Purpose: This section contains information about certification periods for cash assistance clients, categorically needy (CN) medical, medically needy (MN) non-institutionalized persons, Medicare Savings Programs and Medical Care Services (MCS).
WAC 388-416-0010 Medical certification periods for recipients of cash assistance programs.
1.The certification period for medical services begins on the first day of the month of application when the client is determined eligible for cash assistance for one of the following programs:
a.Temporary assistance for needy families (TANF);
b.Aged, Blind, or Disabled (ABD) cash assistance;
c.Pregnant Women Assistance (PWA);
d.Supplemental Security Income (SSI); or
e.Refugee assistance.
2.The certification period for the medical programs associated with the cash programs in subsection (1) of this section continues as long as eligibility for these programs lasts. When a client's cash assistance is terminated, eligibility for medical assistance is continued until eligibility is redetermined as described in WAC 182-504-0100.
3.The certification period for medical can begin up to three months prior to the month of application for clients described in subsection (1) of this section if the conditions in WAC 182-504-0015 (6) apply.
When a client applying for TANF or Refugee Assistance is not eligible until the following month but meets CN medical eligibility in the month of application, CN medical is authorized beginning the first day of the month of application.
WAC 182-504-0015 Certification periods for categorically needy (CN) scope of care medical assistance programs.
A certification period is the period of time a person is determined eligible for a categorically needy (CN) scope of care medical program. Unless otherwise stated in this section, the certification period begins on the first day of the month of application and continues to the last day of the last month of the certification period.
For a child eligible for the newborn medical program, the certification period begins on the child's date of birth and continues through the end of the month of the child's first birthday.
For a woman eligible for a medical program based on pregnancy, the certification period ends the last day of the month that includes the sixtieth day from the day the pregnancy ends.
For families the certification period is twelve months with a six-month report required as a condition of eligibility as described in WAC 388-418-0011.
For children, the certification period is twelve months. Eligibility is continuous without regard to changes in circumstances other than aging out of the program, moving out of state, failing to pay a required premium(s), incarceration or death.
When the child turns nineteen the certification period ends even if the twelve-month period is not over. The certification period may be extended past the end of the month the child turns nineteen when:
The child is receiving inpatient services (see WAC 388-505-0230 ) on the last day of the month the child turns nineteen;
The inpatient stay continues into the following month or months; and
The child remains eligible except for exceeding age nineteen.
For an SSI-related person the certification period is twelve months.
When the medical assistance unit is also receiving benefits under a cash or food assistance program, the medical certification period will begin anew at each:
Approved application for cash or food assistance; or
Completed eligibility review.
A retroactive certification period can begin up to three months immediately before the month of application when:
The client would have been eligible for medical assistance if the client had applied; and
If the client is eligible only during the three-month retroactive period, that period is the only period of certification, except when:
A pregnant woman is eligible in one of the three months preceding the month of application, but no earlier than the month of conception. Eligibility continues as described in subsection 3;
A child is eligible for a CN medical program as described in WAC 388-505-0210(1) through (5) and (7) in one of the three months preceding the month of application. Eligibility continues for twelve months from the earliest month that the child is determined eligible.
Any months of a retroactive certification period are added to the designated certification periods described in this section.
Coverage under premium-based programs included in apple health for kids as described in WAC 388-505-0210 and chapter 388-542 WAC begins no sooner than the month after creditable coverage ends.
1.Eligibility must be determined separately for any retroactive CN certification period. It is possible for a client to be ineligible in the month of application, but eligible within the previous three months.
2.For Children's and Pregnancy medical retroactive CN certification periods:
a.Choose the income budgeting method most beneficial to the client.
b.If eligible in a retro month, children are eligible for 12 months continuous and pregnant women are eligible through the 60 days post partum coverage.
3.A client approved for ABD cash may be eligible for three months retroactive coverage Medicaid benefits when the client:
a.Incurred an unpaid medical bill in the prior three months (retro period).
b.Meets all financial and categorical requirements for the ABD cash program in each retro month;
c.Has a disability approval date for the retro month(s);
d.Meet citizenship verification requirements. Screen in an SSI-related medical AU for the retroactive period so CN coverage can be authorized.
EXAMPLE
Client applies for Children's medical on January 2, requesting retro medical in December. Countable income is over AM (anticipated monthly) budgeting but under CA (averaging) for retro month. Worker documents that the CA budgeting method was chosen for the retro month as this was the most beneficial method for the client and approves. Child is eligible for 12 months continuous coverage beginning the month of December.
EXAMPLE
Pregnant woman applies in March, but her countable income exceeds the standard. Her countable income in January was below the standard. Since she was also pregnant in January, one of the previous three months, she is eligible from January 1 through the entire pregnancy and the postpartum extension. The certification period is for that entire period.
A newborn should be added to an existing F06 or F04 assistance unit when you have citizenship and identity verification and a SSN or application for SSN. Unless you have a current application, do not initiate a review; the other children will continue in their current certification period and if no longer eligible at the next review ACES will continue the newborn through the 12 months continuous eligibility. There is no longer the need to open the newborn on F05 unless you do not have the required citizenship, identity and SSN.
NOTE:
If the existing household income is over the standard for F06 when you add the newborn you will need to open F05.
WAC 182-504-0020 Certification periods for the noninstitutional medically needy (MN) program.
The certification period for the noninstitutional medically needy (MN) program for clients with countable income equal to or below the medically needy income level (MNIL):
Begins on the first day of the month in which eligibility is established; and
Is approved for twelve calendar months.
The certification period for the noninstitutional MN program for clients with countable income above the MNIL:
Begins on the day that spenddown is met; and
Continues through the last day of the final month of the base period as described in WAC 388-519-0110.
A retroactive MN certification period may be established for any or all of the three months immediately prior to the month of application.
Expenses used to meet the spenddown liability for the current or the retroactive certification periods are the responsibility of the client. The department is not responsible to pay for any expense or portion of an expense which has been used to meet the spenddown liability. See WAC 388-519-0110.
A new application must be submitted for each subsequent certification period for which medically needy coverage is requested.
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.
