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 department determines medicaid eligibility for children and pregnant women who enroll through BH. 

2. Eligible children are enrolled in the basic health 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, except as follows:

   1. The process for enrolling in managed care described in WAC 388-538-0060(3) does not apply since enrollment is through the health care authority, the state agency that administers BH;

   2. American Indian/Alaska Native (AI/AN) clients cannot choose fee-for-service or PCCM as described in WAC 388-538-0060(2). They must enroll in a BH-contracted MCO.

   3. If a Medicaid eligible client applying for BH plus does not choose an MCO prior to the department's eligibility determination, the client is transferred from BH plus to the department for assignment to managed care.

   4. The department does not consider the basic health plus and the maternity benefits programs to be third party.