5000-5 Incomplete Verification
5000-5
INCOMPLETE VERIFICATION
5000-5 A. CIRCUMSTANCES FOR WHICH VERIFICATION MAY BE WAIVED
Eligibility may be found for the first two calendar months without
complete verification if all of the following conditions are met and
documented in the case file:
1. The eligibility factor that is not fully verified requires
documentary evidence;
2. The necessary documents are not in the possession of the
applicant and he or she cannot easily obtain them;
3. The documents have been requested and cannot be
reasonably expected to be received within the 30 days allowed
for the caseworker to make a final eligibility decision;
4. At least one collateral contact has been made, which verifies
the factor of eligibility is met;
5. There is no reason to doubt the applicant’s statement about
the factor in question;
6. The caseworker requested a supervisory review of the case
situation and the supervisor approves a temporary finding of
eligibility; and
7. The case is placed in a suspense system to assure that the
documents are received and the factor is fully verified at least
10 days before the end of the second month.
5000-5 B. CIRCUMSTANCES FOR WHICH VERIFICATION CANNOT BE
WAIVED
Social Security Enumeration: Verification requirements for Social
Security enumeration applications cannot be waived with the
exception of Newborn Coverage (see Section 5330). Applicants
must have a Social Security Number or apply for one as a condition
of eligibility for Medicaid. (For more information on applying for a
Social Security number, see Section 5014 and the Administrative
Procedures Manual.)
U.S. Citizenship and Eligible Alien Status: Verification of US.
citizenship and identity cannot be waived unless exempt. See
Section 5011 for exceptions to this requirement.
Caretaker Relationship: If the caseworker is unable to verify the
child’s relationship to his or her possible specified relative, the child
will not be considered a household member for Family Medicaid
purposes. See Section 5120-1.
5005 Application And Review Process
5005
APPLICATION AND REVIEW PROCESS
In order for the Division of Public Assistance (DPA) to determine a
household’s eligibility, the household must:

Submit an identifiable application;

Complete and sign an approved application form;

Attend an interview with a DPA caseworker, DPA-contracted
fee agent, or Native Family Assistance Program (NFAP)
agency staff person, if an interview is required; and,

Provide documentation and verification, including required
forms, needed to determine program eligibility.
An application form must be given to the individual the same day
DPA or the fee agent receives a request for an application. All
households must be advised that they may file an application the
same day they contact the office in order to establish their benefit
start date. Individuals requesting an application by phone will be sent
one the same day the telephone request is made.
Fee agents help individuals who live in communities that do not have
a local DPA office apply for public assistance. DPA provides fee
agents with applications and other forms individuals need to apply for
assistance. Individuals are not required to go to a fee agent, and may
send the application directly to the nearest DPA office.
An application is considered filed when a DPA office receives an
acceptable application form containing the applicant's name, address,
and signature. Faxed applications are accepted.
Applicants must be advised that eligibility cannot be determined until
a member of the household completes an application form and
participates in an interview with a caseworker, fee agent, or Native
Family Assistance Program agency, if an interview is required.
The receipt of an identifiable application in a DPA district office
establishes the application filing date. The caseworker has 30 days
following the application filing date to process the application. When
the applicant asks to apply for another program prior to the eligibility
determination, use the original filing date and benefits start date for
all programs.
Note:
If an individual appears to be eligible under more than
one Medicaid eligibility category, the individual may
select the category.
5005-2 The Application Form
5005-2
THE APPLICATION FORM
5005-2 A. What is an Acceptable Application Form?
The Gen 50B, Application for Services form, is the initial
application form that is used to apply for any public assistance
program, except the Heating Assistance Program. To apply for
Heating Assistance, a Heating Assistance Program application must
be completed.
The Gen 72, Eligibility Review Form, is the review application form
that is used to determine continued eligibility for Adult Public
Assistance, Food Stamps, Medicaid, and Temporary Assistance.

If received in the month following the end of the review period,
the Gen 72 form can be used as an initial application form.

If received after the month following the end of the review
period, a Gen 50B application form is required. The Gen 72
form will be accepted to protect the benefit start date;
however, it cannot be used as the initial application form.
The Native Family Assistance Program (NFAP) TANF application
form is an acceptable application form for Adult Public Assistance,
Food Stamps, Medicaid, and Temporary Assistance.
The following specialized application forms are also available and
their use is encouraged when appropriate:
The Gen 132, Denali KidCare Application, used for all poverty level
children, pregnant women, and all children applying for or receiving
SSI;
The Gen 33, Application for Medicaid and Title IV-E Foster Care
for a child in DHSS Custody, used by the Office of Children’s
Services (OCS) to apply for children in state custody, Title IV-E foster
care and adoption assistance agreements, and state-only adoption
assistance agreements;
The Gen 35, Application for Medicaid for a child in DHSS
Custody, used by youth corrections staff and specialized/Title IV-E
caseworkers.
5005-2 B. When is an Application Required?
1. Upon the individual's first application for a program, except if
the individual is already a recipient of another DPA assistance
program.
2. Upon application from a denied, withdrawn, or closed status,
unless the denial or closure was the result of an administrative
error.
3. Any time the caseworker believes the individual’s
circumstances have changed sufficiently to justify conducting a
special redetermination of eligibility, including when an office
conducts a special review project for all or part of its caseload.
5005-2 C. When is an Application Not Required?
1. To reopen a closed case as a result of an individual's timely
request for a fair hearing, or to open or reopen a case as the
result of a fair hearing decision.
2. To reopen a case that had been closed incorrectly.
3. To redetermine eligibility after the initial application is denied
for failing to provide verification and the household provides
the verification within 30 days from the application filing date.
4. To redetermine eligibility after the application is denied for
failing to attend an interview and the household contacts the
office to reschedule the interview within 30 days from the
application filing date.
5. When there is a change in “payee”, “in care of” addressee, or
mailing address.
6. When the individual is already a Medicaid recipient in another
eligibility category.
Example:
An 18-year old individual is removed from the Family
Medicaid or Denali KidCare case because of age. If the
18 year old meets all the financial and non-financial
criteria of the Medicaid program that individual may be
moved to the Under 21 Medicaid eligibility category
without a new application.
7. When an applicant is being added to an ongoing Medicaid
case. All additional forms and documentation needed for that
individual (i.e., a 1603, verification of citizenship, etc.) must be
obtained before eligibility can be determined.
Example:
A cousin moves into the home of a family already
receiving Family Medicaid.
8. When an individual is already part of an active public
assistance case and the existing case file already includes the
information needed to make a prospective Medicaid
determination. The caseworker must carefully document the
source of information used to make the eligibility
determination. TPL or any other missing information should
be requested separately.
9. When a family moves from FM to Transitional Medicaid, or
from Transitional Medicaid to FM or Denali KidCare.
10. When an applicant originally applied for TEFRA, but at the
time of application was only found eligible for FM or Denali
KidCare. The recipient is not required to file a new application
at the time the recipient does move to TEFRA.
11. When a household is ineligible for the first month, but eligible
for the second month. See Section 5005-6A.
5005-2 D. What is an Identifiable Application?
An identifiable application is an acceptable application form
containing the applicant’s name, address, and signature (or
witnessed mark) of the individual seeking assistance or of the
individual's authorized representative. Each DPA office must accept
and date the identifiable application when it is presented.
An individual who contacts a DPA office and who shows interest in
the program or a desire to apply shall be advised of his or her right to
submit an identifiable application on the date of the contact in order to
establish the benefit start date. The individual may file an identifiable
application on an acceptable application form as described at Section
5005-2.
5005-2 E. Who Can Sign the Application Form?

An adult household member

A minor parent

An authorized representative

An individual who has legal authority to act on the applicant’s
behalf (i.e., Office of Public Advocacy, legal guardian)

An individual with appropriate power of attorney.

A responsible person, if the individual filing the application is
incapable of applying and of appointing an authorized
representative in writing.

If a child is living with more than one caretaker relative, either
of the relatives may be an eligible signer of the DKC
application.

The parent, guardian, or the child may sign the Denali KidCare
or Under 21 Medicaid application when the caseworker
determines it is appropriate.
Note:
Any person has a right to submit an application for
Medicaid or Denali KidCare and to sign the application
form, either for themselves or on behalf of another
person.
The signer must certify, under penalty of perjury, the truth of the
information contained in the application.
The appropriate individual to sign a Medicaid or Denali KidCare
application is a specified relative of a dependent child, the authorized
representative of a specified relative, or, if the specified relative is
incompetent or incapacitated, a responsible individual acting on
behalf of the specified relative. If a child is living with more than one
specified relative, either of the relatives may be an eligible signer.
When both parents are included in the case, both parents must sign
the application.
5005-2 F. Who can be an Authorized Representative?
A responsible adult, 18 years or older, may be designated by the
applicant in writing as authorized representative. If the applicant is
illiterate, his/her mark must be witnessed by two individuals who must
each sign their names and date the document. No special form is
required.
Authorized representatives may sign the application and act on
behalf of a household. A household member should prepare or
review the application, if possible, even though the authorized
representative will be filing the application and/or attending the
interview.
5005-2 G. Completing the Application Form
In addition to making an identifiable application and having it signed
by an eligible individual, the applicant must answer all of the
questions on the application form.
If the individual requests help in completing the application form, the
caseworker will offer assistance.
If the application form is not completed, the caseworker will allow the
household an opportunity to complete the form. In this case, written
notification will be sent to the household listing the items that need to
be completed. See Section 5005-6(C), Pending the Application.
5005-4 The Interview
5005-4
THE INTERVIEW
5005-4 A. When is an Interview Required?
Interviews are mandatory for all initial applicants. A face-to-face
interview is required at the time of initial application unless the faceto-face interview is waived. See Section 5005-4(D) for policy on
when an interview can be waived.
Exception:
Interviews are not required for Denali KidCare
applications.
5005-4 B. Who Must Attend the Interview?
A member of the applicant household who can sign the application
form or an individual authorized by the household must attend the
interview.
5005-4 C. Who Can Conduct the Interview?
1. DPA Caseworker: Most individuals will be interviewed by a
DPA caseworker in the DPA office or by telephone.
2. DPA-contracted Fee Agent: In communities where there is
no DPA Office, the fee agent conducts the interview for
individuals who want to apply for public assistance. The fee
agent will complete a Fee Agent Interview Report form (FA #1)
and submit it with each application.
3. Native Family Assistance Program (NFAP) Agency: We
will accept the NFAP interview, if one is conducted, and not
require the individual to be interviewed again. If the NFAP
interview notes are not provided with the application, the
caseworker should obtain them from the NFAP agency.
Note:
Regardless of who conducts the interview, if additional
information or verification is needed to process the
application, the caseworker will contact the applicant to
get this information.
5005-4 D. When Can the Face-to-Face Interview be Waived?
Face-to-face interviews can be waived when the applicant is unable
to attend the interview for reasons including:
1. Illness or disability;
2. Transportation difficulties;
3. Prolonged severe weather;
4. Needed to care for a family member;
5. Living in a location not served by a DPA office; or
6. Work or training hours that preclude an in-office interview
during office hours.
The caseworker shall document the reasons a face-to-face interview
is waived. A household whose face-to-face interview is waived shall
be interviewed by telephone or through correspondence.
5005-4 E. Interviews Conducted at the DPA Office
Interviews must be scheduled for applicants who cannot be
interviewed on the day they submit an application.
The interview must be scheduled timely to ensure eligible households
have an opportunity to participate within 30 days after the application
is filed.
Applicants may bring anyone they choose to the interview. During
the interview, applicants must be informed of their rights and
responsibilities and basic program procedures.
When the applicant fails to appear from a scheduled interview and
does not reschedule, the application is denied. If the household
contacts the office within 30 days of the application filing date, the
office must schedule an interview. If the household is determined
eligible, the original application is used and benefits start based on
the date the application was filed.
Note:
If an application is registered on EIS as a request for
service, EIS will automatically deny the application on the
30th day from the date the application was filed. The
household is notified via a system-generated notice.
5005-4 F. Changes Reported at the Interview
Applicant households must report all changes affecting their eligibility
or benefits at the interview.
Changes reported after the interview, but before a case decision is
made, will be considered in the initial eligibility determination.
When the household reports a new household member before a case
decision is made, the new member is considered part of the
household. The benefit start date is used to determine the benefits
for the household, including the new member. See Section 5002-3
for policy under the one day-one month principle.
The individual must be in the home at least one day of the month to
be included in that month. However, when the household reports
prior to the eligibility determination that a person moved out, that
person is not considered part of the household for any month.
Example # 1:
A household applies May 27. At the interview on June 5,
the individual reports her spouse moved in on May 30.
The spouse is considered part of the household and the
household’s benefit start date is May 1. If the spouse
moved in on June 3, the spouse is included in the
household effective June 1.
Example #2:
A household applies on July 28th and is interviewed
August 9th. During the interview, the individual reports
that her husband moved out on August 4th and is not
expected to return. The husband is not considered part
of the household for either July or August, and
verification of his income and resources are not needed.
Income and resources available to the household must
still be considered.
5005-5 Verification
5005-5
VERIFICATION
See Section 5000-4 for policy on verification.
5005-5 A. Verification Required Prior to Allowing Deductions
Caseworkers must obtain verification of allowable expenses when the
expenses result in a deduction of countable income. Households
must be given an opportunity to provide the verification before the
eligibility determination is made. If the household does not provide
verification of the following expenses, the application is processed
without the deduction.

Dependent care expenses.

Deductible child support payments.
5005-5 B. Information from Data Systems and EIS Interfaces
Several data systems and computer interfaces are available through
the Internet and on-line EIS access. Caseworkers must check these
systems for each household member at each application and review
as part of the verification process.
In some situations, the information will be from the source and can be
used as verification. In other situations, the caseworker must followup on the information.
Example:
The caseworker checks the interfaces and data systems
for the two members of an applicant household. The
Department of Labor system shows one is currently
receiving unemployment benefits of $120 weekly. This
information is used as income verification since the
information is directly from the source of the income. The
caseworker also finds that the other applicant had
earnings listed for the prior quarter. The caseworker
contacts the household to determine if the person is still
working or if there is any change in health insurance and,
if so, requests verification.
Direct Data Systems
INGENS Public Information
Database
NSTAR or NFIN State of
Alaska Child Support Services
Division
State of Alaska Department of
Labor (DOL)
Automated Status Verification
System (ASVS)
EIS Interfaces (using the
INME menu)
BENDEX Social Security
Administration
SDX Social Security
Administration
State of Alaska Department of
Labor (DOL)
State of Alaska Permanent
Fund Dividend Division
Senior Benefits Program
State Verification Exchange
System (SVES)
Information Verified
Ownership of resources
including vehicles, real estate,
fishing permits, mining claims,
boats
Child Support collections Child
support disbursements Legal
obligation to pay child support
Unemployment Insurance
Benefits
Qualified alien status of
household members who are
not U.S. citizens
Information Verified
SSA payments
SSI payments
Employment history through
quarterly wage match
PFD payments
Senior Benefits Program
payments
SSA and SSI payments
5005-6 Actions On Application
5005-6
ACTIONS TAKEN ON THE APPLICATION
Every applicant must be provided with adequate written notice of the
action taken on the application. Adequate notice means that the
individual is informed of the action taken, the reasons for the action,
and the manual sections from the appropriate program policy manual
that supports the action.
5005-6 A. Approving the Application
An approval notice must be sent to the household following a
determination of eligibility. Except when the application is delayed as
described below, approved households must receive benefits no later
than 30 days after the application filing date. To meet this
requirement, the caseworker must authorize the benefits by the 28th
calendar day following the application filing date. See Section 50056(F) for policy on when an application is delayed.
Eligible First Month/Ineligible Second Month: A household may
be eligible for the month of application and ineligible in the
subsequent month. In this case, the household should be approved
only for the month of application.
Ineligible First Month/Eligible Second Month: A household may
be ineligible for the month of application but eligible in the
subsequent month. Even though denied for the month of application,
the household does not have to reapply. The same application is
used for the first month denial and the determination of eligibility for
the subsequent month.
5005-6 B. Benefit Start Date
The benefit start date determines the date from which benefits begin.
It is the date a household initially requests benefits and files an
identifiable application:

At the DPA office: The benefit start date is the date the DPA
office receives the application form; or

With a Native Family Assistance Program (NFAP) Agency:
The benefit start date is the date the NFAP agency receives
the application form.
5005-6 C. Pending the Application
When the office needs the applicant to submit a complete application
form, or provide information needed to determine eligibility, the
application is pended, and a notice is sent. The notice clearly informs
the applicant what is needed to complete the application. Applicants
will be given at least 10 days, but no more than 30 days, from the
date of this notice to provide the verification. The same verification
pend time frames will be consistently applied to all applicants within
each office.
1. Applicants failing to provide all necessary verification at the
interview will be sent a pend notice no later than 30 days after
the application filing date requesting the required verification.
2. Applicants contacting the agency within the pend period
expressing difficulty in obtaining required verification will be
offered assistance. The caseworker should extend the pend
period if additional time is needed to obtain the information. A
new pend notice should be sent.
3. If the applicant does not complete the application process, the
application is denied at the end of the period provided in the
notice.
5005-6 D. Denying the Application
A denial notice must be sent to the applicant explaining the reason
for the denial. This notice should be sent as soon as possible
following the determination of ineligibility, but no later than 30 days
following the application filing date.
Applicants denied for failing to provide needed verification by the end
of the pend period will be sent a notice of denial at the end of the
pend period. If the applicant provides the verification after the pend
period but within 30 days of the application filing date, the caseworker
must accept the verification and make an eligibility determination
without requiring a new application. If the household is found eligible,
the caseworker will use the original benefit start date.
Note:
When the deadline for processing an application or
providing verification does not fall on a workday, it will be
extended to the next workday.
See Section 5005-4(E) for policy on denying applicants for failing to
attend an interview.
5005-6 E. Withdrawing an Application
The applicant may voluntarily withdraw the application at any time
before the eligibility determination is made. A written or verbal
request to withdraw is acceptable. The reason for withdrawal (if
known) shall be documented in the case file. The applicant shall be
advised of his or her right to reapply at any time by submitting a new
application. A notice shall be sent to the individual denying the
withdrawn application.
If the individual wants to apply again once an application has been
withdrawn, he or she must complete a new application.
5005-6 F. When the Application is Delayed
If a household's eligibility has not been determined or benefits have
not been authorized to an eligible household by the 30th day
following the application filing date, the application is delayed. The
caseworker will determine the cause for the delay and take
appropriate action:
1. Agency-caused delays
include cases where the application was not approved, denied or
pended within the allowable time limits.
If an eligibility determination cannot be made by the 30th day from
the application filing date because of action required by the agency,
the case is left in a pending status. The household must be sent a
pend notice by the 30th day.
2. Household-caused delays
include situations where the office cannot take further action on the
application without an action from the household.
If the household fails to submit a complete application form or attend
an interview by the 30th day from the application filing date the
application is denied.
5008
RETROACTIVE MEDICAID ELIGIBILITY
Retroactive Medicaid eligibility may be available to a Medicaid
applicant who did not apply for assistance until after they received
care, either because they were unaware of Medicaid or because the
nature of their illness prevented the filing of an application.
Retroactive eligibility is available when there is an unpaid medical bill
for a service provided for three full months immediately before the
month of application providing the individual meets all the eligibility
criteria. An applicant does not need to be eligible in the month of
application (or current month) to be eligible for one or more months of
retroactive Medicaid.
Retroactive Medicaid may also be available to an individual who is
added to a case (e.g., child returns home). See Sections 5005-2(B)
and (C) to determine if a new application is required.
The date of application, rather than the date of the eligibility
determination, establishes the beginning of the three-month
retroactive period. Eligibility for a retroactive month cannot be
assumed based on current month eligibility. Determine eligibility for
each month separately using the eligibility rules in effect for that
month.
The caseworker must inform each applicant of the availability of
retroactive Medicaid coverage.

Ask the applicant if he or anyone in the household needs help
paying for an unpaid medical bill during the retroactive period.

Accept and document the applicant’s statement of medical
need.
Retroactive Medicaid is determined using:

Actual income received in each month;

Adjusted gross income for self-employment based on the
appropriate type (monthly, seasonal or annual) of selfemployment. (see Section 5164-1(C) for definitions and
Section 5164-2 for budgeting methods); and

Actual resources that were available in each month.
Example:
An individual applies for Medicaid coverage in June. The
caseworker determines that the individual was eligible for
retroactive Medicaid coverage in March and April, but not
in May. Any services covered by Medicaid that the
individual received in March and April that have not been
paid for can be covered by Medicaid.
Deceased Applicants -- Application for retroactive Medicaid
coverage may be made on behalf of a deceased person. Payment
will be made for covered services rendered to the deceased person
during each month the person was eligible for Medicaid during the
three month period, however, Medicaid does not pay transportation
expenses for recipients who are deceased.
Medicaid Coverage During Retroactive Period -- Individuals
eligible for retroactive Medicaid are eligible for the same amount and
scope of Medicaid services as was available to other Medicaid
recipients during that time period. Coverage of services that normally
require prior authorization are not automatically denied due to lack of
approval prior to receipt of services during the retroactive eligibility
period.
Inform the recipient to give a copy of the retroactive Medicaid
approval notice to the health care provider to assure that any
retroactive claim is processed appropriately. The provider can then
attach a copy to the claim before submitting it for payment.
Only Unpaid Medical Bills --Medicaid will only pay enrolled
providers for unpaid medical claims for covered Medicaid services
during the three-month retroactive period. Medicaid will not
reimburse a recipient for medical services received during the
retroactive period that have already been paid.
Pregnant Woman Medicaid -- Eligibility may be granted
retroactively. The retro-month determines the first month of eligibility
and continues forward throughout the pregnancy. See Section 5310B.
Postpartum Medicaid -- Eligibility may not be granted retroactively.
The woman must be receiving Medicaid on the date that her
pregnancy terminates in order to receive postpartum coverage.
State Residency Required -- If an applicant has recently moved to
Alaska, and did not reside in the state during the three-month
retroactive period, the responsibility for medical coverage rests with
the previous state of residence. Application may be made in Alaska
for any month (during the three-month period) in which the individual
did reside in the state, as long as that person was not receiving
benefits from another state during the same time period.
Transitional Medicaid -- For the purposes of determining
Transitional Medicaid eligibility, retroactive Medicaid can be used to
determine whether a current Medicaid recipient in another eligibility
category or a new applicant would have been eligible for Family
Medicaid in three of the last six months. For more details see Section
5220.
5011 U.S. Citizenship And Eligible Alien Status
5011 U.S. Citizenship And Eligible Alien Status
5011
U.S. CITIZENSHIP AND ELIGIBLE ALIEN STATUS
To be eligible for Medicaid, including Denali KidCare, an individual
must be a U.S. citizen or a qualified alien.
U.S. citizens must provide verification of their U.S. citizenship and
identity to be eligible for Medicaid benefits.
Qualified aliens must provide verification of their satisfactory
immigration status when they apply for Medicaid benefits.
Note:
Verification of satisfactory immigration status is not
required for an alien applying for treatment of an
emergency medical condition. See Section 5600.
Verification of U.S. citizenship and identity is not required for:

A current Supplemental Security Income (SSI) recipient;
Note:
A screen-print of the State Data Exchange (SDX)
interface may be used to verify and document a former
SSI recipient’s citizenship. An SSI recipient’s citizenship
status can be found in the Alien Indicator Code at
position 578 on the SDX.

A current Medicare recipient;

An individual receiving Social Security Disability Insurance
(SSDI) benefits;

Children in state foster care or Title IV-E adoption assistance;

A newborn child, including a baby whose mother is a nonqualified alien and is determined eligible under “Emergency
Treatment for Aliens” for the labor and delivery of the child.
Documentation of U.S. citizenship would be required when
the child turns age one. receiving newborn coverage through
the end of his or her first birthday.
Verification of U.S. citizenship or immigration status is needed only
for the individuals who will receive benefits, not for individuals
applying for or renewing Medicaid or Denali KidCare on behalf of
someone else.
Note:
If an individual who is a mandatory household member is
found ineligible for Medicaid for failure to provide
verification of their own citizenship and identity, or
immigration status, that individual’s needs, income, and
resources continue to be included in the financial
eligibility determination for the household.
5011-2 Documenting United States Citizenship
5011-2
DOCUMENTING UNITED STATES CITIZENSHIP
5011-2 A. ACCEPTABLE DOCUMENTATION
Verification of citizenship and identity must be obtained from original
documents or certified copies from the issuing agency, unless
verification is obtained through the Bureau of Vital Statistics (BVS) or
Permanent Fund Dividend (PFD) interface as described below. An
agency staff member or out-stationed staff will make a photocopy of
the documents for the case file and stamp or note on the copy that an
original or a certified copy was seen. A DPA-contracted fee agent
may also verify and note on the photocopy that an original or certified
copy was seen. Uncertified copies, including notarized copies are
not acceptable.
Although some documents contain a statement, “DO NOT COPY”,
DPA staff may copy and file these documents in the case file for the
official purpose of establishing Medicaid eligibility.
Once a person’s citizenship is documented and recorded, it is not
necessary to get proof again unless that person’s citizenship
becomes questionable.
Data Matches and Interfaces:
For citizenship, verification may be obtained from a data match or
online access with the Bureau of Vital Statistics (BVS), or from
information on the PFD interface.
When birth information is verified through an automated data match
with BVS, the EIS HERC screen will be coded with "BV" and will
override any prior code.
The PFD interface may be used for individuals who applied for a PFD
for the first time in 1989 or after and claim U.S. citizenship. The PFD
Division requires that an original or certified copy of a birth certificate,
certificate of naturalization or other acceptable document be
submitted. When a birth certificate is received, the state of birth is
recorded in the PFD data with a two letter state identifier. The PFD
interface can be accepted as verification of citizenship when all of the
following information appears on the screen:

US Citizenship (CITIZEN FLAG) is Y

Place of birth (BIRTH STATE) is two digit state code

Year of first application (FIRST APP YEAR) is 1989 or later
When the birth state field shows “//”, other verification of citizenship is
required as this code means the individual was born in another
country, for example when someone is a naturalized citizen.
If information obtained from the client, is not consistent with
information from the PFD interface, additional documentation must be
obtained from the client to verify citizenship.
When birth information is verified through the online BVS access look
up, or the PFD interface, enter code “IN” in the verification field on the
EIS HERC screen. A screen print of the information must be placed
in case file. For BVS, the screen print must be marked “For DPA Use
Only”. These screen prints should not be copied.
If verification is not available through the BVS or PFD interface, and
there is no record that an original or certified copy was seen, this
documentation must be requested from the applicant or recipient.

For Applications:
Verification must be obtained prior to authorizing benefits for an
application. If verification is not available through BVS or the PFD
interface, it must be requested.

For Reviews:
The individual must be making a good faith effort to obtain
verification of U.S. citizenship and identity before benefits are
authorized.
Levels of Acceptable Documents:
The list below provides allowable documentation for verifying U.S.
citizenship and identity. There are four levels of verification listed in
order of preference. If a higher level document is not available, a
lower level may be used.
Level One: Acceptable for Both Proof of Citizenship and Identity

State Data Exchange (SDX) interface for a former SSI
recipient;

A U.S. Passport;

A Certificate of Naturalization (Forms N-550 or N-570); or

A Certificate of U.S. Citizenship (Forms N-560 or N-561).
Level Two: Acceptable for Proof of Citizenship: (Must have an
additional form of identity verification.)

Verification of birth through a Bureau of Vital Statistics (BVS)
online access or an electronic BVS data match;

A U.S. birth certificate showing birth in one of the 50 States,
the District of Columbia, Puerto Rico (if born on or after
January 13, 1941), Guam (on or after April 10, 1899), the
Virgin Islands of the U.S. (on or after January 17, 1917),
American Samoa, Swain’s Island, or the Northern Mariana
Islands (after November 4, 1986) recorded before 5 years of
age;

A Certification of Report of Birth (Forms FS-545 or DS-1350);

A Report of Birth Abroad of a U.S. Citizen (Form FS-240);

A U.S. Citizen I.D. Card (Forms I-179 or I-197);

An American Indian Card (I-872) issued by the Department of
Homeland Security with the classification code “KIC”;

A Northern Mariana Identification Card (Form I-873);

A final adoption decree showing the child’s name and U.S.
place of birth;

Evidence of U.S. Civil Service employment before June 1,
1976;

U.S. Military Record showing a U.S. place of birth, such as a
DD-214, or similar official document that shows a U.S. place of
birth; or

Evidence of meeting the automatic criteria for U.S. citizenship
under the Child Citizenship Act of 2000. See subsection
5011-2 B.
Level Three: (Must have an additional form of identity verification.)
Level three documents are allowed when both primary and
secondary verification is not available and include:

For individuals who are age 16 or older, an extract of a
hospital birth record on hospital letterhead established at the
time of the person’s birth that was created five years before
the initial application date and that indicates a U.S. place of
birth. This may also include medical records of post-natal
care. For children under age 16, the document must have
been created near the time of birth or five years before the
date of application;
Note:
A souvenir birth certificate issued by a hospital is not
acceptable verification

Life, health, or other insurance record showing a U.S. place of
birth that was created at least five years before the initial
application date and that indicates a U.S. place of birth. For
children under age 16, the document must have been created
near the time of birth or five years before the date of
application;

Religious record recorded in the U.S. within three months of
birth showing the birth occurred in the U.S. and showing either
the date of the birth or the individual's age at the time the
record was made. The record must be an official record, such
as a baptismal certificate that is recorded with the religious
organization. This does not include entries in a family bible; or

Early school record showing a U.S. place of birth. The school
record must show the name of the child, the date of admission
to the school, the date of birth, a U.S. place of birth, and the
names(s) and place(s) of birth of the applicant's parents.
Level Four: (Must have an additional form of identity verification.)
Level four documents are allowed when first, second and third level
verification is not available and include:

One of the following documents that shows a U.S. place of
birth and was created at least five years before the application
for Medicaid For children under 16, the document must have
been created near the time or birth or 5 years before the date
of application:

Seneca Indian tribal census record;

Bureau of Indian Affairs tribal census records of the Navajo
Indians;

U.S. State Vital Statistics official notification of birth
registration;

A delayed U.S. public birth record that is recorded more than
five years after the person’s birth;

Statement signed by the physician or midwife who was in
attendance at the time of birth;

Medical (clinic, doctor, or hospital) record created at least
five years before the initial application date that indicates a
U.S. place of birth.

Federal or State census record showing U.S. citizenship or a
U.S. place of birth;

The Roll of Alaska Natives maintained by the Bureau of Indian
Affairs. The Roll only contains information of individuals who
were born prior to December 18, 1971. Using a release of
information, staff may contact the Bureau of Indian Affairs to
request information and documentation on the individual from
the Roll;

Institutional admission papers from a nursing facility, skilled
care facility or other institution created at least 5 years before
the initial application date that indicates a U.S. place of birth;
or
As a Last Resort:

A written declaration made by at least two individuals of whom
one is not related to the applicant/recipient and who have
personal knowledge of the event(s) establishing the applicant’s
or recipient’s claim of citizenship. If known, the declaration
should also explain why documentary evidence establishing
the applicant’s claim of citizenship does not exist or cannot be
readily obtained. The person(s) making the declaration must
be able to provide proof of his/her own citizenship and identity
for the declaration to be accepted.
A separate declaration is needed from the applicant or
recipient, or other knowledgeable individual (guardian or
representative) explaining why the evidence does not exist or
cannot be obtained. The declarations must be signed under
penalty of perjury.
Acceptable Proof of Identity: (Must have an additional verification
of citizenship.)

A driver’s license issued by a state or territory with a
photograph of the individual or other identifying information
such as name, age, sex, race, height, weight, or eye color. A
voter's registration card or Canadian driver's licenses are not
acceptable verification;

Identification card issued by the federal, state, or local
government with the same information included on driver’s
licenses listed above;

Certificate of Degree of Indian Blood, or other U.S. American
Indian/Alaska Native Tribal document with a photograph or
other personal identifying information relating to the individual;

School identification card with a photograph of the individual;

U.S. military card or draft record;

Military dependent’s identification card;

U.S. Coast Guard Merchant Mariner card; or
When no Other Identity Document is Available:

Three or more documents that together reasonably confirm the
identity of an individual, such as employer identification cards,
high school and college diplomas from accredited institutions
(including general education and high school equivalency
diplomas), marriage certificates, divorce decrees and property
deeds/titles. The documents must list the individual's name,
plus any additional information establishing the individual's
identity and must have consistent identifying information. This
form of identity may not be used when U.S. citizenship is
documented under level four.
Identity for Children Under age 16:

Clinic, doctor or hospital record;

School records, which may include nursery or daycare record
and report cards. Verification of these records must be made
with the issuing school; or

A Medicaid application, or a declaration that states the date
and place of the child’s birth that is signed by a parent,
guardian, or caretaker relative under penalty of perjury. The
Medicaid application or an identity declaration may be used for
children under age 18 in limited circumstances, such as
when school ID cards and drivers' licenses are not available to
the individual in their locality.
Identity for Disabled Individuals in Institutional Care:

A declaration signed under penalty of perjury by a residential
care facility director or administrator on behalf of the individual
in the facility when the individual does not have or cannot get
any of the documentation listed above.
Note:
A declaration for identity may not be accepted if a
declaration for citizenship was provided.
5011-2 B. CITIZENSHIP FOR CERTAIN CHILDREN BORN OUTSIDE THE
UNITED STATES
Effective February 27, 2001, the Child Citizenship Act of 2000 allows
a child born outside of the United States to acquire citizenship of the
United States automatically when all of the following conditions have
been fulfilled:
1. At least one parent of the child is a citizen of the United States,
whether by birth or naturalization;
2. The child is under the age of eighteen years; and
3. The child is residing in the United States in the legal and
physical custody of the United States citizen parent; pursuant
to a lawful admission for permanent residence.
Note:
Because proof of citizenship is not automatically issued
to eligible children, parents must provide proof of the
child’s relationship (such as a birth certificate) to their
U.S. citizen parent and proof that the child is lawfully
admitted into the U.S. Parents of a foreign born child
who meet the conditions of the new law should be
encouraged to apply for a certificate of citizenship for
their child with the USCIS and/or for a passport for their
child with the Department of State.
5011-2 C. FOREIGN BORN CHILDREN ADOPTED BY U.S. CITIZENS
Under the Child Citizenship Act of 2000, a foreign born child under
age 18 who has been legally adopted by at least one U.S. citizen
parent automatically becomes a U.S. citizen when the legal adoption
is finalized. Most of the time, a parent will be able to verify the U.S.
citizenship of their child by producing a U.S. birth certificate.
Once a U.S. citizen, the five-year bar no longer applies. However,
until the legal adoption is finalized, a foreign born child who arrives
after 8/22/96 is subject to the 5 year bar.
Effective January 1, 2004, a new entrant (IR-3) program was
implemented, which focuses on newly entering orphans with full and
final adoptions abroad. Under this new program, these children will
automatically receive a Certificate of Citizenship within 45 days of
entry into the U.S.
5104-7
INDIVIDUALS INCLUDED IN THE HOUSEHOLD AND WHOSE
INCOME AND RESOURCES DO COUNT, BUT WHO ARE NOT
ELIGIBLE FOR COVERAGE
Parents living in the same home as a dependent child may have their
needs included in the household, even though they are disqualified
for Medicaid coverage for themselves. These parents are kept in the
household so that the child is not penalized for the disqualifying
actions of the parent. The disqualified parent’s resources and
income do count in determining financial eligibility. These individuals
include:
1. The parent of a dependent child, when the parent is
disqualified from Medicaid eligibility for failure to cooperate
with CSSD;
2. The parent fails to provide or verify information under Section
5000-4;
3. The parent of a dependent child, when the parent is ineligible
because of income deemed from a spouse who is only a
stepparent to the dependent child.
4. The parent of a dependent child, when the parent is
disqualified from Medicaid eligibility because the parent is a
qualified alien subject to the 5-year bar or is a non-qualified
alien. This also includes any siblings that are non-qualified
aliens. See Section 5011-5.
5. A mandatory household member found ineligible for Medicaid
for failure to provide verification of their own citizenship and
identity or immigration status. See Section 5011.
5125 Deprivation
5125
DEPRIVATION
To be eligible for Family Medicaid, a dependent child must be
deprived of the parental support and care of one or both of the child's
parents. Deprivation occurs when a parent does not continue to live
in the home of the child, except for a temporary absence allowed at
Section 5120-5, or because of under-employment of the parents.
Deprivation is based upon the condition of the parents, not the
condition of the child or of another relative. Deprivation must always
be verified and documented.
There are three causes of deprivation recognized in Alaska:

Deprivation by Death (See Section 5125-1)

Deprivation by Under-Employment (See Section 5125-2)

Deprivation by Continued Absence (See Section 5125-3)
Historical Note:
Historically, when one or both natural or adoptive parents
were incapacitated by a physical or mental defect, illness,
or disability, the child was considered deprived of
parental support and care. While this form of deprivation
is recognized under federal law, it no longer has a
practical application in Alaska. Effective July 1, 1997,
Alaska Medicaid policy on deprivation by unemployment
was expanded, such that all two parent households who
would have had to rely on deprivation by parental
incapacity to qualify for Family Medicaid will meet the
requirements for deprivation by unemployment.
5125-1
DEPRIVATION BY DEATH
When one or both natural or adoptive parents of a child are
deceased, the child is deprived of parental support and care.
5125-2
5125-2 Deprivation By Unemployment
DEPRIVATION BY UNDER-EMPLOYMENT
5125-2 A. DEFINITION OF UNDER-EMPLOYMENT
A child living in a two-parent home is deprived of parental support
and care because of under-employment when the household income
does not exceed the Family Medicaid need standard for the
household size.
5125-2 B. PREGNANT WOMEN IN THIRD TRIMESTER
A pregnant woman with no other Family Medicaid eligible children
who is in her last 90 days of pregnancy may qualify for Family
Medicaid based upon deprivation by under-employment if the ALL of
following criteria are met:
1. The father of the unborn child is living in the home.
Note:
If she is legally married, the pregnant woman’s spouse is
presumed under state law to be the father of the child,
unless a court determines otherwise.
2. If not married to the pregnant woman, the father of the unborn
child must acknowledge paternity by signing a Bureau of Vital
Statistics Affidavit of Paternity (BVS Form 16).
3. All other Family Medicaid financial and non-financial eligibility
criteria are met.
During the third trimester, only the pregnant woman may receive
Medicaid coverage. While the needs of the unborn child and the
child’s father are included in the eligibility determination, neither is
eligible for Medicaid coverage until the baby is born. Once the child
is born, the child and the father may be added to the Family Medicaid
case. Until the father is actually a Medicaid recipient, the father is not
required to pursue development of income.
5125-3 Deprivation By Continued Absence
5125-3
DEPRIVATION BY CONTINUED ABSENCE
5125-3 A. DEFINITIONS
In deciding whether deprivation by continued absence exists, the
caseworker will use the following definitions:
Maintenance means providing regular, predictable, and frequent
contributions of cash, which are for a child’s basic needs and are
significant in value. Sporadic gifts once a month or less frequently is
not the same as maintenance.
Physical care includes activities such as providing clean clothing,
washing, dressing, preparing meals, feeding, putting to bed, or
assisting with other personal care needs. Substantial amounts of
physical care must be provided on a regular, frequent, and
predictable basis in order for the caseworker to find that a parent is
providing physical care for a child.
Guidance includes activities such as accompanying the child to the
doctor, providing transportation, attending school activities and
conferences, assisting with school work or extra curricular activities,
monitoring activities or play, providing discipline, and participating in
decisions concerning the child's well-being. Substantial guidance
must be provided on a regular, frequent, and predictable basis in
order for the caseworker to find that a parent is providing guidance to
a child.
5125-3 B. CIRCUMSTANCES IN WHICH A CONTINUED ABSENCE
CONSTITUTES DEPRIVATION.
A child is deprived of parental support and care when a parent does
not continue to live in the home of the child, except for a temporary
absence. See Section 5120-5 B.
The child is deprived of parental support and care, even if a divorced,
separated, unmarried, hospitalized, or institutionalized parent, with
whom the child does not live, has some contact with the child.
5125-3 C. DURATION OF CONTINUED ABSENCE
There are no minimum time limit requirements on how long a
continued absence must have lasted or be expected to last. It is
never acceptable to hold an application in order to verify that
deprivation exists. For recent absence cases, the caseworker must
answer the following two questions before reaching an eligibility
decision about deprivation:
1. Is one of the parents absent from the home now?
2. Is that absence such that the conditions of section 5125-3 B
above are met, and it appears reasonable to predict that the
conditions of 5125-3 B above will be met?
If the answer to either or both of these questions is "no", then
deprivation does not exist. If the answer to both of the questions is
"yes", then deprivation exists.
5125-3 D. DETERMINING DEPRIVATION WHEN THE ABSENT PARENT
HAS CONTACT WITH THE CHILD
Occasionally a divorced, separated, or unwed parent may have
contact with the child, visiting the child in the child’s home, having the
child visit in his or her home, picking the child up from school or home
and taking the child to activities, etc. If such visits occur they do not
automatically lead to the finding, that deprivation does not exist. All of
the available circumstances of the visits must be gathered and
examined to see if the criteria of Section 5125-3 B are met. Whatever
the cause of the alleged absence of the parent from the home of the
child, cases in which there is frequent contact of the child with the
absent parent will be treated as follows:
1. Obtaining Absent Parent Residence Information
The caseworker must determine if the allegedly absent parent is in
fact absent, which means not living in the child's home. Absence
exists if the parent maintains a residence elsewhere that is not
temporary, and actually uses that residence as his or her primary
home, as shown by keeping regularly-used personal possessions
and clothing there, regularly receiving telephone calls and mail
there, reporting that residence to others as his or her address, etc.
The caseworker must evaluate items of proof which tend to show
where the absent parent lives. Each item of proof must be
evaluated along with the other items so that the caseworker can
decide whether the home of the child and the absent parent are the
same.
The caseworker must allow for the fact that domestic relations may
appear cordial and open with respect to the child and visitation.
However, circumstances may exist otherwise that make it
impossible for the applying caretaker relative to present or obtain
proof concerning the absent parent's actual residence. Benefits will
not be denied because the caretaker relative cannot provide this
proof. The caseworker must, where necessary, obtain residence
information from the absent parent and/or from collateral contacts.
2. Complaints
Frequent contact cases, particularly those involving a history of
custody disputes or those involving some sort of Child Support
Enforcement recovery, are often subject to complaints from
relatives, neighbors, or one of the parents, or made anonymously.
The most frequent source of such complaints involves the question
of where the allegedly absent parent really resides. While all such
complaints must be documented and at least examined, no finding
on deprivation can be made without a full investigation. Complaints
from any source, anonymous or otherwise, must be examined
carefully and weighed in light of the possible motives of the
complainant. Documents showing residence or mailing address
must be weighed according to how recent they are and who
provided the information they show.
3. Examples of Proof
Following are examples of proof, which may be relevant to deciding
where someone lives:

Where the person keeps the majority of his/her personal
belongings;

The amount of time spent at one address as opposed to
another;

Housing records, e.g., lease, rent receipts;

Unemployment Insurance Benefit records;

Child support records;

Correctional, police, or probation records;

Tax records;

Employer or union records;

School registration;

Mailing address for government benefits which require
mailing to the current address;

Address used for credit;

Address given to utilities or creditors as a current address;

Vehicle registration, driver's license, or post office address
that has changed since the absence started;

Information about the frequency, type, and length of the
absences;

Collateral contacts with landlords, neighbors, or other
reliable persons.
5125-3 E. EXAMPLES OF PARENTAL ABSENCE
1. Planned Absence
Short, planned absences for such activities as vacations, visiting
relatives, National Guard summer camp, or seeking/securing
employment may temporarily disrupt the household unit and
reduce the amount of support, care, or guidance the absent parent
is able to provide. However, planned absences do not result in a
finding of deprivation unless the test set out in Section 5125-3B is
met. Deprivation cannot be denied simply because the separation
began as a planned absence. The current situation must be
examined to determine if deprivation now exists.
2. Divorce
Divorce is a judicial termination of a marriage by written decree of a
court. Deprivation may exist if a child's natural or adoptive parents
are divorced and one or both parents are out of the child's home.
Verification:
Verify with a copy of the divorce decree and by collateral
contacts on the actual living situation.
When a divorce has been granted that also involves a child
custody order, it is possible that the actual location of the child and
the parent who is actually the caretaker may be very different from
what is specified in the custody order. The specified terms may
bear no relationship at all to who actually has custody of the child
or when visitation occurs. Thus, an order providing for joint or
shared custody does not by itself demonstrate that deprivation
does not exist. The caseworker must examine the actual situation
to determine if the criteria in Section 5125-3 B are met.
3. Legal Separation
Legal separation occurs when a court issues a written decree
establishing the right of married parties to live apart without actually
terminating their marital bonds. Deprivation exists if the couple is
not living together.
Verification:
Verify with a copy of the separation order and by
collateral contacts on the actual living situation.
4. Separation Without a Court Decree
Deprivation may exist when the natural or adoptive parents are not
living together and desertion has not occurred.
Verification:
Verify with collateral contacts on the actual living
situation.
5. Desertion
Desertion occurs when either or both parents willfully abandon the
home, leaving it without the necessities of life and with no
indication of any plan to return.
Verification:
Verify with collateral contacts.
6. Unwed Parents
Birth out of wedlock may be considered as a condition depriving
the child of parental support and care if one or both of the unwed
parents are absent from in the home of the child and the other
aspects of deprivation exist.
Unrelated male living in home. In the circumstance where an
applicant household consists of a parent, child, and an unrelated
male, there is a possibility that the unrelated male is the father of
the child.
Deprivation by reason of continued absence will not exist if:

The unrelated male is determined to be the father of the
child by a court decision; or

A birth certificate is issued listing the unrelated male as the
child's father. Normally, the Alaska Birth Certificate of a child
born out of wedlock will not list any father, unless the father
has signed a Vital Statistics Affidavit of Paternity; or

The unrelated male acknowledges paternity using the DPA
GEN #7.
If a caseworker believes that an unrelated male in the household
may be the father, he must complete the Division of Public
Assistance Statement of Relationship form (GEN #7). If none of the
three conditions above exists, and the person indicates on this
form that he is not the father, deprivation exists.
7. Hospitalization
Deprivation may exist if the absent parent is hospitalized or
institutionalized for prolonged treatment of physical or mental
illness. In order for deprivation to exist, the severity and duration of
the illness must be such that the role of the sick parent in providing
support and care for the child is interrupted or terminated.
Verification:
Verify by obtaining a statement from a medical provider
that confirms institutionalization and gives an assessment
of the duration and severity of the illness.
8. Deportation
Deprivation of parental support or care due to continued absence
of the parent exists when a parent has been deported from the
United States. There are no requirements concerning how long the
parent must be gone.
Verification:
Verify by obtaining by court documents or Immigration
and Naturalization Service documents ordering
deportation.
9. Imprisonment/Work Release
Deprivation of parental support or care due to continued absence
of the parent will be found to exist when a parent has been
sentenced to a correctional institution or is being held in a
correctional institution to await legal proceedings.
Work Release. Deprivation may be found to exist in the instance
when the parent is on a work-release program and living at home,
providing the following conditions are met:

A parent has been convicted of an offense and is under
sentence of a court, and

The sentence requires, and the parent is performing, unpaid
public or community services during working hours.
Verification:
Verify by obtaining a statement from an official of the
custodial institution.
10. Single Parent Adoption
Deprivation exists if there is evidence of a court-approved single
parent adoption.
Verification:
Verify by viewing the court order of adoption. Document
that this court order was seen; do not place a copy in the
case file.
11. Military Service
If the absent parent is in the military or other uniformed service
(including Coast Guard or Public Health Service), deprivation may
exist if the absence is not solely due to military service. If the
military parent is away from home on an assigned duty or tour
elsewhere, this is a planned absence and not deprivation.
Deprivation exists only if the parent is absent from the home and
the extent of his involvement in providing support and care
immediately before and during the assignment constitutes
deprivation.
Verification:
Verify absence and deprivation with military authorities
and other collateral contacts.