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182-538-063  <<  182-538-065 >>   182-538-067

WAC 182-538-065

Agency filings affecting this section

Medicaid-eligible basic health (BH) enrollees.

(1) Certain children and pregnant women who have applied for, or are enrolled in, managed care through basic health (BH) (chapter 70.47 RCW) are eligible for medicaid under pediatric and maternity expansion provisions of the Social Security Act. The agency determines medicaid eligibility for children and pregnant women who enroll through BH.
(2) Eligible children are enrolled in the BH plus program and eligible pregnant women are enrolled in the maternity benefits program.
(3) The administrative rules and regulations that apply to managed care enrollees also apply to medicaid-eligible clients enrolled through BH plus or the maternity benefits program as described in this section, except as follows:
(a) American Indian and Alaska native (AI/AN) clients cannot choose fee-for-service or PCCM as described in WAC 182-538-060(2). They must enroll in a HCA-contracted MCO.
(b) The agency does not consider the basic health plus and the maternity benefits programs to be third party.
(4) This section does not apply to the subsidized basic health program found in chapter 182-24 WAC.
[Statutory Authority: RCW 41.05.021, 42 C.F.R. 438. WSR 13-02-010, § 182-538-065, filed 12/19/12, effective 2/1/13. WSR 11-14-075, recodified as § 182-538-065, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.522. WSR 06-03-081, § 388-538-065, filed 1/12/06, effective 2/12/06. Statutory Authority: RCW 74.08.090, 74.09.522, 2003 E1 c 25 § 201(4), 2004 c 276 § 201(4), 42 U.S.C. 1396N (section 1915 (b) and (c) of the Social Security Act of 1924). WSR 05-01-066, § 388-538-065, filed 12/8/04, effective 1/8/05. Statutory Authority: RCW 74.09.080, 74.08.510, [74.08.]522, 74.09.450, 1115 Waiver, 42 U.S.C. 1396. WSR 02-01-075, § 388-538-065, filed 12/14/01, effective 1/14/02. Statutory Authority: RCW 74.08.090, 74.09.510 and [74.09.]522 and 1115 Federal Waiver, 42 U.S.C. 1396 (a), (e), (p), 42 U.S.C. 1396r-6(b), 42 U.S.C. 1396u-2. WSR 00-04-080, § 388-538-065, filed 2/1/00, effective 3/3/00.]