WAC 388-503-0505 General eligibility requirements for medical programs

1. Persons applying for benefits under the medical coverage programs established under chapter 74.09 RCW must meet the eligibility criteria established by the department in chapters 388-400 through 388-555 WAC. 

2. Persons applying for medical coverage are considered first for federally funded or federally matched programs. State-funded programs are considered after federally funded programs and are not available to the client except for brief periods when the state-funded programs offer a broad scope of care which meet a specific client need.

3. Unless otherwise specified in program specific WAC, the eligibility criteria for each medical program is as follows:

   1. Verification of age and identity (chapters 388-404, 388-406, and 388-490 WAC); and

   2. Residence in Washington state (chapter 388-468 WAC); and

   3. Citizenship or immigration status in the United States (chapter 388-424 WAC); and

   4. Possession of a valid Social Security Account Number (chapter 388-476 WAC); and

   5. Assignment of medical support rights to the state of Washington (388-505-0540); and

   6. Cooperation in securing medical support (chapter 388-422 WAC); and

   7. Application for Medicare and enrollment into Medicare's prescription drug program if:

      1. It is likely that the individual is entitled to Medicare; and

      2. The state has authority to pay Medicare cost sharing as described in chapter 388-517 WAC.

   8. Countable resources within program limits (chapters 388-470 and 388-475 and 388-478 WAC); and

   9. Countable income within program limits (chapters 388-450 and 388-475 and 388-478 WAC).

4. In addition to the general eligibility requirements in subsection (3) of this section, each program has specific eligibility requirements as described in applicable WAC.

5. Persons living in a public institution,  including a correctional facility, are not eligible for the department's medical coverage programs.  For a person under age twenty or over age sixty-five who is a patient in an institution for mental disease, see WAC 388-513-1315 (13)  for exception.

6. Persons terminated from SSI or TANF cash grants and those who lose eligibility for categorically needy (CN) medical coverage have their CN coverage continued while their eligibility for other medical programs is redetermined. This continuation of medical coverage is described in chapter 388-434 WAC.