reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-503 - Persons eligible for medical assistance › Section 182-503-0130 - Authorized representative

Current through Register Vol. 24-14, July 15, 2024
(1)
Designating an authorized representative (AREP)
.
(a)A person may designate an AREP to act on
				his or her behalf in eligibility-related interactions with the medicaid agency
				by completing the agency's Authorized Representative Designation Form (DSHS
				14-532), or through any of the methods described in
				42 C.F.R.
				435.907(a) and
				42 C.F.R.
				435.923. The Authorized Representative
				Designation Form is available online at
https://www.dshs.wa.gov/fsa/forms
.
(b) A court-appointed legal guardian with
				authority to make financial decisions on a person's behalf is that person's
				AREP.
(c)An agreement creating
				power of attorney (POA) that grants decision-making authority regarding the
				person's financial interactions with the agency establishes the POA as the
				AREP.
(d)If a person is unable to
				designate an AREP due to a medical condition, an individual may designate
				himself or herself as the AREP by signing the agency's Authorized
				Representative Designation Form (DSHS 14-532).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-503 - Persons eligible for medical assistance › Section 182-503-0505 - Washington apple health-General eligibility requirements

Current through Register Vol. 24-14, July 15, 2024
(1) When you apply for Washington apple
				health programs established under chapter 74.09 RCW, you must meet the
				eligibility criteria in chapters 182-500 through 182-527 WAC.
(2) When you apply for apple health, we first
				consider you for federally funded or federally matched programs. We consider
				you for state-funded programs after we have determined that you are ineligible
				for federally funded and federally matched programs.
(3) Unless otherwise specified in a program
				specific WAC, the eligibility criteria for each program are as follows:
(a) Age (WAC
				182-503-0050
				);
(b) Residence in Washington
				state (WAC
				182-503-0520
				and
				182-503-0525
				);
(c) Citizenship or immigration
				status in the United States (WAC
				182-503-0535
				);
(d) Possession of a valid Social
				Security account number (WAC
				182-503-0515
				);
(e) Assignment of medical
				support rights to the state of Washington (WAC
				182-503-0540
				);
(f) Application for medicare and
				enrollment into medicare's prescription drug program if:
(i) You are likely entitled to medicare;
				and
(ii) We have authority to pay
				medicare cost sharing as described in chapter 182-517 WAC.
(g) If your eligibility is not based on
				modified adjusted gross income (MAGI) methodology, your countable resources
				must be within specific program limits (chapters 182-512, 182-513, 182-515,
				182-517, and 182-519 WAC); and
(h)
				Countable income within program limits:
(i)
				For MAGI-based programs, see WAC
				182-505-0100;
(ii) For the refugee program, see WAC
				182-507-0130;
(iii) For the medical care services program,
				see WAC
				182-508-0005;
(iv) For the health care for workers with
				disabilities (HWD) program, see WAC
				182-511-1000;
(v) For the SSI-related program, see WAC
				182-512-0010;
(vi) For long-term care programs, see
				chapters 182-513 and 182-515 WAC;
(vii) For medicare savings programs, see WAC
				182-517-0100;
				and
(viii) For the medically needy
				program, see WAC
				182-519-0050.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-503 - Persons eligible for medical assistance › Section 182-503-0510 - Washington apple health-Program summary

Current through Register Vol. 24-14, July 15, 2024
(1) The agency
				categorizes Washington apple health programs into three groups based on the
				income methodology used to determine eligibility:
(a) Those that use a modified adjusted gross
				income (MAGI)-based methodology described in WAC
				182-509-0300, called MAGI-based
				apple health programs;
(b) Those
				that use an income methodology other than MAGI, called non-MAGI-based apple
				health programs, which include:
(i)
				Supplemental security income (SSI)-related apple health programs;
(ii) Temporary assistance for needy families
				(TANF)-related apple health programs; and
(iii) Other apple health programs not based
				on MAGI, SSI, or TANF methodologies.
(c) Those that provide coverage based on a
				specific status or entitlement in federal rule and not on countable income,
				called deemed eligible apple health programs.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-503 - Persons eligible for medical assistance › Section 182-503-0515 - Washington apple health- Social Security number requirements

Current through Register Vol. 24-14, July 15, 2024
(1) To be eligible
				for Washington apple health (medicaid), or tailored supports for older adults
				(TSOA) described in WAC
				182-513-1610,
				you (the applicant or recipient) must provide your valid Social Security number
				(SSN) or proof of application for an SSN to the medicaid agency or the agency's
				designee, except as provided in subsections (2) and (6) of this
				section.
(2) An SSN is not required
				if you are:
(a) Not eligible to receive an SSN
				or may only be issued an SSN for a valid nonwork reason described in
				20 C.F.R.
				422.104;
(b) A household member who is not applying
				for apple health coverage, unless verification of that household member's
				resources is required to determine the eligibility of the client;
(c) Refusing to obtain an SSN for
				well-established religious objections as defined in
				42 C.F.R.
				435.910(h)(3); or
(d) Not able to obtain or provide an SSN
				because you are a victim of domestic violence.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-503 - Persons eligible for medical assistance › Section 182-503-0520 - Washington apple health-Residency requirements-Persons who are not residing in an institution

Current through Register Vol. 24-14, July 15, 2024
(1) A resident
				is a person (including an emancipated person under age eighteen and a married
				person under age eighteen who is capable of indicating intent) who currently
				lives in Washington and:
(a) Intends to
				reside here, including persons without a fixed address; or
(b) Entered the state looking for a job;
				or
(c) Entered the state with a job
				commitment.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-503 - Persons eligible for medical assistance › Section 182-503-0525 - Washington apple health-Residency requirements for an institutionalized person

Current through Register Vol. 24-14, July 15, 2024
(1) An
				institutionalized person is a person who resides in an institution as defined
				in WAC 182-500-0050. The term "person"
				used in this section means an "institutionalized person" unless otherwise
				indicated. It does not include persons who receive services under a home and
				community-based waiver program. When a state is making a placement for a person
				in another state, the term institution also includes foster care homes,
				licensed as described in 45
				C.F.R. 1355.20.
(2) The agency must determine whether a
				person is capable of indicating their intent to reside in Washington state when
				deciding whether that person is a resident of the state. The agency determines
				that persons who meet the following criteria are deemed incapable of indicating
				intent to reside in the state:
(a) The person
				is judged legally incompetent by a court of law;
(b) A physician, psychologist or licensed
				medical professional in the field of intellectual disabilities has determined
				that the person is incapable of indicating intent; or
(c) The person is incapable of declaring
				intent due to a documented medical condition.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-503 - Persons eligible for medical assistance › Section 182-503-0530

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 41.05.021, Patient Protection and Affordable
					 Care Act ( Public Law
					 111-148 ), 42 C.F.R. § 431, 435, and 457, and
					 45 C.F.R. § 155. WSR 13-14-019, §
											182-503-0530, filed 6/24/13,
					 effective 7/25/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-503 - Persons eligible for medical assistance › Section 182-503-0532

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 41.05.021,
					 74.09.035, and
					 2011 1st sp.s. c
					 36 . 12-19-051, §
											182-503-0532, filed 9/13/12,
					 effective 10/14/12.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-503 - Persons eligible for medical assistance › Section 182-503-0540 - Assignment of rights and cooperation

Current through Register Vol. 24-14, July 15, 2024
(1) When you become eligible for any of the
				agency's health care programs, you assign certain rights to the state of
				Washington. You assign all rights to any type of coverage or payment for health
				care that comes from:
(a) A court
				order;
(b) An administrative agency
				order; or
(c) Any third-party
				benefits or payment obligations for medical care which are the result of
subrogation
or contract (see WAC
				182-501-0100
				).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-503 - Persons eligible for medical assistance › Section 182-503-0555

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 41.05.021,
					 74.09.035, and
					 2011 1st sp.s. c
					 36 . 12-19-051, §
											182-503-0555, filed 9/13/12,
					 effective 10/14/12.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-503 - Persons eligible for medical assistance › Section 182-503-0560

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 41.05.021,
					 74.09.035, and
					 2011 1st sp.s. c
					 36 . 12-19-051, §
											182-503-0560, filed 9/13/12,
					 effective 10/14/12.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-503 - Persons eligible for medical assistance › Section 182-503-0565 - Washington apple health-Age requirements for medical programs based on modified adjusted gross income (MAGI)

Current through Register Vol. 24-14, July 15, 2024
The following age requirements apply to persons whose
				  eligibility for Washington apple health (WAH) is based on modified adjusted
				  gross income (MAGI) methodology per WAC
				  182-509-0305.
(1) You must be age sixty-four or younger to
				be eligible for WAH MAGI-based adult coverage as described in WAC
				182-505-0250.
(2) Your household must include an eligible
				dependent child age seventeen or younger to be eligible for WAH parent or
				caretaker relative coverage as described in WAC
				182-505-0240. For purposes of
				this subsection, an "eligible dependent child" is a child related to you in one
				of the ways described in WAC
				182-500-0020.
(3) A child must be age eighteen or younger
				to be eligible for WAH for kids as described in WAC
				182-505-0210 with the following
				exceptions:
(a) An institutionalized child may
				still qualify under a children's health care program through the age of
				twenty-one (see WAC
				182-514-0230 );
(b) A foster care child may qualify for WAH
				foster care coverage through the age of twenty-six (see WAC
				182-505-0211 ).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-504 - Certification periods and change of circumstance › Section 182-504-0005 - Washington apple health-Retroactive certification period

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency approves a
				retroactive Washington apple health (WAH) certification period for the three
				months immediately before the month of application when an individual:
(a) Requests retroactive WAH on his or her
				application, within the certification period following the retroactive period,
				or before the determination of benefits and any appeal process is
				final;
(b) Would have been eligible
				for WAH for any or all of the three months if he or she had applied during the
				retroactive period; and
(c) The
				individual received covered medical services as described in WAC
				182-501-0060
				and
				182-501-0065.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-504 - Certification periods and change of circumstance › Section 182-504-0015 - Washington apple health-Certification periods for categorically needy programs

Current through Register Vol. 24-14, July 15, 2024
(1) A certification
				period is the period of time we determine that you are eligible for a
				categorically needy (CN) Washington apple health program. Unless otherwise
				stated in this section, the certification period begins on the first day of the
				month of application and continues through the end of the last month of the
				certification period.
(2) Newborn
				coverage begins on the child's date of birth and continues through the end of
				the month of the child's first birthday.
(3) If you are eligible for apple health
				based on pregnancy, the certification period continues through the last day of
				the month the pregnancy ends. After-pregnancy coverage begins the first day of
				the month, following the end of the pregnancy, and ends the last day of the
				12th month from the time after-pregnancy coverage began.
(4) If you are newly eligible for apple
				health coverage and had a pregnancy end within the last 12 months, your
				certification period for after-pregnancy coverage:
(a) Begins the first day of the month you are
				eligible; and
(b) Ends the last day
				of the 12th month following the end of your pregnancy.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-504 - Certification periods and change of circumstance › Section 182-504-0020 - Certification periods for the noninstitutional medically needy program

Current through Register Vol. 24-14, July 15, 2024
(1) The
				certification period for the noninstitutional medically needy (MN) program for
				clients with countable income equal to or below the medically needy income
				level (MNIL):
(a) Begins on the first day of
				the month in which eligibility is established; and
(b) Is approved for twelve calendar
				months.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-504 - Certification periods and change of circumstance › Section 182-504-0025 - Medicare savings program certification periods

Current through Register Vol. 24-14, July 15, 2024
Certification periods for the different kinds of medicare
				  savings programs are not all the same. The chart below explains the
				  differences.
Medicare Savings Program
Certification Period
Start Date
QMB
(qualified medicare
								beneficiary)
S03
12 months
On the first day of the month following QMB
								eligibility determination
SLMB
(Special low income medicare
								beneficiary)
S05
12 months
Up to three months prior to the certification
								period if on the first day of the first month of certification, the
								person:
Is or has been enrolled in medicare Part B;
								and
Meets SLMB eligibility requirements.
QDWI
(Qualified disabled working
								individual)
S04
12 months
Up to three months prior to the certification
								period if on the first day of the first month of certification, the
								person:
Is or has been enrolled in medicare Part A;
								and
Meets QDWI eligibility requirements.
QI-1
(Qualified individual)
S06
Thru the end of the calendar year following QI-1
								eligibility determination
Up to three months prior to the certification
								period if on the first day of the first month of certification, the
								person:
Is or has been enrolled in medicare Part B;
								and
Meets QI-1 eligibility requirements.
11-24-018, recodified as WAC
					 182-504-0025, filed 11/29/11,
					 effective 12/1/11. 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). 05-01-126, § 388-416-0035, filed 12/15/04,
					 effective 1/15/05. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.055,
					 74.04.057 and
					 74.08.090. 98-16-044, §
					 388-416-0035, filed 7/31/98, effective 9/1/98. Formerly WAC 388-521-2150,
					 388-521-2155 and 388-521-2160.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-504 - Certification periods and change of circumstance › Section 182-504-0030

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 41.05.021,
					 74.09.035, and
					 2011 1st sp.s. c
					 36 . 12-19-051, §
											182-504-0030, filed 9/13/12,
					 effective 10/14/12.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-504 - Certification periods and change of circumstance › Section 182-504-0035 - Washington apple health-Renewals

Current through Register Vol. 24-14, July 15, 2024
(1)
				For all Washington apple health (WAH) programs, the following applies:
(a) You are required to complete a renewal of
				eligibility at least every 12 months with the following exceptions:
(i) If you are eligible for WAH medically
				needy with spenddown, then you must complete a new application at the end of
				each three- or six-month base period;
(ii) If you are eligible for WAH alien
				emergency medical, then you are certified for a specific period of time to
				cover emergency in-patient hospitalization costs only (see WAC
				182-507-0115(8));
(iii) If you are eligible for WAH refugee
				coverage, you must complete a renewal of eligibility after 12 months;
				or
(iv) If you are a child on apple
				health for kids without premiums, your first renewal is due the month of your
				sixth birthday.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-504 - Certification periods and change of circumstance › Section 182-504-0040

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 41.05.021,
					 74.09.035, and
					 2011 1st sp.s. c
					 36 . 12-19-051, §
											182-504-0040, filed 9/13/12,
					 effective 10/14/12.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-504 - Certification periods and change of circumstance › Section 182-504-0100

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 41.05.021,
					 74.09.035, and
					 2011 1st sp.s. c
					 36 . 12-19-051, §
											182-504-0100, filed 9/13/12,
					 effective 10/14/12.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-504 - Certification periods and change of circumstance › Section 182-504-0105 - Washington apple health-Changes that must be reported

Current through Register Vol. 24-14, July 15, 2024
(1) You must report changes in your household
				and family circumstances to us (the agency or its designee) timely according to
				WAC 182-504-0110.
(2) We tell you what you are required to
				report at the time you are approved for WAH coverage. We also will tell you if
				the reporting requirements change.
(3) You must report the following:
(a) Change in residential address;
(b) Change in mailing address;
(c) Change in marital status;
(d) When family members or dependents move in
				or out of the residence;
(e)
				Pregnancy;
(f)
				Incarceration;
(g) Change in
				institutional status;
(h) Change in
				health insurance coverage including medicare eligibility; and (i) Change in
				immigration or citizenship status.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-504 - Certification periods and change of circumstance › Section 182-504-0110 - Washington apple health-When to report changes

Current through Register Vol. 24-14, July 15, 2024
(1) All changes you report to us (the agency
				or its designee), as required by WAC
				182-504-0105, are used to decide
				if you can receive or keep receiving Washington apple health (WAH)
				coverage.
(2) You must report
				changes during your certification period within thirty days of when the change
				happened.
(3) You must report all
				changes during application, renewal, or redetermination of your WAH
				eligibility, regardless of when the change happened.
(4) For a change in income, the date a change
				happened is the first date you received income based on the change. For
				example, the date you receive your first paycheck for a new job or the date you
				got a paycheck with a wage increase is the date the change happened.
(5) If you do not report a change or you
				report a change late, we will decide if you can receive or keep receiving WAH
				coverage based on the date the change was required to be reported.
(6) If you do not report a change or you
				report a change late, and if it affects the amount you must pay toward your
				cost of care as described in WAC
				182-513-1380 or chapter 182-515
				WAC, you may become liable for overpayments we make on your behalf and you may
				need to pay more to your care provider.
(7) If you do not report a change or you
				report a change late, it may result in us overpaying you and you having to pay
				us back for the health care costs we overpaid. See chapter 182-520
				WAC.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-504 - Certification periods and change of circumstance › Section 182-504-0120 - Washington apple health-Effective dates of changes

Current through Register Vol. 24-14, July 15, 2024
(1) We (the agency or its desig-nee)
				determine the date a change affects your Washington apple health (WAH) coverage
				based on:
(a) The date you report the change
				to us;
(b) The date you give us the
				requested verification; and
(c) The
				type of WAH you or your family is receiving.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-504 - Certification periods and change of circumstance › Section 182-504-0130 - Washington apple health-Continued coverage pending an appeal

Current through Register Vol. 24-14, July 15, 2024
(1) Continued
				coverage is when you continue to receive Washington apple health benefits while
				appealing a medicaid agency adverse action to terminate, suspend, or reduce
				your:
(a) Medicaid eligibility; or
(b) Authorization for a covered
				service.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0100 - Monthly income standards for MAGI-based programs

Current through Register Vol. 24-14, July 15, 2024
(1) Each year, the federal government
				publishes new federal poverty level (FPL) income standards in the Federal
				Register found at
https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines/prior-hhs-poverty-guidelines-federal-register-references
.
(a) The income standards for the following
				Washington apple health programs change on the first day of April every year
				based on the new FPL, except for subsections (2) and (3) of this
				section.
(b) The agency determines
				income eligibility by comparing countable income as determined of the person's
				medical assistance unit (MAU), as determined under WAC
				182-506-0010
				and
				182-506-0012,
				to the applicable income standard. Rules for determining countable income are
				in chapter 182-509 WAC.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0115 - Washington apple health-Eligibility for pregnancy and after-pregnancy coverage

Current through Register Vol. 24-14, July 15, 2024
(1) A pregnant
				person is eligible for Washington apple health pregnancy coverage if the
				person:
(a) Meets citizenship or immigration
				status under WAC
				182-503-0535;
(b) Meets Social Security number requirements
				under WAC 182-503-0115;
(c) Meets
				Washington state residency requirements under WAC
				182-503-0520
				and
				182-503-0525;
				and
(d) Has countable income at or
				below the limit described in:
(i) WAC
				182-505-0100
				to be eligible for categorically needy (CN) coverage; or
(ii) WAC
				182-505-0100
				to be eligible for medically needy (MN) coverage. MN coverage begins when the
				pregnant person meets any required spenddown liability as described in WAC
				182-519-0110.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0117 - Washington apple health-Eligibility for pregnant minors

Current through Register Vol. 24-14, July 15, 2024
(1) For the purposes of this rule, "minor"
				means a person under the age of 19.
(2) A pregnant minor who meets Washington
				state residency requirements under WAC
				182-503-0520
				and
				182-503-0525
				is eligible for the Washington apple health for kids program.
(3) The medical assistance unit (MAU) of a
				pregnant minor is the pregnant minor.
(4) There are no income standards and no
				resource tests for a pregnant minor to be eligible for apple health for
				kids.
(5) To ensure reimbursement
				from the U.S. Department of Health and Human Services, every pregnant minor
				applicant for apple health for kids must provide their Social Security number,
				unless they are exempt under WAC
				182-503-0515,
				and must provide their citizenship or immigration status. The immigration
				status of a pregnant minor who is an undocumented alien (see WAC
				182-503-0530)
				will not be disclosed to any third party.
(6) The assignment of rights as described in
				WAC
				182-503-0540
				does not apply to pregnant minors.
(7) A pregnant minor covered by the apple
				health for kids program has a one-year certification period. If a minor has
				their 19th birthday during their pregnancy, they are automatically enrolled in
				apple health for pregnancy coverage through the end of the month their
				pregnancy ends. They are eligible for after-pregnancy coverage for 12 months,
				beginning the first day of the month after their pregnancy ends.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0120 - Washington apple health breast and cervical cancer treatment program for women-Client eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) Effective
				April 1, 2014, a woman is eligible for categorically needy (CN) coverage under
				the Washington apple health (WAH) breast and cervical cancer treatment program
				(BCCTP) only when she:
(a) Has been screened
				for breast or cervical cancer under the department of health's breast,
				cervical, and colon health program (BCCHP);
(b) Requires treatment for breast cancer,
				cervical cancer, or a related precancer-ous condition;
(c) Is under sixty-five years of
				age;
(d) Is not eligible for other
				WAH-CN coverage, including coverage under the MAGI-based adult group;
(e) Is uninsured or does not otherwise have
				creditable coverage;
(f) Meets
				residency requirements under WAC
				182-503-0520;
(g) Meets Social Security number requirements
				under WAC
				182-503-0515;
(h) Is a U.S. citizen, U.S. national,
				qualifying American Indian born abroad, or qualified alien under WAC
				182-503-0535; and
(i) Meets the income standard set by the
				BCCHP in DOH form 342-031.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0210 - Eligibility for children

Current through Register Vol. 24-14, July 15, 2024
(1)
General eligibility.
For purposes of this section, a child must:
(a) Be a Washington state resident under WAC
				182-503-0520 and
				182-503-0525;
(b) Provide a Social Security number under
				WAC 182-503-0515, unless exempt;
				and
(c) Meet program-specific
				requirements.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0211 - Washington apple health-Foster care

Current through Register Vol. 24-14, July 15, 2024
(1) A client under
				the age of 18 is eligible for Washington apple health foster care coverage when
				they:
(a) Are in foster care, as determined
				by the department of children, youth, and families (DCYF), under the legal
				responsibility of the state, or a federally recognized tribe located within the
				state; and
(b) Meet Washington
				residency requirements as described in WAC
				182-503-0520
				or
				182-503-0525.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0215 - Children's Washington apple health with premiums

Current through Register Vol. 24-14, July 15, 2024
(1) A child is eligible for Washington apple
				health with premiums if the child:
(a) Meets
				the requirements in WAC
				182-505-0210(1);
(b) Has countable income below the standard
				in WAC 182-505-0100(6)(b);
				and
(c) Pays the required premium
				under WAC
				182-505-0225, unless the child is
				exempt under WAC
				182-505-0225(2)(c).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0220

Current through Register Vol. 24-14, July 15, 2024
12-13-056, recodified as WAC
					 182-505-0220, filed 6/15/12,
					 effective 7/1/12. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.402,
					 74.09.470, and 2008 session law.
					 09-07-086, § 388-542-0050, filed 3/17/09, effective 4/17/09. Statutory
					 Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530,
					 74.09.700, and 2007 c 5.
					 08-05-018, § 388-542-0050, filed 2/12/08, effective 3/14/08. Statutory
					 Authority:
					 RCW
					 74.08.090,
					 74.09.510,
					 74.09.522, 74.09.450, and 2004 c
					 276. 04-16-064, § 388-542-0050, filed 7/30/04, effective 8/30/04.
					 Statutory Authority:
					 RCW
					 74.09.080, 74.08.510, [74.08.]522, 74.09.450,
					 1115 Waiver, 42 U.S.C.
					 1396. 02-01-075, § 388-542-0050, filed
					 12/14/01, effective 1/14/02. Statutory Authority:
					 RCW
					 74.08.090, 74.09.450. 00-07-103, §
					 388-542-0050, filed 3/17/00, effective
					 4/17/00.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0225 - Children's Washington apple health with premiums - Calculation and determination of premium amount

Current through Register Vol. 24-14, July 15, 2024
(1) For the
				purposes of this chapter, means an amount paid for health care coverage under
				WAC 182-505-0215.
(2) Premium requirement. Eligibility for
				Washington apple health premium-based program under WAC
				182-505-0215 requires payment of
				a monthly premium.
(a) The first monthly
				premium is due in the month following the determination of
				eligibility.
(b) There is no
				premium requirement for health care coverage received in the month eligibility
				is determined or in any prior month.
(c) A child who is American Indian or Alaska
				native is exempt from the monthly premium requirement.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0230

Current through Register Vol. 24-14, July 15, 2024
12-13-056, recodified as WAC
					 182-505-0230, filed 6/15/12,
					 effective 7/1/12. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.402,
					 74.09.470, and 2008 session law.
					 09-07-086, § 388-542-0300, filed 3/17/09, effective 4/17/09. Statutory
					 Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530,
					 74.09.700, and 2007 c 5.
					 08-05-018, § 388-542-0300, filed 2/12/08, effective 3/14/08. Statutory
					 Authority:
					 RCW
					 74.08.090,
					 74.09.510,
					 74.09.522, 74.09.450, and 2004 c
					 276. 04-16-064, § 388-542-0300, filed 7/30/04, effective 8/30/04.
					 Statutory Authority:
					 RCW
					 74.09.080, 74.08.510, [74.08.]522, 74.09.450,
					 1115 Waiver, 42 U.S.C.
					 1396. 02-01-075, § 388-542-0300, filed
					 12/14/01, effective 1/14/02. Statutory Authority:
					 RCW
					 74.08.090, 74.09.450. 00-07-103, §
					 388-542-0300, filed 3/17/00, effective
					 4/17/00.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0235

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 41.05.021,
					 74.04.050,
					 74.04.057,
					 74.09.500, and PPACA, §
					 2102(b)(1)(A) of the Social Security Act, and
					 Public Law
					 111-3 (CHIPRA). 11-23-077, §
											182-505-0235, filed 11/15/11,
					 effective 12/16/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0237

Current through Register Vol. 24-14, July 15, 2024
12-13-056, recodified as WAC
					 182-505-0237, filed 6/15/12,
					 effective 7/1/12. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057, and
					 74.08.090, and Apple Health for
					 Kids Act (ESHB 2128); 42
					 U.S.C. 1305;
					 Public Law
					 111-3 (Children's Health Insurance Program
					 Reauthorization Act of 2009). 11-03-001, § 388-542-0020, filed 1/5/11,
					 effective 2/5/11. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.402,
					 74.09.470, and 2008 session law.
					 09-07-086, § 388-542-0020, filed 3/17/09, effective 4/17/09. Statutory
					 Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530,
					 74.09.700, and 2007 c 5.
					 08-05-018, § 388-542-0020, filed 2/12/08, effective 3/14/08. Statutory
					 Authority:
					 RCW
					 74.08.090 and
					 74.09.522. 06-07-014, §
					 388-542-0020, filed 3/3/06, effective 4/3/06. Statutory Authority:
					 RCW
					 74.08.090,
					 74.09.510,
					 74.09.522, 74.09.450, and 2004 c
					 276. 04-16-064, § 388-542-0020, filed 7/30/04, effective
					 8/30/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0240 - Parents and caretaker relatives

Current through Register Vol. 24-14, July 15, 2024
(1)
				A person is eligible for Washington apple health categorically needy (CN)
				coverage when the person:
(a) Is a parent or
				caretaker relative of a dependent child who meets the criteria described in WAC
				182-503-0565(2);
(b) Meets citizenship and immigration status
				requirements described in WAC
				182-503-0535;
(c) Meets general eligibility requirements
				described in WAC
				182-503-0505; and
(d) Has countable income below the standard
				in WAC 182-505-0100(2).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0245

Current through Register Vol. 24-14, July 15, 2024
11-23-091, recodified as WAC
					 182-505-0245, filed 11/17/11,
					 effective 11/21/11. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057, and
					 74.08.090. 11-13-031, §
					 388-478-0065, filed 6/7/11, effective 7/8/11. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090, and
					 74.09.530. 05-15-080, §
					 388-478-0065, filed 7/14/05, effective 8/14/05. Statutory Authority:
					 RCW
					 74.08.090,
					 74.04.050,
					 74.04.057,
					 74.09.530, and Section 673(2) (
					 42 U.S.C.
					 9902(2) ). 01-18-056, §
					 388-478-0065, filed 8/30/01, effective 9/30/01. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.055,
					 74.04.057 and
					 74.08.090. 98-16-044, §
					 388-478-0065, filed 7/31/98, effective 9/1/98. Formerly WAC 388-507-0710 and
					 388-508-0820.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0250 - Washington apple health-MAGI-based adult medical

Current through Register Vol. 24-14, July 15, 2024
(1) Effective on or after January 1, 2014, a
				person is eligible for Washington apple health (WAH) modified adjusted gross
				income (MAGI)-based adult coverage when he or she meets the following
				requirements:
(a) Is age nineteen or older and
				under the age of sixty-five;
(b) Is
				not entitled to, or enrolled in, medicare benefits under Part A or B of Title
				XVIII of the Social Security Act;
(c) Is not otherwise eligible for and
				enrolled in mandatory coverage under one of the following programs:
(i) WAH SSI-related categorically needy (CN);
(ii) WAH foster care program;
				or
(iii) WAH adoption support
				program;
(d) Meets
				citizenship and immigration status requirements described in WAC
				182-503-0535;
(e) Meets general eligibility requirements
				described in WAC
				182-503-0505; and
(f) Has net countable income that is at or
				below one hundred thirty-three percent of the federal poverty level for a
				household of the applicable size.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0300 - Hospital presumptive eligibility

Current through Register Vol. 24-14, July 15, 2024
(1)
Purpose.
The hospital presumptive eligibility (HPE) program
				provides temporary Washington apple health coverage to HPE-eligible persons who
				enroll through an HPE-qualified hospital.
(2)
HPE-eligible persons.
To be
				HPE-eligible:
(a) A person must:
(i) Be younger than age 65; and
(ii) Meet the eligibility requirements for
				one or more of the following programs:
(A)
				Washington apple health for pregnant women (chapter 182-505 WAC);
(B) Washington apple health for kids (chapter
				182-505 WAC);
(C) Washington apple
				health for foster care (chapter 182-505 WAC);
(D) Washington apple health for parents and
				caretaker relatives (chapter 182-505 WAC);
(E) Washington apple health for adults
				(chapter 182-505 WAC); or
(F)
				Family planning only services (chapter 182-532 WAC).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-505 - Family, children, pregnancy and adult medical programs › Section 182-505-0515

Current through Register Vol. 24-14, July 15, 2024
12-02-034, recodified as §
											182-505-0515, filed 12/29/11,
					 effective 1/1/12. Statutory Authority:
					 RCW
					 74.08.090,
					 74.08A.100,
					 74.09.080, and 74.09.415. WSR
					 02-17-030, § 388-503-0515, filed 8/12/02, effective 9/12/02. Statutory
					 Authority:
					 RCW
					 74.04.050,
					 74.04.055,
					 74.04.057 and
					 74.08.090. WSR 98-16-044, §
					 388-503-0515, filed 7/31/98, effective
					 9/1/98.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-506 - Medical financial responsibility › Section 182-506-0010 - Medical assistance units for MAGI-based programs

Current through Register Vol. 24-14, July 15, 2024
This section applies to applicants or recipients whose
				  financial eligibility for Washington apple health coverage is based on modified
				  adjusted gross income methodology under WAC
				  182-503-0510 and
				  182-509-0300.
(1) General medical assistance unit (MAU)
				rules.
(a) The rules in this section describe
				how the medicaid agency must determine who is in an applicant's or recipient's
				MAU.
(b) Each person will have an
				individualized MAU and may have different eligibility results than other people
				on the same application.
(c) The
				countable income used to determine a person's eligibility is the sum of the
				countable income of everyone in the person's MAU.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-506 - Medical financial responsibility › Section 182-506-0012 - Determining a person's medical assistance unit

Current through Register Vol. 24-14, July 15, 2024
This section applies to people whose financial eligibility
				  for Washington apple health coverage is based on modified adjusted gross income
				  methodology.
(1) Determining a tax
				filer's medical assistance unit (MAU).
(a) A
				tax filer is a person who:
(i) Expects to file
				a federal income tax return; and
(ii) Does not expect to be claimed as a tax
				dependent on a federal income tax return.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-506 - Medical financial responsibility › Section 182-506-0015 - Medical assistance units for non-MAGI-based Washington apple health programs

Current through Register Vol. 24-14, July 15, 2024
This section explains how medical assistance units (MAUs) are
				  constructed for programs not based on modified adjusted gross income (MAGI)
				  methodologies. (MAGI-based programs are described in WAC
				  182-503-0510.)
(1) An MAU is a person or group of people who
				must be included together when determining eligibility. MAUs are established
				based on each person's relationship to other family members and the person's
				financial responsibility for the other family members. MAUs for non-MAGI-based
				programs include an applicant and persons financially responsible for the
				applicant as described in subsection (2) of this section (as limited by
				subsection (3) of this section).
(2) Financial responsibility applies as
				follows:
(a) Married persons living together
				are financially responsible for each other;
(b) Natural, adoptive, or step-parents are
				financially responsible for their unmarried, minor children living in the same
				household;
(c) Minor children are
				financially responsible for only themselves;
(d) Married persons not living together are
				financially responsible for each other to the extent described in WAC
				182-512-0960
				and chapters 182-513 and 182-515 WAC when one or both are residing in a medical
				institution, or one or both are applying for or receiving home and
				community-based services.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-506 - Medical financial responsibility › Section 182-506-0020

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 41.05.021,
					 74.09.035, and
					 2011 1st sp.s. c
					 36 . 12-19-051, §
											182-506-0020, filed 9/13/12,
					 effective 10/14/12.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-507 - Medical assistance programs for noncitizens › Section 182-507-0110 - Washington apple health - Alien medical programs

Current through Register Vol. 24-14, July 15, 2024
(1) To qualify for an alien medical program
				(AMP) a person must:
(a) Be ineligible for
				federally funded Washington apple health (WAH) programs due to the
				citizenship/alien status requirements described in WAC
				182-503-0535;
(b) Meet the requirements described in WAC
				182-507-0115,
				182-507-0120, or
				182-507-0125; and
(c) Meet all categorical and financial
				eligibility criteria for one of the following programs, except for the Social
				Security number or citizenship/alien status requirements:
(i) An SSI-related medical program described
				in chapters 182-511 and 182-512 WAC;
(ii) A MAGI-based program referred to in WAC
				182-503-0510; or
(iii) The breast and cervical cancer
				treatment program for women described in WAC
				182-505-0120; or
(iv) A medical exten-sion described in WAC
				182-523-0100.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-507 - Medical assistance programs for noncitizens › Section 182-507-0115 - Alien emergency medical program (AEM)

Current through Register Vol. 24-14, July 15, 2024
(1) A person nineteen years of age or older
				who is not pregnant and meets the eligibility criteria under WAC
				182-507-0110 is eligible for the
				alien emergency medical program's scope of covered services described in this
				section if the person meets (a) and (b) or (c) of this subsection:
(a) The medicaid agency determines that the
				primary condition requiring treatment meets the definition of an emergency
				medical condition as defined in WAC
				182-500-0030, and the condition
				is confirmed through review of clinical records; and
(b) The person's qualifying emergency medical
				condition is treated in one of the following hospital settings:
(i) Inpatient;
(ii) Outpatient surgery;
(iii) Emergency room services, which must
				include an evaluation and management (E&M) visit by a physician;
				or
(c) Involuntary
				Treatment Act (ITA) and voluntary inpatient admissions to a hospital
				psychiatric setting that are authorized by the agency's inpatient mental health
				designee (see subsection (5) of this section).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-507 - Medical assistance programs for noncitizens › Section 182-507-0120 - Alien medical for dialysis and cancer treatment, and treatment of life-threatening benign tumors

Current through Register Vol. 24-14, July 15, 2024
In addition to the provisions for emergency care described
				  in WAC 182-507-0115, the medicaid agency
				  also considers the conditions in this section as an emergency, as defined in
				  WAC 182-500-0030.
(1) A person nineteen years of age or older
				who is not pregnant and meets the eligibility criteria under WAC
				182-507-0110 may be eligible for
				the scope of service categories under this program if the condition requires:
(a) Surgery, chemotherapy, and/or radiation
				therapy to treat cancer or life-threatening benign tumors;
(b) Dialysis to treat acute renal failure or
				end stage renal disease (ESRD); or
(c) Anti-rejection medication, if the person
				has had an organ transplant.