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.

(Social Service Specialist  provides mandatory free form text via 14-118)

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

(Social Service Specialist  provides mandatory free form text via 14-118)

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

(Social Service Specialist  provides mandatory free form text via 14-118)

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

(Social Service Specialist  provides mandatory free form text via 14-118)

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.

(Social Service Specialist  provides mandatory free form text via 14-118)

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

(Social Service Specialist  provides mandatory free form text via 14-118)

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

(Social Service Specialist  provides mandatory free form text via 14-118)

510

Past Work

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

388-449-0080

(Social Service Specialist  provides mandatory free form text via 14-118)

511

Other Work

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

388-449-0080

(Social Service Specialist  provides mandatory free form text via 14-118)

517

388-406-0065

388-448-0030   388-448-0040   388-448-0160   388-448-0170

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 182-523-0100

(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):

182-505-0210

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):

182-503-0540

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 received [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.

182-517-0300

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

(If used for ABD or MCS denial or termination, Social Service Specialist provides mandatory free form text via 14-118)