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WAC 182-505-0210  Washington apple health -- Eligibility for children.

Effective October 1, 2013.

(1) Unless otherwise stated in this section, a child is a person who is under nineteen years of age (including the month the person turns nineteen).  To be eligible for one of the Washington apple health (WAH) for kids programs described below, a child must:

                (a) Be a resident of Washington state, as described in WAC 182-503-0520 and 182-503-0525;

                (b) Provide a Social Security number (SSN) as described in WAC 182-503-0515 unless exempt; and

                (c) Meet any additional requirements listed for the specific program.

(2) Children under one year of age are eligible for WAH categorically needy (CN) coverage, without a new application, when they are born to a mother who is eligible for WAH:

                (a) On the date of the newborn's birth, including a retroactive eligibility determination; or

                (b) Based on meeting a medically needy (MN) spenddown liability with expenses incurred no later than the date of the newborn's birth.

(3) Children are eligible for WAH at no cost when they:

                (a) Have countable family income that is no more than two hundred ten percent of the federal poverty level (FPL) as described in WAC 182-505-0100;

                (b) Are currently eligible for supplemental security income (SSI); or

                (c) Received SSI payments in August 1996 and would continue to be eligible for those payments except for the August 1996 passage of amendments to federal disability definitions.

(4) Children are eligible for premium-based WAH as described in WAC 182-505-0215 when they:

                (a) Have countable family income that is not more than three hundred twelve percent of FPL as described in WAC 182-505-0100;

                (b) Do not have other creditable health insurance as described in WAC 182-505-0220; and

                (c) Pay the required monthly premiums as described in WAC 182-505-0225.

(5) Children are eligible for WAH home and community based waiver programs as described in chapter 182-515 WAC when they:

                (a) Meet citizenship or immigration status as described in WAC 182-503-0525;

                (b) Meet SSI-related eligibility requirements as described in chapter 182-512 WAC; and

                (c) Meet program specific age requirements.

(6) Children are eligible for the WAH long-term care program when they meet the institutional program rules as described in chapter 182-513 or 182-514 WAC, and either:

                (a) Reside or are expected to reside in a medical institution, intermediate care facility for the intellectually disabled (ICF/ID), hospice care center, or nursing home for thirty days or longer; or

                (b) Reside or are expected to reside in an institution for mental diseases (IMD) or inpatient psychiatric facility:

                                (i) For ninety days or longer and are age seventeen or younger; or

                                (ii) For thirty days or longer and are age eighteen through twenty-one.

(7) Children are eligible for the WAH medically needy (MN) program as described in WAC 182-519-0100 when they:

                (a) Meet citizenship or immigrant status as described in WAC 182-503-0535;

                (b) Have countable family income that exceeds three hundred twelve percent of FPL as described in WAC 182-505-0100; or

                (c) Have countable family income that is more than two hundred ten percent of FPL, but are not eligible for premium-based WAH as described in subsection (4) of this section because of creditable coverage; and

                (d) Meet a spenddown liability as described in WAC 182-515-0110, if required.

(8) Children are eligible for WAH SSI-related programs as described in chapter 182-512 WAC when they:

                (a) Meet citizenship or immigration status as described in WAC 182-503-0535;

                (b) Meet SSI-related eligibility as described in chapter 182-512 WAC; and

                (c) Meet an MN spenddown liability as described in WAC 182-519-0110, if required.

(9) Children who are not eligible for WAH under subsections (5) through (8) of this section because of their immigration status, are eligible for the WAH alien emergency medical program if they:

                (a) Meet the eligibility requirements of WAC 182-507-0110;

                (b) Have countable family income:

                                (i) That exceeds three hundred twelve percent of FPL as described in WAC 182-505-0100; or

                                (ii) That is more than two hundred ten percent of FPL, but they are not eligible for premium-based WAH as described in subsection (4) of this section because of creditable coverage; and

                (c) Meet a spenddown liability as described in WAC 182-519-0110, if required.

(10) Children who are in foster care or receive subsidized adoption services are eligible for coverage under the WAH foster care program described in WAC 182-505-0211.

(11) Children who are incarcerated in a public institution (as defined in WAC 182-500-0050), or a city or county jail, are not eligible for any WAH program, with the following exceptions:

                (a) Children who reside in an IMD as described in subsection (6) of this section; or

                (b) Children who are released from a public institution or city or county jail to a hospital for inpatient treatment.  Children who are released from an IMD to a hospital setting must be unconditionally discharged from the IMD to qualify for coverage under this provision. 


This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.