Is there a good reason my application for cash or medical assistance has not been processed?
WAC 388-406-0035
WAC 388-406-0035
Effective November 1, 2009
WAC 388-406-0035 How long does the department have to process my application?
We must process your application as quickly as possible. We must respond promptly to your application and to any information you give us. We cannot delay processing your request by using the time limits stated in this section as a waiting period for determining eligibility.
Unless your eligibility determination is delayed good cause under WAC 388-406-0040, we process your application for benefits within thirty calendar days, except:
If you are pregnant, we must process your application for medical assistance within fifteen working days;
If you are applying for General assistance (GA U), alcohol or drug addiction treatment (ADATSA), or medical assistance, we must process your application within forty-five calendar days unless there is good cause as described in WAC 388-406-0045; and
If you are applying for medical assistance that requires a disability decision, we must process your application within sixty calendar days.
For calculating time limits, "day one" is the date following the date:
The department received your application for benefits under WAC 388-406-0010;
Social Security gets a request for food benefits from a Basic Food assistance unit in which all members either get or are applying for Supplemental Security Income (SSI);
You are released from an institution if you get or are authorized to get SSI and request Basic Food through Social Security prior to your release.
WAC 388-406-0040 What happens if the processing of my application is delayed?
We process your application for benefits as soon as possible. We do not intentionally delay processing your application for benefits for any reason. If we have enough information to decide eligibility for:
Basic Food, we promptly process your request for benefits even if we need more information to determine eligibility for cash or medical;
Medical assistance, we promptly process your request for medical even if we need more information to determine eligibility for cash or Basic Food.
If you have completed your required interview under WAC 388-452-0005 and we have enough information to determine eligibility, then we promptly process your application even if is after thirty days from the date of your application.
If additional information is needed to determine eligibility, we give you:
A written request for the additional information; and
An additional thirty days to provide the information.
If you fail to keep or reschedule your interview in the first 30 calendar days after filing your application, your application will be denied on the 30th day. If you are still interested in Basic Food benefits, you will need to reapply. Benefits will be based on your second application date.
If we have not processed your application for Basic Food by the sixtieth day and:
You are responsible for the delay, we deny your request for benefits.
If we are responsible for the delay, we:
Promptly process your request if we have the information needed to determine eligibility; or
Deny your request if we don't have enough information to determine eligibility. If we deny your request we notify you of your right to file a new application and that you may be entitled to benefits lost.
If you reapply by the sixtieth day of your first application, met your interview requirements under WAC 388-452-0005, and are eligible, we give you benefits lost from:
The date of your first application if we caused the delay in the first thirty days; or
The month following the month of your first application if you caused the delay in the first thirty days.
WAC 388-406-0045 Is there a good reason my application for cash or medical assistance has not been processed?
If your application for cash or medical assistance is not processed within the time limits under WAC 388-406-0035, the department must decide if there is a good reason for the delay. This good reason is also called "good cause."
We do not have a good reason for not processing your application for TANF or SFA within thirty days if:
We did not give or send you a notice of what information we needed to determine your eligibility within twenty days from the date of your application;
We did not give or send you a notice that we needed additional information or action within five calendar days of the date we learned that more information was needed to determine eligibility;
We did not process your application within five calendar days from getting the information needed to decide eligibility; and
We decide good cause exists but do not document our decision in the case record on or before the time limit for processing the application ends.
We do have a good reason for not processing your application timely if:
You do not give us the information or take an action needed for us to determine eligibility;
We have an emergency beyond our control; or
There is no other available verification for us to determine eligibility and the eligibility decision depends on information that has been delayed such as:
Medical documentation;
For cash assistance, extensive property appraisals; or
Out-of-state documents or correspondence.
For medical assistance, good cause exists only when the department otherwise acted promptly at all stages of the application process.
For general assistance (GA), good cause exists if you apply when you are confined in Washington State public institution as defined in WAC 388-406-0005 (6) (a).
For cash and medical assistance applications, good cause exists only when the local office meets all processing requirements and the client causes a delay in the process.
EXAMPLE
Client applies for TANF. We schedule an interview appointment timely. The client does not appear for the appointment. The client requests a second appointment on the 29th day following the date of application. Because the client caused the delay, good cause for not processing the application within 30 days exists.
EXAMPLE
Mark applies for GA on August 17th. He is scheduled to be released from Walla Walla Correctional facility on September 1st. His forty-five days ends on September 30th. We receive the medical evidence and establish incapacity on September 28th. He is released on October 5th. Mark is eligible for benefits beginning October 5th. The client caused the delay, so good cause for not processing the application within 45 days exists. (See: Applications for Assistance - Completing the Process)
