Chapter 182-508 WAC

Last Update: 10/7/14

CLASSIC AND STATE-FUNDED WASHINGTON APPLE HEALTH ELIGIBILITY FOR ADULTS

WAC Sections

182-508-0001Washington apple health—Coverage options for adults not eligible under MAGI methodologies.
182-508-0005Eligibility for Washington apple health medical care services eligibility and scope of coverage.
182-508-0150Enrollment cap for medical care services (MCS).
DISPOSITION OF SECTIONS FORMERLY CODIFIED IN THIS TITLE
182-508-0010Incapacity requirements for medical care services (MCS). [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0010, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0015Determining if an individual is incapacitated. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0015, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0020Acceptable medical evidence. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0020, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0030Required medical evidence. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0030, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0035How severity ratings of impairment are assigned. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0035, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0040PEP Step I—Review of medical evidence required for eligibility determination. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0040, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0050PEP Step II—Determining the severity of mental impairments. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0050, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0060PEP Step III—Determining the severity of physical impairments. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0060, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0070PEP Step IV—Determining the severity of multiple impairments. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0070, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0080PEP Step V—Determining level of function of mentally impaired individuals in a work environment. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0080, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0090PEP Step VI—Determining level of function of physically impaired individuals in a work environment. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0090, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0100PEP Step VII—Evaluating a client's capacity to perform relevant past work. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0100, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0110PEP Step VIII—Evaluating a client's capacity to perform other work. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0110, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0120Deciding how long a client is incapacitated. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0120, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0130Medical care services—Limited coverage. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0130, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0160When medical care services benefits end. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0160, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0220How alcohol or drug dependence affects an individual's eligibility for medical care services (MCS). [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0220, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0230Eligibility standards for medical care services (MCS); aged, blind, or disabled (ABD); and Alcohol and Drug Addiction Treatment and Support Act (ADATSA). [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0230, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0300What is the purpose of this chapter? [WSR 11-22-051, recodified as § 182-508-0300, filed 10/31/11, effective 10/31/11. Statutory Authority: RCW 74.08.090, 74.50.80 [74.50.080]. WSR 00-16-077, § 388-800-0005, filed 7/28/00, effective 9/1/00.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0305Detoxification—Covered services. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0305, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0310ADATSA—Purpose. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0310, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0315ADATSA—Covered services. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0315, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0320ADATSA—Eligible individuals. [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0320, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0325When am I eligible for ADATSA treatment services? [WSR 11-22-051, recodified as § 182-508-0325, filed 10/31/11, effective 10/31/11. Statutory Authority: RCW 74.08.090, 74.50.80 [74.50.080]. WSR 00-16-077, § 388-800-0050, filed 7/28/00, effective 9/1/00.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0330What clinical incapacity must I meet to be eligible for ADATSA treatment services? [WSR 11-22-051, recodified as § 182-508-0330, filed 10/31/11, effective 10/31/11. Statutory Authority: RCW 74.50.080 and 2002 c 64. WSR 03-02-079, § 388-800-0055, filed 12/30/02, effective 1/30/03. Statutory Authority: RCW 74.08.090, 74.50.80 [74.50.080]. WSR 00-16-077, § 388-800-0055, filed 7/28/00, effective 9/1/00.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0335Will I still be eligible for ADATSA outpatient services if I abstain from using alcohol or drugs, become employed, or have a relapse? [WSR 11-22-051, recodified as § 182-508-0335, filed 10/31/11, effective 10/31/11. Statutory Authority: RCW 74.08.090, 74.50.80 [74.50.080]. WSR 00-16-077, § 388-800-0057, filed 7/28/00, effective 9/1/00.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0340What is the role of the certified chemical dependency service provider in determining ADATSA eligibility? [WSR 11-22-051, recodified as § 182-508-0340, filed 10/31/11, effective 10/31/11. Statutory Authority: RCW 74.50.080 and 2002 c 64. WSR 03-02-079, § 388-800-0060, filed 12/30/02, effective 1/30/03. Statutory Authority: RCW 74.08.090, 74.50.80 [74.50.080]. WSR 00-16-077, § 388-800-0060, filed 7/28/00, effective 9/1/00.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0345What are the responsibilities of the certified chemical dependency service provider in determining eligibility? [WSR 11-22-051, recodified as § 182-508-0345, filed 10/31/11, effective 10/31/11. Statutory Authority: RCW 74.50.080 and 2002 c 64. WSR 03-02-079, § 388-800-0065, filed 12/30/02, effective 1/30/03. Statutory Authority: RCW 74.08.090, 74.50.80 [74.50.080]. WSR 00-16-077, § 388-800-0065, filed 7/28/00, effective 9/1/00.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0350What happens after I am found eligible for ADATSA services? [WSR 11-22-051, recodified as § 182-508-0350, filed 10/31/11, effective 10/31/11. Statutory Authority: RCW 74.50.080 and 2002 c 64. WSR 03-02-079, § 388-800-0070, filed 12/30/02, effective 1/30/03. Statutory Authority: RCW 74.08.090, 74.50.80 [74.50.080]. WSR 00-16-077, § 388-800-0070, filed 7/28/00, effective 9/1/00.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0355What criteria does the certified chemical dependency service provider use to plan my treatment? [WSR 11-22-051, recodified as § 182-508-0355, filed 10/31/11, effective 10/31/11. Statutory Authority: RCW 74.50.080 and 2002 c 64. WSR 03-02-079, § 388-800-0075, filed 12/30/02, effective 1/30/03. Statutory Authority: RCW 74.08.090, 74.50.80 [74.50.080]. WSR 00-16-077, § 388-800-0075, filed 7/28/00, effective 9/1/00.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0360Do I have to contribute to the cost of residential treatment? [WSR 11-22-051, recodified as § 182-508-0360, filed 10/31/11, effective 10/31/11. Statutory Authority: RCW 74.08.090, 74.50.80 [74.50.080]. WSR 00-16-077, § 388-800-0085, filed 7/28/00, effective 9/1/00.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0365What happens when I withdraw or am discharged from treatment? [WSR 11-22-051, recodified as § 182-508-0365, filed 10/31/11, effective 10/31/11. Statutory Authority: RCW 74.50.080 and 2002 c 64. WSR 03-02-079, § 388-800-0090, filed 12/30/02, effective 1/30/03. Statutory Authority: RCW 74.08.090, 74.50.80 [74.50.080]. WSR 00-16-077, § 388-800-0090, filed 7/28/00, effective 9/1/00.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0370What are the groups that receive priority for ADATSA services? [WSR 11-22-051, recodified as § 182-508-0370, filed 10/31/11, effective 10/31/11. Statutory Authority: RCW 74.50.080 and 2002 c 64. WSR 03-02-079, § 388-800-0100, filed 12/30/02, effective 1/30/03. Statutory Authority: RCW 74.08.090, 74.50.80 [74.50.080]. WSR 00-16-077, § 388-800-0100, filed 7/28/00, effective 9/1/00.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.
182-508-0375ADATSA—Eligibility for state-funded medical care services (MCS). [Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0375, filed 9/13/12, effective 10/14/12.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. 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.


182-508-0001
Washington apple healthCoverage options for adults not eligible under MAGI methodologies.

(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 sixty-five 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 sixteen through sixty-four;
(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;
(d) Have net income that does not exceed the income standard described in WAC 182-511-1060; and
(e) 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 182-513-1305.
(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) WAH-MN long-term care coverage is determined under WAC 182-514-0255 for an adult age nineteen or twenty who:
(i) Meets institutional status requirements described in WAC 182-513-1320;
(ii) Does not meet blind or disabled criteria described in WAC 182-512-0050; and
(iii) Has 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 sixty-five 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, 41.05.160, P.L. 111-148, 42 C.F.R. §§ 431, 435, 457, and 45 C.F.R. § 155. WSR 14-21-040, § 182-508-0001, filed 10/7/14, effective 11/7/14. Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-508-0001, filed 9/13/12, effective 10/14/12.]



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.]



182-508-0150
Enrollment cap for medical care services (MCS).

(1) Enrollment in medical care services (MCS) coverage is subject to available funds.
(2) The 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 thirty-day reconsideration period for incapacity reviews under WAC 388-447-0110(4);
(c) The person is being terminated from a 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 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, but the determination was not completed prior to the enrollment cap effective date.
(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 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.
[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, § 182-508-0150, 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, § 182-508-0150, filed 9/13/12, effective 10/14/12.]