Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY DISEASE PROGRAM (STATE-FUNDED) › Section 182-540-015 - Kidney disease program (KDP) - General eligibility criteria

Current through Register Vol. 24-14, July 15, 2024
(1) Persons must
				  meet the following criteria to be eligible for the kidney disease program (KDP)
				  :
(a) Reside in the state of Washington as
				  required under WAC
				  182-503-0520 or
				  182-503-0525;
(b) Be diagnosed with end-stage renal disease
				  (ESRD) requiring dialysis or kidney transplant as defined in WAC
				  182-540-005 or have received a
				  kidney transplant;
(c) Be
				  determined ineligible for any other Washington apple health (WAH) program,
				  including medicaid; the alien medical program described in WAC
				  182-507-0110; the medical care
				  services (MCS) program described in WAC
				  182-508-0005; and another
				  state-funded medical program with the following exceptions:
(i) Persons who are found eligible for the
				  medically needy (MN) program but are required to meet the spenddown liability
				  under WAC
				  182-519-0110 or who are found or
				  become eligible for the alien emergency medical programs described in WAC
				  182-507-0110, are eligible for
				  KDP until the spenddown liability has been met;
(ii) A KDP contractor may use KDP funding as
				  available to pay for medical expenses on behalf of a spenddown client as
				  expenses are incurred by the person, and those expenses will be treated as if
				  the person incurred the financial liability for the expense;
(iii) When a KDP contractor uses KDP funding
				  to pay for monthly health insurance premiums (including WSHIP premiums) on
				  behalf of a spenddown client, those committed funds may continue to be paid
				  even if the person becomes eligible for MN coverage by meeting the spenddown
				  liability. Payment may continue until the person is no longer otherwise
				  eligible for KDP or until the person applies to the agency and is found
				  eligible for assistance in paying the premiums;
(iv) A KDP contractor may use KDP funding to
				  pay for premiums under the health care for workers with disabilities program
				  described in chapter 182-511 WAC if it is cost-effective for the kidney center
				  and KDP funds are available.
(d) Submit an application for medicare to the
				  Social Security Administration (SSA) within thirty calendar days of applying
				  for KDP and provide the KDP contractor with a copy of SSA's approval or denial
				  determination notice with the following exceptions:
(i) Clients that have any employer group
				  health plan (EGHP) or COBRA plan; and
(ii) Clients who are still within the
				  thirty-month EGHP period.
(e) Have countable income which is equal to
				  or less than two hundred twenty percent of the federal poverty level (FPL)
				  ;
(f) Have countable resources
in an amount that is equal to or less than the resource
					 standards under the qualified medicare beneficiary (QMB) program. Resource
					 rules are defined in WAC
					 182-540-030;
(g) Report changes in circumstances as
				  required under WAC
				  182-540-023.