WAC 182-504-0040 Requirements for a midcertification review for medical care services (MCS).

1.  A midcertification review (MCR) is a form sent by the agency or the agency's designee to gather information about the MCS recipient's current circumstances.  The answers provided are used to determine if the individual remains eligible for medical coverage.   

2.  A recipient of MCS must complete a midcertification review unless the review period is six months or less.

3.  The review form is sent in the fifth month of the MCS certification or review period and must be completed by the tenth day of month six.

4.  If the individual is required to complete a midcertification review, it can be completed in one of the following ways:

a.  Complete the form and return it to the DSHS office.  The MCR will be considered complete if all the following steps are taken:

i.  The form is completed in full and any changes in circumstances for the household are indicated;

ii.  The form is signed and dated;

iii.  Proof is provided of any changes that are reported; and

iv.  The form is returned to DSHS by mail or in person along with any required proof by the due date on the review.

b.  Complete the midcertification review over the phone.   The MCR will be considered complete over the phone if all of the following steps are taken:

i.  DSHS is contacted at the phone number on the review form and told about any changes in the household's circumstances;

ii.  Proof is provided of any changes that are reported, and DSHS may be able to verify some information over the phone; and

iii.  Required proof is returned to DSHS by the due date on the review. 

c.  Complete the application process for another program.   If the agency or the agency's designee approves an application for another program in the month the MCR is due, the application is used to complete the review when the same individual is head of household for the application and the midcertification review.

5.  If eligibility for medical coverage ends because of the information provided in the midcertification review, the change takes effect the next month even if this does not give ten days notice before the effective date of the termination.

6.  If the required midcertification review is not completed, medical coverage under the MCS program stops at the end of the month the review was due.

7.  Late reviews.   If the midcertification review is completed after the last day of the month the review was due, the agency or the agency's designee will process the review as described below based on when the review is received:

a.  Midcertification reviews that are completed by the last day of the month after the month the review was due:   The agency or the agency's designee determines the MCS recipient's eligibility for ongoing medical coverage.  If the individual is determined to be eligible, coverage is reinstated based on the information in the review, unless there is a wait list due to an enrollment cap under WAC 182-508-0150;

b.  Midcertification reviews completed after the last day of the month after the month the review was due:   The agency or the agency's designee treats the review as a request to send an application.  In order to determine eligibility for ongoing MCS medical coverage, the application process as described in chapter 388-406 WAC  must be completed.