PDFWAC 182-505-0225

Children's Washington apple health with premiums—Calculation and determination of premium amount.

(1) For the purposes of this chapter, "premium" means an amount paid for health care coverage under WAC 182-505-0215.
(2) Premium requirement. The 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.
(3) Monthly premium amount.
(a) The premium amount for the medical assistance unit (MAU) is based on countable income under chapter 182-509 WAC and the number of people in the MAU under chapter 182-506 WAC.
(b) The premium amount is as follows:
(i) If the MAU's countable income exceeds 210 percent of the federal poverty level (FPL) but does not exceed 260 percent of the FPL, the monthly premium for each child is $20.
(ii) If the MAU's countable income exceeds 260 percent of the FPL but does not exceed 312 percent of the FPL, the monthly premium for each child is $30.
(iii) The medicaid agency charges a monthly premium for no more than two children per household.
(iv) Payment of the full premium is required. Partial payments cannot be designated for a specific child or month.
(v) Any third party may pay the premium on behalf of the household. Failure of a third party to pay the premium does not eliminate the obligation of the household to pay past due premiums.
(c) A change that affects the premium amount takes effect the month after the change is reported.
(4) Nonpayment of premiums. The agency writes off past-due premiums after 12 months.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 24-20-052, s 182-505-0225, filed 9/25/24, effective 10/26/24; WSR 17-12-018, § 182-505-0225, filed 5/30/17, effective 6/30/17. WSR 12-13-056, recodified as § 182-505-0225, filed 6/15/12, effective 7/1/12. 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). WSR 11-23-077, § 388-505-0211, filed 11/15/11, effective 12/16/11. 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). WSR 11-03-001, § 388-505-0211, 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. WSR 09-07-086, § 388-505-0211, 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. WSR 08-05-018, § 388-505-0211, 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. WSR 04-16-064, § 388-505-0211, filed 7/30/04, effective 8/30/04. Statutory Authority: RCW 74.08.090, 74.09.055, 2004 c 276. WSR 04-08-125, § 388-505-0211, filed 4/7/04, effective 5/8/04.]