reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1510 - Home and community based (HCB) waiver services authorized by the developmental disabilities administration (DDA)

Current through Register Vol. 24-14, July 15, 2024
This chapter describes the general and financial eligibility
				  requirements for categorically needy (CN) home and community based (HCB)
				  waivers authorized by the developmental disabilities administration (DDA). The
				  definitions in WAC 182-513-1100 and chapter 182-500 WAC apply throughout this
				  chapter.
(1) The DDA waiver programs
				are:
(a) Basic Plus;
(b) Core;
(c) Community protection;
(d) Children's intensive in-home behavioral
				support (CIIBS); and
(e) Individual
				and family services (IFS).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1511 - Home and community based (HCB) waiver services authorized by the developmental disabilities administration (DDA)-General eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) To be eligible
				for home and community based (HCB) waiver services authorized by the
				developmental disabilities administration (DDA), a person must:
(a) Meet specific program requirements under
				chapter 388-845 WAC;
(b) Be an
				eligible client of the DDA;
(c)
				Meet the disability criteria for the supplemental security income (SSI) program
				under WAC
				182-512-0050;
(d) Need the level of care provided in an
				intermediate care facility for the intellectually disabled (ICF/ID);
(e) Have attained institutional status under
				WAC 182-513-1320;
(f) Be able to reside in the community and
				choose to do so as an alternative to living in an ICF/ID;
(g) Be assessed for HCB waiver services, be
				approved for a plan of care, and receive HCB waiver services under (a) of this
				subsection, and:
(i) Be able to live at home
				with HCB waiver services; or
(ii)
				Live in a department-contracted facility with HCB waiver services, such as:
(A) A group home;
(B) A group training home;
(C) A child foster home, group home, or
				staffed residential facility;
(D)
				An adult family home (AFH); or
(E)
				An adult residential care (ARC) facility.
(iii) Live in the person's own home with
				supported living services from a certified residential provider; or
(iv) Live in the home of a contracted
				companion home provider.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1512 - Home and community based (HCB) waiver services authorized by the developmental disabilities administration (DDA)-Financial eligibility if a client is eligible for a noninstitutional SSI-related categorically needy (CN) program

Current through Register Vol. 24-14, July 15, 2024
(1) A client is
				financially eligible for home and community based (HCB) waiver services
				authorized by the developmental disabilities administration (DDA) if:
(a) The client is receiving coverage under
				one of the following categorically needy (CN) medicaid programs:
(i) Supplemental security income (SSI)
				program under WAC
				182-510-0001. This includes SSI
				clients under 1619(b) status; or
(ii) Health care for workers with
				disabilities (HWD) under chapter 182-511 WAC; or
(iii) SSI-related noninstitutional (CN)
				program under chapter 182-512 WAC; or
(iv) The foster care program under WAC
				182-505-0211 and the client meets
				disability requirements under WAC
				182-512-0050.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1513 - Home and community based (HCB) waiver services authorized by the developmental disabilities administration (DDA)-Financial eligibility using SSI-related institutional rules

Current through Register Vol. 24-14, July 15, 2024
(1) If a person is
				not eligible for a categorically needy (CN) program under WAC
				182-515-1512, the agency
				determines eligibility for home and community based (HCB) waiver services
				authorized by the developmental disabilities administration (DDA) using
				institutional medicaid rules. This section explains how a person may qualify
				using institutional rules.
(2) A
				person must meet:
(a) General eligibility
				requirements under WAC
				182-513-1315 and
				182-515-1511;
(b) Resource requirements under WAC
				182-513-1350; and
(c) Have available income at or below the
				special income level (SIL) defined under WAC
				182-513-1100.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1514 - Home and community based (HCB) services authorized by the developmental disabilities administration (DDA)-Client financial responsibility

Current through Register Vol. 24-14, July 15, 2024
(1) A client
				eligible for home and community based (HCB) waiver services authorized by the
				developmental disabilities administration (DDA) under WAC
				182-515-1513 must pay toward the
				cost of care and room and board under this section.
(a) Post-eligibility treatment of income,
				participation, and participate are all terms that refer to a client's
				responsibility towards cost of care.
(b) Room and board is a term that refers to a
				client's responsibility toward food and shelter in an alternate living facility
				(ALF).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1540

Current through Register Vol. 24-14, July 15, 2024
WSR 13-01-017, recodified as WAC
					 182-515-1540, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005 (DRA), and 2010 1st sp.s. c 37§ 209(1). WSR
					 12-21-091, § 388-515-1540, filed 10/22/12, effective 11/22/12. Statutory
					 Authority:
					 RCW
					 34.05.353(2)(d),
					 74.08.090, and chapters 74.09,
					 74.04 RCW. WSR 08-11-047, §
					 388-515-1540, filed 5/15/08, effective 6/15/08. Statutory Authority:
					 RCW
					 74.08.090,
					 74.09.520. WSR 05-11-082, §
					 388-515-1540, filed 5/17/05, effective 6/17/05. Statutory Authority: 2001 c
					 269, RCW
					 74.09.700,
					 74.08.090,
					 74.04.050,
					 74.09.575 and chapter 74.39 RCW.
					 WSR 03-13-052, § 388-515-1540, filed 6/12/03, effective
					 7/13/03.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1550

Current through Register Vol. 24-14, July 15, 2024
WSR 13-01-017, recodified as WAC
					 182-515-1550, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005 (DRA), and 2010 1st sp.s. c 37§ 209(1). WSR
					 12-21-091, § 388-515-1550, filed 10/22/12, effective 11/22/12. Statutory
					 Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.520,
					 74.09.530 and 2004 c 276 §
					 206(6)(b). WSR 07-03-087, § 388-515-1550, filed 1/18/07, effective
					 2/18/07. Statutory Authority:
					 RCW
					 74.08.090,
					 74.09.520. WSR 05-11-082, §
					 388-515-1550, filed 5/17/05, effective 6/17/05. Statutory Authority: 2004 c 276
					 § 206(6)(b) and Townsend vs. DSHS, U.S. District Court, Western District
					 of Washington, No. C 00-0944Z. WSR 04-16-029, § 388-515-1550, filed
					 7/26/04, effective 8/26/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0100 - Trust index

Current through Register Vol. 24-14, July 15, 2024
The medicaid agency or the agency's designee applies the
				  following rules to determine how trusts affect eligibility for medicaid:
(1) WAC 182-516-0105 General rules that apply
				to all trusts.
(2) WAC 182-516-0110
				Self-settled trusts overview.
(3)
				WAC 182-516-0115 Revocable self-settled trusts established on or after August
				11, 1993.
(4) WAC 182-516-0120
				Irrevocable self-settled trusts for a disabled client under age sixty-five
				established on or after August 11, 1993.
(5) WAC 182-516-0125 Irrevocable pooled
				self-settled trusts for a disabled client established on or after August 11,
				1993.
(6) WAC 182-516-0130
				Irrevocable self-settled trusts established on or after August 11,
				1993.
(7) WAC 182-516-0135
				Self-settled trusts established before August 11, 1993.
(8) WAC 182-516-0140 Third-party
				trusts.
(9) WAC 182-516-0145 Trusts
				containing both assets of the beneficiary and third-party assets.
WSR 13-01-017, recodified as §
											182-516-0100, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 34.05.353(2)(d),
					 74.08.090, and chapters 74.09,
					 74.04 RCW. WSR 08-11-047, §
					 388-561-0100, filed 5/15/08, effective 6/15/08. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090, and
					 74.09.575. WSR 03-13-113, §
					 388-561-0100, filed 6/17/03, effective 8/1/03. Statutory Authority:
					 RCW
					 74.04.050,
					 74.08.090, and
					 74.09.500. WSR 01-06-043, §
					 388-561-0100, filed 3/5/01, effective
					 5/1/01.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0105 - General rules that apply to all trusts

Current through Register Vol. 24-14, July 15, 2024
(1) Regardless of treatment under this
				chapter, all trusts remain subject to Title 182 WAC, which include income and
				resource rules under chapter 182-512 WAC and asset transfer rules under WAC
				182-513-1363,
				unless specified otherwise.
(2) The
				medicaid agency or the agency's designee treats the trust or a distribution
				from the trust as a third-party resource under WAC
				182-501-0200
				if:
(a) The agency or the agency's designee
				determines the trust is not an available resource or determines the
				distributions from a trust are not income; and
(b) The terms of the trust or how the trust
				is being administered meet the third-party resource rules under WAC
				182-501-0200.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0110 - Self-settled trusts overview

Current through Register Vol. 24-14, July 15, 2024
(1) A trust
				containing the assets of a beneficiary's spouse may be a self-settled trust
				based on the date it was established. For specific rules regarding this, see
				WAC 182-516-0130.
(2) To determine
				whether the assets of the self-settled trust should be counted as income, a
				resource, or an asset transfer, the medicaid agency or the agency's designee
				applies the following rules based on when the trust was established:
(a) For revocable self-settled trusts, see
				WAC 182-516-0115.
(b) For
				irrevocable self-settled trusts for a disabled client under age sixty-five
				established on or after August 11, 1993, see WAC 182-516-0120.
(c) For irrevocable pooled self-settled
				trusts for a disabled client established on or after August 11, 1993, see WAC
				182-516-0125.
(d) For all other
				irrevocable self-settled trusts:
(i)
				Established on or after August 11, 1993, see WAC 182-516-0130.
(ii) Established before August 11, 1993, see
				WAC 182-516-0135.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0115 - Revocable self-settled trusts established on or after August 11, 1993

Current through Register Vol. 24-14, July 15, 2024
(1) This section
				applies to revocable trusts that are self-settled and established on or after
				August 11, 1993.
(2) This section
				does not apply to assets in a revocable trust established before August 11,
				1993.
(3) A revocable trust is a
				self-settled trust if:
(a) The assets of the
				trust are at least partially from the beneficiary or the beneficiary's
				spouse;
(b) The trust is not
				established by will; and
(c) The
				trust was established by:
(i) The beneficiary
				or that beneficiary's spouse;
(ii)
				A person, including a court or administrative body, with legal authority to act
				in place or on behalf of the beneficiary or that beneficiary's spouse;
				or
(iii) A person, including a
				court or administrative body, acting at the direction or upon the request of
				the beneficiary or that beneficiary's spouse.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0120 - Irrevocable self-settled trusts for a disabled client under age sixty-five established on or after August 11, 1993

Current through Register Vol. 24-14, July 15, 2024
(1) This section governs how the agency or
				the agency's designee treats self-settled trusts, for a disabled client under
				age sixty-five established under
				42
				U.S.C. 1396p(d)(4)(a) on or
				after August 11, 1993, for medicaid eligibility purposes.
(2) A self-settled trust established on or
				after August 11, 1993, is not an available resource if:
(a) The beneficiary is under age sixty-five
				and disabled under WAC
				182-512-0050(1)(c)
				when the trust is established;
(b)
				The trust is irrevocable;
(c) The
				trust was established for the sole benefit of that beneficiary;
(d) The trust was established by the
				beneficiary's parent, the beneficiary's grandparent, the beneficiary's legal
				guardian, by a court, or on or after December 13, 2016, the beneficiary;
				and
(e) The trust says that the
				states that have spent medicaid funds for the beneficiary will receive all
				amounts remaining in the trust up to the amount of medicaid funds spent for the
				beneficiary.
(i) For trusts established from
				August 11, 1993, to July 31, 2003, the trust must pay the states when the
				beneficiary dies.
(ii) For trusts
				established on or after August 1, 2003, the trust must pay the states when the
				beneficiary dies, the trust terminates, or the beneficiary's disability
				ends.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0125 - Irrevocable pooled self-settled trusts for a disabled client established on or after August 11, 1993

Current through Register Vol. 24-14, July 15, 2024
(1) This section
				governs how the agency or the agency's designee treats pooled self-settled
				trusts, for a disabled client established under
				42
				U.S.C. 1396p(d)(4)(c) on or
				after August 11, 1993, for medicaid eligibility purposes.
(2) A pooled self-settled trust established
				on or after August 11, 1993, is not an available resource if:
(a) The beneficiary is disabled under WAC
				182-512-0050(1)(c)
				when the trust is established;
(b)
				The trust is irrevocable;
(c) An
				account in the trust was established for the sole benefit of that
				beneficiary;
(d) An account in the
				trust was established by that beneficiary, the beneficiary's parent,
				grandparent, legal guardian, or by a court;
(e) The trust was established by and is
				managed by a nonprofit association;
(f) A separate account is maintained for each
				beneficiary of the trust, but, for the purposes of the investment and
				management of funds, the trust pools these accounts; and
(g) The trust says that:
(i) Upon the death of the beneficiary, or,
				for trust accounts established on or after August 1, 2003, when the trust
				account terminates or the beneficiary's disability ends, the funds will remain
				in the trust to benefit other disabled beneficiaries; or
(ii) The states that have spent medicaid
				funds for the beneficiary will receive all amounts remaining in the trust
				account for that beneficiary up to the amount of medicaid funds spent for the
				beneficiary.
(A) For trust accounts
				established from August 11, 1993, to July 31, 2003, the trust must pay the
				states when the beneficiary dies.
(B) For trust accounts established on or
				after August 1, 2003, the trust must pay the states when the beneficiary dies,
				the trust terminates, or the beneficiary's disability ends.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0130 - Irrevocable self-settled trusts established on or after August 11, 1993

Current through Register Vol. 24-14, July 15, 2024
(1) This section
				governs irrevocable self-settled trusts established on or after August 11,
				1993, that do not meet the rules under either WAC 182-516-0120 or
				182-516-0125.
(2) A trust
				established on or after August 1, 2003, is a self-settled trust if:
(a) The assets of the trust are at least
				partially from the beneficiary or the beneficiary's spouse, or would have been
				owned by the beneficiary or the beneficiary's spouse unless diverted by the
				beneficiary, the beneficiary's spouse, the court, or someone acting on behalf
				of the beneficiary or the beneficiary's spouse;
(b) The trust is not established by will;
				and
(c) The trust was established
				by:
(i) The beneficiary or that beneficiary's
				spouse;
(ii) A person, including a
				court or administrative body, with legal authority to act in place or on behalf
				of the beneficiary or that beneficiary's spouse; or
(iii) A person, including a court or
				administrative body, acting at the direction or upon the request of the
				beneficiary or that beneficiary's spouse.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0135 - Self-settled trusts established before August 11, 1993

Current through Register Vol. 24-14, July 15, 2024
(1) A revocable or irrevocable self-settled
				trust established before August 11, 1993, under this section is one:
(a) Established other than by will by a
				beneficiary or that beneficiary's spouse;
(b) Under which that beneficiary may be the
				beneficiary of all or part of the payments from the trust; and
(c) Under which the distribution of those
				payments is determined by one or more trustees who are permitted to exercise
				any discretion with respect to the distribution to the beneficiary.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0140 - Third-party trusts

Current through Register Vol. 24-14, July 15, 2024
(1) This section
				governs third-party trust as defined under WAC
				182-516-0001.
(2) A trust containing the assets of a
				beneficiary's spouse may be a self-settled trust based on the date it was
				established. For specific rules regarding this, see WAC 182-516-0130.
(3) A testamentary trust is a third-party
				trust created by a will where the trust is in the will and the estate is the
				grantor.
(4) There is no
				requirement for a state to be named as a remainder beneficiary in third-party
				trusts.
(5) If the beneficiary has
				the power to acquire the assets from the third-party trust, the trust is an
				available resource.
(6) If the
				beneficiary has no power to access or control trust assets or distributions, as
				described under WAC 182-516-0105(4), a third-party trust is not an available
				resource.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0145 - Irrevocable trusts containing both assets of the beneficiary and third-party assets

Current through Register Vol. 24-14, July 15, 2024
(1) For irrevocable
				trusts that contain both assets of the beneficiary and third-party assets, the
				medicaid agency or the agency's designee treats the assets of the beneficiary
				under the self-settled trust rule in effect as of the date of the trust's
				establishment:
(a)After August 11, 1993:
(i) For irrevocable self-settled trusts for a
				disabled client under age sixty-five, see WAC
				182-516-0120;
(ii) For irrevocable pooled self-settled
				trusts for a disabled client, see WAC
				182-516-0125;
				and
(iii) For all other trusts, see
				WAC
				182-516-0130.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0200 - Annuities established prior to April 1, 2009

Current through Register Vol. 24-14, July 15, 2024
(1) A revocable annuity is an available
				resource.
(2) An irrevocable
				annuity established prior to May 1, 2001, is not an available resource when
				issued by an individual, insurer, or other body licensed and approved to do
				business in the jurisdiction in which the annuity is established.
(3) The income from an irrevocable annuity
				that meets the requirements of this section is income for determining
				eligibility and the amount of participation in the total cost of care. The
				annuity itself is not a resource .
(4) Subject to subsection (5) of this
				section, an annuity established on or after May 1, 2001, and before April 1,
				2009 , is an available resource unless it:
(a) Is irrevocable;
(b) Is paid out in equal monthly amounts
				within the actuarial life expectancy of the annuitant;
(c) Is issued by an individual, insurer, or
				other body licensed and approved to do business in the jurisdiction in which
				the annuity is established; and
(d)
				Names the state of Washington as the beneficiary of the remaining funds up to
				the total of medicaid funds spent on the client during the client's lifetime.
				This subsection only applies if the annuity is in the client's
				name.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0201 - Annuities established on or after April 1, 2009

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency or the agency's
				designee determines how an annuity, purchased by or on behalf of an annuitant
				and established on or after April 1, 2009, affects eligibility for
				medicaid.
(2) General information.
(a) Clients of noninstitutional medicaid must
				disclose to the agency or the agency's designee any interest that client, or
				the financially responsible members of that client's assistance unit, has in an
				annuity.
(b) Clients of
				institutional or home and community-based (HCB) waiver services must disclose
				to the agency or the agency's designee any interest that client, or that
				client's community spouse, has in an annuity.
(c) Subject to (d) of this subsection, this
				section applies when the annuitant is:
(i)
				The client of medicaid;
(ii) That
				client's spouse, if that spouse is financially responsible for that client;
				or
(iii) That client's community
				spouse.
(d) If this
				section does not apply because of (c) of this subsection, but the client of
				institutional or HCB waiver services, or that client's community spouse, is the
				owner of the annuity, then the purchase of the annuity is evaluated as an asset
				transfer under WAC
				182-513-1363.
(e) For the definition of "disabled," see WAC
				182-512-0050(1)(b)
				and (c).
(f) Actuarial life expectancy in this section
				is rounded up to the nearest whole year.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0300 - Life estates

Current through Register Vol. 24-14, July 15, 2024
(1) "Life estate"
				means an ownership interest in real property only during the lifetime of a
				specified person.
(2) Subject to
				subsection (3) of this section, a life estate is an available resource, unless
				it is either excluded or unavailable under chapter 182-512 WAC.
(3) For someone applying for or receiving
				long-term services and supports, a life estate interest is subject to the home
				equity limits under:
(a) WAC
				182-513-1350
				for institutional and home and community-based (HCB) waiver programs;
				and
(b) WAC
				182-513-1215
				for community first choice.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-516 - Trusts, annuities, life estates, and promissory notes-Effect on medical programs › Section 182-516-0400 - Promissory notes and loans

Current through Register Vol. 24-14, July 15, 2024
(1)
				General.
(a) In this section, note includes
				promissory note, loan or other obligation to pay.
(b) The medicaid agency or the agency's
				designee determines the value of outstanding principal and interest payments
				using amortization schedules, unless otherwise stated in this
				section.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-517 - Medicare-related medical eligibility › Section 182-517-0100 - Federal medicare savings programs

Current through Register Vol. 24-14, July 15, 2024
(1) Available programs. The medicaid agency
				offers eligible clients the following medicare savings programs (MSPs):
(a) The qualified medicare beneficiary (QMB)
				program;
(b) The specified
				low-income medicare beneficiary (SLMB) program;
(c) The qualified individual (QI-1) program;
				and
(d) The qualified disabled and
				working individuals (QDWI) program.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-517 - Medicare-related medical eligibility › Section 182-517-0300 - State-funded medicare buy-in programs

Current through Register Vol. 24-14, July 15, 2024
(1) A person is eligible for the state-funded
				medicare buy-in program (SBIP) if the person:
(a) Is entitled to or receiving
				medicare;
(b) Is not eligible for a
				federal medicare savings program under WAC
				182-517-0100; and
(c) Is eligible for coverage under:
(i) The categorically needy (CN) program; or
(ii) The medically needy (MN)
				program;
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-517 - Medicare-related medical eligibility › Section 182-517-0310

Current through Register Vol. 24-14, July 15, 2024
12-13-056, recodified as WAC
					 182-517-0310, filed 6/15/12,
					 effective 7/1/12. Statutory Authority:
					 Public Law
					 110-275,
					 Section
					 113 (Medicare Improvements for Patients and
					 Providers Act),
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090, and
					 74.09.500. 09-20-027, §
					 388-517-0310, filed 9/29/09, effective 10/30/09. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530 and 42 U.S.C. Section
					 1396a. 07-15-032, § 388-517-0310, filed 7/12/07, effective 8/12/07.
					 Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530, and
					 42 U.S.C.
					 1396 a(a) (Section 1902(n)(2) of the Social
					 Security Act of 1924). 05-14-125, § 388-517-0310, filed 7/1/05, effective
					 8/1/05.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-517 - Medicare-related medical eligibility › Section 182-517-0320

Current through Register Vol. 24-14, July 15, 2024
12-13-056, recodified as WAC
					 182-517-0320, filed 6/15/12,
					 effective 7/1/12. Statutory Authority:
					 RCW
					 41.05.021 and 42 U.S.C. § 1396a(n)(2).
					 12-04-027, § 388-517-0320, filed 1/26/12, effective 2/26/12. Statutory
					 Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530 and 42 U.S.C. Section
					 1396a. 07-15-032, § 388-517-0320, filed 7/12/07, effective 8/12/07.
					 Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530, and
					 42 U.S.C.
					 1396 a(a) (Section 1902(n)(2) of the Social
					 Security Act of 1924). 05-14-125, § 388-517-0320, filed 7/1/05, effective
					 8/1/05.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-518 - Washington apple health-Letters and notices › Section 182-518-0005 - Washington apple health-Notice requirements-General

Current through Register Vol. 24-14, July 15, 2024
(1) For the purposes of this chapter, "we"
				refers to the agency or its designee and "you" refers to the applicant for, or
				recipient of, health care coverage.
(2) This section applies only to notices and
				letters that we send about eligibility for Washington apple health (WAH)
				programs. WAC
				182-501-0165 applies to notices
				and letters regarding prior authorization or other action on requests to cover
				specific fee-for-service health care services.
(3) We send you written notices (letters)
				when we:
(a) Approve you for health care
				coverage for any program;
(b)
				Reconsider your application for other types of health care coverage based on
				new information;
(c) Deny you
				health care coverage (including because you withdrew your application) for any
				program (according to rules in WAC
				182-503-0080 );
(d) Ask you for more information to decide if
				you can start or renew health care coverage;
(e) Renew your health care coverage;
				or
(f) Change or terminate your
				health care coverage, even if we approve you for another kind of
				coverage.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-518 - Washington apple health-Letters and notices › Section 182-518-0010 - Washington apple health-Notice requirements approval and denial notices

Current through Register Vol. 24-14, July 15, 2024
(1) We send written
				notice when we approve, reopen, reinstate, or deny coverage for any Washington
				apple health (WAH) program. The notice includes the information described in
				WAC 182-518-0005(4)
				and all of the following:
(a) The WAH
				coverage for each person approved, reopened or reinstated;
(b) The date that each person's coverage
				begins (the effective date); and
(c) The dates for which we approved each
				person's coverage (certification period).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-518 - Washington apple health-Letters and notices › Section 182-518-0015 - Washington apple health-Notice requirements verification requests

Current through Register Vol. 24-14, July 15, 2024
(1) We send you
				written notice when we need more information as described in WAC
				182-503-0050 to decide if you are
				eligible to receive or continue receiving Washington apple health (WAH)
				coverage. The notice includes:
(a) A
				description or list of the information that we need;
(b) When we must have the information (see
				WAC 182-503-0060 for applications and
				WAC 182-504-0035 for
				renewals);
(c) What action we will
				take and on what date, if we do not receive the information; and
(d) Information required in WAC
				182-518-0005(4).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-518 - Washington apple health-Letters and notices › Section 182-518-0020 - Washington apple health-Notice requirements-Renewals

Current through Register Vol. 24-14, July 15, 2024
(1) We send you written notice before we stop
				your WAH coverage at the end of your certification period as described in WAC
				182-504-0035.
(2) When we can administratively renew your
				coverage (as defined in WAC
				182-500-0010 ), the notice
				includes:
(a) Your new certification
				period;
(b) The information we used
				to renew your coverage; and
(c) A
				request for you to give us updated information, if any of the information we
				used is inaccurate.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-518 - Washington apple health-Letters and notices › Section 182-518-0025 - Washington apple health Notice requirements - Actions to terminate, suspend, or reduce eligibility or authorization for a covered service

Current through Register Vol. 24-14, July 15, 2024
(1)
General
				rule.
(a) We send written notice to
				you at least ten days before taking adverse action to terminate, suspend, or
				reduce your:
(i) Medicaid eligibility;
				or
(ii) Authorization for a covered
				service.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-518 - Washington apple health-Letters and notices › Section 182-518-0030 - Washington apple health-Modified adjusted gross income (MAGI) notice requirements-Electronic notices

Current through Register Vol. 24-14, July 15, 2024
(1) For programs based on modified adjusted
				gross income (MAGI), you may choose to get notices by regular mail or in an
				electronic format through Washington Healthplanfinder.
(2) We send you letters (notices) about your
				eligibility for Washington apple health programs as described in WAC
				182-518-0005 through
				182-518-0025.
(3) When you select electronic notifications,
				also referred to as "paperless," we:
(a)
				Confirm your selection by regular mail;
(b) Notify you by email when a new notice has
				posted to your account; and
(c)
				Consider the notice received by you as of the date on the notice as described
				in WAC 182-518-0005.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-519 - Medically needy and spenddown › Section 182-519-0100 - Eligibility for the medically needy program

Current through Register Vol. 24-14, July 15, 2024
(1) A person who meets the following
				conditions may be eligible for medically needy (MN) coverage under the special
				rules in chapters 182-513 and 182-515 WAC:
(a) Meets the institutional status
				requirements of WAC
				182-513-1320; or
(b) Resides in a medical institution as
				described in WAC
				182-513-1395.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-519 - Medically needy and spenddown › Section 182-519-0110 - Spenddown of excess income for the medically needy program

Current through Register Vol. 24-14, July 15, 2024
(1) A person who
				applies for Washington apple health (WAH) and is eligible for medically needy
				(MN) coverage with a spenddown may choose a three-month or a six-month base
				period. A base period is a time period used to compute the spenddown liability
				amount. The months must be consecutive calendar months, unless a condition in
				subsection (4) of this section applies.
(2) A base period begins on the first day of
				the month a person applies for WAH, unless a condition in subsection (4) of
				this section applies.
(3) A person
				may request a separate base period to cover up to three calendar months
				immediately before the month of application. This is called a retroactive base
				period.
(4) A base period may vary
				from the terms in subsections (1), (2), or (3) of this section if:
(a) A three-month base period would overlap a
				previous eligibility period;
(b)
				The person has countable resources over the applicable standard for any part of
				the required base period;
(c) The
				person is not or will not be able to meet the temporary assistance to needy
				families (TANF)-related or supplemental security income (SSI)-related
				requirement for the required base period;
(d) The person is eligible for categorically
				needy (CN) coverage for part of the required base period; or
(e) The person was not otherwise eligible for
				MN coverage for each month of the retroactive base period.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-520 - Fraud referrals and overpayments › Section 182-520-0005 - Washington apple health fraud referrals and overpayments

Current through Register Vol. 24-14, July 15, 2024
(1) The agency or the agency's designee may
				refer a case to the office of fraud and accountability for a fraud
				investigation when it has reliable information that the person purposely
				misrepresented their circumstances in order to qualify for Washington apple
				health .
(2) When a fraud
				investigation reveals substantial evidence to support a finding of fraud, the
				case is referred for prosecution. The prosecuting attorney's office decides
				which cases will be prosecuted.
(3)
				When a referral results in a conviction, an overpayment amount for the cost of
				the apple health coverage is established.
(4) The person is responsible to pay the
				agency for the amount of overpayment established as a result of a fraud
				conviction.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-520 - Fraud referrals and overpayments › Section 182-520-0010 - Washington apple health overpayments resulting from an administrative hearing

Current through Register Vol. 24-14, July 15, 2024
(1) If a person
				asks for Washington apple health coverage to continue during an appeal, he or
				she must pay the agency for the cost of that coverage if both (a) and (b) of
				this subsection occur:
(a) The administrative
				law judge, or review judge if applicable, enters an order:
(i) That the person was not eligible for
				apple health coverage during the appeal;
(ii) Dismissing the hearing under WAC
				182-526-0285(3)
				because the person defaulted (did not attend or refused to participate) and the
				agency's action that was appealed included a finding that the person was not
				eligible for apple health coverage; or
(iii) Dismissing the hearing under WAC
				182-526-0285(4)
				due to a written agreement between all the parties that the person will pay for
				an overpayment of the cost of apple health coverage.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-520 - Fraud referrals and overpayments › Section 182-520-0015 - Long-term services and supports client overpayments

Current through Register Vol. 24-14, July 15, 2024
(1)
General right to recover.
(a) A long-term services and supports (LTSS)
				client overpayment is any payment for LTSS made by the agency or the agency's
				designee on a client's behalf in excess of that to which the client is legally
				entitled.
(b) An LTSS client
				overpayment may be caused by:
(i) A client or
				a client's authorized representative misstating or failing to reveal a fact
				affecting eligibility under WAC
				182-503-0505;
(ii) A client or a client's authorized
				representative failing to timely report a change required under WAC
				182-504-0105; or
(iii) The agency or the agency's designee's
				error.
(c) The agency or
				the agency's designee may recoup an LTSS client overpayment:
(i) Up to six years after the date of the
				notice in subsection (2) of this section; and
(ii) Regardless of whether the program is
				state-funded, federally funded, or both.
(d) The amount of the LTSS client overpayment
				equals the amount the agency or the agency's designee paid on the client's
				behalf minus the amount to which the client was legally entitled.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-521 - Public health emergency rules › Section 182-521-0100 - Noncountable income and resources during the COVID-19 public health emergency

Current through Register Vol. 24-14, July 15, 2024
(1) This section
				describes certain types of income and resources received as a result of the
				COVID-19 public health emergency that the health care authority (agency) does
				not count as income or resources when determining apple health eligibility.
				This includes certain unemployment income; any Federal Pandemic Unemployment
				Compensation (FPUC) or Recovery Rebates authorized under the Coronavirus Aid,
				Relief, and Economic Security (CARES) Act; and other needs-based and
				disaster-related benefits authorized as a result of the COVID-19 public health
				emergency. The non-countable income and resources in this section are in
				addition to other noncountable income and resources in this title, such as
				those described in WAC
				182-509-0320,
				182-512-0860,
				and
				182-513-1340.
(2) For all apple health programs, including
				both modified adjusted gross income-based (MAGI) and nonmodified adjusted gross
				income-based (non-MAGI) programs, the agency does not count as income for Apple
				Health determinations of eligibility or cost-sharing calculations any of the
				following:
(a) Federal pandemic unemployment
				compensation benefits of six hundred dollars per week issued for the period of
				March 18, 2020, through July 31, 2020;
(b) Federal pandemic unemployment
				compensation benefits of three hundred dollars per week issued for the period
				of December 26, 2020, through September 6, 2021;
(c) Lost wages assistance unemployment
				compensation benefits of three hundred dollars per week issued for the period
				of weeks ending August 1, 2020, through September 6, 2021, due to the federal
				Disaster Relief Fund authorized for states to offset lost wages due to the
				COVID-19 pandemic, known as Lost Wage Assistance (LWA);
(d) Payments from the pandemic relief payment
				program as authorized by Governor Jay Inslee on December 27, 2020;
(e) Pandemic Recovery Rebates (also known as
				stimulus checks or economic impact payments);
(f) Needs-based and disaster-related benefits
				from other agencies, organizations, or tribal entities including, but not
				limited to:
(i) Federal Emergency Management
				Agency (FEMA) programs, such as FEMA COVID-19 Funeral Assistance;
(ii) State programs, such as disaster cash
				assistance and the Washington immigrant relief fund; and
(iii) Local/municipal programs, such as the
				city of Seattle hospitality workers relief fund and disaster relief fund for
				immigrants; and
(g)
				Pandemic-related changes to federal refundable tax credits including, but not
				limited to, the child tax credit, the earned income tax credit, and the child
				and dependent tax care credit.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-521 - Public health emergency rules › Section 182-521-0200 - Coverage after the public health emergency (PHE) ends

Current through Register Vol. 24-14, July 15, 2024
(1) In response to
				the coronavirus (COVID-19) public health emergency (PHE) declared by the
				Secretary of the U.S. Department of Health and Human Services (HHS) and in
				response to Section 6008 of the Families First Coronavirus Response Act
				(Public Law
				116-127), the medicaid agency:
(a) Continues your Washington apple health
				coverage unless your eligibility determination was made incorrectly, or you:
(i) Are deceased;
(ii) Move out-of-state;
(iii) Request termination of your coverage;
				or
(iv) No longer meet citizenship
				or immigration requirements as described in WAC
				182-503-0535.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-523 - Medical extensions › Section 182-523-0100 - Washington apple health-Medical extension

Current through Register Vol. 24-14, July 15, 2024
(1) A parent or caretaker relative who was
				eligible for and who received coverage under Washington apple health for
				parents and caretaker relatives, described in WAC
				182-505-0240,
				in any three of the last six months is eligible, along with all dependent
				children living in the household, for twelve months' extended health care
				coverage if the person becomes ineligible for coverage due to increased
				earnings or hours of employment.
(2) A person remains eligible for apple
				health medical extension unless:
(a) The
				person:
(i) Moves out of state;
(ii) Dies; or
(iii) Leaves the household.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-523 - Medical extensions › Section 182-523-0110 - Medical extensions-Reporting requirements (Repealed)

Current through Register Vol. 24-14, July 15, 2024
12-13-056, recodified as WAC
					 182-523-0110, filed 6/15/12,
					 effective 7/1/12. Statutory Authority:
					 RCW
					 74.08.090 and 2001 c 7 § 209. 02-10-018,
					 § 388-523-0110, filed 4/22/02, effective
					 5/23/02.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-523 - Medical extensions › Section 182-523-0120

Current through Register Vol. 24-14, July 15, 2024
12-13-056, recodified as WAC
					 182-523-0120, filed 6/15/12,
					 effective 7/1/12. Statutory Authority:
					 RCW
					 74.08.090 and 2001 c 7 § 209. 03-14-108,
					 § 388-523-0120, filed 6/30/03, effective 6/30/03; 02-10-018, §
					 388-523-0120, filed 4/22/02, effective
					 5/23/02.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-523 - Medical extensions › Section 182-523-0130 - Medical extension-Redetermination

Current through Register Vol. 24-14, July 15, 2024
(1) When the agency or its designee
				determines the family or an individual family member is ineligible during the
				medical extension period, the agency or its designee must determine if they are
				eligible for another medical program.
(2) Children are eligible for twelve month
				continuous eligibility beginning with the first month of the medical extension
				period.
(3) When a family reports a
				reduction of income, the family may be eligible for the Washington apple health
				for parents and caretaker relatives program (described in WAC
				182-505-0240 ) instead of medical
				extension benefits.
(4) When a
				medical extension period is ending, the family is required to complete a
				renewal of eligibility as described in WAC
				182-504-0035.
(5) Postpartum and family planning extensions
				are described in WAC
				182-505-0115.
12-13-056, recodified as WAC
					 182-523-0130, filed 6/15/12,
					 effective 7/1/12. Statutory Authority:
					 RCW
					 74.08.090,
					 74.09.530, and 74.09.415.
					 05-23-013, § 388-523-0130, filed 11/4/05, effective 1/1/06. Statutory
					 Authority:
					 RCW
					 74.08.090 and 2001 c 7 § 209. 02-10-018,
					 § 388-523-0130, filed 4/22/02, effective
					 5/23/02.