How to Become Eligible for Medicaid

If you are Alaska Native and found to be not eligible for Department of Public Assistance.  Review your denial.  You can request an appeal of the decision.

Often receiving large cooperation dividends (over $2000 annually) results in being over income or having income mixed in the same account.  Review the option to establish a Native Dividend Account to help qualify you for benefits.

You can get additional assistance with benefits through your local tribal office or the following regional agencies:

• Southeast Alaska Independent Living (SAIL)
• Southeast Alaska Regional Health Consortium (SEARHC)
• Catholic Community Services Care Coordination
• Ketchikan Indian Community (KIC) Elder Services offers in-home supports within the city limits of Ketchikan, Alaska.
• Alaska Legal Services
• Disability Law Center of Alaska

A Power of Attorney is a legal document that allows someone else to make decisions on your behalf.  The person you appiont is known as a legal decision maker.  The point of time when your appionted person begins making decisions for you is outlined in the legal document for example, upon your signature (immediately), certain dates, or upon your incapacity (when you can no longer make your own decision per a court).  In Alaska, two physicians or a psychiatrist can complete an affidavit that states that you lack capacity to make your own decisions at which time your Power of Attorney would be able to make all the decisions you have outlined in the Power of Attorney document to assist you.

Power of Attorney or sometimes known as a durable Power of Attorney tend to be able to make decisions about financial matters such as accessing bank statements, paying bills, or establishing insurance benefits.

A Power of Attorney is also the name associated with a personal decision maker for an Advance Directive. An Advanced Directive is a legal document that allows you to choose a decision maker for your medical care needs and end of life decisions.

The State of Alaska Division of Senior and Disabilities Services will sometimes require a client of Personal Care Services or Medicaid Wavier to have to have a limited Power of Attorney.  This type of appointment is limited to very specific duties like signing timesheet for services.

You can choose a person to act on your behalf  as your primary decision maker as well as an alternative representative who can assist you if your first choose is unable to provide the assistance. You will want to choose someone who you trust with your information and who knows what kind of decisions you would make for yourself, if you could express your own wishes.

To obtain Alaska Power of Attorney documents: See Alaska Legal Services Family Self-Help at:

https://alaskalawhelp.org/issues/life-planning/powers-of-attorneyadvance-directives

To obtain the State of Alaska Division of Senior and Disability Services Limited Power of Attorney at:

https://health.alaska.gov/dsds/Documents/pca/Limited_POA.pdf

For assistance with completing a Power of Attorney

Alaska Legal Services – https://alaskalawhelp.org/issues/life-planning/powers-of-attorneyadvance-directives

Other possible resources private legal counsel, case manager, or hospital social worker.

Guardianship is a legal process to appoint a decision maker for decisions regarding medical/dental care, placement (where you live), employeement services and supports, and the services associated with your personal care needs. 

Conservator is a legal process to appoint a decision maker for decisions regarding your financial affairs, benefits, and assets.

Guardianship and Conservatorship can be appointed in combined as a Full Guardianship, one or the other, or limited to very specific duties and timeframes.

Guardianship and Conservatorships require a petition to the State of Alaska Superior Court for consideration.  The court has 180 days to schedule a court hearing after the receipt of a petition.  If there is immediate risk of serious illness, injury, or death without court intervention, a petition for an emergency hearing can be filed with the court.  If accepted, the court has 72 hours to schedule a hearing date.

The State of Alaska website has a self-help section for guardianship and conservatorship that provides the required petitioning forms and reporting documents.  pg-510 Guardianship Duties is a very useful document for outlining the guardianship process and requirements.

• State of Alaska Court System
• Alaska Guardianship Association
• Office of Public Advocacy
• Adult Public Assistance
• National Guardianship Association
• Private Legal Counsel

The Social Security Administration offers recipients to appoint someone else to assist with financial management of income received by Social Security.   Social Security does not recognize an appointed Power of Attorney, Guardian, or Conservator as a decision maker unless the decision maker has been approved as a Representative Payee.  In limited situations a professional representative payee may be available.  In most cases, Social Security will task the recipient in choosing a family or friend to act on their behalf.

Social Security Administration will require a Representative Payee at times to receive financial benefits.  In this situation, often a physician has documented that a decision maker is needed to assist with financial decision making.  If the medical condition changes or improves additional medical documentation can be submitted to request to end the representative payee relationship.  

If for some reason the appionted Representative Payee is not available or needs to be changed.  Contact Social Security Administration immediately.  You may be required to have an alternative Represenative Payee to continue to recieve monthly cash funds.  

Social Security Administration Representative Payee Program

A Miller Trust is an legal document known as an Irrevocable Income Trust.  This is a trust that is created with an attorney to divert monthly income to qualify for Medicaid or other benefits.  All individuals seeking benefits are eligible.  The income placed into the trust can be utilized for non-Medicaid covered medical expenses, travel, entertainment, phone and internet services, vehicle, pet services, and much more.  The funds are restricted to not be used for cash, food, monthly utility bills (electricity), or rent.  The trust document does require a third-party decision maker to monitor the trust Accounting should be managed for annual reporting to the Department of Public Assistance.  Upon death, the proceeds remaining in the trust are returned to the Department of Public Assistance to off-set your medical care received while benefited under Medicaid.

DPA Brouchure Miller Trust: http://dpaweb.hss.state.ak.us/e-forms/pdf/MED-23.pdf

Alaska Legal Services can assist with the development of a Miller Trust document.  They require an application at which time they will request from the applicant the Department of Public Assistance – Medicaid notification/denial letter for “being over resource.”

Alaska Legal Services

For more information

An Irrevocable Asset Trust is a legal document created by an attorney to secure assets (savings, property, high valued items etc.) to be diverted into Trust to qualify for Medicaid or other federal benefits.  Asset Trusts must be created before the age of 65 years, disability determination is required, and the Trust must be managed by a third-party non-profit agency.  In Alaska, the State of Alaska Office of Public Advocacy manages asset trust under a Conservatorship.  The cash Assets placed into the trust can be utilized for non-Medicaid covered medical expenses, travel, entertainment, phone and internet services, vehicle, pet services, and much more.  The funds are restricted to not be used for cash, food, monthly utility bills (electricity), or rent. Accounting must be managed for annual reporting to the Department of Public Assistance. Upon death, the proceeds remaining in the trust are returned to the Department of Public Assistance to off-set your medical care received while benefited under Medicaid.

http://dpaweb.hss.state.ak.us/e-forms/pdf/MED-22.pdf

Department of Administration Office of Public Advocacay 

ABLE Accounts are legal document that is often created by an attorney to help divert income into a specialized trust account for continued eligibility for Medicaid and other Federal and State benefits.  Funds can be used for household items, travel, pets, etc.  Accounting must be managed by a third party and for annual reporting to the Department of Public Assistance.

Alaskable Plan: https://savewithable.com/ak/home.html

The State of Alaska allows for recipients of Alaska Native Corporations to save income associated with their membership with one of several corporations.  A bank account needs to be established by you, utilizing income received through a cooperation dividend.  The account can only hold dividend related money.  Up to $2000 per year can be held in the account and is not counted towards your total asset limit for State of Alaska benefits.  Any amount received in the year over $2000 is subject to the resource limits by Department of Public Assistance.  If your native dividends are mingled with other income, the funds are considered a resource and could make you ineligible for benefits.  Other monthly income, such as Social Security VA, retirement should be held seperately from you Native Dividend account and are also subject to a $2000 resoucre limit.  the utilizing a Native Dividend account and some planning you can have up to $4000 per month is income on hand without penality by the Department of Public Assistance.   

Irrevocable Burial Account – Special Trust account created with the mortuary to plan for your future burial. Funds can be placed into an account for end-of-life expenses.  When funds are placed into the Trust they can not be removed until your passing.  

Alaskan Memorial Park & Legacy Funeral Homes Homes https://www.legacyalaska.com/

The resource levels for the various Department of Public Assistance programs change annually.  If you have received a letter that indicated that you have been found to be over the resource limits and ineligible there are several things that you can do to resolve the problem.

Spend Down  – a process to reduce your saving (assets) to the resource limit for your household.  You can spend down funds on bills owed, household repairs and needs, medical care, clothing, etc.  Spending down does not mean that you give your money away.  Giving money away is viewed as fraud to qualify for Medicaid benefits.  You may also be able to save funds in specialized accounts.

• Miller Trust Account – could be established to help direct your income so that you would be no longer over the income resource limits.  http://dpaweb.hss.state.ak.us/e-forms/pdf/MED-23.pdf
• Asset Trust – Special Needs and Pooled Trust – could be used if you are under the age of 65 years to help manage assets. http://dpaweb.hss.state.ak.us/e-forms/pdf/MED-22.pdf 
• Irrevocable Burial Account – Special account created with the mortuary to plan for your future burial. Funds can be placed into an account for end-of-life expenses.  Alaskan Memorial Park & Legacy Funeral Homes Homes https://www.legacyalaska.com/

If you have received a notice that you are missing documents:

Start my reviewing the letter to see if you have the missing document.  Often it is a bank statement or policy letter.

Let your Medicaid Case Worker know that you are seeking the document that is missing.  You may ask questions specifically about the type of document needed.  It is very important that you stay in contact with your Medicaid Case Worker, so they know the status of your efforts to obtain the missing record.

Keep copies of all documents sent.  There are times when documents will need to be sent repeatedly.  Having copies on hand and knowing when they were previviously sent will assist you in working with your case manager in a more timely fashion. 

For additional assistance:

Southeast Alaska Independent Living (SAIL) 

Alaska Legal Services

Disablity Law Center of Alaska