WAC 182-504-0120 Washington apple health -- Effective dates of changes.
Effective August 29, 2014.
- We (the agency or its designee) determine the date a change affects your Washington apple health (WAH) coverage based on:
- The date you report the change to us;
- The date you give us the requested verification; and
- The type of WAH you or your family is receiving.
- When you report a change after you submit your application, but before your application is processed, the change is considered when processing your application.
- If another person, agency, or data source reports a change in circumstances, the information may be used in determining your eligibility. We will not rely on information received from a person, agency, or data source to terminate your WAH coverage without requesting additional information from you.
- A change in income affects your ongoing eligibility only if it is expected to continue beyond the month when the change is reported, and only if it is expected to last more than two months.
- A change that results in termination of your WAH coverage takes effect the first of the month following the advance notice period.
- The advance notice period:
- Begins on the day we send the letter about the change to you; and
- Is determined according to the rules in WAC 182-518-0025.
- A change that results in a decreased scope of care takes effect on the first of the month following the advance notice period. Examples of a decreased scope of care are:
- Termination of WAH categorically needy (CN) medical and approval for other WAH coverage with a lesser scope of care such as WAH medically needy (MN) medical;
- WAH-MN recipient with a change that increases the spenddown liability amount;
- WAH-MN recipient with no spenddown liability with a change that results in WAH-MN with a spenddown liability.
- A change that results in an increased scope of care takes effect on the first of the month following the date the change was reported, when you provide the required verification:
- Within ten days of the date we requested the verification; or
- By the end of the month of your change report, whichever is later.
If you are a WAH-MN applicant with a spenddown liability that has not yet been met and you report a change that results in your becoming eligible for WAH-CN medical or WAH for adults, your change report will be treated as a new application for purposes of retroactive WAH coverage as described in WAC 182-504-0005.
- If you do not provide the required verification timely under subsection (8) of this section, we make the change effective the first of the month following the month in which you provide the verification. We may terminate your WAH coverage if you do not provide the required verification.
- When a law or regulation requires a change in WAH, the date specified by the law or regulation is the effective date of the change.
- When a change in income or allowable expenses is reported timely (within thirty days) and changes the amount you pay towards the cost of your care for institutional programs (residing in a medical institution), we calculate your new participation amount based on:
- Either actual income received in a month or allowable deductions incurred in a month, or both; or
- An estimate of your monthly or allowable expenses in a prospective period of six months or less, based on both actual income received in a preceding period of six months or less and income expected to be received during the prospective period. At the end of the prospective period or when any significant change occurs, we reconcile this estimate for the period with income received during the same period.
- When a change in income, or allowable expenses, changes the amount you pay towards the cost of your care for a home and community-based waiver or service, we calculate your new participation amount effective the first of the month following the date the change was reported, except that the new participation amount will be effective the month the change occurs if the change is the loss of an income source that you report within thirty days of the change.
- We use the following rules to determine the effective date of change for the health care for workers with disabilities (HWD) program:
- HWD coverage begins the month after coverage in another medical program ends and the premium amount has been approved by the eligible person; and
- If a change in income increases or decreases the monthly premium, the change is effective the first of the month after the change is reported. For more information on premium requirements for this program, see WAC 182-511-1250.
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.