Code

Reason Code Title / Text Requirement

    WAC        References    

Free Form Text

501

SSA Denial

You aren't eligible for ABD cash assistance or categorically needy medical benefits because:

The Social Security Administration has denied your application for Supplemental Security Income SSI.

We reviewed your case to determine if you qualify for Aged, Blind, or Disabled (ABD) cash assistance or Categorically Needy (CN) Medicaid. 

You reported you were unable to work because:

(Disability Specialist should provide the FSS with free form text via the 14-118).

Based on a review of your records, you do not qualify for ABD cash or CN Medicaid benefits. This is because you are not disabled under ABD or CN Medicaid rules.

 You are not disabled because the Social Security Administration (SSA) determined that your condition doesn’t meet federal Supplemental Security Income (SSI) disability requirements.  Your SSI application was denied on:

(Disability Specialist should provide the FSS with free form text via the 14-118).

We can make a new disability decision if: (1) you are appealing that SSA decision; (2) you have a new condition that SSA did not consider; or (3) your condition has changed or deteriorated since that SSA decision.  If one of these situations applies to you, please tell us.

WAC 388-400-0060; 388-449-0001 (ABD); 42 CFR 435.541(CN Medicaid).  You can view the Washington Administrative Code (WAC) online at http://slc.leg.wa.gov/wacbytitle.htm.  You can view the Code of Federal Regulations (CFR) online at http://www.gpo.gov.  You can also view them at your public library reference desk.  If you can’t find this information, please call our office.

502

Gainful Employment

You aren't eligible for ABD cash assistance or categorically needy medical benefits because:

We have determined you are not disabled because you are currently working

We reviewed your case to determine if you qualify for Aged, Blind, or Disabled (ABD) cash assistance or Categorically Needy (CN) Medicaid. 

You must meet certain rules to qualify for ABD cash or CN Medicaid based on disability. Your health problem must keep you from doing any kind of substantial work and must last or be expected to last at least 12 months in a row or result in death.

Based on a review of your records, you do not qualify for ABD cash or CN Medicaid benefits.  This is because you are not disabled under ABD cash or CN Medicaid rules. 

You are not disabled because your current work is substantial gainful activity (SGA).  If you earn more than $1,000 per month in 2011, you are considered to be engaging in SGA.

Our records indicate you currently earn $______ per month.

We considered the following when we determined your monthly income:

(Disability Specialist should provide the FSS with free form text describing records, jobs, income, deductions, etc.)

WAC 388-400-0060, 388-449-0001, 388-449-0005 (ABD); 20 CFR 416.910, .920, .974, .975, .976 (CN Medicaid).  You can view the Washington Administrative Code (WAC) online at http://slc.leg.wa.gov/wacbytitle.htm.  You can view the Code of Federal Regulations (CFR) online at http://www.gpo.gov.  You can also view them at your public library reference desk.  If you can’t find this information, please call our office.

503

Acceptable Medical Source (and no medical)

You aren't eligible for ABD cash assistance or categorically needy medical benefits because:

You didn't provide medical evidence from an acceptable medical source to support your claim of disability. 20 CFR 416.908, 20 CFR 416.913 and 20 CFR 416.912

We reviewed your case to determine if you qualify for Aged, Blind, or Disabled (ABD) cash assistance or Categorically Needy (CN) Medicaid. 

You must meet certain rules to qualify for ABD cash or CN Medicaid based on disability. Your health problem must keep you from doing any kind of substantial work and must last or be expected to last at least 12 months in a row or result in death.

You reported you were unable to work because: (Disability Specialist should provide the FSS with free form text via the 14-118).

Based on a review of your case, you do not qualify for ABD cash or CN Medicaid benefits.  This is because you are not disabled under ABD cash or CN Medicaid rules.  We consider age, education, training, work experience, and medical and other records when determining how health problems affect ability to work.

The following information was used to decide your claim:

(Disability Specialist should provide the FSS with free form text via the 14-118).

You are not eligible for ABD cash or CN Medicaid because you did not provide evidence from an acceptable medical source listed under WAC 388-449-0010 or 20 CFR 416.913.  You are responsible for providing evidence to support your claim.  You were asked to provide evidence from an acceptable medical source, but did not do so.  Therefore, a decision was made based on the evidence in your file.  Your evidence doesn’t show you have a medically determinable impairment that impacts your ability to work and lasted or will last 12 months in a row.

WAC 388-449-0001, 388-449-0010, 388-449-0015, 388-449-0060 (ABD); 20 CFR 416.908, .912, .913, .920 (CN Medicaid).  You can view the Washington Administrative Code (WAC) online at http://slc.leg.wa.gov/wacbytitle.htm.  You can view the Code of Federal Regulations (CFR) online at http://www.gpo.gov.  You can also view them at your public library reference desk.  If you can’t find this information, please call our office.

504

Insufficient Information

You aren't eligible for ABD cash assistance or categorically needy medical benefits because:

These reports don't contain enough medical information to determine if you are likely to be disabled. 20CFR 416.988, 20 CFR 416.913 and 20 CFR 416.912

388-449-0060

We reviewed your case to determine if you qualify for Aged, Blind, or Disabled (ABD) cash assistance or Categorically Needy (CN) Medicaid. 

You must meet certain rules to qualify for ABD cash or CN Medicaid based on disability. Your health problem must keep you from doing any kind of substantial work and must last or be expected to last at least 12 months in a row or result in death.

You reported you were unable to work because:

(Disability Specialist should provide the FSS with free form text via the 14-118).

Based on a review of your case, you do not qualify for ABD cash or CN Medicaid benefits.  This is because you are not disabled under ABD cash or CN Medicaid rules.  We consider age, education, training, work experience, and medical and other records when determining how health problems affect ability to work.

The following information was used to decide your claim:

(Disability Specialist should provide the FSS with free form text via the 14-118).

You are not eligible for ABD cash assistance or CN Medicaid because your file doesn't contain enough evidence to show that you are disabled.  You are responsible for providing evidence to support your claim.  You were asked to provide more evidence, but did not do so.  Therefore, a decision was made based on the evidence in your file.  Your evidence doesn’t show that your impairments are severe enough to keep you from working for 12 months in a row.

WAC 388-449-0001, 388-449-0010, 388-449-0015, 388-449-0035, 388-449-0040, 388-449-0045, 388-449-0050, 388-449-0060 (ABD); 20 CFR 416.912, .913, .920, .988, (CN Medicaid).  You can view the Washington Administrative Code (WAC) online at http://slc.leg.wa.gov/wacbytitle.htm.  You can view the Code of Federal Regulations (CFR) online at http://www.gpo.gov.  You can also view them at your public library reference desk.  If you can’t find this information, please call our office.

505

Chemical Dependency

You aren't eligible for ABD cash assistance or categorically needy medical benefits because:

Based on the objective information contained in these reports we can't determine you are disabled because drugs or alcohol are material to your impairment.

We reviewed your case to determine if you qualify for Aged, Blind, or Disabled (ABD) cash assistance or Categorically Needy (CN) Medicaid.

You must meet certain rules to qualify for ABD cash or CN Medicaid based on disability. Your health problem must keep you from doing any kind of substantial work and must last or be expected to last at least 12 months in a row or result in death.

You reported you were unable to work because: (Disability Specialist should provide the FSS with free form text via the 14-118).

Based on a review of your case, you do not qualify for ABD cash or CN Medicaid benefits.  This is because you are not disabled under ABD cash or CN Medicaid rules.  We consider age, education, training, work experience, and medical and other records when determining how health problems affect ability to work.

The following information was used to decide your claim:

(Disability Specialist should provide the FSS with free form text via the 14-118).

You are not eligible for ABD cash assistance or CN Medicaid because drug or alcohol addiction is a contributing factor material to your impairments. In the absence of drugs or alcohol, your remaining impairments are not expected to be severe enough for 12 months in a row to keep you from working.

WAC 388-449-0001, 388-449-0015, 388-449-0035, 388-449-0040, 388-449-0045, 388-449-0050, 388-449-0060 (ABD); 20 CFR 416.920, .935 (CN Medicaid).  You can view the Washington Administrative Code (WAC) online at http://slc.leg.wa.gov/wacbytitle.htm.  You can view the Code of Federal Regulations (CFR) online at http://www.gpo.gov.  You can also view them at your public library reference desk.  If you can’t find this information, please call our office.

506

Duration

You aren't eligible for ABD cash assistance or categorically needy medical benefits because:

Your reported impairment is not expected to last for at least 12 months.

388-449-0060

We reviewed your case to determine if you qualify for Aged, Blind, or Disabled (ABD) cash assistance or Categorically Needy (CN) Medicaid.

You must meet certain rules to qualify for ABD cash or CN Medicaid based on disability. Your health problem must keep you from doing any kind of substantial work and must last or be expected to last at least 12 months in a row or result in death.

You reported you were unable to work because: (Disability Specialist should provide the FSS with free form text via the 14-118).

Based on a review of your health problems, you do not qualify for ABD cash or CN Medicaid benefits.  This is because you are not disabled under ABD cash or CN Medicaid rules.  We consider age, education, training, work experience, and medical and other records when determining how health problems affect ability to work.

The following information was used to decide your claim:

(Disability Specialist should provide the FSS with free form text via the 14-118).

You are not eligible for ABD cash assistance or CN Medicaid because your condition is not expected to remain severe enough for 12 months in a row to keep you from working.

WAC 388-449-0001, 388-449-0060 (ABD); 20 CFR 416.905, .909, .920 (CN Medicaid).  You can view the Washington Administrative Code (WAC) online at http://slc.leg.wa.gov/wacbytitle.htm.  You can view the Code of Federal Regulations (CFR) online at http://www.gpo.gov.  You can also view them at your public library reference desk.  If you can’t find this information, please call our office.

507

388-422-0030

None Required

509

Severity

You aren't eligible for ABD cash assistance or categorically needy medical benefits because:

388-449-0060

We reviewed your case to determine if you qualify for Aged, Blind, or Disabled (ABD) cash assistance or Categorically Needy (CN) Medicaid. 

You must meet certain rules to qualify for ABD cash or CN Medicaid based on disability. Your health problem must keep you from doing any kind of substantial work and must last or be expected to last at least 12 months in a row or result in death.

You reported you were unable to work because: (Disability Specialist should provide the FSS with free form text via the 14-118).

Based on a review of your health problems, you do not qualify for ABD cash or CN Medicaid benefits.  This is because you are not disabled under ABD cash or CN Medicaid rules. We consider age, education, training, work experience, and medical and other records when determining how health problems affect ability to work.

The following information was used to decide your claim:

(Disability Specialist should provide the FSS with free form text via the 14-118).

You are not eligible for ABD cash assistance or CN Medicaid because your impairments do not significantly impact your ability to work.

WAC 388-449-0001, 388-449-0035, 388-449-0040, 388-449-0045, 388-449-0050, 388-449-0060 (ABD); 20 CFR 416.920, .921 (CN Medicaid).  You can view the Washington Administrative Code (WAC) online at http://slc.leg.wa.gov/wacbytitle.htm.  You can view the Code of Federal Regulations (CFR) online at http://www.gpo.gov.  You can also view them at your public library reference desk.  If you can’t find this information, please call our office.

510

Past Work

You aren't eligible for ABD cash assistance or categorically needy medical benefits because:

388-449-0080

We reviewed your case to determine if you qualify for Aged, Blind, or Disabled (ABD) cash assistance or Categorically Needy (CN) Medicaid. 

You must meet certain rules to qualify for ABD cash or CN Medicaid based on disability. Your health problem must keep you from doing any kind of substantial work and must last or be expected to last at least 12 months in a row or result in death.

You reported you were unable to work because: (Disability Specialist should provide the FSS with free form text via the 14-118).

Based on a review of your health problems, you do not qualify for ABD cash or CN Medicaid benefits.  This is because you are not disabled under ABD cash or CN Medicaid rules.  We consider age, education, training, work experience, and medical and other records when determining how health problems affect ability to work.

The following information was used to decide your claim:

(Disability Specialist should provide the FSS with free form text via the 14-118).

We determined you do not have a health problem that meets or equals one of the impairments listed at 20 CFR Part 404, Subpart P, Appendix 1.

Based on your age, education, training, work experience, and medical and other records, we determined you are able to perform past relevant work including:

(Disability Specialist should provide the FSS with free form text via the 14-118).

You have significant impairments, but are not eligible for ABD cash or CN Medicaid because you are able to do past relevant work.  If you can still do past relevant work, you are not disabled under ABD cash or CN Medicaid rules.

WAC 388-449-0001, 388-449-0020, 388-449-0030, 388-449-0050, 388-449-0080 (ABD); 20 CFR 416.920, .945, .960 (CN Medicaid).  You can view the Washington Administrative Code (WAC) online at http://slc.leg.wa.gov/wacbytitle.htm.  You can view the Code of Federal Regulations (CFR) online at http://www.gpo.gov.  You can also view them at your public library reference desk.  If you can’t find this information, please call our office.

511

Other Work

You aren't eligible for ABD cash assistance or categorically needy medical benefits because:

388-449-0080

We reviewed your case to determine if you qualify for Aged, Blind, or Disabled (ABD) cash assistance or Categorically Needy (CN) Medicaid.

You must meet certain rules to qualify for ABD cash or CN Medicaid based on disability. Your health problem must keep you from doing any kind of substantial work and must last or be expected to last at least 12 months in a row or result in death.

You reported you were unable to work because: (Disability Specialist should provide the FSS with free form text via the 14-118).

Based on a review of your health problems, you do not qualify for ABD cash or CN Medicaid benefits.  This is because you are not disabled under ABD cash or CN Medicaid rules.  We consider age, education, training, work experience, and medical and other records when determining how health problems affect ability to work.

The following information was used to decide your claim:

(Disability Specialist should provide the FSS with free form text via the 14-118).

We determined you do not have a health problem that meets or equals one of the impairments listed at 20 CFR Part 404, Subpart P, Appendix 1.

Based on your age, education, training, work experience, and medical and other records, we determined you can perform other work including:

(Disability Specialist should provide the FSS with free form text via the 14-118, including at least two examples of ‘other work’).

You have significant impairments and are not able to do past relevant work.  But you are not eligible for ABD cash or CN Medicaid because you can do other work.  If there are other jobs you can do, you are not disabled under ABD or CN Medicaid rules.

WAC 388-449-0001, 388-449-0020, 388-449-0030, 388-449-0050, 388-449-0100 (ABD); 20 CFR 416.920, .945, .960, .963, .964, .965, .966 (CN Medicaid).  You can view the Washington Administrative Code (WAC) online at http://slc.leg.wa.gov/wacbytitle.htm.  You can view the Code of Federal Regulations (CFR) online at http://www.gpo.gov.  You can also view them at your public library reference desk.  If you can’t find this information, please call our office.

517

This reason code generates letter 0006-05. On that letter, you must enter the following information:

On 00/00/00, I asked you to provide some information by 00/00/00. I still need:

List of items:

(The social Worker should provide the FSS with some free-form text (via the 14-118).

518

182-508-0005

This reason code generates letter 0006-06. On that letter, you must enter the following information:

On 00/00/00, I asked you to provide some information by 00/00/00. I still need

List of items:

(The social Worker should provide the FSS with some free-form text (via the 14-118).

519

182-508-0005

This reason code generates letter 0006-04. On that letter, you must enter the following information:

On 00/00/00, I got a report form from Dr. (Name of doctor) that said your (specify condition) has improved so much that you can work now.

(The social Worker should provide the FSS with some free-form text (via the 14-118).

520

Change In Federal Law
There has been a change in the Federal law that regulates this program.

None

None Required

521

182-508-0005

This reason code generates letter 0006-04. On that letter, you must enter the following information:

On 00/00/00, I got a report form from Dr. (Name of doctor) that said your (specify condition) has improved so much that you can work now.

(The social Worker should provide the FSS with some free-form text (via the 14-118).

522

182-508-0005         388-449-0005

You work # hours per week for (employer) as a (position).

(The social Worker should provide the FSS with some free-form text (via the 14-118).

523

182-508-0005         388-449-0005

This reason code generates letter 0006-07. On that letter, you must enter the following information:

We made a mistake when we put you on MCS on (date). You did not meet our requirements because _________ (enter case specific information regarding the medical information received and why it doesn’t meet severity and/or duration requirements - e.g. “The information we got from Dr. Sun showed your back injury was not severe enough to keep you from doing light work that you have done in the past.”).

(The social Worker should provide the FSS with some free-form text (via the 14-118).

525

No Eligibility Review Form
We did not get your review form. If we get it before the end of the month, we will reconsider our decision. If you have already sent it, let me know.  See WAC rule (Washington Administrative Code):

388-434-0005  388-434-0010  388-492-0090  388-492-0110  388-492-0100

None Required

528

Eligibility Review Form Incomplete
The eligibility review form that you sent to us was not complete. We need for you to complete the form before we can continue your benefits. See WAC rule (Washington Administrative Code):

388-492-0110 388-492-0100

You must return the completed form to us by 00/00/00 in order for your benefits to continue.

531

Voluntary Withdrawal for Excess Resources
You withdrew your request for assistance because you have too many resources to get assistance right now.

388-513-1350; 388-406-0050

None required

534

Family Medical To 12-Month Medical Extension
Your cash benefits will stop because of earnings. Medical benefits for your family will continue under the Medical Extension Benefit program. You will get a separate letter to tell you about this program.  See WAC rule (Washington Administrative Code):

388-478-0065 388-478-0020 388-523-0100

(Name) works at __________ and now makes $_______.

535

Error in Initial Eligibility - Removed Continuous Tracking for Child
- For Administrative Use Only

None

Specify the reason for termination and a WAC related to that reason.

540

CEAP Financial Worker Closure- For Administrative Use Only

None

None Required

542

We got your change report form. Some information is still missing. We sent you a letter telling you what you need to give to us. We did not get it.

388-418-0011

Specify what is missing.

543

DETOX Financial Worker Closure - For Administrative Use Only

None

None Required

544

Your bank didn't honor your premium payment.

381-541-0200

None Required

549

You asked us to stop your Transitional Food benefits; or We approved your request for Basic Food. See WAC rule (Washington Administrative Code):

388-489-0020

None Required

550

Voluntary Withdrawal
You withdrew your request for assistance. See WAC rule (Washington Administrative Code):

388-406-0050, 388-492-0020

None Required

551

Whereabouts Unknown
We don’t know where you are. See WAC rule (Washington Administrative Code):

388-458-0030, 388-492-0020

None Required

552

Failed To Provide Verification
You did not give us the information we needed. See WAC rule (Washington Administrative Code):

388-472-0005 388-490-0005 388-458-0020, 388-492-0020

On 00/00/00, I asked you to provide some information by 00/00/00. I still need:

List of items

555

Application Opened In Error - For Administrative Use Only

None

None Required

556

Non-Cooperation With Quality Control - Food Assistance
You did not cooperate with the Food Stamp Quality Control reviewer. See WAC rule (Washington Administrative Code):

388-464-0001, 388-492-0020

You cannot get benefits for # months because    . You can regain your eligibility by     . If you have any questions about this, call the Quality Assurance worker at 000-000-0000.

557

AU Requests Closure
You asked us to stop your assistance.

None

None Required

558

Failed To Cooperate In Securing Other Income And Resources
You have income or resources that you could use but you haven’t made a reasonable effort to get them. If there is a good reason why you have not done this, please tell us. See WAC rule (Washington Administrative Code):

388-450-0005 388-470-0005 388-470-0015

You told us that you have (type of income/resource). To become eligible, you must try to make it available by _______(specify what they must do to make income or resource available).

559

Client Already Received Assistance In Another AU For This Benefit Month
Although you can belong to more than one assistance unit, you can only get benefits from one at a time. See WAC rule (Washington Administrative Code):

388-400-0005 388-400-0010 388-400-0025 388-400-0030 388-400-0040 388-400-0045

You are already getting cash assistance.
Or
You are already getting food assistance.
Or
You are already getting medical assistance.

561

AU Screened In Error - System Generated Only

None

None Required

562

Due to your child(ren)'s immigration status they do not qualify for Medicaid. The Children's Health Program is now full and your child(ren) are on a waiting list. When an opening occurs, you will be contacted to review family circumstances. See WAC rule (Washington Administrative Code):

388-505-0210

Specify which children.

564

Non-Cooperation With TPL Process
You did not cooperate in obtaining another source of coverage for your medical care. See WAC rule (Washington Administrative Code):

388-505-0540

You told us that you could get help with medical from (specify TPL source).

566

Refused to Cooperate With Application Process
You refused to cooperate in the application process. Based on the information we have, we are unable to determine your eligibility. See WAC rule (Washington Administrative Code):

388-406-0025 388-406-0035 388-406-0050 388-406-0060 388-452-0005, 388-492-0020, 388-406-0050

You did not     . If you need help, let me know and I will try to assist you.

567

Drug / Alcohol Center Loses Certification
You cannot receive food assistance. The drug or alcohol center where you live is not a certified public or private nonprofit organization. See WAC rule (Washington Administrative Code):

388-408-0040

None Required

569

Child Accepted To Foster Care
Our rules say that a child who is in foster care for 90 days or more must be taken off cash assistance. See WAC rule (Washington Administrative Code):

388-408-0015 388-454-0015

None Required

572

User Voided Application - For Administrative Use Only

None

None Required

575

Not Receiving Cash Assistance - For Administrative Use Only

None

None Required

576

Client Already Received Annual 3 Month M99 Maximum
You can only get Medically Indigent benefits for 3 months out of every 12. You have already used your 3 months.  See WAC rule (Washington Administrative Code):

388-438-0100

You received Medically Indigent benefits for 00/00 through 00/00.

577

Missed Application Deadline - For Administrative Use Only

None

None Required

578

Non-Cooperation with Chemical Dependency Assessment or Treatment

You aren’t eligible for assistance because you didn’t cooperate with a chemical dependency assessment or treatment.  You aren’t eligible for assistance again until you reapply and cooperate with assessment or treatment.

388-449-0220     

182-508-0005

You were sent a notice on _______ explaining that you must follow through with a chemical dependency assessment or treatment by ______.

You aren’t eligible for ABD cash or Medical Care Services (MCS) because you didn’t cooperate with a chemical dependency assessment or treatment.  You aren’t eligible for assistance again until you reapply and cooperate with assessment or treatment.

WAC 388-449-0220 (ABD); WAC 182-508-0005 (MCS). You can view these regulations online at http://slc.leg.wa.gov/wacbytitle.htm.  You can also view them at your public library reference desk.  If you can’t find this information, please call our office.

585

DCA Adult Eligible For TANF, Established Loan Repayment - For Administrative Use Only

None

None Required

586

DCA Ineligible

To get Diversion Cash Assistance everyone in your family must be able to get TANF/SFA (Temporary Assistance for Needy Families/State Family Assistance). See WAC rule (Washington Administrative Code):

None

Specify which DCA requirement was not met.

587

Already Eligible For Program In Different AU - For Administrative Use Only

388-408-0035

388-412-0005

The following persons aren't eligible for [cash/food] assistance for [MM/YYYY] because they already recieved [cash/food] assistance in another household:

[list name of ineligible persons]

NOTE: You may need to manually create a denial or termination letter or add text to the ACES system-generated letter.

588

Ineligible ESLMB Already Receiving MA
You are not eligible for the ESLMB program because you are receiving Medicaid benefits. See WAC rule (Washington Administrative Code):

You are not eligible for the Qualified Individual (QI-1) Program because you are receiving Medicaid Benefits. You are eligible for the State-funded Buy-In Program. We will pay for your Medicare Part A premiums, if you have any, as well as your Part B premiums, coinsurance, and deductibles.

388-517-0300

None Required

589

Based on your current medical information, you are no longer disabled under Social Security rules. See WAC rule (Washington Administrative Code):

388-511-1105

None Required

590

You have a penalty period because you gave away a non exempt asset or sold it for less than fair market value.

You, your representative or guardian, or with your consent, the facility where you live, may request an undue hardship waiver if you can show that without LTC services you will be deprived of housing, food, clothing or medical care and that your health or life will be endangered.

The request must be:

• In writing
• State the basis for requesting the undue hardship waiver
• Be signed by the requestor and include the requestor's name, address and telephone number and
• Be made within 90 days of the date of denial or termination of LTC services.

388-513-1363; 388-513-1364; 388-513-1365; 388-513-1367

Explain the amount of the transfer used to determine the penalty or penalties periods. Indicate the dates the penalty period starts and ends.

599

Other - For User Generation Only

None

None Required