PDFWAC 182-508-0005

Washington apple health medical care services—Eligibility and scope of coverage.

(1) A person is eligible for state-funded Washington apple health medical care services (MCS) coverage to the extent of available funds if the person is:
(a) Determined by the department of social and health services to be eligible for benefits under:
(i) The aged, blind, or disabled program as described in WAC 388-400-0060;
(ii) The housing and essential needs referral program as described in WAC 388-400-0070; or
(iii) The survivors of certain crimes (SCC) program, as described in WAC 388-424-0035, which includes victims of human trafficking as described in RCW 74.04.005;
(b) Not eligible for another federally funded categorically needy (CN) (as defined in WAC 182-500-0020) or alternative benefits plan (ABP) (as defined in WAC 182-500-0010) Washington apple health program; and
(c) Not residing in a public institution as defined in WAC 182-500-0050.
(2) If an enrollment cap exists under WAC 182-508-0150, a waiting list of people may be established.
(3) A person's period of eligibility for MCS is the same as the person's period of eligibility for:
(a) The aged, blind, or disabled program as described in WAC 388-449-0150;
(b) The person's incapacity authorization period for the housing and essential needs referral program as described in WAC 388-447-0110; or
(c) The person's period of eligibility for the SCC program as described in WAC 388-424-0035.
(4) The MCS program covers only the medically necessary services defined in WAC 182-501-0060.
(5) The MCS program does not cover medical services received outside the state of Washington unless the medical services are provided in a border city listed in WAC 182-501-0175.
[Statutory Authority: RCW 41.05.021, 41.05.160, and 2022 c 297 § 205(22). WSR 23-03-064, § 182-508-0005, filed 1/12/23, effective 2/12/23. Statutory Authority: RCW 41.05.021, 41.05.160, and 2020 c 136. WSR 22-02-034, § 182-508-0005, filed 12/29/21, effective 2/1/22. 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 14-16-019, § 182-508-0005, filed 7/24/14, effective 8/24/14. Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0005, filed 9/13/12, effective 10/14/12.]