Ariz. Admin. Code § 9-28-401.01

Current through Register Vol. 30, No. 50, December 13, 2024

Section R9-28-401.01 - General

A. Application for ALTCS coverage.

1. The Administration shall provide a person the opportunity to apply for ALTCS as described under Chapter 22, Article 3, unless specified otherwise in this Section.

2. To apply for ALTCS, a person shall submit an application to an ALTCS eligibility office.

a. The application shall contain the applicant's name and address.

b. Before the application is approved, a person listed in A.A.C. R9-22-302(2) shall sign the application.

c. A witness shall also sign the application if an applicant signs the application with a mark.

d. The date of application is the date the application is received by the Administration or its designee as described in R9-22-302.

3. Except as provided in R9-22-306, the Administration shall determine eligibility within 45 days from the date of application.

4. An applicant or representative who files an ALTCS application may withdraw the application for ALTCS coverage either orally or in writing to the ALTCS eligibility office where the application was filed. The Administration shall provide the applicant with a denial notice under subsection (E).

5. If an applicant dies while an application is pending, the Administration shall complete an eligibility determination for the deceased applicant.

6. If a person dies before an application is filed, the Administration shall complete an eligibility determination on an application filed on behalf of the deceased applicant, if the application is filed in the month of the person's death.

B. Conditions of ALTCS eligibility. Except for persons identified in subsection (C), the Administration shall approve a person for ALTCS if all conditions of eligibility are met. The conditions of eligibility are:

1. Citizenship and alien status under Chapter 22, Article 3;

2. SSN under Chapter 22, Article 3 ;

3. Living arrangements under R9-28-406;

4. Resources under R9-28-407;

5. Income under R9-28-408;

6. Transfers under R9-28-409;

7. A legally authorized person shall assign rights to the Administration for medical support and for payment of medical care from any first- and third-parties as described under R9-22-311,

8. A person shall take all necessary steps to obtain annuity, pension, retirement, and disability benefits for which a person may be entitled ;

9. State residency under R9-22-305;

10. Medical eligibility as specified in Chapter 28, Article 3 ; and

11. Providing information and verification as specified under Chapter 22, Article 3.

C. Persons eligible for Title IV-E or Title XVI are only required to meet the conditions under subsection (B)(6), (B)(10), (B)(11) and with respect to trusts, A.R.S. § 36-2934.01.

D. Eligibility effective date.

1. Eligibility is effective on the first day of the month that all eligibility requirements are met, including the period described under R9-22-303.

2. The effective date of eligibility for an applicant who moves into Arizona is no sooner than the date Arizona residency is established.

3. The effective date of eligibility for an inmate applying for medical coverage is the date the applicant no longer meets the definition of an inmate of a public institution.

E. Notice. The Administration shall send a person a notice of the decision regarding the person's application. The notice shall include a statement of the action and an explanation of the person's hearing rights as specified in 9 A.A.C. 34 and:

1. Approval. If the applicant meets all the eligibility requirements and conditions of eligibility of this Article, the Administration or its designee shall approve the application and provide the applicant with an approval notice. The approval notice shall contain:

a. The name of each approved applicant,

b. The effective date of eligibility for each approved applicant,

c. The amount of share of cost, and

d. The applicant's right to appeal the decision.

2. Denial. If an applicant fails to meet the eligibility requirements or conditions of eligibility of this Article, the Administration or its designee shall deny the application and provide the applicant with a denial notice. The denial notice shall contain:

a. The name of each ineligible applicant,

b. The specific reason why the applicant is ineligible,

c. The income and resource calculations for the applicant compared to the income or resource standards for eligibility when the reason for the denial is due to the applicant's income or resources exceeding the applicable standard,

d. The legal citations supporting the reason for the ineligibility,

e. The location where the applicant can review the legal citations, and

f. The applicant's right to appeal the decision and request a hearing.

F. Confidentiality. The Administration shall maintain the confidentiality of a person's record under A.A.C. R9-22-512.

Ariz. Admin. Code § R9-28-401.01

New Section made by final rulemaking at 14 A.A.R. 2090, effective July 5, 2008 (Supp. 08-2). Amended by final rulemaking at 19 A.A.R. 3320, effective November 30, 2013. Amended by final rulemaking at 20 A.A.R. 193, effective 1/7/2014.