WAC 182-508-0010 Incapacity requirements for medical care services (MCS).

Eligibility for the medical care services (MCS) program is based on an individual being incapacitated from working.  For an individual to receive MCS program benefits, the agency or the agency's designee must determine the individual is incapacitated.

"Incapacitated" means that an individual cannot be gainfully employed as a result of a physical or mental impairment that is expected to continue for at least ninety days from the date the individual applies.

"Mental impairment" means a diagnosable mental disorder.  The agency or the agency's designee excludes any diagnosis of or related to alcohol or drug abuse or addiction.

"Physical impairment" means a diagnosable physical illness. 

(1)  The agency or the agency's designee determines the individual is incapacitated if the individual is:

(a)  Disabled based on Social Security Administration (SSA) disability criteria;

(b)  Eligible for services from the division of developmental disabilities (DDD);

(c)  Diagnosed as having mental retardation based on a full scale score of seventy or lower on the Wechsler adult intelligence scale (WAIS);

(d)  At least sixty-four years and seven months old;

(e)  Eligible for long-term care services from aging and disability services administration; or

(f)  Approved through the progressive evaluation process (PEP).

(2)  The agency or the agency's designee considers an individual to be incapacitated for ninety days after:

(a)  The individual is released from inpatient treatment for a mental impairment if:

(i)  The release from inpatient treatment was not against medical advice; and

(ii)  The individual was discharged into outpatient treatment.

(b)  The individual is released from a medical institution where the individual received long-term care services from the aging and disability services administration.