WAC 182-504-0015 Washington apple health -- Certification periods for categorically needy programs.

WAC 182-504-0015 Washington apple health -- Certification periods for categorically needy programs.

Effective July 5, 2022

  1. A certification period is the period of time we determine that you are eligible for a categorically needy (CN) Washington apple health program. Unless otherwise stated in this section, the certification period begins on the first day of the month of application and continues through the end of the last month of the certification period.
  2. For a newborn eligible for apple health, the certification period begins on the child's date of birth and continues through the end of the month of the child's first birthday.
  3. If you are eligible for apple health based on pregnancy, the certification period continues through the last day of the month the pregnancy ends. After-pregnancy coverage begins the first day of the month, following the ends of the pregnancy, and ends the last day of the 12th month from the time after-pregnancy coverage began.
  4. If you are newly eligible for apple health coverage and had a pregnancy end within the last 12 months, your certification period for after-pregnancy coverage:
    1. Begins the first day of the month you are eligible; and
    2. Ends the last day of the 12th month following the end of your pregnancy.
  5. If you are eligible for the refugee program, the certification period ends at the end of the 12th month following your date of entry to the United States.
  6. For all other CN coverage, the certification period is 12 months.
  7. If you are a child, eligibility is continuous throughout the certification period regardless of a change in circumstances, unless a required premium (described in WAC 182-505-0225) is not paid for three consecutive months, or you:
    1. Turn age 19;
    2. Move out-of-state; or
    3. Die.
  8. When you turn 19, the certification period ends after the redetermination process described in WAC 182-504-0125 is completed, even if the 12-month period is not over, unless:
    1. You are receiving inpatient  services (described in WAC 182-514-0230) on the last day of the month you turn 19;
    2. The inpatient stay continues into the following month or months; and
    3. You remain eligible except for turning age 19.
  9. A retroactive certification period is described in WAC 182-504-0005.
  10. Coverage under premium-based programs included in apple health for kids as described in chapter 182-505 WAC begins no sooner than the month after creditable coverage ends.

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.