WAC 182-508-0150

Effective October 14, 2012

WAC 182-508-0150 Enrollment cap for medical care services (MCS).

  1. Enrollment in medical care services (MCS) coverage is subject to available funds.
  2. The agency may limit enrollment into MCS coverage by implementing an enrollment cap and waiting list.
  3. If an individual is denied MCS coverage due to an enrollment cap:

a.  The individual is added to the MCS waiting list based on the date the individual applied.

b.  Applicants with the oldest application date will be the first to receive an opportunity for enrollment when MCS coverage is available.

        4.  An individual is exempted from the enrollment cap and wait list rules when:

a.  MCS was terminated due to agency error;

b.  The individual is in the thirty-day reconsideration period for incapacity reviews under WAC 182-508-0160 (4); or

c.  The individual is being terminated from a CN medical program and was receiving and eligible for CN coverage prior to the date a wait list was implemented and the following conditions are met:

i.  The individual met financial and program eligibility criteria for MCS at the time their CN coverage ended; and

ii.  The individual met the incapacity criteria for MCS at the time their CN coverage ended.

d.  The individual applied for medical coverage and an eligibility decision was not completed prior to the enrollment cap effective date.

5.  If the individual is sent an offer for MCS enrollment, the individual must submit a completed application no later than the last day of the month following the month of enrollment offer.  The individual must reapply within this time period and subsequently be determined eligible before MCS coverage can begin.  The individual must reapply and requalify even if the individual was previously determined eligible for MCS.

6.  The individual is removed from the MCS wait list if the individual:

a.  Is not a Washington resident;

b.  Is deceased;

c.  Requests removal from the wait list;

d.  Fails to submi an applicaiton after an enrollment offer is sent as described in subsection (5) of this section;

e.  Reapplies as described in subsection (5) of this section, but does not qualify for MCS; or

f.  Is found eligible for categorically or medically needy coverage.

 

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.