WAC 182-538-0065

Effective July 1, 2011

WAC 182-538-0065 Medicaid-eligible basic health (BH) enrollees.

(1) Certain children and pregnant women who have applied for, or are enrolled in, managed care through basic health (BH) (chapter 70.47 RCW) are eligible for medicaid under pediatric and maternity expansion provisions of the Social Security Act. The agency determines medicaid eligibility for children and pregnant women who enroll through BH.

(2) Eligible children are enrolled in the BH plus program and eligible pregnant women are enrolled in the maternity benefits program.

(3) The administrative rules and regulations that apply to managed care enrollees also apply to medicaid-eligible clients enrolled through BH plus or the maternity benefits program as described in this section, except as follows:

     (a) American Indian and Alaska native (AI/AN) clients cannot choose fee-for-service or PCCM as described in WAC 182-538-060(2). They must enroll in a HCA-contracted MCO.

     (b) The agency does not consider the basic health plus and the maternity benefits programs to be third party.

(4) This section does not apply to the subsidized basic health program found in chapter 182-24 WAC. 

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.