WAC 388-505-0110

Effective August 7, 2004

WAC 388-505-0110 Medical assistance coverage for adults not covered under family medical programs

  1. An adult who does not meet the institutional status requirements as defined in WAC 388-513-1320 and who does not receive waiver services as described in chapter 388-515 WAC is considered for categorically needy (CN) coverage under this chapter. Persons excluded from this section have rules applied to eligibility from chapter 388-513 WAC. Under this section a person is eligible for CN coverage when the person: 

    1. Meets citizenship/immigrant, residency, and Social Security number requirements as described in WAC 388-503-0505; and

    2. Has CN countable income and resources that do not exceed the income and resource standards in WAC 388-478-0080; and

    3. Is sixty-five years of age or older, or meets the blind and/or disability criteria of the federal SSI program.

  2. An adult not meeting the conditions of subsection (1)(b) is eligible for CN medical coverage if the person:

    1. Is a current beneficiary of Title II of the Social Security Act (SSA) benefits who:

      1. Was a concurrent beneficiary of Title II and Supplemental Security Income (SSI) benefits;

      2. Is ineligible for SSI benefits and/or state supplementary payments (SSP); and

      3. Would be eligible for SSI benefits if certain cost-of-living (COLA) increases are deducted from the client's current Title II benefit amount:

        1. All Title II COLA increases under P.L. 94-566, section 503 received by the client since their termination from SSI/SSP; and

        2. All Title II COLA increases received during the time period in subsection (1)(d)(iii)(A) of this section by the client's spouse or other financially responsible family member living in the same household.

    2. Is an SSI beneficiary, no longer receiving a cash benefit due to employment, who meets the provisions of section 1619(b) of Title XVI of the SSA;

    3. Is a currently disabled client receiving widow's or widower's benefits under section 202(e) or (f) of the SSA if the disabled client:

      1. Was entitled to a monthly insurance benefit under Title II of the SSA for December 1983; and

      2. Was entitled to and received a widow's or widower's benefit based on a disability under section 202(e) or (f) of the SSA for January 1984;

      3. Became ineligible for SSI/SSP in the first month in which the increase provided under section 134 of P.L. 98-21 was paid to the client;

      4. Has been continuously entitled to a widow's or widower's benefit under section 202(e) or (f) of the SSA;

      5. Would be eligible for SSI/SSP benefits if the amount of that increase, and any subsequent COLA increases provided under section 215(i) of the SSA, were disregarded;

      6. Is fifty through fifty-nine years of age; and

      7. Filed an application for Medicaid coverage before July 1, 1988.

    4. Was receiving, as of January 1, 1991, Title II disabled widow or widower benefits under section 202(e) or (f) of the SSA if the person:

      1. Is not eligible for the hospital insurance benefits under Medicare Part A;

      2. Received SSI/SSP payments in the month before receiving such Title II benefits;

      3. Became ineligible for SSI/SSP due to receipt of or increase in such Title II benefits; and

      4. Would be eligible for SSI.SSP if the amount of such Title II benefits or increase in such Title II benefits under section 202(e) or (f) of the SSA, and any subsequent COLA increases provided under section 215(i) of the act were disregarded.

    5. Is a disabled or blind client receiving Title II Disabled Adult Childhood (DAC) benefits under section 202(d) of the SSA if the client:

      1. Is at least eighteen years old;

      2. Lost SSI/SSP benefits on or after July 1, 1988, due to receipt of or increase in DAC benefits; and

      3. Would be eligible for SSI/SSP if the amount of the DAC benefits or increase under section 202(d) of the DAC and any subsequent COLA increases provided under section 215(i) of the SSA were disregarded.

    6. Is a client who:

      1. In August 1972, received:

        1. Old age assistance (OAA);

        2. Aid to blind (AB);

        3. Aid to families with dependent children (AFDC); or

        4. Aid to the permanently and totally disabled (APTD); and

      2. Was entitled to or received retirement, survivors, and disability insurance (RSDI) benefits; or

      3. Is eligible for OAA, AB, AFDC, SSI, or APRD solely because of the twenty percent increase in Social Security benefits under P.L. 92-336.

  3. An adult who does not meet the institutional status requirement as defined in WAC 388-513-1320 and who does not receive waiver services as described in chapter 388-515 WAC is considered for medically needy (MN) coverage under this chapter. Persons excluded from this section have rules applied to eligibility from chapter 388-513 WAC. Under this section a person is eligible for MN coverage when the person:

    1. Meets citizenship/immigrant, residency, and Social Security number requirements as described in WAC 388-503-0505; and

    2. Has MN countable income that does not exceed the income standards in WAC 388-478-0080, or meets the excess income spenddown requirements in WAC 388-519-0110; and

    3. Meets the countable resource standards in WAC 388-478-0070; and

    4. Is sixty-five years of age or older or meets the blind and/or disability criteria of the federal SSI program.

  4. MN coverage is available for an aged, blind, or disabled ineligible spouse of an SSI recipient. See WAC 388-519-0100 for additional information.

  5. An adult may be eligible for the alien emergency medical program as described in WAC 388-438-0110.

  6. An adult is eligible for the state-funded general assistance - expedited Medicaid disability (GA-X) program when they:

    1. Meet the requirements of the cash program in WAC 388-400-0025 and 388-478-0030; or

    2. Meet the SSI-related disability standards but cannot get the SSI cash grant due to immigration status or sponsor deeming issues. Clients may be eligible for GA cash benefits and CN medical coverage due to different sponsor deeming requirements.

  7. An adult is eligible for the state-funded medical care services (MCS) program when the person is eligible for GAU or ADATSA program coverage as described in WAC 388-400-0025 and 388-800-0048. GAU clients residing in counties designated as mandatory managed care plan counties must enroll in a plan, pursuant to WAC 388-538-063.

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.