Current through Register Vol. 24-18, September 15, 2024
(1) The agency
categorizes Washington apple health programs into three groups based on the
income methodology used to determine eligibility:
(a) Those that use a modified adjusted gross
income (MAGI)-based methodology described in WAC
182-509-0300, called MAGI-based
apple health programs;
(b) Those
that use an income methodology other than MAGI, called non-MAGI-based apple
health programs, which include:
(i)
Supplemental security income (SSI)-related apple health programs;
(ii) Temporary assistance for needy families
(TANF)-related apple health programs; and
(iii) Other apple health programs not based
on MAGI, SSI, or TANF methodologies.
(c) Those that provide coverage based on a
specific status or entitlement in federal rule and not on countable income,
called deemed eligible apple health programs.
(2) MAGI-based apple health programs include
the following:
(a) Apple health parent and
caretaker relative program described in WAC
182-505-0240;
(b) MAGI-based apple health adult medical
program described in WAC
182-505-0250, for which the scope
of coverage is called the alternative benefits plan (ABP) described in WAC
182-500-0010;
(c) Apple health for pregnant women program
described in WAC
182-505-0115;
(d) Apple health for kids program described
in WAC 182-505-0210(3)(a);
(e) Premium-based apple health for kids
described in WAC
182-505-0215;
(f) Apple health long-term care for children
and adults described in chapter 182-514 WAC; and
(g) Apple health alien emergency medical
program described in WAC
182-507-0110 through
182-507-0125 when the person is
eligible based on criteria for a MAGI-based apple health program.
(3) Non-MAGI-based apple health
programs include the following:
(a)
SSI-related programs which use the income methodologies of the SSI program
(except where the agency has adopted more liberal rules than SSI) described in
chapter 182-512 WAC to determine eligibility:
(i) Apple health for workers with
disabilities (HWD) described in chapter 182-511 WAC;
(ii) Apple health SSI-related programs
described in chapters 182-512 and 182-519 WAC;
(iii) Apple health long-term care and hospice
programs described in chapters 182-513 and 182-515 WAC;
(iv) Apple health medicare savings programs
described in chapter 182-517 WAC; and
(v) Apple health alien emergency medical
(AEM) programs described in WAC
182-507-0110 and
182-507-0125 when the person
meets the age, blindness or disability criteria specified in WAC
182-512-0050.
(b) TANF-related programs which use the
income methodologies based on the TANF cash program described in WAC
388-450-0170 to determine
eligibility, with variations as specified in WAC
182-509-0001(5)
and program specific rules:
(i) Refugee
medical assistance (RMA) program described in WAC
182-507-0130; and
(ii) Apple health medically needy (MN)
coverage for pregnant women and children who do not meet SSI-related
criteria.
(c) Other
programs:
(i) Breast and cervical cancer
program described in WAC
182-505-0120;
(ii) Family planning only programs described
in chapter 182-532 WAC;
(iii)
Medical care services described in WAC
182-508-0005;
(iv) Apple health for pregnant minors
described in WAC
182-505-0117;
(v) Kidney disease program described in
chapter 182-540 WAC; and
(vi)
Tailored supports for older adults described in WAC
182-513-1610.
(4) Deemed eligible apple health programs
include:
(a) Apple health SSI medical program
described in chapter 182-510 WAC, or a person who meets the medicaid
eligibility criteria in 1619b of the Social Security Act;
(b) Newborn medical program described in WAC
182-505-0210(2);
(c) Foster care program described in WAC
182-505-0211;
(d) Medical extension program described in
WAC 182-523-0100; and
(e) Family planning extension described in
WAC 182-505-0115(5).
(5) A person is eligible for categorically
needy (CN) health care coverage when the household's countable income is at or
below the categorically needy income level (CNIL) for the specific
program.
(6) If income is above the
CNIL, a person is eligible for the MN program if the person is:
(a) A child;
(b) A pregnant woman; or
(c) SSI-related (aged 65, blind or
disabled).
(7) MN health
care coverage is not available to parents, caretaker relatives, or adults
unless they are eligible under subsection (6) of this section.
(8) A person who is eligible for the apple
health MAGI-based adult program listed in subsection (2)(b) of this section is
eligible for ABP health care coverage as defined in WAC
182-500-0010. Such a person may
apply for more comprehensive coverage through another apple health program at
any time.
(9) For the other
specific program requirements a person must meet to qualify for apple health,
see chapters 182-503 through 182-527 WAC.
12-13-056, recodified as WAC 182-503-0510, filed 6/15/12,
effective 7/1/12. 12-02-034, recodified as § 182-505-0510, filed 12/29/11,
effective 1/1/12. Statutory Authority:
RCW
34.05.353(2)(d),
74.08.090, and chapters 74.09,
74.04 RCW. 08-11-047, § 388-503-0510, filed 5/15/08, effective 6/15/08.
Statutory Authority:
RCW
74.04.050,
74.04.057,
74.08.090, and
74.09.530. 05-07-097, §
388-503-0510, filed 3/17/05, effective 4/17/05. Statutory Authority:
RCW
74.08.090,
74.08A.100,
74.09.080, and 74.09.415.
02-17-030, § 388-503-0510, filed 8/12/02, effective 9/12/02. Statutory
Authority:
RCW
74.04.050,
74.04.055,
74.04.057 and
74.08.090. 98-16-044, §
388-503-0510, filed 7/31/98, effective
9/1/98.
