Applications for Assistance - Special Situations
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Applications for Assistance - Special Situations


Revised December 31, 2013



Purpose: This section contains applications procedures for special situations, including when an applicant is temporarily out of state and the Trial Visit Program.

WORKER RESPONSIBILITIES

*** As a result of implementation of the Affordable Care Act (ACA), this clarifying page may no longer be effective for medical coverage applications received on or after 10/01/2013. Please see the ACA Transition Plan for more information. Clients under 65 years of age who need to apply for medical coverage on or after 10/01/2013 should be referred to Washington Healthplanfinder. Applications for medical coverage for households where all members are 65 years of age and older should be referred to Washington Connection. ***

    • 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. 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.
  1.   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.

NOTE: An overnight hospital stay is not a qualifying event by itself. Sometimes emergency services or outpatient services can be overnight. If you are unsure of whether the hospitalization was inpatient, please contact the facility before denying the application.

NOTE: Many of the inmate applications that come to DSHS for inpatient stays are processed by financial staff dedicated to this function. NGMA requests are completed by jail or hospital staff, identified by an inmate application cover-sheet and directed to the attention of a dedicated staff person for completion. NGMA applications from the Dept. of Corrections are routed to Olympia CSO for processing. NGMA requests coming from the University of Washington Medical Center are processed by the Region 2 - 1290 staff.
Modification Date: December 31, 2013