WAC 182-503-0532 Citizenship requirements for the medical care services (MCS) and ADATSA programs.

(1)  To receive medical care services (MCS) benefits, an individual must be ineligible for the temporary assistance for needy families (TANF) or the Supplemental Security Income (SSI) program for a reason other than failure to cooperate with program requirements, and belong to one of the following groups as defined in WAC 388-424-0001:

(a)  A U.S. citizen;

(b)  A U.S. national;

(c)  An American Indian born outside the U.S.;

(d)  A "qualified alien" or similarly defined lawful immigrant such as victim of trafficking; or

(e)  A nonqualified alien who meets the Washington state residency requirements as listed in WAC 182-503-0520.

(2) To receive ADATSA benefits, an individual must belong to one of the following groups as defined in WAC 388-424-0001:

(a) A U.S. citizen;

(b) A U.S. national;

(c) An American Indian born outside the U.S.;

(d) A "qualified alien" or similarly defined lawful immigrant such as victim of trafficking; or

(e) A nonqualified alien who meets the Washington state residency requirements as listed in WAC 182-503-0520.

WAC 182-503-0555 Age requirement for MCS and ADATSA.

To be eligible for medical care services (MCS) or the Alcohol and Drug Addiction Treatment and Support Act (ADATSA) program an individual must be:

1. Eighteen years of age or older; or
2. For MCS only, if under eighteen years of age, a member of a married couple:

a.  Residing together; or

b.  Residing apart solely because a spouse is:

i.  On a visit of ninety days or less;

ii. In a public or private institution;

iii. Receiving care in a hospital, long-term care facility, or chemical dependency treatment facility; or

iv. On active duty in the uniformed military services of the United States.

WAC 182-503-0520 Residency requirements for medical care services (MCS).

This section applies to medical care services (MCS).

(1)  A resident is an individual who:

(a)  Currently lives in Washington and intends to continue living here permanently or for an indefinite period of time; or

(b)  Entered the state looking for a job; or

(c)  Entered the state with a job commitment.

(2)  An individual does not need to live in the state for a specific period of time to be considered a resident.

(3)  An individual receiving MCS can temporarily be out of the state for more than one month.  If so, the individual must provide the agency or the agency's designee with adequate information to demonstrate the intent to continue to reside in the state of Washington.

(4)  An individual may not receive comparable benefits from another state for the MCS program.

(5)  A former resident of the state can apply for MCS while living in another state if:

(a)  The individual:

(i)  Plans to return to this state;

(ii) Intends to maintain a residence in this state; and

(iii) Lives in the United States at the time of the application.

(b)  In addition to the conditions in (a)(i), (ii), and (iii) of this subsection being met, the absence must be:

(i)  Enforced and beyond the individual's control; or

(ii)  Essential to the individual's welfare and is due to physical or social needs.

(c)  See WAC 388-406-0035, 388-406-0040, and 388-406-0045  for time limits on processing applications.

(6)  Residency is not a requirement for detoxification services.

(7)  An individual is not a resident when the individual enters Washington state only for medical care.  This individual is not eligible for any medical program.  The only exception is described in subsection (8) of this section.

(8)  It is not necessary for an individual moving from another state directly to a nursing facility in Washington state to establish residency before entering the facility.  The individual is considered a resident if they intend to remain permanently or for an indefinite period unless placed in the nursing facility by another state.

(9)  An individual's residence is the state:

(a)  Where the parent or legal guardian resides, if appointed, for an institutionalized individual twenty-one years of age or older, who became incapable of determining residential intent before reaching age twenty-one;

(b)  Where an individual is residing if the individual becomes incapable of determining residential intent after reaching twenty-one years of age;

(c)  Making a placement in an out-of-state institution; or

(d)  For any other institutionalized individual, the state of residence is the state where the individual is living with the intent to remain there permanently or for an indefinite period.

(10)  In a dispute between states as to which is an individual's state of residence, the state of residence is the state in which the individual is physically located.

WAC 182-503-0560 Impact of fleeing felon status on eligibility for medical care services (MCS).

This section applies to medical care services (MCS).

1.  An individual is considered a fleeing felon if the individual is fleeing to avoid prosecution, custody, or confinement for a crime or an attempt to commit a crime that is considered a felony in the place from which the individual is fleeing.

2.  If the individual is a fleeing felon, or who is violating a condition of probation or parole as determined by an administrative body or court that has the authority to make this decision, is not eligible for MCS benefits.

WAC 182-504-0030 Medical certification periods for recipients of medical care services (MCS).

1.  The certification period for medical care services (MCS) begins:

a.  The date the agency or the agency's designee has enough information to make an eligibility decision; or

b.  No later than the forty-fifth day from the date the agency or the agency's designee received the application unless the applicant is confined in a Washington state public institution as defined in WAC 388-406-0005  (6)(a) on the forty-fifth day, in which case MCS coverage will start on the date of release from confinement.

2.  The certification period may or may not run concurrently with the incapacity review; and

3.  MCS coverage may end before the certification period ends when the incapacity review and financial review do not run concurrently.

WAC 182-504-0040 Requirements for a midcertification review for medical care services (MCS).

1.  A midcertification review (MCR) is a form sent by the agency or the agency's designee to gather information about the MCS recipient's current circumstances.  The answers provided are used to determine if the individual remains eligible for medical coverage.   

2.  A recipient of MCS must complete a midcertification review unless the review period is six months or less.

3.  The review form is sent in the fifth month of the MCS certification or review period and must be completed by the tenth day of month six.

4.  If the individual is required to complete a midcertification review, it can be completed in one of the following ways:

a.  Complete the form and return it to the DSHS office.  The MCR will be considered complete if all the following steps are taken:

i.  The form is completed in full and any changes in circumstances for the household are indicated;

ii.  The form is signed and dated;

iii.  Proof is provided of any changes that are reported; and

iv.  The form is returned to DSHS by mail or in person along with any required proof by the due date on the review.

b.  Complete the midcertification review over the phone.   The MCR will be considered complete over the phone if all of the following steps are taken:

i.  DSHS is contacted at the phone number on the review form and told about any changes in the household's circumstances;

ii.  Proof is provided of any changes that are reported, and DSHS may be able to verify some information over the phone; and

iii.  Required proof is returned to DSHS by the due date on the review. 

c.  Complete the application process for another program.   If the agency or the agency's designee approves an application for another program in the month the MCR is due, the application is used to complete the review when the same individual is head of household for the application and the midcertification review.

5.  If eligibility for medical coverage ends because of the information provided in the midcertification review, the change takes effect the next month even if this does not give ten days notice before the effective date of the termination.

6.  If the required midcertification review is not completed, medical coverage under the MCS program stops at the end of the month the review was due.

7.  Late reviews.   If the midcertification review is completed after the last day of the month the review was due, the agency or the agency's designee will process the review as described below based on when the review is received:

a.  Midcertification reviews that are completed by the last day of the month after the month the review was due:   The agency or the agency's designee determines the MCS recipient's eligibility for ongoing medical coverage.  If the individual is determined to be eligible, coverage is reinstated based on the information in the review, unless there is a wait list due to an enrollment cap under WAC 182-508-0150;

b.  Midcertification reviews completed after the last day of the month after the month the review was due:   The agency or the agency's designee treats the review as a request to send an application.  In order to determine eligibility for ongoing MCS medical coverage, the application process as described in chapter 388-406 WAC  must be completed.

 

 

WAC 182-504-0100 Changes of circumstances--Changes that must be reported by a recipient of medical care services (MCS).

1.  An individual who receives medical care services (MCS) coverage must report the following changes:

a.  A change in address;

b.  A change in who lives in the home with the individual;

c.  When the individual's total gross monthly income goes over the eligibility standards for MCS and ADATSA as listed in WAC 182-508-0230;

d.  When liquid resources are more than four thousand dollars;

e.  When the individual has a change in employment.  The individual must notify the agency or the agency's designee if they:

i.  Get a job or change employers;

ii.  Change from part-time to full-time employment or from full-time to part-time employment;

iii.  Have a change in hourly wage rate or salary; or

iv.  Stop working.

2.  Changes listed in subsection (1) of this section must be reported to the agency or the agency's designee by the tenth day of the month following the month the change happened.

3.  When the change is a change in income, the date a change happened is the date the individual first received the income, e.g., the date of receipt of the first paycheck for a new job or the date of a paycheck showing a change in the amount of the individual's wage or salary.

4.  Changes that are reported late may result in receiving medical benefits to which the individual is not entitled.

WAC 182-506-0020 Assistance units for medical care services (MCS).

1.  An adult who is incapacitated as defined in WAC 182-508-0010  can be in a medical care services assistance unit (AU).

2.  For an incapacitated adult who is married and lives with their spouse, the agency or the agency's designee decides who to include in the AU based on who is incapacitated:

a.  If both spouses are incapacitated as defined in WAC 182-508-0010, then the agency or the agency's designee includes both spouses in the AU.

b.  If only one spouse is incapacitated, then the agency or the agency's designee includes only the incapacitated spouse in the AU.  Some of the income of the spouse not in the AU is counted as income to the AU as determined according to WAC 182-509-0135. 

WAC 182-508-0130 Medical care services--Limited coverage.

1. The agency covers only the medically necessary services within the applicable program limitations listed in WAC 182-501-0060.
2. The agency does not cover medical services received outside the state of Washington unless the medical services are provided in a border city listed in WAC 182-501-0175.