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Denali KidCare

Denali KidCare logoFrequently Asked Questions

 

Listed below are frequently asked questions regarding the Denali KidCare health coverage program.
You may click on a subject or scroll through this page and see if your question can be answered here before
contacting the Denali KidCare office
.

Questions About Income

1. What are the income requirements?

2. Does the permanent fund dividend count as income?

  • No.

3. Do Native Corporation dividends count as income?

  • Up to $2000 in a calendar year per person will not be counted. Any amount in excess of $2000 will be counted as income.

4. Does military COLA or other benefits count as income?

  • COLA and other benefits may be counted; they must be listed on the application.

5. Do SSI payments count as income?

  • No.

6. Do Social Security payments count as income?

  • Yes.

7. Does room and/or board count as income?

  • If a person is working in exchange for room and board, it will be counted. If the room and board is free, it won't be.

8. Do subsidized guardianship, adoption or foster care payments count as income?

  • No.

9. Do bingo earnings count as income?

  • Yes. Bingo earnings are counted as unearned income.

10. How is self-employment income reported and counted?

  • Seasonalized or annualized self-employment income (i.e. commercial fishing, construction, etc.) can be verified by the federal tax return that covers the most recently completed self-employment period. If a federal tax return is not available, the applicant can submit business records for the most recently completed self-employment period.

    When an applicant is self-employed in a business that is generally conducted year-round, but may experience considerable fluctuations in monthly income (i.e. cab driver, house cleaning, Avon, etc.), eligibility may be determined with verification of income from the last 30 days and, if available, the most recent income tax return. The income tax return is only used to determine if the applicant's monthly income has a history of fluctuating month to month and, if so, allows the caseworker to make a reasonable determination that the applicant's average monthly income is likely to remain below the income limit for Denali KidCare. If the income earned in the last 30 days is below the income limit, the client may be found eligible even if the average monthly income calculated using the income tax return is over the income limit. If no income tax return is available the caseworker may accept other forms of client statement. This will be especially necessary when the client is beginning a new self-employment enterprise.

11. If a person has no income whatsoever, what proof would be acceptable?

  • No proof is required. However, an applicant may be called and asked how they support themselves with no income.

12. Which household member's income counts for eligibility purposes for children?

  • Only the income of the child's natural or adoptive parent(s) is counted. The income of stepparents, aunts, uncles, and grandparents, or boyfriends or girlfriends of the custodial parent, even if they are residing in the household, is not counted.

13. Which household member's income counts for eligibility purposes for pregnant women?

  • Her income and her spouse's income are counted, and if she is under 21 and living at home, her parent(s) income is counted. The income of other household members such as a boyfriend, stepparents, aunts, uncles, and grandparents, even if they are residing in the household, is not counted.

14. If an 18 year-old is living with his or her parents, does the parents' income count?

  • Yes.

15. What are allowable deductions from gross pay and from adjusted self-employment income?

  • The only allowable deductions from gross pay and from adjusted self-employment income are the $90 standard work expense deduction and the dependent care deduction. The allowable dependent care deductions are: $175 per individual age 2 and older, and $200 per child under age 2.


16. When does an adoptive parent's income count for Denali KidCare eligibility?

  • An adoptive parent's income counts for Denali KidCare eligibility from the moment the legal adoption was finalized in court or by the tribal authority. A copy of the new birth certificate showing the new parents verifies the legal adoption.

17. Suppose a family is composed of a mother, father, three children, and the two minor sisters of the mother. For determining eligibility, how big is the family, and whose income counts?

  • As long as the sisters are under age 21, they may be included as optional members of the household, making a household of seven. Everyone's income counts. If the two sisters make the other children ineligible (because of their additional income), their needs and income are removed from the household and the eligibility of the children is determined separately. Likewise, if the other children make the two sisters ineligible, the needs of the other children are removed, and the eligibility of the two sisters is determined separately.

18. Does the original pay stub need to be mailed in, or will copies be accepted?

  • Copies of pay stubs are fine; however, they will not be returned to the applicant.

19. Does an applicant need to submit proof of Social Security or SSI income, or can the eligibility technician find it in the computer?

  • It can be found via computer, but will take three to five days. A bank statement showing direct deposit of SSA or SSI, or a copy of a letter from SSA showing the current year benefit amount, is considered adequate verification, and will speed up the eligibility determination.


Other Eligibility Questions

1. Does a tribal adoption differ from any other kind of legal adoption, in terms of Denali KidCare eligibility?

  • No. There are some differences between a court ordered adoption and a tribal adoption under Family Medicaid, but those differences do not apply to Denali KidCare.

2. Are children in subsidized adoptions eligible for Denali KidCare?

  • A child in a subsidized adoption may be eligible for Denali KidCare. Specialized workers in DPA offices using special eligibility criteria handle these cases. Usually the adoption assistant coordinator in the Office of Children's Services (OCS) will submit the application.

3. If a person needs medical care in the month they turn nineteen, can they apply and be eligible for Denali KidCare for that month?

  • Yes. They can apply and receive services, if eligible, during the month they turn nineteen. They may also be eligible for retroactive coverage of unpaid medical bills from a Medicaid provider in the three previous months. After the month in which they turn nineteen, they can apply at a DPA office for another program called Under 21 Medicaid. However, the program uses a lower income standard and includes an asset test.

4. If a family is caring for children, related or unrelated, on an informal (not formal foster care) basis, can the head of household apply for these children?

  • Yes. Anyone can apply on behalf of the child. In this situation, only the children's income will be counted.

5. When is a child considered to be living independently of his or her parents?

  • A child is considered to be living independently of his or her parents when:
    • a child's most recent placement or living arrangement was not in the home of the child's parents; or
    • a child has left the home to attend an educational institution, National Guard Youth Corps, or other educational, training, or treatment environment that involves a residential living arrangement

6. If the children in a family are on Denali KidCare, and one of the children is in boarding school and returns from school, how can this child be added?

  • Call or write to the Denali KidCare office and tell them you want to add your child who has returned from boarding school. You will need to provide the child's name, date of birth, and social security number.

7. If a woman has a miscarriage, can her prenatal care be covered retroactively, and will she be covered for two months afterwards?

  • If a woman applied for or was receiving Denali KidCare coverage on or before the date of the miscarriage, she is eligible for two months of postpartum care. A woman may be eligible for up to three months of retroactive coverage before the date of application as long as she was financially eligible and pregnant in those months.

8. Can a runaway, homeless or emancipated teen apply for herself/himself?

  • Yes. A teen who is living independently of his or her parents may apply for Denali KidCare or Medicaid on their own.

9. Are children in state custody eligible for Denali KidCare?

  • There are different kinds of state custody and this affects what type of medical assistance is available to a child. A child in a correctional institution is not eligible for Denali KidCare. A child in protective custody, such as foster care, may be eligible for Denali KidCare, but they are most often covered under a different Medicaid eligibility category. For a child in foster care, it is the responsibility of the social worker to apply for Medicaid for that child.

10. Which parent should submit the application in families where there is joint custody?

  • While either parent could initially submit an application for their child, eligibility will be determined using the income and household situation of the parent who is exercising the primary responsibility for the care and control of the child. That parent is the one who would be required to sign the application before benefits could be issued.

Questions About Other Insurance

1. Can this program be used in conjunction with other health plans that underinsure - with high deductible, no dental or other limitations?

  • Perhaps. If a family gross income is at or below 150% of the Federal Poverty Guideline (FPG) for Alaska, the child may be eligible for Denali KidCare regardless of existing coverage. If their gross income is over 150% FPG, children are probably not eligible if they have existing group health insurance, regardless of the adequacy of that insurance or the amount of the deductibles or co-payments.

    Pregnant women up to 175% FPG can have other insurance and still be eligible for Denali KidCare.

2. What is not considered health insurance coverage?

  • Coverage limited to a specific service (i.e. dental care or vision care); Tribal or Indian Health Services; Worker's Compensation; school injury insurance; and auto, homeowner or general liability insurance are not considered health insurance coverage.


3. If a person drops individual insurance coverage or employer sponsored insurance coverage because they qualify for Denali KidCare below the 150% FPG income level, but then their income rises to between 150% and 175%, would there be a penalty for "voluntarily" dropping insurance within the last 12 months?

  • No

4. If a parent has the option of insuring a child through their insurance, but has not elected to do that, is the child eligible for Denali KidCare?

  • Yes. If a child is currently uninsured and meets the qualifications, the child may be eligible for Denali KidCare.

5. If children are already on Medicaid, should they apply for Denali KidCare?

  • No. If children are already on Medicaid, they do not need to apply. The medical coverage for both programs is identical.

6. If a child might be eligible for coverage under the TEFRA category of Medicaid, would it be better to apply for TEFRA or Denali KidCare?

  • It is easier and faster to apply for Denali KidCare. It is the same coverage package as TEFRA. TEFRA does not provide the child with any additional services that are not also available through Denali KidCare.


Newborn Notification Procedures

1. What is the correct process for notifying Denali KidCare when a baby is born?

  • A report of birth may be submitted by the mother, provider, or hospital, via telephone, mail or fax to the Denali KidCare office. Reports of birth should contain the name of the parent(s), mother's Denali KidCare ID number or SSN, child's name, sex and date of birth.

2. What happens after the Denali KidCare office is notified of the birth of a baby?

  • The Denali KidCare office will determine eligibility for the baby within ten days of receipt of the report of birth. Information will be available on the Eligibility Verification System (EVS) system within approximately one week after eligibility is established.

3. How can this process mentioned in question 2 above be hastened for newborns requiring emergency medical treatment and/or emergency travel?

  • Emergency medical treatment is generally provided regardless of coverage. Providers generally cover true emergencies and can work on forms of payment after the fact. The health care provider or parent would call the Denali KidCare office during business hours and explain the circumstances.

    If the baby requires emergency travel, the report of birth may be telephoned to the Denali KidCare office as soon as possible.

4. How can a health care provider be assured that a newborn requiring emergency medical treatment will be eligible for Medicaid/Denali KidCare?

  • A child born to a woman who is eligible for Medicaid or Denali KidCare in the delivery month is automatically eligible for Denali KidCare without application. Eligibility for the newborn continues until the end of the month in which the child turns one year old if the child remains in the mother's household and both mother and child remain residents of Alaska.

    A mother is not required to submit an application for Medicaid or Denali KidCare for herself before delivery, but in order to have the birth month covered, the woman must apply within the three month retroactive period and be determined eligible for the month of birth.

    In other words, as long as the mother applies for and is eligible for Medicaid/Denali KidCare for the birth month, even if she applies after the baby is born, the baby is eligible for Newborn coverage.

Questions About the Application

 

1. Who qualifies as an authorized representative?

  • Anyone the applicant designates who is at least 18 years old may qualify as an authorized representative.

    An authorized representative is someone who has adequate knowledge of the individual and has been designated by the applicant, in writing, as his or her authorized representative. An authorized representative can continue to represent the applicant with their Denali KidCare case in the future, and work directly on their behalf with the Denali KidCare office eligibility staff.

2. Are applicants required to submit their pregnancy verification using the Denali KidCare Pregnancy verification form, or can they provide it another way?

  • Applicants must provide documentation for pregnancy verification, if applicable, with their application, but they do not have to use Denali KidCare form. The Denali KidCare Pregnancy Verification Form is provided only as a convenient way for applicants and providers to show pregnancy verification, and it can be easily enclosed with their application.

    Applicants also have the option of enclosing a signed statement from their health care provider; including a physician, nurse practitioner, community health aide, physician's assistant, or public health nurse. It should include the name of the provider, their title and the date, along with the applicant's name, social security number and estimated delivery date. This statement should be enclosed with their Denali KidCare application.

3. Regarding the question on the application, "Do any of the children have a severe disability or developmental condition expected to last more than twelve months?" Are parents supposed to submit documentation of these conditions?

  • No. A yes or no answer to this question is all that is required. If a person is over income for Denali KidCare, but has answered "yes," it tells the caseworker that they should send a letter to the parents telling them of health coverage that may be available under the TEFRA option of Medicaid.


Questions About Renewals

1. How will families know their current Denali KidCare coverage is expiring?

  • They will receive a Renewal Form in the mail with instructions. They need to return the Renewal Form by the date indicated on the accompanying letter.

2. What happens if a card expires and a family doesn't renew on time?

  • The family will have to reapply for Denali KidCare. Families are sent two reminder letters before the eligibility expiration date-- one letter is sent the month before the renewal is due and the 2nd notice is sent in the month the renewal is due.

3. Is a faxed renewal form acceptable?

  • Yes. However, the renewal form must be complete with proof of income and any changes in health insurance.You may fax your renewal for in Anchorage to 269-0986 or toll-free to 1-855-769-0986.

If you have questions or need further information, please call us.

From within the Anchorage area, phone 269-6529.

From other areas of the state, you may phone toll free 1-888-318-8890.

If you have questions about Denali KidCare or would like an application or renewal mailed to you, please call us or email denali.kid.care@alaska.gov


3601 C Street, Frontier Building, Suite 120
P.O. Box 240047, Anchorage, Alaska 99524-0047

Website: hss.state.ak.us/dhcs/DenaliKidCare