WSR 16-01-034 PERMANENT RULES HEALTH CARE AUTHORITY (Washington Apple Health) [Filed December 8, 2015, 3:56 p.m., effective January 8, 2016] Effective Date of Rule: Thirty-one days after filing.
Purpose: This filing is necessary to correct an incorrect cross-citation.
Citation of Existing Rules Affected by this Order: Amending WAC 182-505-0210.
Adopted under notice filed as WSR 15-20-100 on October 6, 2015.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: December 8, 2015.
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 15-15-153, filed 7/21/15, effective 8/21/15)
WAC 182-505-0210 Washington apple health—Eligibility for children.
(1) Unless otherwise stated in this section, a child is a person age eighteen or younger (including the month the child turns nineteen). To be eligible for one of the Washington apple health (WAH) for kids programs, a child must:
(a) Be a resident of Washington state under WAC 182-503-0520 and 182-503-0525;
(b) Provide a Social Security number (SSN) under WAC 182-503-0515 unless exempt; and
(c) Meet any additional requirements listed for the specific program.
(2) Children younger than age one are eligible for WAH categorically needy (CN) coverage, without a new application, when they are born to a mother who is eligible for WAH:
(a) On the date of the newborn's birth, including a retroactive eligibility determination; or
(b) Based on meeting a medically needy (MN) spenddown liability with expenses incurred by the date of the newborn's birth.
(3) Children are eligible for WAH at no cost when they:
(a) Have countable family income that is no more than two hundred ten percent of the federal poverty level (FPL) under WAC 182-505-0100;
(b) Are currently eligible for supplemental security income (SSI); or
(c) Received SSI payments in August 1996 and would continue to be eligible for those payments except for the August 1996 passage of amendments to federal disability definitions.
(4) Children are eligible for premium-based WAH under WAC 182-505-0215 when they:
(a) Have countable family income that is not more than three hundred twelve percent of FPL under WAC 182-505-0100;
(b) Do not have other creditable health insurance under WAC 182-500-0020; and
(c) Pay the required monthly premiums under WAC 182-505-0225.
(5) Children are eligible for WAH home and community based waiver programs under chapter 182-515 WAC when they:
(a) Meet citizenship or immigration status under WAC ((182-503-0525)) 182-503-0535;
(b) Meet SSI-related eligibility requirements under chapter 182-512 WAC; and
(c) Meet program-specific age requirements.
(6) Children are eligible for the WAH long-term care program when they meet the institutional program rules under chapter 182-513 or 182-514 WAC, and either:
(a) Reside or are expected to reside in a medical institution, intermediate care facility for the intellectually disabled (ICF/ID), hospice care center, or nursing home for thirty days or longer; or
(b) Reside or are expected to reside in an institution for mental diseases (IMD) (as defined in WAC 182-500-0050(1)) or inpatient psychiatric facility:
(i) For ninety days or longer and are age seventeen or younger; or
(ii) For thirty days or longer and are age eighteen through twenty-one.
(7) Children are eligible for the WAH-MN program under WAC 182-519-0100 when they:
(a) Meet citizenship or immigrant status under WAC 182-503-0535;
(b) Have countable family income that exceeds three hundred twelve percent of FPL under WAC 182-505-0100; or
(c) Have countable family income that is more than two hundred ten percent of FPL, but are not eligible for premium-based WAH as described in subsection (4) of this section because of creditable coverage; and
(d) Meet a spenddown liability under WAC 182-519-0110, if required.
(8) Children are eligible for WAH SSI-related programs under chapter 182-512 WAC when they:
(a) Meet citizenship or immigration status under WAC 182-503-0535;
(b) Meet SSI-related eligibility under chapter 182-512 WAC; and
(c) Meet an MN spenddown liability under WAC 182-519-0110, if required.
(9) Children who are not eligible for WAH under subsections (5) through (8) of this section because of their immigration status, are eligible for the WAH alien emergency medical program if they:
(a) Meet the eligibility requirements of WAC 182-507-0110;
(b) Have countable family income:
(i) That exceeds three hundred twelve percent of FPL under WAC 182-505-0100; or
(ii) That is more than two hundred ten percent of FPL, but they are not eligible for premium-based WAH, as described in subsection (4) of this section because of creditable coverage; and
(c) Meet a spenddown liability under WAC 182-519-0110, if required.
(10) Children who are in foster care or receive subsidized adoption services are eligible for coverage under the WAH foster care program described in WAC 182-505-0211.
(11) Children who are incarcerated in a public institution (as defined in WAC 182-500-0050(4)) that is not an IMD, are not eligible for any WAH program unless they are receiving inpatient hospital services outside of the public institution.
(12) Children who reside in a public institution that is an IMD are eligible for WAH under this section but are not eligible to receive inpatient hospital services outside of the IMD unless they are unconditionally discharged from the IMD before receiving the services.
|