Letters

Revised March 25, 2011

Purpose: The department of social and health services (DSHS) sends you letters to tell you about your case.

100 Series Reason Code Protocols

Revised July 30, 2015

Purpose:

  • 100 Series Reason Code Protocols
  • Go to the Reason Code Link chart to link directly to a specific reason code or scroll through the list below.
  • For ACES Procedures go to ACES Letters in the ACES User Manual.

Code

Reason Code Title / Text

WAC References

Recommended Free Form Text 

101

ABD Cash/HEN Referral Spouse Ineligible
You can’t receive Aged, Blind, & Disabled (ABD) Cash or Housing and Essential Needs (HEN) Referral when your spouse receives Supplemental Security Income (SSI).

182-508-0005

388-400-0060

388-400-0070

388-474-0010

None Required

102

WASHCAP Application Month Denied - For Administrative Use Only

None

None Required

103

WASHCAP Terminates - Client Has Had Earned Income For More Than Three Months
You can’t receive WASHCAP food assistance because you’ve been working more than 3 months.

388-492-0030

None Required

104

SSA Terminates WASHCAP Food Assistance
Social Security asked us to stop your food benefits See WAC rule (Washington Administrative Code)

388-492-0110

388-492-0030

388-492-0120

None Required

105

WASHCAP Terminates - Client Living Situation Has Changed

You can't receive Washington State Combined Application Project (WASHCAP) food benefits because your living arrangement changed.

388-492-0030

None Required

106

WASHCAP Terminates - Client Getting $1.00 Or Less SSI Money

You stopped receiving SSI cash.

388-492-0030

None Required

107

WASHCAP Terminates - Client Not Eligible For SSI Money Or Medical
SSA decided that you cannot get SSI. See WAC rule (Washington Administrative Code):

388-492-0030

388-492-0120

None Required

109

Not SSP Eligible - Client's SSI Terminated

You can’t receive a state supplemental payment if you’re not receiving a SSI payment

388-474-0012

None Required

110

Not SSP Eligible - Invalid Living Arrangement

You can’t receive a state supplemental payment when you live in an institution

388-474-0012

None Required

111

Not SSP Eligible - SSI Eligibility Category Change

You can only receive a State Supplemental Payment (SSP) if you receive SSI and one of the following is true:

  • You live with your SSI ineligible spouse.
  • You are blind.
  • You are age 65 or older.

388-474-0012

None Required

112

Receiving Tribal TANF Benefits

We believe you are eligible for cash benefits from the tribe

388-400-0005

If you are a client in a household which is eligible for a tribal TANF program, you cannot receive state and tribal TANF in the same month.

120

Failed to Provide Proof of Citizenship/Identity

You did not provide proof of citizenship for a member or members of your household. Proof of citizenship is required before a person can receive medical.

388-490-0005

182-503-0535

Specify the persons who are ineligible due to lack of proof of citizenship

130

Not TFA Eligible – Not Recipient of BF in Prior Month            

The people listed above will not get Transitional Food benefits with you because they did not get Basic Food benefits with you during the last month you got TANF. If you want to find out if you would get more food benefits by including others in your household, please apply for Basic Food. You can choose the program that gives you the most benefits, Basic Food or Transitional Food.

388-408-0035
388-489-0005

None Required

131

A Member of the Household is now receiving TANF

Someone who gets Transitional Food with you is approved for Temporary Assistance for Needy Families (TANF) or Tribal TANF. We will see if you can get Basic Food. You may need to turn in an eligibility review for us to see if you can get Basic Food.

388-489-0025

Specify the person who is receiving TANF or Tribal TANF.

132

RCA E&T Participation

Refugee Cash Assistance requires participation in an employment and training program.

388-466-0120

388-466-0150

None required
133

One Caretaker Relative Recipient

Only one caretaker (non-parent) can be recipient on a TANF or SFA grant.

388-408-0025 None required
134

No WF Orientation

The person(s) listed below didn't attend the required WorkFirst Orientation.

388-400-0005

388-400-0010

None required

141

Mid-Certification Review Not Returned

We did not get your mid-certification report form. If you get us what we need before the end of the month, we will reconsider our decision. You must either:

·         Turn in the form; or

·         Call us to report your current circumstances.

388-418-0011

None Required

142

Incomplete Mid-Certification Review

We got your mid-certification report form. Some information is still missing. We sent you a letter telling you what you need to give to us. We did not get it.

388-418-0011

List the missing items.

160

MCS Enrollment Cap

We aren't currently enrolling new members in this program.  This medical program isn't accepting new enrollees because of an enrollment cap due to limited funding.

182-508-0150 None required
161

MCS Enrollment Cap - Client Placed on Wait List

We aren't currently enrolling new members in this program.

This medical program isn't accepting new enrollees because of limited funding.  We added you to the waiting list.  Those on the waiting list longest will receive the first opportunity to apply.  We'll notify you by mail when space is available.

182-508-0150 None required
162

MCS Enrollment Cap - Already on Wait List

We aren't currently enrolling new members in this program. You are already on the medical coverage waiting list. 

182-508-0150 None required
163 Medical Care Services (MCS) is only available for recipients of the AGed, Blind, Disabled, (ABD) cash program, or the Housing and Essential Needs (HEN) Referral program.  The household member(s) listed won't be eligible for assistance from these programs. 182-508-0150 None required
164 You entered the U.S. on or after August 22, 1996 and were eligible for limited health care coverage.  You have been here legally for 5 years.  Your health care coverage is ending.  You may be eligible for new health care coverage under the Affordable Care Act. To find out go to www.wahealthplanfinder.org or call 1-855-923-4633.  This change does not affect your HEN eligibility. 182-503-0535
182-508-0001
182-508-0005
388-400-0060
388-400-0070
388-424-0015
None required
177

Missed Food Application Deadline 

We must make a decision on your eligibility within 30 days from the date you applied. We don’t have enough information to determine your eligibility. We’ve denied your application. 

388-406-0035 388-406-0040 None required.

187

Client Already Received CN Medicaid In Another AU For This Benefit Month - For Administrative Use Only

None

None Required

188

Medical Review Not Completed

Your medical disability review was not completed in time. This is because: We did not get updated medical information; or We got your medical information but it is still being reviewed.

182-512-0050

Specify person who is being terminated.

 
195

Failed Blind or Disabled Requirements - HWD

You don't meet federal blind or disability requirements based on the medical evidence we have.

182-511-1050

182-511-1150

None required

200 Series Reason Code Protocols

Revised August 21, 2015

Purpose:

  • 200 Series Reason Code Protocols
  • Go to the Reason Code Link chart to link directly to a specific reason code or scroll through the list below.
  • For ACES Procedures go to ACES Letters in the ACES User Manual.

Code

Reason Code Title / Text

WAC References

Recommended Free Form Text

200

Non-Citizen Medicaid Ineligibility 

You do not meet the citizenship or alien status requirements to receive Washington Apple Health.

182-503-0505

182-503-0535

Need to specify which persons in AU do not meet citizenship requirements.

201

Living Arrangement - Cash / Medical Assistance
Due to your living arrangement, we do not consider you a member of the household.

388-408-0015

388-408-0020

388-408-0025

388-408-0060

388-408-0070

182-506-0010

182-506-0015

 

Your living arrangement does not meet our requirements because (specify relevant requirement and how client's living situation does not meet that requirement)      .

(Note to Users: This reason code is based on the valid value entered in the living arrangement field on the DEM1 screen).

202

Citizenship / Alien Status
Immigrant requirements have not been met to receive these benefits.

388-400-0070

388-424-0010

388-424-0015

388-424-0020

182-503-0505

182-503-0535

182-505-0115

182-505-0210

182-505-0240

182-505-0250

182-508-0001

 

If client submitted verification of alien status:

You do not meet the requirements because (specify relevant requirement and how client's alien status does not meet that requirement).                        .

If client didn't submit verification of status:

We can't determine if you meet our requirements because we do not have verification of your citizenship status.

203

Receiving SSI
People who receive Supplemental Security Income (SSI) can't receive DSHS cash benefits for themselves or a Housing and Essential Needs (HEN) Referral.

388-408-0020

388-400-0060

388-400-0070

388-474-0020

None Required

204

No Dependent Child
You are not pregnant and do not have a dependent child living with you. You will get another letter if you can get medical benefits from another program.  See WAC rule (Washington Administrative Code):

182-505-0240

If pending medical:

We have not figured out if you are eligible for medical assistance because we are still waiting to hear if your condition meets our definition of a disability or emergency medical condition.

205

Failed Age / School Attendance
Children over 18 years old must meet certain requirements to get these benefits. Your child does not meet these requirements.  See WAC rule (Washington Administrative Code):

388-404-0005

 

(Name) is # years old. S/he cannot get assistance because (specify requirement that client does not meet).     .

206

Living Arrangement - Food Assistance
Due to your current living arrangement, we do not consider you a member of the household.  See WAC rule (Washington Administrative Code):

388-408-0035

388-408-0040

388-492-0030

Your living arrangement does not meet our requirements because (specify requirement that client does not meet)     .

(Note to Users: This reason code is based on the valid value entered in the living arrangement field on the DEM1 screen).

207

Failed Eligible Student Requirement - Food Assistance
Students have to meet certain requirements to get benefits. You do not meet the requirements.  See WAC rule (Washington Administrative Code):

388-482-0005

Specify requirements and why client doesn't meet them.

208

Failed Social Security Number (SSN) Requirement

We don't have one of the following:

  • A valid Social Security Number (SSN)
  • Proof of a recent application for a SSN

182-505-0115

182-508-0001

388-476-0005

182-503-0505

182-503-0515

Need to specify which person(s) in AU we require the SSN for. 

209

Failed Refugee Requirement
Refugees and asylees must meet certain requirements to get benefits from this program. You do not meet the requirements. See WAC rule (Washington Administrative Code):

388-400-0030

388-466-0005

182-507-0130

182-507-0135

For refugees:
You entered the United States on 00/00/00.  (Specify why this doesn't meet the requirements.)

or

For asylees:
You were granted asylee status on 00/00/00. (Specify why this doesn't meet the requirement.)

 

 

Code

Reason Code Title / Text

WAC References

Free Form Text

210

Failed Residency Requirement
We do not consider you a resident of Washington.

388-400-0005

388-400-0040

388-400-0060

388-400-0070

388-454-0015

388-468-0005

182-503-0505

182-503-0520

182-503-0525

You do not meet the residency requirements because (specify client facts showing why client is not considered a WA resident)    .

212

No Relationship

To get cash assistance for a child, you must be:

  • a relative
  • a legal guardian,
  • acting as the child's parent, or
  • a court ordered custodian.

See WAC rule (Washington Administrative Code):

388-454-0005

388-454-0010

 

(Caretaker's name) is not a relative of specified degree, legal guardian, acting as a parent or permanent custodian of (Child's Name).

(Note to Users: This reason code is based on the valid value entered in the relationship field on the STAT screen).

If pending medical:
We have not figured out if you are eligible for medical assistance because we are still waiting to hear if your medical condition meets our definition of a disability or emergency.

213

Failed Pregnancy Requirement - S Medical & Family Planning Medical
You cannot get benefits until we have proof that you are pregnant or have been pregnant in the last 12 months. See WAC rule (Washington Administrative Code):

388-462-0010

388-408-0015

You are not eligible for post-partum coverage because it has been more than 2 months since your pregnancy ended.  or You are not eligible for family planning coverage since it has been more than 12 months since your pregnancy ended.

214

TANF Pregnancy Only - Father of Unborn Not Eligible
Only a pregnant woman can get TANF/SFA when there are no other children in the household. Until the baby is born, the father of your unborn child cannot get TANF/SFA.  SeeWAC rule (Washington Administrative Code):

388-408-0015

None Required

215

Failed Work Registration Requirements
You are required to participate in the Employment and Training program. You have not met the registration requirements or given us proof that you have good cause not to participate.  See WAC rule (Washington Administrative Code):

388-444-0015

388-444-0005

388-444-0050

You did not      on 00/00/00. You cannot get benefits from 00/00/00 to 00/00/00 unless you      .  If you don't do this, you will have to reapply after 00/00/00 and start participating.

218

Roomer - Food Assistance
The person listed above is a roomer. A roomer is someone who pays for rent and not for meals. Roomers must apply for food assistance on their own.  See WAC rule (Washington Administrative Code):

388-408-0035

None Required

219

Voluntary Quit
We do not have proof that you had good cause to quit your job.  SeeWAC rule (Washington Administrative Code):

388-444-0060

388-444-0065

388-444-0070

388-444-0075

You quit your job or reduced your work effort at      on 00/00/00. You cannot get benefits until [disqualification period] unless you become exempt from work registration.  If you want benefits, you must reapply.

You can get food assistance, during this time if you become exempt from work registration.


Code

Reason Code Title / Text

WAC References

Free Form Text

220

Failed Age Requirement - Medical
You do not meet the age requirement for this program.  See WAC rule (Washington Administrative Code):

182-505-0210

182-505-0211

182-508-0001

You must be         to get benefits from this program.

221

Failed Incapacity Requirement
We do not have proof that your condition keeps you from working for at least 90 days.

388-447-0001

(The social service specialist will provide mandatory free form text via the 14-118)

222

Eligibility Not Established For Month
We could not approve your benefits for the months listed because we did not get your information in time. You will get another letter listing the months that you can get benefits. See WACrule (Washington Administrative Code):

182-513-1315

182-515-1505

182-515-1510

388-406-0055

388-406-0056

None Required

223

Failed E&T Requirements - 2nd Offense
You are required to participate in the Employment and Training program. You have not met the registration requirements or given us proof that you have good cause not to participate. Since this is your second offense, you may not get food assistance for 3 months and until you participate.  See WAC rule (Washington Administrative Code):

388-444-0050

388-444-0005

388-444-0055

388-444-0010

You did not           on 00/00/00. You cannot get benefits until 00/00/00.  If you want food assistance after that, you must reapply and start participating.

224

Failed E&T Requirements - 3rd Offense
You are required to participate in the Employment and Training program. You have not met the registration requirements or given us proof that you have good cause not to participate. Since this is your third offense, you may not get food assistance for 6 months and until you participate.  See WAC rule (Washington Administrative Code):

388-444-0050

388-444-0005

388-444-0010

388-444-0055

You did not        on 00/00/00. You cannot get benefits until 00/00/00.  If you want food assistance after that, you must reapply and start participating.

225

Now Receiving SSI
When you get SSI (Supplemental Security Income) you also get medical benefits from DSHS. You will get a letter telling you about SSI Medical. If you have questions, please call 1-800-562-3022.  See WAC rule (Washington Administrative Code):

182-510-0005

None Required

226

Residing In Inpatient Psychiatric Institution
We cannot give you cash assistance while you are living in an inpatient psychiatric institution.  See WAC rule (Washington Administrative Code):

388-400-0060

388-400-0070

None Required

227

Under Previous Work Registration Penalty - Food Assistance
You have a penalty period because you did not participate in the Employment and Training program. We cannot give you food assistance until the penalty period is over, you reapply and you participate.  See WACrule (Washington Administrative Code):

388-444-0055

388-444-0050

388-444-0005

388-444-0010

You cannot get benefits until 00/00/00. We told you about this on 00/00/00.

228

IV-D Non-Cooperation
You have not helped DCS (Division of Child Support) get support for a child you get benefits for. You don't have to help DCS if you prove you have good cause because it would put you or a child in danger.  If you swear under oath that you have given DCS all the information you have, you will keep getting medical benefits. Contact your DCS worker for more information.See WAC rule (Washington Administrative Code):

388-422-0005

388-422-0010

388-422-0020

388-14A-2040

388-14A-2041

388-14A-2045

388-14A-2050

388-14A-2060

388-14A-2075

DCS told us that you (specify non-cooperation)     .

229

Exceeds Adult Recipient TANF Time Limits

An adult or emancipated minor in your assistance unit received 60 months of TANF/SFA cash assistance and doesn't qualify for a time limit hardship extension.

388-484-0005

388-484-0006

388-484-0010

None Required

 

Code

Reason Code Title / Text

WAC References

Free Form Text

230

Verification
You did not give us the information we asked for.  We can't figure out if you are eligible without it.

388-472-0005

388-490-0005

388-400-0070

On 00/00/00, I asked you to provide the following items by 00/00/00: List of items

232

IPV Disqualified
A judge or hearing officer found that you broke a food assistance rule on purpose. You will get another letter with information about your penalty. See WAC rule (Washington Administrative Code):

388-446-0020

388-446-0015

This is the (first/second/third) time that (name) has done this. S/he cannot get benefits again until 00/00/00.

233

Change In Household Size
The number of people getting assistance with you has changed. See WAC rule (Washington Administrative Code):

388-400-0060

388-400-0070

388-408-0025

388-408-0030

388-408-0035

388-408-0015

388-408-0020

(Name) moved in/out on 00/00/00. or (Name) is now/no longer getting benefits with you because.

235

Review Not Complete
We did not get your review form. If we get it before the end of the month, we will reconsider our decision. If you have already sent it, let me know.  See WAC rule (Washington Administrative Code):

182-504-0035

388-434-0005

388-434-0010

388-492-0110

388-492-0100

388-492-0090

388-400-0070

None Required

237

Change In Shelter Cost / Shelter Deduction
There was a change in the amount you pay for housing and utilities.  See WAC rule (Washington Administrative Code):

388-450-0195

388-478-0010

388-478-0020

388-478-0027

388-478-0090

388-492-0070

388-450-0190

388-478-0033

388-478-0035

For cash assistance:
You now have housing costs.

or
You no longer have housing or utility costs.

For food assistance:
Your____changed from $   to $   .

238

Change In Food Assistance Medical Expenses
Your medical expenses have changed.  See WAC rule (Washington Administrative Code):

388-450-0200

If newly elderly/disabled:

Since you are now considered disabled or elderly we are using your medical expenses to figure out how much of your income counts.

 

 

Code

Reason Code Title / Text

WAC References

Free Form Text

240

CEAP AUTO Close - For Administrative Use Only

None

None Required

242

Prior Lump Sum Penalty Period Exists
You cannot get assistance because of your lump sum payment.  See WAC rule (Washington Administrative Code):

388-450-0245

388-470-0005

182-509-0220

You got $      from      on 00/00/00. You cannot get benefits until 00/00/00. We told you about this on 00/00/00.

244

Death
We were notified someone passed away.  Please accept our condolences for your loss.

182-503-0505

388-408-0005

388-408-0035

388-492-0030

388-489-0025

Specify the person who died.

245

No Eligible Household Members
No one in your household meets the requirements to get assistance.  See WAC rule (Washington Administrative Code):

388-400-0070

388-408-0005

388-408-0015

388-408-0020

388-408-0025

388-408-0035

388-408-0060

388-408-0070

388-492-0030

If no other reason code or letter: No one is eligible because (specify the requirement if not met.  If more than one specify the one that applies to all members or the one that primarily prevented eligibility)      .

246

Under Previous Penalty
Your penalty period is not yet over. Ask your worker what to do to get out of sanction.  See WAC rule (Washington Administrative Code):

388-444-0055

182-505-0240

You cannot get benefits because (specify what action caused the penalty).     . We told you about this on 00/00/00. You cannot get benefits until 00/00/00.

247

Under Previous Non-Cooperation With QC Penalty
Your penalty period is not yet over. Ask your worker what to do to get out of sanction.  See WAC rule (Washington Administrative Code):

388-464-0001

You cannot get benefits for # months because (specify what action caused the penalty)     . You can regain your eligibility by (specify actions needed to be eligible again     . If you have any questions about this, call the Quality Assurance worker at (000) 000-0000.

248

Head of Household Not Eligible
The person listed as the head of household for your food assistance cannot get food assistance.  See WAC rule (Washington Administrative Code):

388-408-0035

388-468-0005

388-492-0030

(Name) cannot get benefits because (specify why that person cannot get benefits - requirement not met and why they don't meet it)     .

249

Receipt Of Benefits From Another State During Month
Your assistance unit already got benefits from another state this month. You can’t get assistance from Washington and another state in the same month. Please contact your worker if you and your children have an emergency.  See WAC rule (Washington Administrative Code):

388-468-0005

388-400-0070

182-503-0505

182-505-0210

182-505-0240

182-508-0001

You already got benefits from (Name of State).

 

Code

Reason Code Title / Text

WAC References

Free Form Text

250

Not Aged, Blind Or Disabled - Medical
You cannot get medical benefits under this program because you do not meet the rules set by the Social Security Administration (SSA). The rules say you must be age 65 or older, blind, or disabled.  See WAC rule (Washington Administrative Code):

182-508-0001

None Required

251

Already Received Food Assistance
You already got food assistance this month. You cannot get more unless you just moved to a shelter for battered women and children.  See WAC rule (Washington Administrative Code):

388-468-0005

388-408-0045

None Required

252

Non-Compliance Sanction for not participating in the WorkFirst program as required  See WAC rule (Washington Administrative Code):

388-310-1600

(Name) is in non-compliance sanction status.

254

Under Previous Transfer Of Resources Penalty - Food Assistance
Your assistance unit sold or gave away property for less than it was worth.  See WAC rule (Washington Administrative Code):

388-488-0010

You transferred your (type of property) on 00/00/00. Since you did not get the fair market value, you cannot get benefits from 00/00/00 to 00/00/00. We told you about this on 00/00/00.

255

Transfer Penalty Still In Effect (MA)
Your penalty period for transferring money or property has not ended. Your penalty cannot be stopped unless you prove that you cannot pay for your housing, food, clothing, or health needs.  See WAC rule (Washington Administrative Code):

182-513-1363

182-513-1364

182-513-1365

182-513-1366

388-488-0005

388-488-0010

You transferred your (type of property) on 00/00/00. Since you did not get the fair market value, you cannot get benefits from 00/00/00 to 00/00/00. We told you about this on 00/00/00.

256

Fleeing Felon & Parole Violation - CA / FA
Our rules say that no one fleeing or breaking parole/probation to avoid going to court or jail for a felony charge can get cash or food assistance.  See WAC rule (Washington Administrative Code):

388-442-0010
388-492-0120

Specify the information used to verify that A/R was fleeing or breaking probation/parole, and what the violation is.  A finding that the A/R is breaking probation or parole must be from an administrative body or court.

258

Failed ABAWD Requirement
You are an Able Bodied Adult Without any Dependents (ABAWD) who did not work or participate in a work or training program. You already got food assistance for three months in this 36-month period and cannot have more now.  See WAC rule (Washington Administrative Code):

388-444-0030

388-444-0035

388-444-0045

None required.

259

Temporary Absence Change Not Reported In 5 Days
Your child is out of your home for more than 180 days.  You did not tell us about this within 5 days of when you knew they'd be gone this long. As a penalty, you will not get your part of the grant for 1 month.

388-418-0007

(Name of child(ren)) left your house on (date).  You knew they were going to be gone for longer than 90 days because (specify information source and how recipient knew this).


Code

Reason Code Title / Text

WAC References

Free Form Text

260

Food Assistance Voluntary Quit - 2nd Offense
We do not have proof you had good cause to quit your job. Because this is the second time you quit a job without good cause, you cannot get food assistance for 3 months. After that, you must reapply and comply with the work requirements to get food assistance again.  See WAC rule (Washington Administrative Code):

388-444-0065

388-444-0075  
388-444-0070

You quit your job at      on 00/00/00. You cannot get benefits until 00/00/00 unless you reapply and (specify what client has to do to get benefits before that).

261

Food Assistance Voluntary Quit - 3rd Or Subsequent Offense
We do not have proof you had good cause to quit your job. Because this is the third time that you quit a job without good cause, you cannot get food assistance for 6 months. After that, you must reapply and comply with the work requirements to get food assistance again.  See WAC rule (Washington Administrative Code):

388-444-0065

388-444-0075
388-444-0070

You quit your job at      on 00/00/00. You cannot get benefits until 00/00/00 unless you reapply and (specify what client has to do to get benefits before that)..

262

Convicted of Receiving PA In 2 Or More States
We cannot give you cash assistance because you were convicted of fraud. You got benefits from more than one state at the same time. The only people with such a conviction that can get cash assistance are pregnant women.  See WAC rule (Washington Administrative Code):

388-446-0010

Specify which other state the benefits were received in and when they were received.

263

Convicted Of Unlawful Practices
You cannot get cash assistance right now because a court decided that you broke the law to get cash assistance.  See WAC rule (Washington Administrative Code):

388-446-0005

388-446-0010

 

388-400-0070

You were convicted on 00/00/00.  The court says you cannot get benefits until 00/00/00.

264

Minor Parent Inappropriate Living Situation
We did not approve your living arrangement. Unmarried parents who are younger than age 18 must have their living arrangement approved by the department unless they live with their parent, legal guardian or other adult relative.  See WACrule (Washington Administrative Code):

388-486-0005

None Required

265

Minor Parent Failed School Requirement
To get assistance, you must be in high school or in another program approved by the department.  See WAC rule (Washington Administrative Code):

388-486-0010

None Required

266

Non-Cooperation With TPL
We did not get your form about other coverage for your medical bills. You cannot get medical benefits from DSHS until we have the information. Your children can still get medical assistance.  See WAC rule (Washington Administrative Code):

182-503-0540

None Required

268

40% WorkFirst Sanction
You are not getting your part of the grant because you did not follow the rules about your IRP (Individual Responsibility Plan). You are in WorkFirst sanction. There are penalties for being in sanction   See WAC rule (Washington Administrative Code):

388-310-1600

(Name) did not (specify IRPrequirement not met)      on 00/00/00. We told you about this on 00/00/00. (Name) can regain eligibility by     .

269

10-Year Penalty For Fraudulent Statement
You are not eligible for food assistance because you have been convicted of providing false identification or residency information. This kind of conviction disqualifies you for ten years.  See WACrule (Washington Administrative Code):

388-446-0020

You were convicted on 00/00/00.

 

 

Code

Reason Code Title / Text

WAC References

Free Form Text

271

Trafficking Less Than $500 Or For Controlled Substance
You were convicted of trading food assistance for a controlled substance. See WAC rule (Washington Administrative Code):

388-446-0020
388-492-0120

You cannot get benefits from 00/00/00 to 00/00/00 because you     .

272

Permanent Disqualification - Illegal Trafficking More Than $500 Or For Controlled Substance
You are permanently disqualified from getting food assistance because you were:

  • Convicted of trading food assistance for a total of $500 or more;
  • Convicted twice of trading food assistance for a controlled substance;
  • Convicted of trading food assistance for firearms, ammunition, or explosives; or

See WAC rule (Washington Administrative Code):

388-446-0020
388-492-0120

You cannot get benefits from 00/00/00 to 00/00/00 because you     .

275

No Longer Receiving SSI
You no longer get SSI (Supplemental Security Income).

182-510-0005

388-492-0030

None Required

276

DSHS doesn't define your medical condition as an emergency.

182-507-0110

182-507-0115

182-507-0120

Specify who in the household doesn't meet the requirements.

277

Not Receiving Medical when Child is Born

The mother of the child listed above was not receiving medical assistance when the child was born.

182-505-0115 None Required

279

QMB Start Date - Administrative Use Only

None

None Required

 

 

Code

Reason Code Title / Text

WAC References

Free Form Text

280

Not Entitled To Medicare Part A
DSHS cannot pay for your Medicare Part B premium because you are not eligible for Medicare Part A. If you have questions about your Medicare coverage, call your Social Security Office.  See WAC rule (Washington Administrative Code):

182-517-0300

None Required

281

Waiver Not Approved
You need an approved plan of care before we can help pay for your care provider.  See WAC rule (Washington Administrative Code):

182-515-1505

182-515-1506

182-515-1510

182-515-1511

We do not have a plan of care for your (type of home or community based (HCB) program).

282

Indian Food Distribution Program
Your assistance unit got food from an Indian Food Distribution Program this month. You are not allowed to get food from two FNS (Food and Nutrition Services) programs in one month.  See WAC rule (Washington Administrative Code):

388-400-0040

None Required

284

Failed To Meet Spenddown Requirement
You didn't give us enough medical bills to meet your spenddown. You can reapply for medical at any time.  See WAC rule (Washington Administrative Code):

182-504-0020

None Required

285

Income Exceeds 250% Of FPL (CHIP)
The amount of your countable income is more than the maximum for the Children's Health Insurance Program (CHIP).  See WAC rule (Washington Administrative Code):

182-505-0100

182-505-0210

The income limit for your family size is $_____

286

Cash Diversion - Not Eligible ForTANF
To get Diversion Cash Assistance everyone in your family must be able to get TANF/SFA (Temporary Assistance for Needy Families/State Family Assistance).  See WAC rule (Washington Administrative Code):

388-432-0005

If no other reason code or letter: You are not eligible for TANF/SFA because     .

288

Ineligible ESLMB Already Receiving MA
You are not eligible for the Qualified Individual (QI-1) Program because you are receiving Medicaid Benefits. You are eligible for the State-funded Buy-In Program. We will pay for your Medicare Part A premiums, if you have any, as well as your Part B premiums, coinsurance, and deductibles.   See WAC rule (Washington Administrative Code):

182-517-0300

None Required

289

Failed To Appear For Application Appointment CA/MA/FA
You or a representative did not appear for the scheduled appointment required to determine your eligibility for financial, medical or food stamp assistance.  See WAC rule (Washington Administrative Code):

388-400-0070

388-406-0050

388-406-0060

388-406-0035

388-452-0005

None Required

 

 

Code

Reason Code Title / Text

WACReferences

Free Form Text

290

Overdue Incapacity Review
You were approved for a limited time period based on the medical information we had. That time period is over and we did not get your updated medical information.

388-447-0110

388-400-0060

388-449-0150

None Required

292

Group Home Decertified
The facility where you live is no longer certified to get food assistance for you. You can't get food assistance while you live there.  See WAC rule (Washington Administrative Code):

388-408-0040
388-460-0010

You live at (Name of Facility).

294

Changed To Family Planning
Since you are no longer pregnant, the type of medical coverage you receive has changed. You will start receiving coverage for only family planning services.  See WAC rule (Washington Administrative Code):

182-505-0115

None Required

295

Dependent Has Creditable Medical Coverage (CHIP)
Your child/children have other medical coverage.  See WAC rule (Washington Administrative Code):

182-505-0215

None Required

 

300 Series Reason Code Protocols

Revised September 2, 2015

Purpose:

  • 300 Series Reason Code Protocols
  • Go to the Reason Code Link chart to link directly to a specific reason code or scroll through the list below.
  • For ACES Procedures go to ACES Letters in the ACES User Manual.

Code

Reason Code Title / Text

WAC References

Recommended Free Form Text

300

Non-Payment of Premium According to our records, you have not paid all required premiums. See WAC rule (Washington Administrative Code):

182-523-0120

None Required

301

Exceeds Income Standard
Your income is over the limit that is allowed for this program. See WAC rule (Washington Administrative Code):

182-505-0100

182-505-0240

182-509-0001

182-511-1050

182-512-0010

182-513-1205

182-513-1245

182-513-1395

182-515-1508

182-515-1513

182-519-0050

182-517-0100

388-450-0015

388-450-0162

388-450-0165

388-478-0060

388-478-0090

None Required

302

Change In Child Support
The amount of legally obligated child support that you pay has changed. See WAC rule (Washington Administrative Code):

388-450-0185

The amount of child support you must pay changed from $_______ to $_____.

304

Additional Requirements Change
The amount of assistance you get for additional requirements has changed. See WAC rule (Washington Administrative Code):

388-478-0050

388-473-0010

388-473-0020

388-473-0040

388-473-0050

388-473-0060

The amount of money you get for (type of additional requirement) has changed from $__ to $__ because     .

305

Food Assistance Change Due To Change In Grant Amount
Your food assistance is changing because the amount of your cash assistance has changed. See WAC rule (Washington Administrative Code):

388-412-0015

388-450-0025

None Required

306

Change In Unearned Income
The amount of unearned income you get has changed. See WAC rule (Washington Administrative Code):

388-418-0020

388-450-0025

388-450-0162

182-504-0120

182-509-0320

182-509-0325

182-512-0750

388-492-0020 

388-492-0030

388-492-0070

Your income from (source) has changed from $___ to $__.

307

Change In Gross Earned Income
The amount of money that you earn has changed. See WAC rule (Washington Administrative Code):

388-450-0030

182-509-0001

182-509-0300

182-512-0010

182-512-0700

388-418-0020

388-450-0030

388-450-0162

Your gross earned income has changed from $___ to $___.

 

Code

Reason Code Title / Text

WAC References

Free Form Text

320

Exceeds Gross Income Limit
Your income is higher than the income limit for this program. See WAC rule (Washington Administrative Code):

182-509-0001

388-450-0165

388-478-0060

388-478-0090

The limit for your household size is $___.

321

Change In Net Deemed Income
The amount of income we consider available to you from an outside source has changed. See WAC rule (Washington Administrative Code):

388-450-0100

388-450-0105

388-450-0115

388-450-0120 

388-450-0155

388-450-0130

388-450-0140

388-450-0160

We are counting $__ of (Name)'s income.

323

Change In Home Maintenance Exemption
The income amount that you are allowed to keep to pay for home expenses is called a home maintenance allowance. Yours is changing because:

  • You have been getting it for 6 months;
  • Your doctor says you have to stay longer; or
  • The amount of your home expense has changed.

See WAC rule (Washington Administrative Code):

182-513-1380

Your home maintenance amount has changed because ________. (add specific details, e.g. “Your rent has changed from $____ to $_____.” Or “On __(date)___, Dr. _____ told us you can’t return home before _____.”)

324

Child Support More Than Grant
Your regular monthly child support payment is more than the grant payment. See WAC rule (Washington Administrative Code):

388-422-0030

None Required

327

Change In Recoupment
We are taking a different amount from your benefits to repay an overpayment. See WAC rule (Washington Administrative Code):

388-410-0005

388-410-0010

388-410-0015

388-410-0030

None Required

328

Excess Net Income - Food Assistance
You can’t get food assistance because your income is above the limit for your household size. See WAC rule (Washington Administrative Code):

388-478-0060

The limit for your household size is $      .

329

Change In Dependent Care Costs
The amount you pay for childcare or dependent care has changed. See WAC rule (Washington Administrative Code):

388-450-0170

388-450-0185

The amount you pay has changed from $____ to $____.

 

Code

Reason Code Title / Text

WAC References

Free Form Text

330

Lump Sum
Your resources are over the limit for this month because of your lump sum payment. See WAC rule (Washington Administrative Code):

182-512-0300

388-450-0245

388-470-0005

You got $__ from __ on 00/00/00. Your countable resources are now $__. Your resources cannot be more than $_____ (specify resource limit for household size).

If the grant is suspended:
We will be subtracting $_____ from next month’s grant. This reduction is for one month only.

If the grant is terminated:
Your lump sum payment is more than the need standard for two months. You can reapply for a cash grant in (month).

331

Excess Net Income - Cash Assistance
Your net income is over the limit for this program. See WAC rule (Washington Administrative Code):

182-512-0010

182-513-1300

182-515-1500

388-478-0020

388-478-0027

388-478-0033

388-478-0050 

388-478-0090

The limit for your household size is $ ____.

332

Change In CPI Allowance
Your Personal Needs Allowance (PNA) changed. See WAC rule (Washington Administrative Code):

182-513-1380

182-513-1385

182-513-1205

182-513-1215

182-513-1225

182-515-1507

182-515-1509

182-515-1512

182-515-1514

None Required

334

Exceeds Earned Income Limit

Your earned income is over the limit for this program

388-478-0035

The limit for your household size is $____.

335

Change In Uncovered Medical Expense Allocation
The amount you can use to pay medical expenses has changed. See WAC rule (Washington Administrative Code):

182-513-1380

182-515-1509

182-515-1514

The amount you can use to pay for the following medical expenses has changed: (Type of expense) from $__to $      .

336

Change In CSMA / FMMA Allocation
The amount we can allow for the maintenance of your family members at home has changed. See WAC rule (Washington Administrative Code):

182-513-1385

Your allocation changed from $___  to $___because __________.

338

Not Eligible Until Month After Application Month
The person listed above cannot get food assistance for the month they applied in. See WAC rule (Washington Administrative Code):

388-406-0055

388-418-0020

None Required

339

Medical Extension Ends
Your medical extension expired and we did not get your review form. If we get it before the end of the month, we will reconsider our decision. If you have already sent it, let me know. If your medical benefits stop and you decide that you still want them, you need to reapply. See WAC rule (Washington Administrative Code):

182-523-0100

182-505-0115

None Required.

 

Code Reason Code Title / Text WAC            References                   Free Form Text

340

QMB Ineligible - Client Is Not Institutional Related
You are no longer eligible for assistance that pays for all or part of your Medicare costs and premiums. The department must count your income differently when you are no longer eligible for Long-Term Care Services, such as Nursing Facility Care, COPES or CAP/OBRA Services. See WAC rule (Washington Administrative Code):

182-517-0100

182-517-0300

182-517-0310

182-517-0320

None Required

341

SSP Rate Change

The state supplemental payment rate for all SSI recipients has changed. See WAC rule (Washington Administrative Code):

388-478-0055

None Required

342

Termination/Denial Due to Non-Payment of Premium

You didn't pay required premiums.

182-505-0225

None Required

343

Third Party Resource Amount Changed

The amount of Third Party Resources you get has changed. See WAC rule (Washington Administrative Code):

182-501-0200

182-513-1380

182-515-1509

The amount of your third party resource has changed from $___ to $__.
345

Home Maintenance Exemption Changed

We changed the housing deduction due to one or more of the following: The amount of your housing costs changed.

Your income changed.

The amount we allow for your housing costs changed.

182-513-1380 None Required.
346

Home Maintenance Exemption Exceeds Time Limit

We ended your housing deduction because you received it for the maximum of 6 months.

182-513-1380 None Required.
347

Home Maintenance Exemption Discontinued

We ended your housing deduction due to one or more of the following: Your living situation changed.

You no longer have a housing cost.

Your doctor doesn't expect you to go home within 6 months.

Your income or expenses changed.

Your marital status changed.

182-513-1380 None Required.
348 Exceeds Ineligible Parent TANF Time Limits
A parent in your home received 60 months of TANF/SFA cash assistance for themselves or on behalf of their child(ren) and doesn’t qualify for a time limit hardship extension.

388-484-0005

388-484-0006

388-484-0010

Specify the name of the parent that is referenced.
349

NCS Permanently Disqualified

 A person is permanently disqualified from receiving TANF/SFA when their case is closed 3 or more times for WorkFirst non-compliance sanction. 
 

388-310-1600

388-400-0005

None Required

 

Code Reason Code Title / Text WAC References     Free Form Text

350

Household Exceeds Allowable Income

Household Exceeds Allowable Income

388-450-0162 Your household income of $______is over the limit for this program.  The income limit for a household of__ is $_____      (300% of the Federal Poverty Level)
351

Not Aged, Blind, or Disabled -Cash

You aren't eligible for benefits under this program because you aren't age 65, blind, or likely to be disabled.  42 CFR 435.541

388-449-0001 None Required

 

Code Reason Code Title / Text WAC         References             Free Form Text

386

Diversion Cash Assistance - No Bona Fide Need
The expenses you need help with are not covered by the Diversion Cash Assistance program.  DCA can only be used to pay for childcare, housing, transportation, expenses to get or keep a job, food and medical expenses.  See WAC rule (Washington Administrative Code):

388-432-0005

You asked for help with the following expenses:

(List expenses)

We cannot cover these expenses because (specify why need is not “bona fide” or is not covered. For example, “You did not give us a written estimate of how much it would cost to fix your car.” Or “You told us you have income of $____ and expenses of $ ____. Based on that, you should have enough money to pay for move-in expenses without our help.”).

388

WA Fund CAP For QI-1 Already Reached
Washington gets a limited amount of money for the Qualified Individual (QI-1) Program. There are no more funds available for this year. You can reapply in December for next year. See WAC rule (Washington Administrative Code):

182-517-0300

None Required

 

400 Series Reason Code Protocols

Revised April 29, 2016

Purpose:

  • 400 Series Reason Code Protocols
  • Go to the Reason Code Link chart to link directly to a specific reason code or scroll through the list below.
  • For ACES Procedures go to ACES Letters in the ACES User Manual.

Code

Reason Code Title / Text

WAC  References                             

Recommended Free Form Text

401

Over Resources
You have too many resources to get assistance right now. See WAC rule (Washington Administrative Code):

182-512-0250

182-512-0300

182-513-1245

182-513-1350

182-513-1395

388-470-0005

388-400-0070

Your resources cannot be more than $_____ (specify resource limit for household size). See the attachment for more information on how we figured out your resources.

410

Excess Home Equity - LTC

You don't qualify for Long Term Care (LTC) services because the equity in your home is over the $500,000 limit.

You may receive LTC services if we approve an undue hardship waiver. We approve hardship waivers when you can show that without LTC services:

  • You will be deprived of housing, food, clothing or medical care.
  • Your life or health will be endangered.

 

Your request must:

  • Tell us in writing the reason you need an undue hardship waiver.
  • Be signed and returned within 30 days of the date of denial or termination of LTC services.
  • Include the name, address and telephone number of the person writing the request.
  • You may authorize your representative, guardian, or facility where you live to file an undue hardship waiver request for you.

182-513-1350

182-513-1367

Explain the equity value we are counting and how we arrived at that number.

411

Transfer Of Resource Disqualification 1 - 12 Months
A member of your assistance unit gave something away or sold it for less than fair market value to become eligible for food assistance. See WACrule (Washington Administrative Code):

388-488-0010

(Name) transferred his/her (type of property) on 00/00/00. That (type of property) is worth$     . Since s/he only got $      for it, you cannot get benefits from 00/00/00 to 00/00/00.

416

Transfer of Resources - CA/MA

You have a penalty period because you gave something away or sold it for less than fair market value.  You can only get benefits now if you prove you cannot pay for your housing, food, clothing, or health needs.

388-488-0005

388-400-0070

Explain the equity value we are counting and how we arrived at that number

417

Transfer of Resources - LTC

You transferred, gave away, or sold resources for less than fair market value. This is called uncompensated value.

182-513-1363

 None required.

460

Payment Standard Reduction

Payment standards are changing. You do not have administrative hearing rights based on a change in payment standards.

 

388-478-0020

388-418-0020

 None required.

 
471

No Related Food Stamp AU

You don’t receive Basic Food, Food Assistance Program for Legal Immigrants (FAP) or Transitional Food Assistance (TFA).

388-493-0010 None Required.
472

Related TANF AU Exists

Someone in your food assistance unit receives Temporary Assistance for Needy Families (TANF) or State Family Assistance (SFA).

388-493-0010 None Required.
473

No Qualifying Child

You don’t have a qualifying child under the age of 18 in your home.

388-493-0010 None Required.
474

Not Working the Minimum Hours Required

We don’t have current proof that you, your spouse, or co-parent works at least 35 hours per week.

388-493-0010 None Required.
475

Food Stamp is the Priority Program

We count Working Family Support as income. Approving this program would close your food assistance. 

388-493-0010 None Required.
476

Working Family Support Program Terminated

The Working Family Support program is ending. 

388-493-0010 None Required.

500 Series Reason Code Protocols

Revised April 29, 2016

Purpose:

  • 500 Series Reason Code Protocols
  • Go to the Reason Code Link chart to link directly to a specific reason code or scroll through the list below.
  • For ACES Procedures go to ACES Letters in the ACES User Manual.

Code

Reason Code Title / Text Requirement

WAC        References    

Recommended Free Form Text

501

SSA Denial

You aren't eligible for ABD cash assistance because the Social Security Administration denied your application for Supplemental Security Income (SSI).

388-449-0001

(Social Service Specialist  provides mandatory free form text via 14-118)

502

Gainful Employment

You aren't eligible for ABD cash assistance. We have determined you aren't disabled because you are currently working.

388-449-0005

(Social Service Specialist  provides mandatory free form text via 14-118)

503

Acceptable Medical Source (and no medical)

You aren't eligible for ABD cash assistance because you didn't provide medical evidence from an acceptable medical source.

388-449-0060

(Social Service Specialist  provides mandatory free form text via 14-118)

504

Insufficient Information

You aren't eligible for ABD cash assistance because the medical evidence we received doesn't contain enough information to determine if you are disabled. 

388-449-0060

(Social Service Specialist  provides mandatory free form text via 14-118)

505

Chemical Dependency

You aren't eligible for ABD cash assistance. We can't determine if you are disabled because the medical evidence we received shows drug or alcohol use is material to your impairment .

388-449-0060

(Social Service Specialist  provides mandatory free form text via 14-118)

506

Duration

You aren't eligible for ABD cash assistance because your impairment does not meet the minimum duration requirement. 

388-449-0060

(Social Service Specialist  provides mandatory free form text via 14-118)

509

Severity

You aren't eligible for ABD cash assistance because your impairment is mild and not expected to keep you from working. 

388-449-0060

(Social Service Specialist  provides mandatory free form text via 14-118)

510

Past Work

You aren't eligible for ABD cash assistance because your impairment doesn't keep you from returning to your past work. 

388-449-0080

(Social Service Specialist  provides mandatory free form text via 14-118)

511

Other Work

You aren't eligible for ABD cash assistance because you have the residual functional capacity to be employed.

388-449-0080

388-449-0100

(Social Service Specialist  provides mandatory free form text via 14-118)

 

517

Termination - No Current Medical

See INCAP denial form for text

182-508-0005

(Social Service Specialist  provides mandatory free form text via 14-118)

518

Medical Evidence Inconclusive
The medical evidence we have does not give us enough information to decide whether you are able to work. As of this date, we cannot confirm your eligibility.

182-508-0005

 

(Social Service Specialist  provides mandatory free form text via 14-118)

519

Medical Information Shows Improvement / Decreased Severity    

The current medical evidence we have leads us to believe that you should not have received benefits because you were able to work.

182-508-0005

 

(Social Service Specialist  provides mandatory free form text via 14-118)

520

Change In Federal Law
There has been a change in the Federal law that regulates this program.

None

None Required

521

Medical Evidence Shows Clear Improvement – Due to Treatment             

Medical evidence shows clear improvement due to treatment.
20 CFR 416.920

182-508-0005

388-449-0060

On 00/00/00, I got a report form from Dr. (Name of doctor) that said your (specify condition) has improved so much that you can work now.

(The Social Worker should provide the FSS with some free-form text via the 14-118).

522

Currently Employed 

Currently employed.

182-508-0005

(Social Service Specialist  provides mandatory free form text via 14-118)

523

Error In Previous Determination Of Incapacity                       

Error in previous determination.

182-508-0005

 

(Social Service Specialist  provides mandatory free form text via 14-118)

525

No Eligibility Review Form
We haven't received your eligibility review or renewal form. 

182-504-0035

388-434-0005

388-434-0010

388-492-0090

388-492-0110

388-492-0100

388-400-0070

None Required

528

Eligibility Review Form Incomplete
The eligibility review or renewal form we received wasn't complete.

 

388-492-0110

388-492-0100

182-504-0035

388-400-0070

388-434-0005

388-434-0010

388-492-0090

You must return the completed form to us by 00/00/00 in order for your benefits to continue.

530

Termination/Cancer Treatment Ends Prior to Cert Period

The Department of Health has determined that your treatment has ended or you no longer meet the requirements of the program.

182-504-0015

182-505-0120

Text should be supplied by unit that works these.

531

Voluntary Withdrawal for Excess Resources
You withdrew your request for assistance because you have too many resources to get assistance right now.

182-513-1350

388-406-0050

None required

532

State-Funded LTC - Program Full

The state-funded long term care services program is subject to caseload limits.  The program is currently full.  We aren't enrolling new members at this time.

182-507-0125 NA
533

Employment requirement not met - HWD

You don't meet the employment requirements for the HWD program.

182-511-1200 NA

535

Error in Initial Eligibility - Removed Continuous Tracking for Child 
- For Administrative Use Only

None

Specify the reason for termination and a WAC related to that reason.

536

Error Initial Eligibility - Removed Locked-in Premium Tier.

- For Administrative Use Only

182-505-0210 NA
537

TANF/SFA Background Check Failure

You can't receive TANF or SFA benefits for the unrelated child living with you because you didn't pass the background check.

388-454-0005

388-454-0006

None Required

540

CEAP Financial Worker Closure- For Administrative Use Only

None

None Required

541 CEAP Program Funds Exhausted - For Administrative Use Only None NA

542

Incomplete six-month report

We got your Mid Certification Review form. Some information is still missing. We sent you a letter telling you what you need to give to us. We did not get it.

182-504-0105

182-504-0120

182-504-0125

388-418-0011

Specify what is missing.

545

Invalid Working Family Support Composition

You can’t be in a separate assistance unit from your spouse or co-parent. If you are eligible for WFS you may be added to your spouse or co-parent’s assistance unit.

388-493-0010 None Required

549

You asked us to stop TFA; or you are now receiving Basic Food.

You asked us to stop your Transitional Food benefits; or We approved your request for Basic Food. See WAC rule (Washington Administrative Code):

388-489-0020

None Required

550

Voluntary Withdrawal
You withdrew your request for assistance. See WAC rule (Washington Administrative Code):

182-503-0080

388-406-0050

388-492-0020

None Required

551

Whereabouts Unknown
We don’t know where you are. SeeWAC rule (Washington Administrative Code):

388-458-0030

388-492-0020

182-503-0520

182-503-0525

182-504-0105

None Required

552

Failed To Provide Verification
You did not give us the information we needed.

182-503-0050

388-400-0070

388-472-0005

388-490-0005

388-458-0020

388-492-0020

On 00/00/00, I asked you to provide some information by 00/00/00. I still need:

List of items

554

RCL Error in Initial Eligibility 

Not Medicaid Eligible on Day of Discharge

182-513-1235 Describe the reason the client was not initially eligible for Medicaid.

555

Application Opened In Error - For Administrative Use Only

None

None Required

556

Non-Cooperation With Quality Control - Food Assistance
You did not cooperate with the food assistance Quality Control reviewer. SeeWAC rule (Washington Administrative Code):

388-464-0001

388-492-0020

388-492-0120

You cannot get benefits for # months because___ . You can regain your eligibility by ___ . If you have any questions about this, call the Quality Assurance worker at 000-000-0000.

557

AU Requests Closure
You asked us to stop your cash, food, or healthcare assistance.

388-458-0030

388-492-0020

182-503-0080

None Required

558

Failed To Cooperate In Securing Other Income And Resources
You have income or resources that you could use but you haven’t made a reasonable effort to get them. If there is a good reason why you have not done this, please tell us. See WAC rule (Washington Administrative Code):

182-503-0050

388-400-0070

388-458-0020

388-472-0005

388-490-0005

You told us that you have (type of income/resource). To become eligible, you must try to make it available by _______(specify what they must do to make income or resource available).

559

Client Already Received Assistance In Another AU For This Benefit Month
Although you can belong to more than one assistance unit, you can only get benefits from one at a time.

388-400-0005

388-400-0010

388-400-0030

388-400-0040

388-400-0060

388-400-0070

You are already getting cash assistance.
Or
You are already getting food assistance.
Or
You are already getting medical assistance.

561

AU Screened In Error - System Generated Only

None

None Required

564

Non-Cooperation With TPL Process
You did not cooperate in obtaining another source of coverage for your medical care. See WAC rule (Washington Administrative Code):

182-503-0540

You told us that you could get help with medical from (specifyTPL source).

566

Refused to Cooperate With Application Process
You refused to cooperate in the application process. Based on the information we have, we are unable to determine your eligibility. See WACrule (Washington Administrative Code):

182-503-0080

388-400-0070

388-406-0035

388-406-0060

388-452-0005

388-492-0020

388-406-0050

You did not ____ . If you need help, let me know and I will try to assist you.

567

Drug / Alcohol Center Loses Certification
You cannot receive food assistance. The drug or alcohol center where you live is not a certified public or private nonprofit organization. See WAC rule (Washington Administrative Code):

388-408-0040

388-492-0020

None Required

569

Child Accepted To Foster Care
Our rules say that a child who is in foster care for 180 days or more must be taken off cash assistance. See WACrule (Washington Administrative Code):

388-408-0015

388-454-0015

None Required

570

Child's Temporary Placement Has Ended

Your child's absence is no longer temporary.

388-454-0015 None Required

572

User Voided Application - For Administrative Use Only

None

None Required

575

Not Receiving Cash Assistance - For Administrative Use Only

None

None Required

577

Missed Application Deadline - For Administrative Use Only

None

None Required

578

Non-Cooperation with Chemical Dependency Assessment or Treatment

You aren’t eligible for assistance because you didn’t cooperate with a chemical dependency assessment or treatment.  You aren’t eligible for assistance again until you reapply and cooperate with assessment or treatment.

182-508-0005

388-449-0220

388-400-0055

388-447-0120

(Social Service Specialist  provides mandatory free form text via 14-118)

585

DCA Adult Eligible For TANF, Established Loan Repayment - For Administrative Use Only

None

None Required

586

DCA Ineligible

To get Diversion Cash Assistance everyone in your family must be able to get TANF/SFA (Temporary Assistance for Needy Families/State Family Assistance). See WAC rule (Washington Administrative Code):

388-432-0005

Specify which DCA requirement was not met.

587

Already Eligible For Program In Different AU - For Administrative Use Only

 

The following persons aren't eligible for [cash/food] assistance for [MM/YYYY] because they already received [cash/food] assistance in another household:

[list name of ineligible persons]

NOTE: You may need to manually create a denial or termination letter or add text to the ACES system-generated letter and WAC references.

588

Ineligible QI-1 Already Receiving MA
You aren't eligible for the Qualified Individual (QI-1) program because you are receiving Washington Apple Health coverage. See WAC rule (Washington Administrative Code):

You are eligible for the State-funded Buy-In Program. We will pay for your Medicare Part A premiums, if you have any, as well as your Part B premiums, coinsurance, and deductibles.

182-517-0300

None Required

589

Failed MA Incapacity Requirements

Based on your current medical information, you are no longer disabled under Social Security rules. See WAC rule (Washington Administrative Code):

182-511-1150

None Required

590

Transfer of Resources - Long Term Care

You have a penalty period because you gave away a non exempt asset or sold it for less than fair market value.

182-513-1363

182-513-1367

Explain the amount of the transfer used to determine the penalty or penalties periods. Indicate the dates the penalty period starts and ends.

596

Failure to Pursue Medicaid

You aren't eligible for ABD cash or Housing and Essential Needs (HEN) Referral because you failed to pursue Medicaid.

 

388-400-0060

388-400-0070

(Social Service Specialist  provides mandatory free form text via 14-118)

597

Manual WASHCAP Earned Income Termination

You can't receive Washington Combined Application Project food assistance because you've been working more than three months.

388-492-0030 None Required
598

WASHCAP Invalid Living Arrangement

You can't receive Washington Combined Application Project food benefits because your living arrangement changed.

388-492-0030 State what the invalid living arrangement is.

599

Other - For User Generation Only

None

(If used for ABD or HEN Referral denial or termination, Social Service Specialist provides mandatory free form text via 14-118)

Information about Letters

Revised March 25, 2011

Purpose: 

WAC 388-458-0002 The department of social and health services (DSHS) sends you letters to tell you about your case. 

WAC 388-458-0011 DSHS sends you a denial letter when you can't get benefits. 

WAC 388-458-0016 DSHS sends you an approval letter when you can get benefits

WAC 388-458-0020 You get a request letter when we need more information. 

WAC 388-458-0025  We send you a change letter if the amount of benefits you are getting is changing. 

WAC 388-458-0030  We send you a termination letter when your benefits stop. 

WAC 388-458-0040   Why do you give me ten days notice before you reduce or stop my benefits?


Clarifying Information - WAC 388-458-0002

Letters are sent to clients in their primary language. ACES supports eight languages besides English:

  • Cambodian
  • Chinese
  • Korean
  • Laotian
  • Russian
  • Spanish
  • Vietnamese
  • Somali

Worker Responsibilities - WAC 388-458-0002

When sending letters to the client, use the client’s current mailing address. If the client did not provide a current mailing address on the application, send the letter to the last known address.

 

NOTE:

This internal DSHS website can only be accessed by DSHS staff or persons who have been authorized by the department.


Clarifying Information - WAC 388-458-0011

  • See APPLICATIONS for the timeframes to process the application.

Clarifying Information - WAC 388-458-0016

  • EBT information is included on this letter. See BENEFIT ISSUANCES for information about EBT.

Worker Responsibilities - WAC 388-458-0016

  • If you are approving more than one type of assistance on the same letter, list the type and benefit amount for each type of assistance separately. Do not combine or list amounts without a program reference.

Clarifying Information - WAC 388-458-0020

  1. Information or action needed depends on the type of assistance.
  2. Additional rules about providing information or taking required action is found in APPLICATIONS and VERIFICATION.
  3. If the client provides the information or takes the action within the 10-day notice period:
    1. Continue benefits at the same amount if the action or information does not result in a reduction of benefits.
    2. Treat the information or action as a newly reported change if it causes a reduction in benefits.
  4. See VERIFICATION for information about paying for requested information.

Worker Responsibilities - WAC 388-458-0020

  1. If you are requesting information for more than one type of assistance, tell the client what is needed for each program. For example, you are pending an application for TANF and Basic Food. You need verification of income for both programs, AP forms for TANF, and verification of rent for Basic Food. Specify this on the letter.
  2. Give examples of the types of verification the client can get. For example, if you need verification of the client's wages, tell them on the letter that they can give you copies of their check stubs or a statement from their employer.
  3. If the client provides the information within the 10-day advance period, treat it as newly reported change. See CHANGES OF CIRCUMSTANCES to determine if the change was reported timely and the correct effective date.
  4. Make sure the client has a supply of return envelopes.
  5. If the due date falls on a weekend or holiday, change the due date on the letter to the next business day.

Clarifying Information - WAC 388-458-0025

  • If you don’t have time to give 10-day notice as needed, the change is effective the month following. To determine if the client has an overpayment, see effective dates in CHANGE OF CIRCUMSTANCES.

Worker Responsibilities - WAC 388-458-0025

  • If a client is NSA, follow their accommodation plan and the procedures in NSA before reducing or stopping benefits.

Clarifying information - WAC 388-458-0030


Clarifying information - WAC 388-458-0040

  • When clients request a fair hearing within the ten-day notice period, they are automatically given continued benefits unless they tell us that they do not want them.

ACES PROCEDURES

Letters Protocols

Revised March 25, 2011

Purpose:

For ACES Procedures go to ACES Letters in the ACES User Manual.

Letter

Letter Title

Freeform Text Requirement

0002-24

Approval for Expedited Food Assistance

List verification needed. Provide examples of what client can provide.

0004-05

General Denial - No Information

List items that you asked for that were not provided.

0006-03

GA Termination on Reconsideration

State what new information was received and why it did not change the determination.

0006-04

GA Termination for Clear Improvement

On 00/00/00, I got a report form from Dr. (Name of doctor) that said your (specify condition) has improved so much that you can work now. Or You work # hours per week for (employer) as a (position).

0006-05

GA Termination for No Medical Information

On 00/00/00, I asked you to provide some information by 00/00/00. I still need: List of items

0006-06

GA Termination for Medical Evidence Inconclusive

On 00/00/00, I asked you to provide some information by 00/00/00. I still need: List of items

0006-07

GA Termination for No Incapacity - Prior Error

We made a mistake when we put you on GAU on (date). You did not meet our requirements because _________ (enter case specific information regarding the medical information received and why it doesn’t meet severity and/or duration requirements - e.g. “The information we got from Dr. Sun showed your back injury was not severe enough to keep you from doing light work that you have done in the past.”).

0017-01

Supplemental Payment for Cash/Food

We are giving you additional benefits for (Month) because ___________.

0020-01

MN Spenddown

List all bills used to meet spenddown

0020-03

Bills Received-Spenddown Not Met

In the first mandatory freeform text section:

  • List the bills used to meet spenddown / EMER

In the second mandatory freeform text section:

  • List all the bills you did not use and why you didn't use them.

0021-01

General Reinstatement for Cash/Food

We are reopening your case because ______________.

0023-01

Missing Verification for Interview

List:

  • The items that you need verification for;
  • If sending the letter for multiple programs, the program that verification requirement applies to; and
  • Examples of what the client can provide.

0023-02

General Request for Information or Action

List:

  • What you need the client to do and/or provide;
  • If sending the letter for multiple programs, the program that verification/action requirement applies to; and
  • If requesting verification, examples of what the client can provide.

0045-02

Cash Assistance Overpayment - Intentional

State why client has an overpayment. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers.

0045-03

Cash Assistance Overpayment - Unintentional

Describe why client has an overpayment. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers.

0045-05

Food Assistance Overpayment - Inadvertent Error

Describe why client has an overpayment. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers.

0045-06

Food Assistance Overpayment - Administrative Error

State why client has an overpayment. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers.

0045-07

Food Assistance Overpayment - IPV

State why client has an overpayment. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers.

0045-08

Medical Assistance Overpayment

State why client has an overpayment. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers.

0045-09

Overpayment Modification

State why the overpayment is being modified. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers.

0055-01

ADH for 1st or 2nd Offense Before 1-1-97

In the first mandatory freeform text section:

  • State why you think the client broke program rules.

 In the second mandatory freeform text section:

  • List the evidence we have about the program violation.

0055-02

1st or 2nd Food Assistance Disqualification After 12-31-96

In the first mandatory freeform text section:

  • State why you think the client broke program rules.

In the second mandatory freeform text section:

  • List the evidence we have about the program violation.

0055-03

ADH for 1st or 2nd Offense/Duplicate Participation

List the evidence we have about the program violation.

0055-04

ADH for Permanent Disqualification

In the first mandatory freeform text section:

  • State why you think the client broke program rules.

In the second mandatory freeform text section:

  • List the evidence we have about the program violation.

0070-03

ETR Not Requested

State why you are not forwarding the request for a decision.

0070-05

ETR Denial

State why the ETR was denied.

0085-01

WorkFirst Non-Participation Appointment

According to your IRP, you are supposed to (State what requirement of the IRP the client is not meeting). State what information you have that leads you to believe this.

(If this appointment will also be a case staffing, then enter the following text):At this appointment, we will also be reviewing your participation in the WorkFirst program with other involved agency staff. I have invited (List agency staff) to this appointment.

0085-02

Food Assistance E&T Good Cause

As part of your E&T (Employment and Training) requirements, you are supposed to (state what E&T requirement the client is not meeting). State what information you have that leads you to believe this.

0085-03

Missed Appointment or Activity for IRP

According to your IRP, you are supposed to (State what requirement of the IRP the client is not meeting). State what information you have that leads you to believe this.

Reason Codes

Revised July 31, 2015

Series Reason Code Protocols

  1. Click on the Reason Code Series number to go to the list of codes in that series in the chart below

  2. In the chart, click on a specific reason code to go directly to the Reason Code Series page and the code you have selected.


100's 200's 300's 400's 500's

The Reason Codes Series pages will show the following elements for each reason code:

  • Code Number
  • Reason Code Title / Required Text
  • WAC Reference
  • Free Form Text

For ACES Procedures go to ACES Letters in the ACES User Manual.


 

101 102 103 104 105 106 107 109
110 111 112 120        
130 131 132 134        
141 142 160 161 162 163 164  
187 188 195          

200 201 202 203 204 205 206 207
208 209            
210 212 213 214 215 218 219  
220 221 222 223 224 225 226 227
228 229            
230 232 233 235 237 238 239  
240 241 242 243 244 245 246 247
248 249            
250 251 252 254 255 256 257 258
259              
260 261 262 263 264 265 266 268
269              
271 272 275 276 279      
280 281 282 283 284 285 286 287
288 289            
290 292 293 294 295 296 297 298
299              

300 301 302 304 305 306 307  
320 321 323 324 327 328 329  
330 331 332 334 335 336 338  
339              
340 341 342 343 345 346 347 348
349 350 351          
386 388            

401 410 417          
411 416 460          

501 502 503 504 505 506 509  
510 511 517 518 519      
520 521 522 523 525 528 530  
531 532 533 535 536 537    
540 541 542 549        
550 551 552 555 556 557 558 559
561   564 566 567 569    
570 572    

575

577

578  

585

586

587

588

589      
590       596 597 598 599