Section 7 AAC 100.910 - Recovery of Medicaid expenditures(a) The department will issue a written recovery notice to an individual, and will seek to recover Medicaid expenditures from that individual, if Medicaid expenditures are made on behalf of that individual and that individual (1) is determined under 7 AAC 100.912, to have (A) committed an intentional program violation that resulted in Medicaid expenditures for health care services to which the individual was not entitled;(B) committed program abuse that resulted in misuse or overuse of Medicaid benefits; or(C) engaged in conduct (i) giving rise to an offense under AS 11, AS 17.30.080, or AS 47.05.210 for which the individual was convicted; and(ii) related to obtaining Medicaid benefits;(2) has waived a hearing available under 7 AAC 100.912(a) (2) or (b)(2);(3) has signed a disqualification consent agreement, confirmed by a court, in which the individual admits committing an intentional program violation or program abuse, and agrees to being disqualified to receive Medicaid benefits; or(4) received continued benefits pending a hearing under 7 AAC 49 and the hearing decision upheld the original denial or case closure.(b) In a recovery notice issued under (a) of this section, the department will notify the individual of(1) the finding of the court or hearing authority;(2) the total Medicaid expenditures made on behalf of the individual and for which the department seeks reimbursement;(3) the amount of repayment that is required; and(4) the need to schedule a meeting with the department to negotiate a repayment schedule.(c) The department will issue a notice of noncompliance to an individual who has received a recovery notice, and who fails to(1) negotiate a repayment schedule in good faith; or(2) comply with a negotiated repayment schedule.(d) In a notice of noncompliance issued under (c) of this section, the department will include a demand for payment in full of the recovery amount within 30 days after the date of receipt of the notice. An individual who does not pay the full amount within 30 days is in default. An individual in default is ineligible for Medicaid until the department determines that the individual is no longer in default. The department will pursue available legal remedies to recover the amount due from the income and resources of the individual in default.(e) If the department determines that an individual or a member of the individual's household will suffer severe economic hardship if the individual is required to repay the amount required in (b) of this section, the department will do one or more of the following: (1) allow the individual to repay less than the total amount;(2) reduce the monthly payment amount by lengthening the negotiated repayment schedule;(3) temporarily suspend repayment.(f) An individual who wishes to dispute any action taken by the department under (a) - (e) of this section or the amount of Medicaid expenditures claimed for recovery under this section may request a hearing under 7 AAC 49.(g) For purposes of (e) of this section, a severe economic hardship is one that would require the individual or the individual's household to forgo basic food or shelter in order to make the payment required under (e) of this section.Eff. 7/20/2007, Register 183Authority:AS 47.05.010
AS 47.05.210
AS 47.05.240
AS 47.07.040