WAC 388-418-0025 Effect of changes on medical program eligibility.
You continue to be eligible for medical assistance until the department determines your ineligibility or eligibility for another medical program. This applies to you if, during a certification period, you become ineligible for, or are terminated from, or request termination from:
A CN Medicaid program;
A program included in apple health for kids; or
Any of the following cash grants:
TANF;
SSI; or
GA-X. See WAC 388-434-0005 for changes reported during eligibility review.
If you become ineligible for refugee cash assistance, refugee medical assistance can be continued through the eight month limit, as described in WAC 388-400-0035(4).
If you receive a TANF cash grant or family medical, you are eligible for a medical extension, as described under WAC 388-523-0100, when your cash grant or family medical program is terminated as a result of:
Earned income; or
Collection of child or spousal support.
A change in income during a certification period does affect eligibility for all medical programs except:
Pregnant women's medical programs;
A program included in apple health for kids, except as specified in subsection (5);
The first six months of the medical extension benefits.
For a child receiving premium-based coverage under a program included in apple health for kids as described in WAC 388-505-0210 and chapter 388-542 WAC, the department must redetermine eligibility for nonpremium-based coverage when the family reports:
Family income has decreased to less than two hundred percent Federal Poverty Level (FPL);
1. Pregnant women and children found eligible for a CN medical program are continuously eligible through the end of their certification period. The only exceptions are aging out of the program, moving out of state, failing to pay a required premium, incarceration, or death. See WAC 388-416-0015.
NOTE:
Newborns approved SSI receives continuous CN for 12 months from the date of the SSI medical opening even if they are no longer eligible under the SSI program.
2. If mail is returned, see if a forwarding address is provided.
If one is provided, update the address. No further action is necessary.
If one is not provided, terminate the assistance for loss of contact/whereabouts unknown. Advance notice is not necessary.
If the client provides an updated Washington address at any time during the original certification period, the assistance unit is reinstated from the month of termination through the end of the original certification period. A new application is not necessary.
EXAMPLE
A household is receiving medical assistance for their children under the F06 program. The original certification period is January through December. In April, mail is returned with no forwarding address. The medical assistance is closed for loss of contact/whereabouts unknown effective 4/30/xx, and a termination letter is sent. In June, the client calls the worker and reports a new Washington address. The worker reinstates the assistance unit from May through December without requiring a new application.
3. When a child is terminated from a CN program because the head of household left the home, the child left the home, out of state residence, citizenship, whereabouts unknown, or no longer in institutional care, the system does not auto-open F06 but does track the 12 month eligibility for that child. When the child reapplies at any time during the remainder of the 12 calendar months of tracking and satisfies non-financial eligibility requirements, the system will approve CN under medical coverage group F06 for the remainder of the 12 month period regardless of income. A child who is no longer eligible for institutional medical coverage under the K01 program because they have discharged from the institutional setting is NOT required to submit a new application or review to receive the balance of the certification. Process the change in living arrangements as a change of circumstances and open an F06 AU for that child through the original certification date.
EXAMPLE
A child is in the hospital and receiving CN coverage under medical coverage group K01. The child is released to return home. The system does not have enough information on the household to automatically open the child on F06. Add an F06 AU to the active K01 AU and allow the system to close the K01 AU as the living arrangement code is updated in each process month. If parental income is not verified or known, code the parents' income verification field as "failed" and the system will not establish a new 12 month certification. It will recognize the continuous eligibility tracking from the K01 program and continue medical coverage for the child under the F06 program for the balance of their 12 month certification period. When a medical request for this child is screened into the system, the system looks at all eligibility factors. If non-financial and financial requirements are met, the system opens a new 12 month certification period and the child begins a new tracking period.
4. See WAC 388-505-0211 and WAC 388-542-0050 for information on closure of premium-based children's healthcare coverage for a client who:
a. Fails to pay their premiums, or
b.Had creditable health insurance coverage at the time of their application or review.
5. When a pregnancy ends, regardless of the reason, medical coverage continues through the end of the month containing the sixtieth day from the day pregnancy ends. See PREGNANCY.
NOTE:
If the pregnant woman is pending spenddown when the baby is born and meets spenddown with the birth of the baby she is eligible for 60 days postpartum MN extension.
6. A working TANF recipient is eligible for family medical even when he/she chooses to terminate cash assistance to save cash TANF months. The client is eligible for family medical (F04) as long as countable income is less than the CNIL.
EXAMPLE
A mother and her two children receive TANF cash benefits. The mother starts working. To 'bank' cash assistance months she requests termination. Redetermine eligibility for TANF-related family medical (F04).
b. A change resulting in eligibility for a medical extension.
8.If changes in income increase the spenddown liability, the change is effective the first of the month after the change. An increase in resources may affect MN eligibility.
WORKER RESPONSIBILITIES
If the client has not met the increased spenddown liability, terminate MN or MI giving advance and adequate notice. See SPENDDOWN.
