Certification Periods - Medical Programs
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Certification Periods - Medical Programs


Revised September 26, 2013



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 182-504-0015Certification periods for categorically needy (CN) scope of care medical assistance programs.
WAC 182-504-0020Certification periods for the noninstitutional medically needy (MN) program.
WAC 182-504-0025Medicare savings program certification periods.
WAC 182-504-0030Medical certification periods for recipients of medical care services (MCS).

Cash Assistance Clients

WAC 388-416-0010
WAC 388-416-0010

Effective November 1, 2011

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.

 

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

*** As a result of implementation of the Affordable Care Act (ACA), this clarifying page may no longer be effective for medical coverage applications received on or after 10/01/2013. Please see the ACA Transition Plan for more information. Clients who need to apply for medical coverage on or after 10/01/2013 should be referred to Washington Healthplanfinder. ***

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.


Categorically Needy (CN) Medical Programs

WAC 182-504-0015

WAC 182-504-0015

Effective October 1, 2013

WAC 182-504-0015 Washington apple health -- Certification periods for categorically needy programs.



(1) A certification period is the period of time a person is determined eligible for a categorically needy (CN) Washington apple health (WAH) 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.

(2) For a newborn eligible for WAH, 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.

(3) For a woman eligible for WAH based on pregnancy, the certification period ends the last day of the month that includes the sixtieth day from the day the pregnancy ends.

(4) For a person eligible for the WAH refugee program, the certification period ends at the end of the eighth month following the client's date of entry to the United States.

(5) For all other WAH-CN coverage, the certification period is twelve months.

(6) For children, eligibility is continuous throughout the certification period regardless of a change in circumstances, unless a required premium (described in WAC 182-505-0225) is not paid for three consecutive months or the child:

(a) Turns age nineteen;

(b) Moves out of state;

(c) Is incarcerated; or

(d) Dies.

(7) When the child turns nineteen, the certification period ends after the redetermination process described in WAC 182-504-0125 is completed, 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:

(a) The child is receiving inpatient services (described in WAC 182-514-0230) on the last day of the month the child turns nineteen;

(b) The inpatient stay continues into the following month or months; and

(c) The child remains eligible except for turning age nineteen.

(8) A retroactive certification period is described in WAC 182-504-0005.

(9) Coverage under premium-based programs included in apple health for kids as described in chapter 182-505 WAC begins no sooner than the month after creditable coverage ends.

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 / WORKER RESPONSIBILITY

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.


  1. 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.

Medically Needy (MN) Program (Non -Institutionalized)

WAC 182-504-0020

WAC 182-504-0020

Effective December 1, 2011

WAC 182-504-0020 Certification periods for the noninstitutional medically needy (MN) program.

  1. 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):

    1. Begins on the first day of the month in which eligibility is established; and

    2. Is approved for twelve calendar months. 

  2. The certification period for the noninstitutional MN program for clients with countable income above the MNIL:

    1. Begins on the day that spenddown is met; and

    2. Continues through the last day of the final month of the base period as described in WAC 388-519-0110.

  3. A retroactive MN certification period may be established for any or all of the three months immediately prior to the month of application.

  4. 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.

  5. A new application must be submitted for each subsequent certification period for which medically needy coverage is requested.

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

The base period begins with the month of application and is usually three or six months, depending upon the client's choice. See SPENDDOWN


Medicare Cost Saving Programs (Formerly Medicare Cost Sharing Programs)

 WAC 182-504-0025

WAC 182-504-0025

Effective December 1, 2011

WAC 182-504-0025 Medicare savings program certification periods.

Certification periods for the different kinds of Medicare Savings Programs are not all the same. The chart below explains the differences. 

Medicare Savings Program Certification Period Start Date

QMB (Qualified Medicare Beneficiary)

S03

12 months On the first day of the month following QMB eligibility determination

SLMB (Special low income Medicare beneficiary)

S05

12 months

Up to three months prior to the certification period if on the first day of the first month of certification, the person:

  • Is or has been enrolled in Medicare Part B; and
  • Meets SLMB eligibility requirements.

QDWI (Qualified disabled working individual)

S04

12 months

Up to three months prior to the certification period if on the first day of the first month of certification, the person:

  • Is or has been enrolled in Medicare Part A; and
  • Meets QDWI eligibility requirements.
QI-1 (Qualified individual) Thru the end of the calendar year following QI-1 eligibility determination

Up to three months prior to the certification period if on the first day of the first month of certification, the person:

  • Is or has been enrolled in Medicare Part B; and
  • Meets QI-1 eligibility requirements.

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.

Medical Care Services Program


WAC 182-504-0030

Error processing SSI file

CLARIFYING INFORMATION

See Applications for the processing time requirements.

Modification Date: September 26, 2013