. Succedent permanent amendment effective July 10, 1991. Succedent emergency amendment effective October 1, 1991. Succedent permanent amendment effective January 9, 1992. Succedent permanent amendment: Filed September 6, 1994; effective October 11, 1994. Succedent emergency amendment effective March 1, 1997. Amended: Filed May 6, 1997; effective June 10, 1997.

Statutory Authority: Social Security Act, Title XIX; 42 C.F.R. 435 ; P.L. 98-369, effective October 1, 1985; The Child Support Enforcement Amendments of 1984, P.L. 98-378 ; P.L. 100-485, Title IV; 42 U.S.C. §402; 54 Federal Requirements 42124-42267; Public Law 104-193 effective August 22, 1996; Code of Ala. 1975, Title 38.