1. (a) In addition to the Medicaid eligibility review under 7 AAC 100.020, the department may conduct a special review of the eligibility of a recipient or recipient's household in the same manner that the department determines the eligibility of a new applicant if the department has reason to question the information on file or the eligibility of the recipient under (b) of this section. As part of a special review, the department may include requiring

   1. (1) that a new application be completed and signed;
   2. (2) an in-person interview;
   3. (3) documentation of all eligibility factors, including those not subject to change; and
   4. (4) a review of any other factor or matter relevant to the recipient's eligibility.
2. (b) If a recipient fails to comply with the applicable provisions of this section, the department may terminate Medicaid eligibility in accordance with this chapter and 7 AAC 49.

3. (c) The department may conduct a special review for any reason, including

   1. (1) a recipient's failure, without good cause, to cooperate with an inquiry that the department conducts to verify information provided to the department under this chapter;
   2. (2) the department's discovery of a change that the recipient did not report to the department;
   3. (3) the department's receipt of a report of several contemporaneous changes that may affect a recipient's eligibility and that the department must verify;
   4. (4) a change in federal or state law that may affect a recipient's Medicaid eligibility;
   5. (5) a recipient's physical move to a new location in the state;
   6. (6) reevaluation of whether a recipient continues to be disabled;
   7. (7) reevaluation of a recipient's absence from the home or state residency;
   8. (8) reevaluation of whether deprivation continues to exist under 7 AAC 100.106; and
   9. (9) a recommendation for review from the office of the department handling matters of fraud.

(Eff. 7/20/2007, Register 183)

Authority: AS 47.05.010, AS 47.07.020, AS 47.07.040