Applications for Assistance - Special Situations

Revised April 10, 2013

WORKER RESPONSIBILITIES

1. Applicant temporarily out of state:
   1. A client who is temporarily out of the state may submit an application if the client:
      1. Meets the program specific definition of resident (see WAC 388-468-0005 );
      2. Has lived in and acquired residence in the state prior to application;
      3. Is living in the United States;
      4. Intend to return to Washington State to live; and
      5. Provide proof of Washington State residence, as evidenced by return trips to the state, maintaining a home in the state, and/or statements from persons knowledgeable of the client's circumstances and intent to return to the state to live.
   2. To process the application:
      1. Arrange for the public assistance agency in the state where the client is living to receive the application, obtain information necessary to make an eligibility determination, and forward this information to the CSO for processing;
      2. Determine eligibility as for any other client.
      3. Arrange for delivery of the warrant if the client is eligible.
2. Trial Visit Program: The Trial Visit Program is part of a treatment plan for clients in institutions. The institution determines if the client is to participate in the program. If assistance is needed before the client can participate in the program, the CSO serving the client's institution will initiate the application.
   1.   Administrative Disability Review Committee:  Each institution will designate a liaison to coordinate with the CSO when an approved trial visit client is in need of public assistance. At least ten days prior to the scheduled release date, the liaison will provide the CSO with a completed Application for Benefits, DSHS 14-001(X) and related supplements. In addition, the liaison will provide:
      1. Dates of the proposed trial visit;
      2. Address of the trial visit residence;
      3. Amount of cash reserve the client has at the institution identified as available to the client;
      4. A medical and social summary of the client when needed;
      5. Verification documents (such as proof of age and citizenship);
      6. Transportation arrangements;
      7. Extension notice of a trial visit at least five days prior to the effective date of the extension.
3. Applications for MSP (S03) screened daily from Social Security Administration Interface (LIS file)
   1. Determine eligibility for a Medicare Savings Program (MSP) and, if requested, all other medical programs.
      1. Review ACES instructions for auto-screened MSP application at the ACES release documents link. 
      2. WA State SSI Related income and resource rules differ from SSA LIS income and resource rules so S03 cannot be auto-opened without an application.
      3. ACES sends a LTR 023-02 and a 14-001 application form.
      4. If client returns the application form, look to see if medical is requested.  If so, determine eligibility for all medical programs. 
      5. If medical is not checked, determine eligibility for only the Medicare Savings Programs (ie S03, S04, S05 and S06). 
      6. The Standard of Promptness (SOP) count begins from the date DSHS received the SSA/LIS input file.  ACES is programmed to apply the correct SOP date. 
      7. Estate Recovery rules apply to all medical programs except MSP. 
      8. Estate Recovery rules apply to all medical programs except MSP.
   2. Denying automated MSP applications.
      1. ACES will auto-deny MSP applications with LTR 004-05 and reason code 230 after 30 days when an application is not returned.
      2. Do not deny for failure to provide information prior to the automated ACES denial.
4.   Medicaid coverage for inmates of a public institution that are admitted inpatient to a hospital or chemical dependency treatment facility.
   1. Inmates of public institutions, such as prison or jail, may be Medicaid eligible if they are admitted to a medical institution (inpatient) and are categorically relatable to a Medicaid program. Being relatable to a program means the applicant is; under age 19, pregnant, over age 65, blind or disabled.
   2. Applicants age 19 to 65 who are not receiving SSI or Social Security Disability must be determined disabled using the SSA disability criteria (refer for NGMA determination through DDDS).
   3. A visit to the Emergency Room is not a qualifying event unless the individual is admitted to the hospital as an inpatient. If there are any questions about whether the stay is inpatient or not please contact the hospital or facility.