WAC 388-505-0210 Children's healthcare programs.

Funding for children's healthcare coverage may come through Title XIX (medicaid), Title XXI SCHIP, or through state-funded programs. There are no resource limits for children's healthcare programs.  Children's healthcare programs that fall under the apple health for kids umbrella are described in subsections (1) through (4) below.

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

a.  The child's mother was eligible for and receiving medical assistance at the time of the child's birth.

b.  The child remains with the mother and resides in the state.

2. Children under the age of nineteen who are U.S. citizens, U.S. nationals, or qualified aliens as described in WAC 388-424-0001 and WAC 388-424-0006 (1) and (4)  are eligible for 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 eligible for SSI-related CN or MN coverage.

3.  Non-citizen children under the age of nineteen, who do not meet qualified alien status as described in  WAC 388-424-0006,  are eligible for state funded CN 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 are eligible for premium-based 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.  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 premiums as described in WAC 388-505-0211.

5.  Children under the age of nineteen 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);

b.  Are ineligible for other federal medicaid programs; and

c.  Meet their spenddown obligation as described in WAC 388-519-0100  and WAC 388-519-0110.

6.  Children under the age of twenty-one who reside or expect to reside in a medical institution, intermediate care facility for the mentally retarded (ICF/MR), nursing home, or psychiatric facility, may be eligible for healthcare coverage. See WAC 388-505-0230  "Family related institutional medical" and WAC 388-513-1320    "Determining institutional status for long-term care".

7.  Children who are in foster care under the legal responsibility of the state, or a federally recognized tribe located within the state, are eligible for federally matched CN medicaid coverage through the month of their:

a.  Eighteenth birthday;

b.  Twenty-first birthday if 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.

8.  Children who receive subsidized adoption services are eligible for federally matched CN Medicaid coverage.

9.  Children under the age of nineteen may also be eligible for:

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); and

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

10.  Children who are ineligible for other programs included in apple health for kids may be eligible for the Alien Emergency Medical program (AEM) if they meet the following criteria:

a.  They have a documented emergent medical condition as defined in WAC 388-500-0005; and

b.  They meet the other AEM program requirements as described in WAC 388-438-0110; and

c.  They have income that exceeds three hundred percent FPL; or

d.  They are disqualified from receiving premium-based coverage as described in subsection (4) of this section because of creditable coverage or non-payment of premiums.

11.  Except for a client described in subsection (6), an inmate of a public institution, as defined in WAC 388-500-0005, is not eligible for any children's healthcare program.