1. (a) A child with a disability who does not qualify for SSI because of parental income or resources is eligible for Medicaid under 7 AAC 100.002(d)(5) and this section if

   1. (1) the child is under 19 years of age;
   2. (2) the Department of Labor and Workforce Development has made a determination that the child is disabled according to SSI criteria;
   3. (3) the child would be eligible for Medicaid under 7 AAC 100.002(d)(4) if the child were living in a medical institution;
   4. (4) the child is living in the home of the child's parent or legal guardian;

   5. (5) the department has determined that the child needs a level of care offered in

      1. (A) an acute care hospital or long-term care, as determined under 7 AAC 140.505;
      2. (B) an intermediate care facility for individuals with an intellectual disability or related condition, as determined under 7 AAC 140.600; or
      3. (C) an inpatient psychiatric hospital, as determined under (c) of this section;
   6. (6) the department determines that the child may receive necessary medical care in a setting other than a medical institution described in (5) of this subsection, and the determination is recorded in the plan of care approved by the department; and
   7. (7) the department has determined that the estimated cost of services provided to the child outside the home will cost less than the cost of institutionalization.
2. (b) Eligibility under this section does not authorize home and community-based waiver services under 7 AAC 130. A child determined eligible under this section who subsequently is separately determined eligible for home and community-based waiver services must be converted to an appropriate alternative eligibility category.

3. (c) For the purpose of determining eligibility under this section, a child requires a level of care provided in an inpatient psychiatric hospital if the child

   1. (1) has a mental illness or severe emotional disturbance that

      1. (A) is diagnosed by a psychiatrist or mental health professional;
      2. (B) is likely to result in harm to self and others; and
      3. (C) has persisted six months and is expected to persist for a total of 12 months or longer;

   2. (2) has at least one of the following mental health symptoms:

      1. (A) psychotic symptoms, characterized by defective or lost contact with reality, hallucinations, or delusions;
      2. (B) a suicide attempt, in the 90-day period before the date of application;
      3. (C) suicidal thoughts, in the 30-day period before the date of application, that include a plan for suicide;
      4. (D) violent behavior as the result of an emotional disturbance, in the 30-day period before the date of application, characterized by a documented attempt by the child to cause injury to a person or substantial property damage;

   3. (3) has functional impairments, relative to expected developmental levels for the child's age and at a level that qualifies the child to receive inpatient psychiatric hospitalization, in at least three of the following areas:

      1. (A) self-care;
      2. (B) interaction with the community;
      3. (C) social relationships;
      4. (D) family relationships;
      5. (E) functioning at school or work;
   4. (4) absent appropriate intervention in the home and community, requires psychiatric hospitalization as documented by a mental health professional; and
   5. (5) can be expected to functionally improve or can avoid further deterioration if care is provided in the home and community.

(Eff. 7/20/2007, Register 183; am 2/1/2010, Register 193)