(1) The purpose of the AIDS health insurance premium payment program is to help people who are not eligible for the medicaid agency's Washington apple health medical programs and who are diagnosed with AIDS pay their health insurance premiums.

(2) To be eligible for the AIDS health insurance premium payment program:

(a) A person must be:

(i) Diagnosed with AIDS as defined in WAC 246-100-011;

(ii) A resident of the state of Washington;

(iii) Responsible for all or part of the health insurance premium payment (without the agency's help);

(b) A person must not:

(i) Be eligible for one of the agency's other medical programs;

(ii) Have personal income that exceeds three hundred seventy percent of the federal poverty level; and

(iii) Have personal assets, after exemptions, exceeding fifteen thousand dollars, except for:

(A) A home used as the person's primary residence; and

(B) A vehicle used as personal transportation.

(3) The agency may contract with a not-for-profit community agency to administer the AIDS health insurance premium payment program. The agency or its contractor determines a person's initial eligibility and redetermines eligibility on a periodic basis. To be eligible, a person must:

(a) Cooperate with the agency's contractor;

(b) Cooperate with the eligibility determination and redetermination process; and

(4) People diagnosed with AIDS who are eligible for an agency medical program may ask the agency to pay their health insurance premiums under a separate process. The client's community services office (CSO) can assist the client with this process.

(5) When a person is eligible for the AIDS health insurance premium payment program, eligibility ceases only when the person:

(a) Is deceased;

(b) Voluntarily quits the program;

(d) Has benefits terminated because the legislature terminated the funding for this program.

(6) The agency sets a reasonable payment limit for health insurance premiums by tracking the charges billed to the agency for clients with AIDS. The agency does not pay health insurance premiums that exceed fifty percent of the average of charges billed to the agency for clients with AIDS.

PDFWAC 182-539-0200

AIDS—Health insurance premium payment program.