PDFWAC 182-505-0115

Washington apple health—Eligibility for pregnancy and after-pregnancy coverage.

(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.
(2) A noncitizen pregnant person who does not meet the requirements in subsection (1)(a) or (b) of this section is eligible for apple health pregnancy coverage if they meet countable income standards for CN or MN coverage as described in subsection (1)(d) of this section.
(3) The assignment of medical support rights as described in WAC 182-503-0540 does not apply to pregnant people.
(4) A person who was eligible for and covered under any CN or MN scope of coverage apple health program on the last day of pregnancy remains continuously eligible for after-pregnancy coverage for 12 months, beginning the month after their pregnancy ends. This includes people who meet an MN spenddown liability with expenses incurred no later than the date the pregnancy ends.
(5) Pregnancy coverage has CN scope of care for all people except those enrolled through the MN program who have MN scope of care. A person's after-pregnancy coverage has the same scope of coverage as their pregnancy coverage.
(6) A person who does not meet the requirements in subsection (4) of this section may qualify for after-pregnancy coverage if they:
(a) Apply for and meet all requirements of the apple health pregnancy coverage program other than pregnancy; and
(b) Apply any time during their 12-month postpartum period to receive ongoing medical coverage until the end of the 12th month after their pregnancy ends.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 22-12-033, § 182-505-0115, filed 5/24/22, effective 6/24/22. Statutory Authority: RCW 41.05.021, 41.05.160, Public Law 111-148, 42 C.F.R. § 431, 435, and 457, and 45 C.F.R. § 155. WSR 14-16-052, § 182-505-0115, filed 7/29/14, effective 8/29/14. WSR 12-13-056, recodified as § 182-505-0115, filed 6/15/12, effective 7/1/12. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, 42 U.S.C. 9902(2). WSR 05-07-032, § 388-462-0015, filed 3/9/05, effective 4/9/05. Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. WSR 02-17-030, § 388-462-0015, 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, § 388-462-0015, filed 7/31/98, effective 9/1/98. Formerly WAC 388-508-0820, 388-508-0830, 388-522-2230 and 388-508-0835.]