(1) When you apply for Washington apple
health programs established under chapter 74.09 RCW, you must meet the
eligibility criteria in chapters
182-500 through
182-527 WAC.
(2) When you apply for apple health, we first
consider you for federally funded or federally matched programs. We consider
you for state-funded programs after we have determined that you are ineligible
for federally funded and federally matched programs.
(3) Unless otherwise specified in a
program-specific WAC, the eligibility criteria for each program are as follows:
(c)
Citizenship or immigration status in the United States (WAC
182-503-0535);
(d) Possession of a
valid Social Security account number (WAC
182-503-0515);
(e) Assignment of medical support rights to
the state of Washington (WAC
182-503-0540);
(f) Application for medicare and enrollment
into medicare's prescription drug program if:
(i) You are likely entitled to medicare;
and
(ii) We have authority to pay
medicare cost sharing as described in chapter
182-517 WAC.
(g) If your eligibility is not based on
modified adjusted gross income (MAGI) methodology, your countable resources
must be within specific program limits (chapters
182-512,
182-513,
182-515,
182-517, and
182-519 WAC); and
(h)
Countable income within program limits:
(iii) For the medical
care services program, see WAC
182-508-0005;
(iv) For the health care for workers with
disabilities (HWD) program, see WAC
182-511-1000;
(vi) For long-term
care programs, see chapters
182-513 and
182-515 WAC;
(vii) For medicare savings programs, see WAC
182-517-0100; and
(viii) For the
medically needy program, see WAC
182-519-0050.
(4) In addition to the general eligibility
requirements in subsection (3) of this section, each program has specific
eligibility requirements as described in applicable WAC.
(5) If you are in a public institution,
including a correctional facility, you are not eligible for full scope apple
health coverage, except in the following situations:
(a) If you are age 21 or younger or age 65 or
older and are a patient in an institution for mental disease (see WAC
182-513-1317(5)); or
(b) You
receive inpatient hospital services outside of the public institution or
correctional facility.
(6) We limit coverage for people who become
residents in a public institution, under subsection (5) of this section, until
they are determined to be eligible for prerelease reentry services or
released.
(7) If you are terminated
from SSI or lose eligibility for categorically needy (CN) or alternative
benefits plan (ABP) coverage, you receive coverage under the apple health
program with the highest scope of care for which you may be eligible while we
determine your eligibility for other health care programs. See WAC
182-504-0125.
Notes
Wash. Admin. Code §
182-503-0505
Amended by
WSR
14-16-052, Filed 7/29/2014, effective
8/29/2014
Amended by
WSR
17-12-017, Filed 5/30/2017, effective
6/30/2017
Amended by
WSR
19-08-029, Filed 3/27/2019, effective
4/27/2019
Amended by
WSR
25-11-007, Filed 5/8/2025, effective
7/1/2025
12-13-056, recodified as WAC 182-503-0505, filed 6/15/12,
effective 7/1/12. Statutory Authority:
RCW
74.04.050,
74.04.057,
74.08.090, and
74.09.530, 42 U.S.C., Section
1396a. 07-21-005, § 388-503-0505, filed 10/4/07, effective 11/4/07. Statutory
Authority:
RCW
74.08.090,
74.09.530, and 2003 1st sp.s. c
25. 04-07-141, § 388-503-0505, filed 3/22/04, effective 4/22/04. Statutory
Authority:
RCW
74.08.090,
74.08A.100,
74.09.080, and 74.09.415.
02-17-030, § 388-503-0505, filed 8/12/02, effective 9/12/02. Statutory
Authority:
RCW
74.04.050,
74.04.055,
74.04.057 and
74.08.090. 98-16-044, §
388-503-0505, filed 7/31/98, effective 9/1/98. Formerly WAC 388-501-0110,
388-503-0305 and 388-505-0501.
