Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-508 - Classic and state-funded Washington apple health eligibility for adults
Section 182-508-0150 - Enrollment cap for medical care services (MCS)
Universal Citation: WA Admin Code 182-508-0150
Current through Register Vol. 24-18, September 15, 2024
(1) Enrollment in medical care services (MCS) coverage is subject to available funds.
(2) The
medicaid agency may limit enrollment into MCS coverage by implementing an
enrollment cap and wait list.
(3)
If a person is denied MCS coverage due to an enrollment cap:
(a) The person is added to the MCS wait list
based on the date the person applied.
(b) Applicants with the oldest application
date will be the first to receive an opportunity for enrollment when MCS
coverage is available as long as the person remains on the MCS wait
list.
(4) A person is
exempted from the enrollment cap and wait list rules when:
(a) MCS was terminated due to agency
error;
(b) The person is in the
30-day reconsideration period for incapacity reviews under WAC
388-447-0110(4);
(c) The person is being terminated from a
categorically needy (CN) medical program and was receiving and eligible for CN
coverage prior to the date a wait list was implemented and at the time their CN
coverage ended, the person met eligibility criteria to receive benefits under
either the aged, blind, or disabled program as described in WAC
388-400-0060
or the housing and essential needs referral program as described in WAC
388-400-0070;
or
(d) The person applied for a
determination by the department of social and health services (DSHS) to be
eligible for benefits under one of the following programs, but the
determination was not completed before the enrollment cap effective date:
(i) The aged, blind, or disabled program as
described in WAC
388-400-0060;
(ii) The housing and essential needs referral
program as described in WAC
388-400-0070;
or
(iii) The survivors of certain
crimes (SCC) program, as described in WAC 388-424-0035, which includes victims
of human trafficking as described in
RCW
74.04.005.
(5) The person is removed from the MCS wait
list if the person:
(a) Is not a Washington
resident;
(b) Is
deceased;
(c) Requests removal from
the wait list;
(d) Is found
eligible for categorically or medically needy coverage; or
(e) Is no longer determined by DSHS to be
eligible for benefits under:
(i) The aged,
blind, or disabled program as described in WAC
388-400-0060;
(ii) The housing and essential needs referral
program as described in WAC
388-400-0070;
or
(iii) The SCC program as
described in WAC 388-424-0035.
Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36 . 12-19-051, §182-508-0150, filed 9/13/12, effective 10/14/12.
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