Current through Register Vol. 24-18, September 15, 2024
(1)
General eligibility. For purposes of this section, a child must:
(a) Be a Washington state resident under WAC
182-503-0520 and
182-503-0525;
(b) Provide a Social Security number under
WAC 182-503-0515, unless exempt;
and
(c) Meet program-specific
requirements.
(2)
Deemed eligibility groups. A child is automatically eligible for
coverage without an application if the child meets the program-specific
requirements in (a) through (c) of this subsection.
(a)
Newborn coverage. A child
under age one is eligible for categorically needy (CN) coverage if the birth
parent was eligible for Washington apple health on the date of delivery:
(i) Including a retroactive eligibility
determination; or
(ii) By meeting a
medically needy (MN) spenddown liability with expenses incurred by the date of
the newborn's birth:
(b)
Washington apple health for supplemental security income (SSI)
recipients. A child who is eligible for SSI is automatically eligible
for CN coverage under WAC
182-510-0001.
(c)
Foster care coverage. A
child age 20 and younger is eligible for CN coverage under WAC
182-505-0211 when the child is in
foster care or receives subsidized adoption services. For children who age out
of the foster care program, see WAC
182-505-0211(3).
(3)
Continuous eligibility for children
under age six. Children are eligible for Washington apple health
continuous eligibility for children under age six when they:
(a) Have household income at or below 215
percent of the federal poverty level at the time of application; or
(b) Received coverage under subsection (5) of
this section and are no longer eligible for deemed coverage under subsection
(5)(b) or (c) of this section.
(4)
MAGI-based eligibility
groups. A child age 18 and younger is eligible for CN coverage based on
modified adjusted gross income (MAGI):
(a) At
no cost when the child's countable income does not exceed the standard in WAC
182-505-0100
(6)(a);
(b) With payment of a premium when the
child's countable income does not exceed the standard in WAC
182-505-0100
(6)(b), and the child meets additional
eligibility criteria in WAC
182-505-0215;
(c) Under chapter 182-514 WAC, if the child
needs long-term care services because the child resides or is expected to
reside in an institution, as defined in WAC
182-500-0050, for 30 days or
longer. An institutionalized child is eligible for coverage under the medically
needy program if income exceeds the CN income standard for a person in an
institution (special income level);
(d) Under WAC
182-505-0117, if a child is
pregnant.
(5)
Non-MAGI-based children's programs. The agency determines
eligibility for the:
(a) Medically needy (MN)
program according to WAC
182-510-0001(6)
and 182-519-0100. A child age 18 and
younger is eligible if the child:
(i) Is not
eligible for MAGI-based coverage under subsection (4) of this
section;
(ii) Meets citizenship or
immigration requirements under WAC
182-503-0535 (2)(a), (b), (c), or
(d); and
(iii) Meets any spenddown liability required
under WAC
182-519-0110.
(b)
SSI-related program. A child
age 18 and younger is eligible for CN or MN SSI-related coverage if the child
meets:
(i) SSI-related eligibility under
chapter 182-512 WAC;
(ii)
Citizenship or immigration requirements under WAC
182-503-0535 (2)(a), (b), (c), or
(d); and
(iii) Any MN spenddown liability under WAC
182-519-0110.
(c)
SSI-related long-term care
program.(i) A child age 18 and younger
is eligible for home and community based (HCB) waiver programs under chapter
182-515 WAC if the child meets:
(A)
SSI-related eligibility under chapter 182-512 WAC;
(B) Citizenship or immigration requirements
under WAC
182-503-0535 (2)(a), (b), (c), or
(d); and
(C) Program-specific age and functional
requirements under chapters 388-106 and 388-845 WAC.
(ii) A child age 18 and younger who resides
or is expected to reside in a medical institution as defined in WAC
182-500-0050 is eligible for
institutional medical under chapter 182-513 WAC if the child meets:
(A) Citizenship or immigration requirements
under WAC
182-503-0535 (2)(a), (b), (c), or
(d);
(B) Blindness or disability criteria under
WAC 182-512-0050; and
(C) Nursing facility level of care under
chapter 388-106 WAC.
(6)
Alien emergency medical
program. A child age 20 and younger who does not meet the eligibility
requirements for a program described under subsections (2) through (5) of this
section is eligible for the alien emergency medical (AEM) program if the child
meets:
(a) The eligibility requirements of WAC
182-507-0110; and
(b) MN spenddown liability, if any, under WAC
182-519-0110.
(7)
Other provisions.
(a) A child residing in an institution for
mental disease (IMD) as defined in WAC
182-500-0050(1)
is not eligible for inpatient hospital services, unless the child is
unconditionally discharged from the IMD before receiving the
services.
(b) A child incarcerated
in a public institution as defined in WAC
182-500-0050(4)
is only eligible for inpatient hospital
services.
Reviser's note:
RCW
34.05.395 requires the use of underlining and
deletion marks to indicate amendments to existing rules. The rule published
above varies from its predecessor in certain respects not indicated by the use
of these markings.
12-13-056, recodified as WAC 182-505-0210, 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). 11-23-077, § 388-505-0210,
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). 11-03-001, § 388-505-0210, 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.
09-07-086, § 388-505-0210, 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.
08-05-018, § 388-505-0210, filed 2/12/08, effective 3/14/08. Statutory
Authority:
RCW
74.08.090,
74.09.530, and 74.09.415.
05-23-013, § 388-505-0210, filed 11/4/05, effective 1/1/06. Statutory
Authority:
RCW
74.04.050,
74.04.055,
74.04.057,
74.08.090. 04-15-057, §
388-505-0210, filed 7/13/04, effective 8/13/04. Statutory Authority:
RCW
74.08.090 and
74.04.050. 03-14-107, §
388-505-0210, filed 6/30/03, effective 7/31/03. Statutory Authority:
RCW
74.08.090,
74.08A.100,
74.09.080, and 74.09.415.
02-17-030, § 388-505-0210, filed 8/12/02, effective 9/12/02. Statutory
Authority:
RCW
74.08.090,
74.04.050, [74.04.]055,
and[74.04.]057 . 01-11-110, § 388-505-0210, filed 5/21/01, effective
6/21/01. Statutory Authority:
RCW
74.08.090 and
74.08A.100. 99-17-023, §
388-505-0210, filed 8/10/99, effective 9/10/99. Statutory Authority:
RCW
74.04.050,
74.04.055,
74.04.057 and
74.08.090. 98-16-044, §
388-505-0210, filed 7/31/98, effective 9/1/98. Formerly WAC 388-509-0905,
388-509-0910 and 388-509-0920.
