Current through Register Vol. 24-18, September 15, 2024
(1)
This chapter provides information on eligibility determinations for adults who:
(a) Need a determination of eligibility on
the basis of being aged, blind, or disabled;
(b) Need a determination of eligibility based
on the need for long-term institutional care or home and community-based
services;
(c) Are excluded from
coverage under a modified adjusted gross income (MAGI)-based program as
referenced in WAC
182-503-0510 on the basis of
medicare entitlement;
(d) Are not
eligible for health care coverage under chapter 182-505 WAC due to citizenship
or immigration requirements; or
(e)
Are not eligible for health care coverage under chapter 182-505 WAC due to
income which exceeds the applicable standard for coverage.
(2) The agency determines eligibility for
Washington apple health (WAH) noninstitutional categorically needy (CN)
coverage under chapter 182-512 WAC for an adult who is age 65 or older, or who
meets the federal blind or disabled criteria of the federal SSI program, and:
(a) Meets citizenship/immigration, residency,
and Social Security number requirements as described in chapter 182-503 WAC;
and
(b) Has CN countable income and
resources that do not exceed the income and resource standards in WAC
182-512-0010.
(3) The agency determines
eligibility for WAH health care for workers with disabilities (HWD) CN coverage
for adults who meet the requirements described in WAC
182-511-1050, as follows:
(a) Are age 16 or older;
(b) Meet citizenship/immigration, residency,
and Social Security number requirements as described in chapter 182-503
WAC;
(c) Meet the federal
disability requirements described in WAC
182-511-1150; and
(d) Are employed full- or part-time
(including self-employment) as described in WAC
182-511-1200.
(4) The agency determines
eligibility for WAH long-term care CN coverage for adults who meet the
institutional status requirements defined in WAC
182-513-1320 under the following
rules:
(a) When the person receives coverage
under a MAGI-based program and needs long-term care services in an institution,
the agency follows rules described in chapter 182-514 WAC;
(b) When the person meets aged, blind, or
disabled criteria as defined in WAC
182-512-0050 and needs long-term
care services, the agency follows rules described in:
(i) Chapter 182-513 WAC, for an adult who
resides in an institution; and
(ii)
Chapter 182-515 WAC, for an adult who is determined eligible for WAH home and
community-based waiver services.
(5) The agency determines eligibility for WAH
noninstitutional CN or medically needy (MN) health care coverage for an adult
who resides in an alternate living facility under rules described in WAC
182-513-1205.
(6) The agency determines eligibility for
WAH-CN coverage under institutional rules described in chapters 182-513 and
182-515 WAC for an adult who:
(a) Has made a
voluntary election of hospice services;
(b) Is not otherwise eligible for
noninstitutional CN or MN health care coverage or for whom hospice is not
included in the benefit service package available to the person; and
(c) Meets the aged, blind, or disabled
criteria described in WAC
182-512-0050.
(7) The agency uses the following
rules to determine eligibility for an adult under the WAH-MN program:
(a) Noninstitutional WAH-MN is determined
under chapter 182-519 WAC for an adult with countable income that exceeds the
applicable CN standard; and
(b)
Non-SSI-related institutional WAH-MN long-term care coverage is determined
under WAC
182-514-0263 for pregnant people
and people age 20 and younger who:
(i) Meet
institutional status requirements described in WAC
182-513-1320;
(ii) Do not meet blind or disabled criteria
described in WAC
182-512-0050; and
(iii) Have countable income that exceeds the
applicable CN standard.
(c) WAH-MN long-term care coverage is
determined under WAC
182-513-1395 for an aged, blind,
or disabled adult who resides in an institution and has countable income that
exceeds the special income level (SIL).
(8) An adult is eligible for WAH-MN coverage
when he or she:
(a) Meets
citizenship/immigration, residency, and Social Security number requirements as
described in WAC
182-503-0505;
(b) Has MN countable income that does not
exceed the effective MN income standards in WAC
182-519-0050, or meets the excess
income spenddown requirements in WAC
182-519-0110;
(c) Meets the countable resource standards in
WAC 182-519-0050; and
(d) Is 65 years of age or older or meets the
blind or disabled criteria of the federal SSI program.
(9) WAH-MN coverage is available for an aged,
blind, or disabled ineligible spouse of an SSI recipient. See WAC
182-519-0100 for additional
information.
(10) An adult who does
not meet citizenship or alien status requirements described in WAC
182-503-0535 may be eligible for
the WAH alien emergency medical program as described in WAC
182-507-0110.
(11) An adult is eligible for the
state-funded medical care services (MCS) program when he or she meets the
requirements under WAC
182-508-0005.
(12) A person who is entitled to medicare is
eligible for coverage under a medicare savings program or the state-funded
buy-in program when he or she meets the requirements described in chapter
182-517 WAC.
Statutory Authority:
RCW
41.05.021,
74.09.035, and
2011 1st sp.s. c
36 . 12-19-051, §182-508-0001, filed 9/13/12,
effective 10/14/12.
