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Language to Include in ARIES Correspondence -Notes from your worker Eligibility Correspondence Income Calculation: The income used to make the determination needs to be identified in the notice. Suggested examples:

· Sara’s monthly countable income from McDonalds is $1462.00. · Michael’s monthly countable income from Unemployment Compensation is $1032.00. · John’s monthly countable income from Fred Meyer is $548.25 and his monthly countable income from Unemployment Compensation is $344.00, for a total monthly countable income of $892.25

Retro Medicaid Approval

You requested retroactive for the month(s) of MM/YYYY. Your request has been approved based on the information you provided. Provide your medical provider(s) with proof of your Medicaid coverage for MM/YYYY to assure that any retroactive claims are processed appropriately. If you do not, you will remain liable for those medical bills.

Renewal Approval (No tax information provided) Your Medicaid has been renewed through MM/DD/YYYY. Because we did not know your tax filing and/or tax dependency status, we based your Medicaid eligibility on those individuals we know live in your household and who are related to you. If your household members have changed, please let us know by contacting us at the number listed above.

Renewal Approval Your Medicaid has been renewed from MM/DD/YYYY through MM/DD/YYYY unless a change is reported that affects Medicaid eligibility.

Income Change Reported You reported a change in your income as listed in the table. Based on this information provided, we have renewed your Medicaid for another year. You will receive Medicaid from MM/DD/YYYY through MM/DD/YYYY unless another change is reported that affects Medicaid eligibility.

Emergency Alien Medicaid Approval You do not qualify for regular Medicaid benefits because you do not meet the Medicaid citizenship requirements. You have been approved for special emergency Medicaid covering the time you were in Providence Hospital only. Medicaid will only pay medical expenses to Providence Hospital from MM/DD/YYYY through MM/DD/YYYY.

Denied for Failure to Provide Information Your application for Medicaid is denied. We asked you to give us proof of your earnings from Sam’s Club by MM/DD/YYYY. Because you did not give us this information, we are not able to determine your eligibility for Medicaid.

Case Summary – Sign Statement of Truth We must have your signature before we can finalize your Medicaid application. If you do not sign and return this form by MM/DD/YYYY, your application will be denied.

Medical Insurance Manual Issuance – If approved for Emergency Alien Medicaid Use the same verbiage that is used in the Eligibility Correspondence for Emergency Alien Medicaid Approval when the MIMI has to be printed out.

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Retro Medicaid Request - Pend You requested Medicaid for the months of _____, ____ & _____. Your eligibility for retroactive Medicaid is based on income you received in each of the months requested. Please provide proof of actual income you received in _____, _____ & _______. If you do not provide this information by the due date, your request for retroactive Medicaid will be denied.

When one child is eligible and the other is not due to having health insurance. The child who has insurance will have the lower income limit used when determining eligibility and the child without insurance will use the higher income limit Eligibility Correspondence – Partial Denial Denali KidCare has two different income limits for children. Children who have other insurance must have their eligibility determined using the lower income limit. Because ___________ has insurance, the lower income limit was used to determine their eligibility. Request for Medical Insurance Information To be eligible for Medicaid, you must cooperate by obtaining or identifying any available source to pay for medical care. This includes but is not limited to private health insurance, Medicare, automobile or homeowner liability insurance, worker’s compensation, and veteran’s benefits. Information about another possible source of payment is needed for name(s).

Determined Eligible for MAGI by the FFM and marked disabled on the application Your Medicaid application approved by the Federally Facilitated Marketplace (FFM) indicates that you may be eligible for disability related Medicaid. If you are interested in applying for this other Medicaid category, you must submit an Application for Services (GEN 50C) to the Division of Public Assistance and complete an interview. If you are found to be eligible for both Medicaid categories, we will explain each category in detail so that you may choose the one that is best for you.

Expansion Group ending Your Medicaid is ending XX/XX/XXXX because you are turning 65 or have been determined disabled and are no longer eligible in the Expansion Group category. You may be eligible for Medicaid in an Aged or Disability related category. If you are interested in applying for this other Medicaid category, you must submit an Application for Services (GEN 50C) to the Division of Public Assistance and complete an interview.

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Language to Include in ARIES Correspondence -Notes from your worker Medicare Benefits We are sending this notice because you appear to be eligible for Medicare benefits. To be eligible for Medicaid benefits from Alaska, you must apply for federal Medicare coverage and let us know by MM/DD/YYYY. You do not need to enroll in a Medicare Part D prescription drug plan if you have other comparable drug coverage. However, Medicaid will not pay for your prescription drugs once you become eligible for Medicare. Your eligibility for Alaska Medicaid benefits may be denied or ended if you do not enroll.

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Medicare is health insurance administered by the federal government for people age 65 or older, and under age 65 with certain disabilities. It helps pay for medical care provided by doctors, hospitals, home health agencies, and skilled nursing homes. You may apply for Medicare by contacting the Social Security office at: ________________________ If the Social Security Administration approves your Medicare application, you will receive a red, white, and blue Medicare card. Please tell me when you get this card. After you become eligible for Medicare coverage, the Alaska Medicaid program will: 1. Pay for your monthly Medicare Part A and/or Part B premium. 2. Pay for cost sharing amounts for Medicare Part A and B doctor and hospital care. This action is supported by State regulations at 7 AAC 100.034 and the Aged/Disabled/Long Term Care Medicaid Manual Sections 505, 506 and 510.If you have any questions about this notice contact our office at the number listed on the first page of this notice.

Incarceration Notice Verbiage Approval of inmate application (N011): Your application for Medicaid benefits was received on XX/XX/XXXX. You are not eligible for Medicaid benefits while you are incarcerated. Since Medicaid can pay for some of the hospital expenses when an inmate is hospitalized for more than 24 hours, your Medicaid benefits will be put into a suspension status until either we are notified of your release from custody or your certification period ends, whichever comes first. This action is supported by 42 CFR 435.1009 Change to inmate subtype (M701): Add text: We received notification that you are now incarcerated. You are not eligible for Medicaid benefits while you are incarcerated. Since Medicaid can pay for some of the hospital expenses when an inmate is hospitalized for more than 24 hours, your Medicaid benefits will be put into a suspension status starting XX/XX/XX. This suspended status will continue until either we are notified of your release from custody or your certification period ends, whichever comes first. This action is supported by 42 CFR 435.1009 Closure at end of certification (N011): Your suspended Medicaid benefits are ending XX/XX/XXXX as your certification period is over and we have not been notified that you have been released from custody. You are not eligible for Medicaid benefits while you are incarcerated. Please apply with a new application if Medicaid benefits are needed. This action is supported by 42 CFR 435.1009 Legal cites for General Correspondence in ARIES. ATAP AS 47.27.010 and 7 AAC 45.210

SB AS 47.45.302 and 7 AAC 47.547

APA AS 47.25.430 and 7 AAC 40.090

SNAP 7 CFR 273 and 7 AAC 46.021

MED 42 CFR 435.952 and 7 AAC 100.016

GRA AS 47.25.120 and 7 AAC 47.140

CAMA AS 47.08.150 and 7 AAC 48.525

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ARIES Correspondence ARIES allows you to generate certain correspondence manually. You can add notes to some manual correspondence and save a manually generated correspondence as a draft so you can return to it later.

1 To create a Manual Correspondence select Correspondence from the Top Level Navigation bar.

2 Select Generate Manual from the Second Level Navigation Bar. The Search Case Information page will display.

3 Search for the case by case number in the Search Criteria.

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Additional Info - Add Comments to Correspondence

General Information Correspondence - is used to request additional information or when the Request for Verification Correspondence is not used.

8 After clicking on the Document Name hyperlink, the Additional Info page displays with the field for adding information to the correspondence.

9 The character limit in the free form text field is 2000.

10 After entering the free form text you must select “Central Print” for the text to be saved in the “Notes from your Worker” field in the correspondence that will be mailed to the client.

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4 The Search Document Information page will display

5 Leave the document field blank select search

6 All manual correspondences will display in the search results table.

7 Click the document name which is a hyperlink that will navigate you to the Additional Information page for the selected correspondence. This page allows you to add free form text to the correspondence you previously selected.

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ARIES Correspondences are generated by actions performed on a case, they can also be worker generated. ARIES Correspondence is used to identify agency written notification to clients to include Medicaid Insurance Manual

Once correspondence is sent from the central print facilty , you can view history of all correspondence sent to the client.

View Pending Correspondence before it is mailed from the central print facility to the client.

1 Top Level Navigation bar select Correspondence

2. 2nd Level Navigation bar select view pending

3. Add case number 4. Select Search

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1 The Additional Info - General Information page displays a message at the top with details for due dates.

2 Add free from text 3 Add legal cites 4 This correspondence can

be local printed or sent to central print

Use this correspondence for: * Medicare Enrollment * Client Request – Application Withdrawal

* Request for verification of reason for moving to another state

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1. To view correspondence history, on the Top Level Navigation bar select Correspondence

2. 2nd Level Navigation bar select view pending

3. You can search for historical correspondence by Case, Application or Document number, Print Dates, Print Mode or Document Name.

4. The search results will display in the table.

5. You will select the radio button for the correspondence you want to view or reprint and click next.

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