Apple Health (Medicaid) rulemaking

To implement RCW 43.20B.030, as amended by section 1, chapter 331, Laws of 2025 (SB 5079), the agency is amending WAC 182-520-0015 to give the governing agencies the authority to waive collections when they determine that a state agency error caused a long-term services and supports client overpayment.

The agency is amending this rule to correct the internet address at which the public can obtain agency forms, including HCA form 13-879, Agreement to Pay for Healthcare Services. The correct address is https://www.hca.wa.gov/billers-providers-partners/forms-and-publications.

The agency is amending this rule to expand eligibility for family planning only (FPO) coverage to people age 26 and younger who are confidentially seeking
those services. The agency filed emergency rules under WSR 25-11-008 to make the change effective May 8, 2025.

The agency is amending its rules to reduce the eligibility period for refugee medical assistance from twelve months to four months for persons whose date of eligibility is on or after May 5, 2025.

The agency is streamlining eligibility for the state-funded long-term care program, including removing the age requirement and eliminating the disability determination requirement while retaining the functional eligibility requirement.

The agency is amending its rules to comply with federal regulations. Effective June 3, 2024, the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, removed a federal rule, 42 CFR § 435.608, thus eliminating the requirement to apply for other benefits as a condition of Medicaid eligibility. States were given 12 months after the effective date to comply.

The agency is amending this rule to update the list of programs for which a person cannot be concurrently eligible with the Medicaid alternative care program.

The agency is providing continuous eligibility for children ages zero to six covered through the Apple Health Children’s Health Insurance Program.

The agency is amending WAC 182-513-1380 to clarify the scope of the housing maintenance allowance.

The agency is amending WAC 182-511-1250 to add detail that will clarify how the agency determines countable income when calculating the program’s premium.