WAC 182-504-0125

Effective October 1, 2013

WAC 182-504-0125 Washington apple health -- Effect of reported changes.



(1) If you report a change required under WAC 182-504-0105 during a certification period, you continue to be eligible for Washington apple health (WAH) coverage until we decide if you can keep getting WAH coverage under a different WAH program.

(2) If your WAH categorically needy (CN) coverage ends due to a reported change and you meet all the eligibility requirements for a different WAH CN program, we will approve your coverage under the new WAH CN program. If you are not eligible for coverage under any WAH CN program but you meet the eligibility requirements for either WAH alternative benefits plan (ABP) coverage or WAH medically need (MN) coverage, we will approve your coverage under the program you are eligible for. If you are not eligible for coverage under any WAH CN program but you meet the eligibility requirements for both WAH ABP coverage and WAH MN coverage, we will approve the coverage that provides more appropriate coverage for your medical needs.

(3) If your WAH coverage ends and you are not eligible for a different WAH program, we stop your WAH coverage after giving you advance and adequate notice, unless the exception in subsection (4) applies to you.

(4) If you claim to have a disability and that is the only basis for you to be potentially eligible for WAH coverage, then we refer you to the division of disability determination services (within the department of social and health services) for a disability determination. Pending the outcome of the disability determination, we also determine if you are eligible for WAH coverage under the SSI related medical program described in chapter 182-512 WAC. If you have countable income in excess of the SSI related categorically needy income level (CNIL), then we look to see if you can get coverage under WAH MN with spenddown as described in chapter 182-519 WAC, pending the final outcome of the disability determination.

(5) If you receive coverage under the WAH parent and caretaker relative program described in WAC 182-505-0240, you will be eligible for the WAH health care extension program described in WAC 182-523-0100, if your coverage ends as a result of an increase in your earned income.

(6) Changes in income during a certification period do not affect eligibility for the following programs:

(a) WAH for pregnant women;

(b) WAH for kids, except as specified in subsection (7) of this section;

(c) WAH for SSI recipients;

(d) WAH refugee program; and

(e) WAH medical extension program.

(7) We redetermine eligibility for children receiving WAH for kids premium-based coverage described in WAC 182-505-0210 when the:

(a) Household's countable income decreases to less than two hundred percent federal poverty level (FPL);

(b) Child becomes pregnant;

(c) Family size changes; or

(d) Child receives SSI.

(8) If you get SSI-related WAH CN coverage and report a change in work or earned income which results in a determination by the division of disability determination services that you no longer meet the definition of a disabled individual as described in WAC 182-512-0050, due to work or earnings at the level of substantial gainful activity, we re-determine your eligibility for coverage under the health care for workers with disabilities (HWD) program. The HWD program is a premium-based program that waives the SGA work or earnings test, and you must approve the premium amount before we can authorize coverage under this program. For HWD program rules, see chapter 188-511 WAC..

(9) Prior to a scheduled renewal or March 31, 2014, whichever is later, your WAH coverage will not end and you will not pay more for your WAH coverage as a result of an eligibility determination if:

(a) You are enrolled in WAH at the time of the eligibility determination;

(b) You were enrolled in WAH prior to October 1, 2013; and

(c) At the time of the eligibility determination, your enrollment in WAH is not yet based on MAGI methodologies.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.