WAC 388-523-0100 Medical extensions--Eligibility.

1. A family who received temporary assistance for needy families (TANF) or family medical program in any three of the last six months in the state of Washington is eligible for extended medical benefits when they become ineligible for their current medical program because the family receives:

   1. Child or spousal support, which exceeds the payment standard described in WAC 388-478-0065, and they are not eligible for any other categorically needy (CN) medical program; or 

   2. Increased earned income, resulting in income exceeding the CN income standard described in WAC 388-478-0065.

2. A family is eligible to receive extended medical benefits beginning the month after termination from TANF cash or family medical program for:

   1. Four months for a family described in subsection (1)(a) of this section; or

   2. Up to twelve months, in two six-month segments, for a family described in subsection (1)(b) of this section. For the purposes of this chapter, months one through six are the initial six-month extension period. Months seven through twelve are the second six-month extension period.

3. A family member is eligible to receive six months of medical extension benefits as described in subsection (2)(b) of this section unless:

   1. The individual family member:

      1. Moves out of state;

      2. Dies;

      3. Becomes an inmate of a public institution;

      4. Leaves the household; or

      5. Does not cooperate, without good cause, with the division of child support or with third party liability requirements.

   2. The family:

      1. Moves out of state;

      2. Loses contact with the department or the department does not know the whereabouts of the family; or

      3. No longer includes a child as defined in WAC 388-404-0005(1).

4. A family member is eligible to receive the second six months of medical extension benefits as described in subsection (2)(b) of this section unless:

   1. The family is no longer eligible for the reasons described in subsection (3)(a) or (b); or

   2. The individual family member is the caretaker adult who:

      1. Stops working or whose earned income stops;

      2. Does not, without good cause, complete and return the completed medical extension report or otherwise provide the required income and child care information; or

      3. Does not, without good cause, pay the billed premium amount for one month.

5. A family described in subsection (3) will not receive medical extension benefits for any family member who has been found ineligible for TANF/SFA cash because of fraud in any of the six months prior to the medical extension period.

6. For the purposes of this chapter, only individual family members that are eligible for Medicaid are certified to receive medical benefits under this program.