Filing

Revised September 29, 2017

Purpose: To explain the rules and procedures on who can apply for Washington Apple Health (Medicaid) coverage, how to apply, and the minimum amount of information that must be provided to start the application process.

WAC 182-503-0010 Washington apple health -- Who may apply.

Effective July 1, 2017.

  1. You may apply for Washington apple health for yourself.
  2. You may apply for apple health for another person if you are:
    1. A legal guardian;
    2. An authorized representative (as described in WAC 182-500-0010);
    3. A parent or caretaker relative of a child age eighteen or younger;
    4. A tax filer applying for a tax dependent age eighteen or younger;
    5. A spouse; or
    6. A person applying for someone who is unable to apply on their own due to a medical condition and who is in need of long-term care services.
  3. If you reside in an institution of mental diseases (as defined in WAC 182-500-0050(1)) or a public institution (as defined in WAC 182-500-0050(4)), including a Washington state department of corrections facility, city or county jail, or secure community transition facility or total confinement facility (as defined in RCW 71.09.020), you, your representative, or the facility may apply for you to get the apple health coverage for which you are determined eligible.
  4. You are automatically enrolled in apple health and do not need to submit an application if you are a:
    1. Supplemental security income (SSI) recipient;
    2. Person deemed to be an SSI recipient under 1619(b) of the SSA;
    3. Newborn as described in WAC 182-505-0210; or
    4. Child in foster care placement as described in WAC 182-505-0211.
  5. You are the primary applicant on an application if you complete and sign the application on behalf of your household.
  6. If you are an SSI recipient, then you, your authorized representative as defined in WAC 182-500-0010, or another person applying on your behalf as described in subsection (2) of this section, must turn in a signed application to apply for long-term care services as described in WAC 182-513-1315

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.

Clarifying Information

Medical applications of parents with joint custody of a minor dependent child

Only one household may receive health care coverage for a child, but for modified adjusted gross income (MAGI) coverage, the child may be listed on more than one application in more than one assistance unit (MAU). The household that cares for the child the majority of time receives coverage for that child, but remember that coverage follows the child within the state. When two households have joint custody of a child, the child may obtain health care services while staying at either home in Washington.

Applications by others

Individuals may apply on behalf of an individual if they have one of the following relationships to the applicant:

  1. A legal guardian;
  2. An authorized representative;
  3. A parent or caretaker relative of a child less than nineteen years of age;
  4. A tax filer applying for a tax dependent less than nineteen years of age; or
  5. A spouse.

Note: While others can apply for benefits on behalf of individuals, HIPAA restrictions prevent us from discussing the individual's health information with the person making the application unless the representative has power of attorney for the individual or the individual has signed an Authorization for release of information.

Authorized Representative

An authorized representative can be any adult who has sufficient knowledge of the individual's circumstances to act on the individual's behalf. In general, the individual chooses who will be their authorized representative. For more information, see Authorized Representative.

Authorized representatives are not authorized to apply on behalf of deceased individuals.

Applications while in a public institution

Prior to release from a public institution, individuals may apply for Apple Health coverage. See the Incarceration overview page for more information.

Dangerous Mentally Ill Offenders (DMIOs) - for non-MAGI Classic Apple Health programs

DSHS has a state law-required agreement with the Department of Corrections (DOC) to accept Medicaid applications from an inmate who is classified as a dangerous mentally ill offender (DMIO). The CSO that serves the area in which the correctional facility releasing the DMIO is located or an alternate CSO as designated by the Regional Office must accept applications from inmates of that facility.

WAC 182-503-0005 Washington apple health -- How to apply.

Effective August 13, 2017.

  1. You may apply for Washington apple health at any time.
  2. For apple health for children, pregnant people, adults age sixty-four and under without medicare, parents and caretaker relatives modified adjusted gross income (MAGI):
    1. You may apply:
      1. Online via the Washington Healthplanfinder at https://www.wahealthplanfinder.org;
      2. By calling the Washington Healthplanfinder customer support center number and completing an application by telephone;
      3. By completing the application for health care coverage (HCA 18-001P) and mailing or faxing to Washington Healthplanfinder; or 
      4. Through a department of social and health services (DSHS) community services office (CSO).
    2. If you need help filing a MAGI-based apple health application, you may:
      1. Contact the Washington Healthplanfinder customer support center number listed on the application for health care coverage form (HCA 18-001P); or
      2. Contact a navigator, health care authority community assistor, or broker.
  3. ​If you seek apple health and have a disability or are blind, age sixty-five or older, eligible for medicare, or need long-term services or supports (non-MAGI), you may apply:
    1. Online via Washington Connection at http://www.WashingtonConnection.org;
    2. By completing the application for aged, blind, disabled/long term care coverage (HCA 18-005) and mailing or faxing to DSHS; or
    3. In person at a local DSHS CSO or home and community services (HCS) office.
  4. For apple health that is not based on MAGI, you may apply if you are:
    1. Age sixty-five or older;
    2. Eligible for medicare;
    3. Applying for health care based on blindness or disability;
    4. Applying for long-term services and supports; or
    5. Applying for assistance with medicare premiums.
  5. You may receive help filing an application by:
    1. Visiting a local DSHS CSO or HCS office; or 
    2. Calling the DSHS community services customer service contact center.
  6. You must apply directly with the service provider for the following programs:
    1. The breast and cervical cancer treatment program WAC 182-505-0120;
    2. The TAKE CHARGE program under chapter 182-532 WAC; and 
    3. The kidney disease program under chapter 182-540 WAC.
  7. For the confidential pregnant minor program under WAC 182-505-0117 and for minors living independently, you must complete a separate application directly with us (the medicaid agency).
    More information on how to give us an application may be found at the agency's web site: http://www.hca.wa.gov.
  8. As the primary applicant or head of household, you may start an application for apple health by:
    1. Providing your:
      1. Full name;
      2. Date of birth; and 
      3. Physical and mailing addresses (if different).
    2. Signing the application.
  9. To complete an application for apple health, you must also give us all of the other information requested on the application.
  10. We help you with your application or renewal in a manner that is accessible to you if you:
    1. Are a person with disabilities, impairments, or other limitations and may need equal access services as described in WAC 182-503-0120; or 
    2. Have limited-English proficiency as described in WAC 182-503-0110.

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.

Clarifying Information

Application Forms

(18-001) through Washington Healthplanfinder - 

Application for aged, blind, disabled/long-term care coverage (18-005)

Program-specific application forms 

Application for Medicare Savings Program (MSP)

Application for the Tailored Supports for Older Adults (TSOA) program 

Opportunity to apply

CSOs must make application forms readily available and provide a form to anyone requesting one. An individual cannot be refused to be given an application form for any reason. For MAGI-based applications done via Washington Healthplanfinder, CSOs provide computers in their lobbies for applicants to apply for health care coverage in Washington Healthplanfinder. Additionally, CSOs may offer assistance in applying in Washington Healthplanfinder when an individual is also applying for SNAP (food assistance).

Starting an application 

An individual has filed a partial application when a signed application is received with at least the name and date of birth of the head of household or primary applicant and his or her physical/mailing address. Once submitted, the individual will have at least 15 days to complete the application and submit verification, if needed.

Where to apply

MAGI-based coverage

Applying for Apple Health through Washington Healthplanfinder is best for individuals who are:

  1. Adults under age 65 without Medicare;
  2. Adults who are parents or caretaker relatives of minor children;
  3. Pregnant; or
  4. Under age 19.

Washington Healthplanfinder applications can be completed:

  1. Online at www.wahealthplanfinder.org;
  2. By phone with the Washington Healthplanfinder Customer Support Center at 1-855-WAFINDER (1-855-923-4633);
  3. Through a navigator;
  4. By submitting a paper Health Care Coverage application (18-001P) by fax to 1-855-867-4467; or
  5. By submitting a paper Health Care Coverage application (18-001P) by mail to:
    Washington Healthplanfinder
    PO Box 946
    ​Olympia, WA 98504

Navigators are available around the state. Navigators are a network of people, usually in clinics and hospitals, who can help individuals find and apply for coverage. The Washington Healthplanfinder Navigator Search can be found at https://www.wahealthplanfinder.org/HBEWeb/Annon_DisplayBrokerNavigatorSearch.action?brokerNavigator=NAV&request_locale=en.

Individuals not eligible via Washington Healthplanfinder but who appear to qualify for non-MAGI coverage will receive an application form by mail to apply for non-MAGI based coverage.

Non-MAGI based Classic Apple Health coverage

DSHS processes applications for individuals who are age 65 or over, eligible for Medicare, are blind or disabled, need a disability determination, or are in need of long-term services and supports. DSHS has two areas that process applications: Economic Services Administration (ESA) and the Aging and Long-Term Support Administration (ALTSA).

DSHS Community Services Office (CSO)

DSHS CSOs processes applications for individuals who are 65 or over, eligible for Medicare, are blind or disabled, or need a disability determination. Applications for non-MAGI Apple Health can be completed:

  1. Online at www.WashingtonConnection.org;
  2. By submitting a paper Application for aged, blind, disabled/long-term care coverage (18-005) by fax to 1-888-338-7410; or
  3. By submitting a paper Application for aged, blind, disabled/long-term care coverage (18-005) by mail to:
    DSHS
    Community Services Division – Customer Service Center
    PO Box 11699
    Tacoma, WA 98411-6699

Find a local CSO at https://www.dshs.wa.gov/esa/community-services-find-an-office

ALTSA Home and Community Services (HCS)

ALTSA’s HCS processes applications for individuals not eligible for MAGI-based coverage and who are in need of care in their own home, a community residential care facility (adult family home or assisted living facility) or nursing facility. More information on the HCS application process can be found in the Medicaid and Long-Term Care Services for Adults publication (22-619).

Individuals eligible under a categorically needy (CN) or alternative benefits plan (ABP) MAGI-based program can receive long-term services and supports (LTSS) if determined functionally eligible by an ALTSA social worker or case manager. A separate application is not needed for active MAGI based individuals for Medicaid personal care (MPC), Community First Choice (CFC) or nursing facility services. If LTSS is needed, contact the HCS intake for an assessment. The intake phone numbers for a social service assessment is located under applications for LTC: https://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/applications-ltc

Applications for services through HCS can be completed:

  1. Online at www.WashingtonConnection.org;
  2. By submitting a paper application for aged, blind, disabled/long-term care coverage (18-005) by fax to 1-855-635-8305; or
  3. By submitting a paper application for aged, blind, disabled/long-term care coverage (18-005) by mail to:
    DSHS
    Home and Community Services – Long Term Care Services
    PO Box 45826
    Olympia, WA 98504-5826

Find a local HCS office at https://www.dshs.wa.gov/altsa/resources

Pending Applications

When an individual submits an application and more information is needed to determine eligibility, they will receive a letter in the mail (unless they are receiving electronic notices through Washington Healthplanfinder). This letter will tell them what information is needed, when to submit it, and how to submit it. See the Verification chapter for more information.

Example: Jenny, age 35, has a pending application for SNAP (Basic Food) and ABD cash. At her intake interview, she requests health care coverage. She reports she is not aged or blind, but may have a disability. The CSO worker offers assistance to apply in Washington Healthplanfinder, which Jenny accepts. The worker inputs the application data into Washington Healthplanfinder and Jenny is approved for Apple Health for Adults.

Example: Maria, age 66, has a pending application for SNAP (Basic Food). At her telephone intake interview, the worker lets her know she may be eligible for non-MAGI (Classic) Apple Health. She decides to apply for coverage as well. The worker can complete an interactive interview, print the application, and mail to the individual for a signature.

Handling multiple applications from the same household (Classic Medicaid only)

  1. Additional applications received before we determine eligibility on the first application:
    1. Do not deny the additional application(s);
    2. Review the application(s) for impact on eligibility and whether the household is applying for any additional programs that were not selected on the first application;
    3. If the household is not applying for additional programs, document in the case that additional application(s) were received, the date(s) the additional application(s) were received, and that the agency is still considering eligibility under the original application date;
    4. If the household is applying for additional programs, treat the application as a new application for the additional programs only and continue to consider any requests for programs which are still pending under the original application date;
    5. Document in ACES to explain any additional information used to determine eligibility; and
    6. Do not extend the Timeliness period for the original application.
      1. Note: If the additional application is received before we determine eligibility on the first application but a worker does not act on the additional application until after the first application has been approved or denied, follow procedures under (2) below.
  2. Additional applications received after we determine eligibility on the first application:
    1. If we denied the first application, treat this as an initial application.
      1. Exception: If we are still within the original 30 day reconsideration period under WAC 182-503-0080 and there has not been a change of circumstances that would warrant a new request for information, then do not treat this as an initial application. Instead, treat this as a reconsideration. See Apple Health Applications - Denial and Reconsideration.
    2. If we approved the first application, review the additional application(s) to determine if household circumstances have changed. Take appropriate actions on any changes reported.
    3. If neither (a) nor (b) applies, the additional application should be denied as a duplicate application as follows:
      1. Use reason code 587;
      2. Send out the required denial letter (if not system generated); and
      3. Add text to explain that the application is being denied because the person(s) on the application is already receiving the Apple Health coverage.

Please note: Reuse AUs! When denying additional applications as described in (b)(iii) above, avoid creating a new AU if an old AU is available.

Name, address, and signature requirements

  1. Name & Address
    If we receive an application without a name or address to contact the individual, we make any reasonable effort we can to contact the individual to find out who the individual is and where they can be reached. If contact cannot be made, no further action needs to be taken.
  2. Applications Marked “Homeless”
    If we receive a paper application that includes a name and signature, but is marked "homeless" and/or does not indicate a mailing address, make a reasonable attempt to locate an address or phone number for the individual. This can be done by searching the electronic case record, case narrative, ACES remarks, or past Washington Healthplanfinder applications to see if there’s a recent address reported. If no address is provided and no contact can be made, no further action needs to be taken.
  3. Signatures
    1. The individual/authorized representative must sign the application.
    2. A minor child may sign the application if there is no adult in the household.
    3. A mark is an acceptable signature if another person witnesses the making of the mark and signs the application.
    4. Online applications are considered signed electronically when transmitted.
    5. Telephonic signatures are accepted through Washington Healthplanfinder’s customer support center.
    6. See matrix below for signature requirements and date of application.

Application Received

Online

In person, mailed, emailed, faxed, dropped off, scanned, or over the phone

Application Signed?

Yes. Always signed when submitted

May or may not be signed. Does not need to be signed in order to be accepted. Must be signed, however, to be processed

Date of Application

Date received or next business day if received after business hours

If signed, date received or next business day if received after business hours. If not signed, see "Action to Take".

Action to Take

Only applicant needs to sign in two parent households

If not signed, or taken over the phone, have the individual sign or mail back for signature. The date we receive the signature is the date of application.

Note: When an interactive interview over the phone or in-person is used to complete an application for benefits, a signature must be obtained.

Additional Situations Requiring an Application or Eligibility Review
Signed application or eligibility review forms are needed for:

  • When an individual is terminated from SSI and we must re-determine eligibility under a different program.
  • Adding someone new to an assistance unit who has either not previously applied, or whose previous DSHS coverage ended more than 30 days earlier.
  • Medically Needy (MN) coverage, and whenever establishing a new base period. If the review is completed by phone, the AFB must be printed out and sent to the individual for signature.
  • When an individual applies for a long-term care (LTC) service, such as COPES, nursing home care, or a DDA waiver, and is expected to receive the LTC service for longer than 30 days. This includes SSI recipients.

Other Programs

Take Charge is a program that provides women and men coverage for family planning services.

Find more information on the Take Charge (Family Planning non-Medicaid) page, including the Take Charge provider directory.

Alien Emergency Medical (AEM) applications are processed by either HCA or DSHS. See the AEM presentation for more information.

Breast and Cervical Cancer Treatment Program (BCCTP) provides health care coverage for women diagnosed with breast or cervical cancer or a related pre-cancerous condition. Find more information at the Department of Health’s BCCTP page. 

The Kidney Disease Program (KDP) is a state-funded program that helps low-income, eligible individuals with treatment costs for end-stage renal disease. Eligibility is determined by each contracted kidney center. More information can be found on the KDP page.

Pregnant minors under 19 who need confidential health care coverage can apply using the Application for Pregnant Teen (14-430) form. The form can be submitted by mail or fax to:

Medical Eligibility Determination Services (MEDS)

PO Box 45531

Olympia, WA 98504-5531

Fax (360) 725-1898

Homeless teens applying on their own will need assistance with their Washington Healthplanfinder application. See the Homeless Teen Process form for more information.

WAC 182-503-0060 Washington apple health (WAH)-- Application processing times.

Effective August 29, 2014.

  1. We process applications for Washington apple health (WAH) within forty-five calendar days, with the following exceptions:
    1. If you are pregnant, we process your application within fifteen calendar days;
    2. If you are applying for a program that requires a disability decision, we process your application within sixty calendar days; or
    3. The modified adjusted gross income (MAGI)-based WAH application process using Washington Healthplanfinder may provide faster or real-time determination of eligibility for medicaid.
  2. For calculating time limits, "day one" is the day we get an application from you that includes at least the information described in WAC 182-503-0005(2). If you give us your paper application during business hours, "day one" is the day you give us your application. If you give us your paper application outside of business hours, "day one" is the next business day. If you experience technical difficulties while attempting to give us your application in Washington Healthplanfinder, "day one" is the day we are able to determine, based on the evidence available, that you first tried to submit an application that included at least the information described in WAC 182-503-0005(2).
  3. We determine eligibility as quickly as possible and respond promptly to applications and information received. We do not delay a decision by using the time limits in this section as a waiting period.
  4. If we need more information to decide if you can get WAH coverage, we will send you a letter within twenty calendar days of your initial application that:
    1. Follows the rules in chapter 182-518 WAC;
    2. States the additional information we need; and
    3. Allows at least ten calendar days to provide it. We will allow you more time if you ask for more time or need an accommodation due to disability or limited-English proficiency.
  5. Good cause for a delay in processing the application exists when we acted as promptly as possible but:
    1. The delay was the result of an emergency beyond our control;
    2. The delay was the result of needing more information or documents that could not be readily obtained;
    3. You did not give us the information within the time frame specified in subsection (1) of this section.
  6. Good cause for a delay in processing the application does NOT exist when:
    1. We caused the delay in processing by:
      1. Failing to ask you for information timely; or
      2. Failing to act promptly on requested information when you provided it timely; or
    2. We did not document the good cause reason before missing a time frame specified in subsection (1) of this section. 

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.

Worker Responsibilities (Non-Classic Medicaid only)

Date stamping the application

  1. Date stamp the application, the same day we get the application, even if the application is sent to the wrong office; or
  2. The next business day if we received the application outside of normal business hours.

Shared Case processing / Transfers

CSO and Foster Care Medical Team (FCMT) may need to coordinate actions on shared cases involving foster and adopted children or foster alumni receiving D01, D02, or D26 medical programs. To contact the FCMT call 1-800-562-3022, extension 15480; or email at FCMT@hca.wa.gov.

CSO and MEDS staff must coordinate actions taken on shared cases. If the CSO needs a shared case transferred, email Medstransfer@hca.wa.gov. For MEDS, if there is a shared case, contact the CSO before making any change. If MEDS staff are unable to reach the CSO to take action on a shared case, they will contact the CSO supervisor of record for action.

How to Contact MEDS:

By Mail:
MEDS
PO Box or Mail Stop 45531
Olympia, Washington 98504-5531

Phone: General Information: 800-562-3022  

FAX: 855-867-4467

Email: Case transfers Medstransfer@hca.wa.gov

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