PDFWAC 182-558-0060

PPP for a client with a qualified employer-sponsored group health insurance plan.

(1) General rule. Under section 1906A of the Social Security Act, the agency pays an eligible person's premium assistance subsidy and other cost-sharing obligations when the agency determines it is cost-effective as defined in WAC 182-558-0020.
(2) Eligible persons. An eligible person is:
(a) A client under age nineteen who is:
(i) Covered under a qualified employer-sponsored group health insurance plan as defined in WAC 182-558-0020;
(ii) Receiving benefits under:
(A) Alternative benefits plan coverage;
(B) Categorically needy coverage; or
(C) Medically needy coverage.
(b) The parent of the client in (a) of this subsection, if:
(i) Enrollment in the health plan depends on a parent's enrollment; and
(ii) The client is a dependent of the parents.
(3) Cost-sharing benefit. The premium payment program (PPP) may provide cost-sharing reimbursement to nonmedicaid-eligible parents for medicaid-covered services under this section.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 24-02-019, § 182-558-0060, filed 12/21/23, effective 3/1/24; WSR 19-11-129, § 182-558-0060, filed 5/22/19, effective 6/22/19; WSR 17-03-014, § 182-558-0060, filed 1/5/17, effective 3/1/17.]