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PDFWAC 182-503-0505

Washington apple healthGeneral eligibility requirements.

(1) When you apply for Washington apple health programs established under chapter 74.09 RCW, you must meet the eligibility criteria in chapters 182-500 through 182-527 WAC.
(2) When you apply for apple health, we first consider you for federally funded or federally matched programs. We consider you for state-funded programs after we have determined that you are ineligible for federally funded and federally matched programs.
(3) Unless otherwise specified in a program specific WAC, the eligibility criteria for each program are as follows:
(a) Age (WAC 182-503-0050);
(b) Residence in Washington state (WAC 182-503-0520 and 182-503-0525);
(c) Citizenship or immigration status in the United States (WAC 182-503-0535);
(d) Possession of a valid Social Security account number (WAC 182-503-0515);
(e) Assignment of medical support rights to the state of Washington (WAC 182-503-0540);
(f) Application for medicare and enrollment into medicare's prescription drug program if:
(i) You are likely entitled to medicare; and
(ii) We have authority to pay medicare cost sharing as described in chapter 182-517 WAC.
(g) If your eligibility is not based on modified adjusted gross income (MAGI) methodology, your countable resources must be within specific program limits (chapters 182-512, 182-513, 182-515, 182-517, and 182-519 WAC); and
(h) Countable income within program limits:
(i) For MAGI-based programs, see WAC 182-505-0100;
(ii) For the refugee program, see WAC 182-507-0130;
(iii) For the medical care services program, see WAC 182-508-0005;
(iv) For the health care for workers with disabilities (HWD) program, see WAC 182-511-1000;
(v) For the SSI-related program, see WAC 182-512-0010;
(vi) For long-term care programs, see chapters 182-513 and 182-515 WAC;
(vii) For medicare savings programs, see WAC 182-517-0100; and
(viii) For the medically needy program, see WAC 182-519-0050.
(4) In addition to the general eligibility requirements in subsection (3) of this section, each program has specific eligibility requirements as described in applicable WAC.
(5) If you are in a public institution, including a correctional facility, you are not eligible for full scope apple health coverage, except in the following situations:
(a) If you are age 21 or younger or age 65 or older and are a patient in an institution for mental disease (see WAC 182-513-1317(5)); or
(b) You receive inpatient hospital services outside of the public institution or correctional facility.
(6) We limit coverage for people who become residents in a public institution, under subsection (5) of this section, until they are released.
(7) If you are terminated from SSI or lose eligibility for categorically needy (CN) or alternative benefits plan (ABP) coverage, you receive coverage under the apple health program with the highest scope of care for which you may be eligible while we determine your eligibility for other health care programs. See WAC 182-504-0125.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 19-08-029, § 182-503-0505, filed 3/27/19, effective 4/27/19; WSR 17-12-017, § 182-503-0505, filed 5/30/17, effective 6/30/17. Statutory Authority: RCW 41.05.021, 41.05.160, Public Law 111-148, 42 C.F.R. § 431, 435, and 457, and 45 C.F.R. § 155. WSR 14-16-052, § 182-503-0505, filed 7/29/14, effective 8/29/14. WSR 12-13-056, recodified as § 182-503-0505, filed 6/15/12, effective 7/1/12. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.530, 42 U.S.C., Section 1396a. WSR 07-21-005, § 388-503-0505, filed 10/4/07, effective 11/4/07. Statutory Authority: RCW 74.08.090, 74.09.530, and 2003 1st sp.s. c 25. WSR 04-07-141, § 388-503-0505, filed 3/22/04, effective 4/22/04. Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. WSR 02-17-030, § 388-503-0505, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. WSR 98-16-044, § 388-503-0505, filed 7/31/98, effective 9/1/98. Formerly WAC 388-501-0110, 388-503-0305 and 388-505-0501.]
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