Apple Health (Medicaid) rulemaking

The agency is developing rules under ESSB 5187 Sec. 211 (83), 68th Legislature, 2023 Regular Session. This legislation directs the agency to implement a program with coverage comparable the categorically needy Medicaid program for certain adults age 19 and older who: (a) have an immigration status making them ineligible for Medicaid or federal subsidies through the Health Benefit Exchange; and (b) are not eligible for another full scope federally funded medical assistance program.

The agency is adding the 1915i income disregard equal to the difference between 150% of the Federal Poverty
Level and 300% of the Federal Benefit Rate. This disregard is targeted to individuals seeking Community Behavioral Health
Support Services (CBHS). This rulemaking aligns with the establishment of the CBHS program, filed under WSR 24-10-081,
effective July 1, 2024.l

Chapter 182-561 WAC is a new chapter to establish the Community Behavioral Support Services (CBHS) benefit.
The CBHS benefit assists eligible clients with obtaining the skills necessary to reside successfully in home and community-based
settings. The chapter includes the eligibility criteria for clients; Apple Health rules requiring medical necessity do not
apply to this benefit. The chapter also includes CBHS provider requirements, eligible diagnoses, covered services, and the
appeal process. Additionally, the agency is amending WAC 182-501-0065 to include CBHS as a service category.

The agency is amending these rules to add dental therapists as an eligible provider type.

The agency is updating the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) chapter to align with guidance from the Centers for Medicare & Medicaid Services.

The agency is amending its rules to increase the income standards for pregnancy and postpartum groups from 193% to 210% of the federal poverty level. This
increase is consistent with legislative directives in chapter 213, Laws of 2024 (2E2SSB 5580).

The State Supplemental Operating budget (section 211 (34), Chapter 376, Laws of 2024, (ESSB 5950)), included funding for the Health Care Authority (HCA) to implement a birth doula benefit for Apple Health (Medicaid) clients. HCA is developing rules in Chapter 182-533 WAC and amending WAC 182-502-0002 to accomplish this.

The agency is amending this rule to expand screening and preventative services for certain sexually transmitted infections during a client visit focused on family planning.

RCW 74.09.830 provides full-scope coverage for 12 months postpartum for pregnant or postpartum persons. This coverage is more generous than and thus replaces the limited scope “Family planning only – Pregnancy related program.” The agency intends to remove language related to this superseded program from chapter 182-532 WAC.

The agency is amending this chapter to clarify rules for RHCs applying for a change in scope rate adjustment and an interim-rate to final-rate adjustment. Additionally, the agency plans to add detailed clarification to the rules regarding adding dental services to an RHC through a change in scope application.