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PDFWAC 182-508-0005

Eligibility for Washington apple health medical care services eligibility and scope of coverage.

(1) A person is eligible for state-funded Washington apple health (WAH) medical care services (MCS) coverage to the extent of available funds if the person is:
(a) Determined by the department of social and health services to be eligible for 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; and
(b) Not eligible for another federally funded categorically needy (CN) (as defined in WAC 182-500-0020) or alternative benefits plan (ABP) (as defined in WAC 182-500-0010) WAH program.
(2) If an enrollment cap exists under WAC 182-508-0150, a waiting list of persons may be established.
(3) A person's period of eligibility for MCS is the same as either the person's period of eligibility for the aged, blind, or disabled program as described in WAC 388-449-0150 or the person's incapacity authorization period for the housing and essential needs referral program as described in WAC 388-447-0110.
(4) The MCS program covers only the medically necessary services defined in WAC 182-501-0060.
(5) The MCS program does not cover medical services received outside the state of Washington unless the medical services are provided in a border city listed in WAC 182-501-0175.
[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 14-16-019, § 182-508-0005, filed 7/24/14, effective 8/24/14. Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0005, filed 9/13/12, effective 10/14/12.]
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