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WAC 182-514-0260  Washington apple health -- MAGI-based long-term care coverage for children eighteen years of age or younger.

Effective October 1, 2013.

  1. Children eighteen years of age or younger must meet the requirements in WAC 182-514-0240 to qualify for the Washington apple health (WAH) modified adjusted gross income (MAGI)-based long-term care (LTC) coverage under this section.
  2. When a child eighteen years of age or younger is eligible for the premium-based WAH for kids program as described in WAC 182-505-0210, the agency or its designee redetermines his or her eligibility using the provisions of this section so that the child's family is not required to pay the premium.
  3. The categorically needy income level (CNIL) for WAH LTC coverage under this section is two hundred ten percent of the federal poverty level (after a standard five percentage point income disregard).
  4. Countable income for categorically needy (CN) coverage under this section is determined using the MAGI methodologies described in chapter 182-509 WAC.
  5. The agency or its designee approves CN health care coverage under this section for twelve calendar months. If the child is discharged from the facility before the end of his or her certification period, the child remains continuously eligible for CN health care coverage through the end of the original certification date, unless he or she ages out of the program, moves out of state, is incarcerated, or dies.
  6. If a child is not eligible for CN health care coverage under this section, the agency or its designee determines the child's eligibility for health care coverage under the WAH institutional medically needy (MN) program described in WAC 182-513-1395.
  7. MN coverage is only available for a child who meets the citizenship requirements under WAC 182-503-0535.
  8. The facility where the child resides may submit an application on the child's behalf and may act as an authorized representative if the child is:
    1. In a court ordered, out-of-home placement under chapter 13.34 RCW; or
    2. Involuntarily committed to an inpatient treatment program by a court order under chapter71.34 RCW.
  9. Children who are eligible for WAH MAGI-based long-term care coverage under the provisions of this section may be required to contribute a portion of their income towards the cost of care as described in WAC 182-514-0265.

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.