WAC 182-505-0210 Apple Health for kids and other children's medical assistance programs.

Funding for coverage under Apple Health for Kids may come through Title XIX (medicaid), Title XXI (CHIP), or through state-funded programs. There are no resource limits for the Apple Health for Kids programs.  Apple Health for Kids coverage is free to children in households with incomes of no more than two-hundred percent of the federal poverty level (FPL), and available on a premium basis to children in households with incomes of no more than three-hundred percent FPL.

1.  Newborns are eligible for federally matched categorically needy (CN) coverage through  their first birthday when:

a.  The newborn is a resident of the state of Washington.

b.  The newborn's mother is eligible for medical assistance:

i. On the date of the newborn's birth, including a retroactive eligibility determination; or

ii.  Based on meeting a medically needy (MN) spenddown liability with expenses incurred on, or prior to, the date of the newborn's birth.

2. Children under the age of nineteen who are U.S. citizens, U.S. nationals, or lawfully present qualified or nonqualified aliens as described in WAC 388-424-0001, WAC 388-424-0010 (4), and WAC 388-424-0006 (1), (4) and (5)  are eligible for free federally matched CN coverage when they meet the following criteria:

a.  State residence as described in chapter 388-468 WAC;

b.  A social security number or application as described in chapter 388-476 WAC;

c.  Proof of citizenship or immigrant status and identity as required by WAC 388-490-0005 (11);

d.  Family income is at or below two-hundred percent Federal Poverty Level (FPL) as described in WAC 388-478-0075  at each application or review; or

e.  They received supplemental security income (SSI) cash payments in August 1996 and would continue to be eligible for those payments except for the August 1996 passage of amendments to federal disability definitions.

f.  They are currently eligible for SSI.

3.  Non-citizen children under the age of nineteen, who are not lawfully present qualified or nonqualified aliens as described in WAC as described in  WAC 388-424-0001,  WAC 388-424-0010 (4), and WAC 388-424-0006 (1), (4), and (5),  are eligible for free state-funded coverage when they meet the following criteria:

a.  State residence as described in chapter 388-468 WAC; and

b.  Family income is at or below two hundred percent FPL at each application or review.

4.  Children under the age of nineteen who are U.S. citizens, U.S. nationals, or lawfully present qualified or nonqualified aliens as described in WAC 388-424-0001, WAC 388-424-0010 (4),  and WAC 388-424-0006 (1), (4), and (5) are eligible for premium-based federally-matched CN coverage as described in chapter 388-542 WAC  when they meet the following criteria:

a.  State residence as described in chapter 388-468 WAC;

b.  Proof of citizenship or immigrant status and identity as required by WAC 388-490-0005 (11);

c.   Family income is over two-hundred percent FPL, as described in WAC 388-478-0075, but not over three-hundred percent FPL at each application or review;

d.  They do not have other creditable health insurance as described in WAC 388-542-0050; and

e.  They pay the required monthly premiums as described in WAC 388-505-0225.

5.  Noncitizen children under the age of nineteen, who are not lawfully present qualified or nonqualified aliens as described in WAC 388-424-0001, 388-424-0010 (4), and 388-424-0006 (1), (4), and (5), are eligible for premium-based state-funded coverage when they meet the following criteria:

a.  State residence as described in chapter 388-468 WAC;

b.  Family income is over two-hundred percent FPL, as described in WAC 388-478-0075, but not over three-hundred percent FPL at each application or review;

c.  They do not have other creditable health insurance as described in WAC 388-542-0050; and

d.  They pay the required monthly premium as described in WAC 388-505-0211.

 6.  Children under age 19 are eligible for the medically needy (MN) medicaid program when they meet the following criteria:

a.  Citizenship or immigrant status, state residence, and social security number requirements as described in subsection (2) (a), (b), and (c) of this section;

b.  Are ineligible for other federally-matched CN programs;

c. Have income that exceeds three hundred percent FPL; or

d. Have income less than three hundred percent FPL, but do not qualify for premium-based coverage as described in subsection (4) of this section because of creditable coverage; and

e. Meet their spenddown liability as described in WAC 388-519-0100  and WAC 388-519-0110.

7.  Children under the age of nineteen who reside or are expected to reside in a medical institution, intermediate care facility for the mentally retarded (ICF/MR), hospice care center, nursing home, institution for mental diseases (IMD) or inpatient psychiatric facility may be eligible for Apple Health for Kids healthcare coverage based upon institutional rules described in WAC 388-505-0260.  Individuals between the age of nineteen and twenty-one may still be eligible for healthcare coverage but not under Apple Health for Kids. See WAC 388-542-0300  "Family related institutional medical" and WAC 388-513-1320    "Determining institutional status for long-term care" for more information.

8.  Children who are in foster care under the legal responsibility of the state, or a federally recognized tribe located within the state, and who meet eligibility requirements for residency, social security number, and citizenship as described in subsection (2)(a), (b), and (c) of this section are eligible for federally-matched CN medicaid coverage through the month of their:

a.  Eighteenth birthday;

b.  Twenty-first birthday if the Children's Administration determines they remain eligible for continued foster care services; or

c.  Twenty-first birthday if they were in foster care on their eighteenth birthday and that birthday was on or after July 22, 2007.

9.  Children are eligible for state-funded CN coverage through the month of their eighteenth birthday if they:

a.  Are in foster care under the legal responsibility of the state or a federally-recognized tribe located within the state; and

b.  Do not meet social security number and citizenship requirements in subsection (2) (b) and (c) of this section.

10.  Children who receive subsidized adoption services are eligible for federally-matched CN coverage.

11.  Children under the age of nineteen not eligible for apple health for kids programs listed above may be eligible for one of the following medical assistance programs not included in apple health for kids:

a.  Family medical as described in WAC 388-505-0220;

b.  Medical extensions as described in WAC 388-523-0100; or

c.  SSI-related MN if they:

i.  Meet the blind and/or disability criteria of the federal SSI program, or the condition of subsection (2) (e) of this section; and

ii.  Have countable income above the level described in WAC 388-478-0070 (1).

d.  Home and community based waiver programs as described in chapter 388-515 WAC; or

e. Alien medical as described in WAC 388-438-0110, if they:

i. Have a documented emergency medical condition as defined in WAC 388-500-0005;

ii. Have income more than three hundred percent FPL; or

iii. Have income less than three hundred percent FPL, but do not qualify for premium-based coverage described in subsection (5) of this section because of creditable coverage.

12.  Except for a child described in subsection (7) of this section, an inmate of a public institution, as defined in WAC 388-500-0005, is not eligible for any Apple Health for Kids program.