(1) The medicaid agency approves a
retroactive Washington apple health (WAH) certification period for the three
months immediately before the month of application when an individual:
(a) Requests retroactive WAH on his or her
application, within the certification period following the retroactive period,
or before the determination of benefits and any appeal process is
final;
(b) Would have been eligible
for WAH for any or all of the three months if he or she had applied during the
retroactive period; and
(2) When an individual is eligible
only during the three-month retroactive certification period, that period is
the only period of certification, except when:
(a) A pregnant individual is eligible in one
of the three months immediately before the month of application, but no earlier
than the month of conception. Eligibility continues as described in WAC
182-504-0015(3).
(b) An individual who is applying within 12
months of their last pregnancy end date is eligible for after-pregnancy
coverage in any of the three months immediately before the month of
application. Continuous eligibility begins from the earliest month the
individual is found eligible as described in WAC
182-504-0015(3)
and (4).
(c) A child is eligible for categorically
needy (CN) WAH as described in WAC
182-505-0210(1) through
(5) and (7) in at least one of the three
months immediately before the month of application. Eligibility after the
retroactive period continues as described in WAC
182-504-0015(11).
(3) An individual applying for the
medically needy (MN) spenddown program may be eligible for a retroactive
certification period as described in WAC
182-504-0020.
(4) An individual applying for a medicare
savings program may be eligible for a retroactive certification period as
described in WAC
182-504-0025.
Notes
Wash. Admin.
Code §
182-504-0005
Amended by
WSR
22-21-086, Filed 10/14/2022, effective
11/14/2022
Statutory Authority:
RCW
41.05.021, Patient Protection and Affordable
Care Act ( Public Law
111-148 ), 42 C.F.R. §§ 431, 435, and
457, and 45 C.F.R. § 155. WSR 13-14-019, §
182-504-0005, filed 6/24/13,
effective 7/25/13.