Medical Care Services - General
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Medical Care Services - General


Revised April 29, 2013



Purpose: This section contains general eligibility rules relating to determining eligibility for the Medical Care Services (MCS) program.

WAC 182-503-0520Residency requirements for medical care services (MCS).
WAC 182-503-0532Citizenship requirements for the medical care services (MCS) and ADATSA programs.
WAC 182-503-0555Age requirement for MCS and ADATSA.
WAC 182-503-0560Impact of fleeing felon status on eligibility for medical care services (MCS).
WAC 182-504-0030Medical certification periods for recipients of medical care services (MCS).
WAC 182-504-0040Requirements for a midcertification review for medical care services (MCS).
WAC 182-504-0100Changes of circumstances--Changes that must be reported by a recipient of medical care services (MCS).
WAC 182-506-0020Assistance units for medical care services (MCS).
WAC 182-508-0130Medical care services--Limited coverage.

Citizenship requirements for the medical care services (MCS) and ADATSA programs.

WAC 182-503-0532

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CLARIFYING INFORMATION

1.  MCS is broadly accessible to immigrants as long as they meet all other program requirements.  Non-immigrants and undocumented aliens, as defined in WAC 388-424-0001, are not eligible for MCS.

2.  Becoming a citizen (naturalizing) is not a program requirement for MCS.


Age Requirements for MCS and ADATSA

WAC 182-503-0555

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CLARIFYING INFORMATION

This section explains the minimum age requirements for an individual to be eligible for Medical Care Services (MCS) or Alcohol and Drug Addiction Treatment Support Act (ADATSA).

Because state or federal law does not set the minimum age requirement for MCS, workers can request an Exception to Rule (ETR) if a client doesn't meet this requirement.

 

 


Residency requirements for medical care services (MCS).

WAC 182-503-0520

WAC 182-503-0520

Effective October 1, 2013

WAC 182-503-0520 Washington apple health -- Residency requirements -- Persons who are not residing in an institution.



(1) A resident is a person (including an emancipated person under age eighteen who is capable of indicating intent) who currently lives in Washington and:

(a) Intends to reside here, including persons without a fixed address; or

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

(c) Entered the state with a job commitment.

(2) A person does not need to live in the state for a specific period of time prior to meeting the requirements in subsection (1) of this section before being considered a resident.

(3) A child under age eighteen who is not covered by subsection (1) of this section and is not eligible for WAH coverage under WAC 182-505-0210(8) through (10), is a resident if:

(a) The child resides in the state, including with a custodial parent or caretaker or without a fixed address; or

(b) The child’s parent or caretaker has entered the state with a job commitment or seeking employment (whether or not currently employed).

(4) A resident applying for or receiving health care coverage can temporarily be out of the state for more than one month without their health care coverage being denied or terminated, if the person:

(a) Intends to return to the state once the purpose of his or her absence has been accomplished and provides adequate information of this intent after a request by the agency or its designee; and

(b) Has not been determined eligible for medicaid or state-funded health care coverage in another state (other than coverage in another state for incidental or emergency health care).

(5) A person who enters Washington state only for health care is not a resident and is not eligible for any medical program. The only exception is for a person who moves from another state directly into an institution in Washington state. Residency rules for institutionalized persons are described in WAC 182-503-0525.

(6) A person of any age who receives a state supplemental payment (SSP) is considered a resident of the state that is making the payment.

(7) A person who receives federal payments for foster or adoption assistance is considered a resident of the state where the person physically resides even if:

(a) The person does not live in the state that is making the foster or adoption assistance payment; or

(b) The person does not live in the state where the adoption agreement was entered.

(8) In a dispute between states, the state of residence is the state in which the person is physically located.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

If residency requirements are questionable for an individual determine if the individual meets one of the following conditions:

  1. Intends to continue living in Washington permanently or for an indefinite period of time; or
  2. Entered the state looking for a job; or
  3. Entered the state with a job commitment.

NOTE:

Residency depends on a person's intent or purpose in coming to WA state at the time of application and renewal.


Temporarily Out of State

A person may be temporarily out of state.  There isn't a specified period before someone loses Washington State residency.  However, the person must demonstrate intent to continue to reside in Washington.

If Residency is Questionable

Residency is questionable when the:

  1. Individual just moved to WA without a job commitment or to search for work;
  2. Individual is attending a WA college/university as a non-resident.

NOTE:

For medical eligibility, a person is not considered a resident when that person enters the state only for medical care.  The only exception is for a person moving directly to a nursing facility in Washington State and who was not placed in the nursing facility by the other state.


For all individuals with questionable residency, ask whether the individual's intent is to remain in WA State.  If the intent is to remain in Washington, then ask the following:

  1. Is the individual keeping a home, property or residence in the state/country that person left?
    1. If no, the individual meets residency requirements with the declared intent.
    2. If yes, does the person have the residence/property listed for sale, if not why?
    3. If individual is still maintaining home/property or residence and cannot document why, that person is not a WA resident and the request for medical assistance should be denied.

NOTE:

If WA residency has been confirmed remember to consider home/property resources when determining eligibility for medical programs with an asset test.


An individual, who states the intent to return home after completing school does not meet residency requirements.

 

An individual, who enters the state with a job commitment or to search for work, meets residency requirements. 


Impact of Fleeing Felon Status on eligibility for MCS

This section explains how being a fleeing felon impacts a client's eligibility for MCS and ADATSA programs.


WAC 182-503-0560

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CLARIFYING INFORMATION

1.  Fleeing felons:

For a person to be "fleeing", they must be acting with the intent to avoid prosecution.  If a magistrate has issued a felony warrant, the person must know that an arrest warrant was issued in order for us to consider that person "fleeing."

2.  Juvenile convictions:

A juvenile offender who flees a felony warrant is subject to the same rules as adult offenders.  This includes persons who were convicted of a felony in a juvenile court.

3.  Probation or parole violation:

Violating a condition of probation or parole means an arrest warrant is issued when the corrections officer informs an administrative body or court that an individual failed to comply with a condition of probation or parole.

a.  What is considered a violation of parole varies from case to case.

b.  A corrections officer may tell us that they intend to issue a warrant, but a person's eligibility is not affected until the warrant is issued.


WORKER RESPONSIBILITIES

1.  Reviewing fleeing felon status:

Take the following actions at application, at review, or when adding an individual to the Assistance Unit (AU):

a.  Ask the person about the possibility of outstanding warrants for each member of the household and record the information in ACES.

b.  Check adult AU members against the Department of Corrections (DOC) Felony Offender Reporting System (FORS) for outstanding wa4rrants and/or felon status.  Follow local office policy on who may use FORS.

c.  If FORS has a warrant listed for an adult member of the household, contact DOC to verify that the warrant is still valid.

2.  When someone has a felony warrant:

a.  Let a person know when that individual has a valid felony warrant.

b.  Give a person who says the warrant is satisfied a chance to prove the status.

c.  We must consider that person "fleeing" and not eligible for MCS or ADATSA benefits unless:

1.  The person can prove the warrant is satisfied, or

2.   The person can reasonably show they have made a good faith effort to satisfy the warrant and have been unable to do so for reasons beyond their control.

d.  Deny or close benefits as appropriate.

3.  RCW 74.04.062 allows us to contact the appropriate law enforcement agency when we learn that a person has a valid outstanding warrant.

4.  When law enforcement contacts the agency:

If a law enforcement official contacts us regarding an individual, cooperate with the official as required by state law.

State Law - RCW 74.04.062 allows us to disclose current address and location information about clients to law enforcement officers when all of the following conditions are met:

a.  They are acting in an official capacity;

b.  They identify themselves;

c.  Provide the client's Social Security Number; and

d.  Demonstrate that the client is a fugitive.


Certification Periods for Recipients of MCS

WAC 182-504-0030

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CLARIFYING INFORMATION

  1. There is no retroactive certification period for MCS coverage.
  2. When the incapacity review date is not extended, MCS coverage will be terminated at the end of the month.
  3. There is a 30-day reconsideration period for the incapacity review.

Worker responsibilities

If the incapacity review date is extended during the 30-day reconsideration period, and the financial eligibility review date has not passed, reinstate the MCS AU and update the incapacity review date.

Requirements for a mid-certification review for medical care services (MCS)

WAC 182-504-0040

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NOTE: If you approve an application on a related AU after deadline for the month a med-certification review is due, the benefits covered in the MCS will still close.  Even though processing the application meets the requirements for the review, you must reinstate the benefits that closed for no mid-certification review.

  1. Required proof for the mid-certification review:  If someone receives MCS, the form instructs the person to give us proof of the changes they tell us about on the MCR, except increases in deductions.  If a person does not include the verification with the MCR, consider whether the change effects eligibility or is questionable before pending for more information.

NOTE: The no-change function in ACES online will process the MCS as complete for all associated AUs.  If you do not have the required proof for the MCS portion of the review to be counted as complete, you must use the mainframe system to process the MCS for each AU.

  1. Mid-certification reviews completed late: If someone does not complete the mid-certification review on time, ACES closes the benefits covered in the MCR at the end of the month the review was due.  We treat mid-certification reviews completed after the month the review was due as described below:
  • Completed by the last day of the month after the month the MCR was due: Process the review to determine ongoing eligibility for MCS benefits and reinstate benefits if appropriate.

  


NOTE: If the person submits an Application for Benefits (AFB) or an Eligibility Review (ER) by the last day of the month after the month the MCR was due and no other assistance program is being requested, you may treat the AFB or ER as and MCR.

  • Received later than the month after the month the MCR was due:  Document that you received the MCR after the end of the month after the month the review was due and the person an application for benefits.

EXAMPLE

Dee receives her Mid-Certification Review (MCR) for Medical Care Services (MCS) due on August 10th.  She does not complete her review as required.  Dee's benefits end on August 31st.  On September 8th, Dee completes her MCR


EXAMPLE

John has an MCR due on January 10th.  He does not return the review form or complete the review over the phone.  ACES closes MCS on January 31st.

On March 4th, John turns in an MCR stating that there were no changes in their circumstances.  He has also attached proof of his income.

  • Because he completed the review later than the end of February, we treat the MCR as a request for an application and send him a new application.
  • John is not eligible for MCS for February.  To receive benefits, he must complete the application process as described under chapter 388-406 WAC and be found eligible for MCS under WAC 182-508-0005.


  1. Applications or Eligibility Reviews received after benefits are closed for no MCR, but before the end of the seventh month: If we close benefits for no mid-certification review and the AU turns in an application for benefits or an eligibility review they may:
    • Treat the application or review form as the MCR and complete their mid-certification review as described under WAC 182-504-0040, reinstate their coverage for the benefit month and withdraw their application for benefits; or
    • Have us process the application which may result in pro-rated eligibility or no total ineligibility  for that month.
  2. Requests to add a person on the MCR:  The MCR asks about people moving into the household and whether or not they want benefits for these person.  If anyone in the household wants benefits, an application or eligibility review form is required.
  3. Requests to add a program/program change on the MCR: A person must complete a new application or eligibility review form to add a program or change programs.
  4. Completing the mid-certification review over the phone:  You do not need a signed MCR form to count the MCR process as complete as long as you review the "Signature and Date" block disclosures with the client.  Make a case note to document that the person acknowledge their understanding.

The requirements for the MCR vary by program.  The elements that must be reviewed and updated at MCR are:

  • Address
  • Deductions (legally obligated child support)
  • Disability
  • Household composition
  • Income
  • Insurance
  • Pregnancy
  • Resources

Get the required proof to complete the review:

  • Update the case record; and
  • Document the actions you took.

Worker responsibilities

Working alerts, barcode tickles, and checking other systems as part of processing the MCR:

To reduce the risk of error, work related alerts in ACES, barcode tickles, and review systems, such as SEMS as appropriate to ensure that the income you budget is based on the best available information. 


ACES PROCEDURES

See Eligibility Review/Recertification Process - Mid-certification reviews


WAC 182-504-0100

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Taking action on changes:

When we receive information about someone's circumstances, we must determine the impact on the person's benefits.  This may include contacting them, contacting other parties, or asking for proof of the circumstances under WAC 182-504-0100.

 

Client Reports:

 

  • Take action based on changes the person reports. This includes when someone volunteers information after we contacted them.

 Third-Party Reports:

  • If we receive information from a third party about someone, follow-up on the information to decide how it impacts the person’s eligibility and benefits.
  • This may include contacting the person, contacting other parties, or asking for proof of their circumstances under WAC 388-490-0005.

 Alerts Verified Upon Receipt:

 

  • An interface that automatically update's the ACES case record is "verified upon receipt".
  • We do not need to take action on alerts the interface updates in ACES.

 Other Alerts:

 

  • We do need to take action on alerts that are not verified upon receipt.
  • Work alerts that are not verified upon receipt to decide how the information impacts the person's eligibility.
  • This may include contacting the person, contacting other parties, or asking for proof of their circumstances under WAC 388-490-0005.

WAC 182-506-0020

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This section determines who is included in an assistance unit for MCS.

  1. Home monitored clients:

Clients that are under 'home monitoring' or 'home detention' are not eligible for MCS because they are considered a 'person in an institution'.  See WAC 182-508-0005.


NOTE: Persons who are participating in the Department of Corrections Family Offender Sentencing Alternative (FOSA) or Community Parenting Alternative (CPA) program may be eligible for MCS coverage.  Refer to the 'Sentencing Alternatives - Offenders with Minor Children' SSB 6639 desk aid for additional information.

   2.   Married couples that are both incapacitated:

If a husband and wife that live together are both incapacitated and apply for MCS, they are in the same AU.  We base eligibility on the two-person eligibility standard for MCS, not two times the amount of the one-person standard.  See WAC 182-508-0230 for the MCS eligibility standard.

   3.     A client that is eligible for TANF can't choose to get MCS:

Because MCS is a state-funded program, clients that are eligible for a federally funded program are not eligible for MCS.  If a client can get TANF, they can't get MCS under WAC 182-508-0005.  A client that is eligible for SFA may be eligible for MCS medical coverage if they meet the incapacity criteria for MCS. 


EXAMPLE

A client takes care of their grandchild on an ongoing basis and is eligible for a TANF grant.  Because the client can get TANF, they can't choose to get MCS for their own needs and not have assistance for the grandchild.


4.  Children: ONLY adults can be in a MCS AU.   See WAC 182-506-0020 for more information.


WAC 182-508-0130

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Modification Date: April 29, 2013