Health care for pregnant women

Revised February 22, 2017

Washington apple health -- Eligibility for pregnant women

WAC 182-505-0115 Washington apple health -- Eligibility for pregnant women.

Effective August 29, 2014.

  1. A pregnant woman is eligible for the Washington apple health (WAH) for pregnant women program if she:
    1. Meets citizenship or immigration status under WAC 182-503-0535;
    2. Meets Social Security number requirements under WAC 182-503-0115;
    3. Meets Washington state residency requirements under WAC 182-503-0520 and 182-503-0525; and
    4. Has countable income at or below the limit described in:
      1. WAC 182-505-0100 to be eligible for categorically needy (CN) coverage; or
      2. WAC 182-505-0100 to be eligible for medically needy (MN) coverage. MN coverage begins when the pregnant woman meets any required spenddown liability as described in WAC 182-519-0110.
  2. A noncitizen pregnant woman who does not need to meet the requirements in subsection (1)(a) or (b) of this section to be eligible for WAH and receives either CN or MN coverage based upon her countable income as described in subsection (1)(d) of this section.
  3. The assignment of medical support rights as described in WAC 182-503-0540 do not apply to pregnant women.
  4. A woman who was eligible for and received coverage under any WAH program on the last day of pregnancy is eligible for extended medical coverage for postpartum care for a minimum of sixty days from the end of her pregnancy. This includes women who meet an MN spenddown liability with expenses incurred no later than the date the pregnancy ends. This extension continues through the end of the month in which the sixtieth day falls.
  5. All women approved for WAH pregnancy coverage at any time are eligible for family planning services for twelve months after the pregnancy 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.

Pregnancy Medical (N03, N23):

This program provides CN coverage with countable income at or below 193% of the FPL without regard to citizenship or immigration status. Once enrolled in Apple Health for Pregnant Women, the individual is covered regardless of any change in income through the end of the month after the sixtieth day after the pregnancy end date (e.g., pregnancy ends June 10, health care coverage continues through August 31). Women receive this postpartum coverage regardless of how the pregnancy ends.

Women who apply for Pregnancy Medical after the baby's birth may not receive postpartum coverage, but they may qualify for help paying costs related to the baby's birth if they submit the application within three months after the month in which the child was born.

To determine the pregnant woman's family size, include the number of unborn children with the number of household members (e.g., a woman living alone and pregnant with twins is considered a three-person household).

Effective April 1, 2017

Household Size Monthly Income Limit
1 N/A
2 $2,612
3 $3,284
4 $3,957
5 $4,629
6 $5,301

Medically Needy Pregnant Women (P99):

This program provides MN coverage to pregnant women with income above 193% of the FPL. Individuals who qualify and enroll in Apple Health for Medically Needy Pregnant Women become eligible for MN coverage after incurring medical costs equal to the amount of the household income that is above the 193% FPL standard. For more explanation of Medically Needy benefits, please see that section of this publication.

Family Planning Extension (P05):

This program provides family planning services only for 10 months after Pregnancy Medical ends. Women receive the Family Planning Extension automatically, regardless of how pregnancy ends.

WAC 182-532-500  Family Planning only program - Purpose.

Effective September 1, 2013

  1. The purpose of the family planning only program is to provide family planning services to:
    1. Increase the healthy intervals between pregnancies; and
    2. Reduce unintended pregnancies in women who received medical assistance coverage while pregnant.
  2. Women receive these services automatically, regardless of how or when the pregnancy ends. This ten-month coverage follows the medicaid agency's sixty-day postpregnancy coverage.
  3. Men are not eligible for the family planning only program.

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.

Take Charge (P06):

This program provides both men and women with incomes at or below 260% FPL coverage for pre-pregnancy family planning services to prevent unintended pregnancies.

Individuals access Take Charge services through local family planning clinics that participate in the program.

WAC 182-532-720  TAKE CHARGE program -- Eligibility.

Effective January 9, 2017

  1. The TAKE CHARGE program is for men and women. To be eligible for the TAKE CHARGE program,
    an applicant must:
    1. Be a United States citizen, U.S. National, or "qualified alien"
      as described in WAC 182-503-0530, and give proof of citizenship or
      qualified alien status and identity upon request from the medicaid
      agency;
    2. Provide a valid Social Security number (SSN);
    3. Be a resident of the state of Washington as described in WAC
      182-503-0520;
    4.  Have an income at or below two hundred sixty percent of the
      federal poverty level as described in WAC 182-505-0100;
    5. Need family planning services;
    6. Have applied for categorically needy coverage, unless the applicant:
      1. Is a domestic violence victim who is covered under the alleged
        perpetrator's health insurance;
      2. Is under eighteen years of age and is seeking confidential
        services; or
      3. Has an income between one hundred fifty percent and two
        hundred sixty percent (inclusive) of the federal poverty level.
    7. Apply voluntarily for family planning services with a TAKE CHARGE
      provider; and
    8. Not be covered currently through another Washington apple
      health program for family planning. If categorically needy coverage is
      approved for a TAKE CHARGE recipient, the individual will be enrolled in
      the categorically needy program.
  2. An applicant who is pregnant or sterilized is not eligible
    for TAKE CHARGE.
  3. An applicant who has concurrent coverage under a creditable
    health insurance policy as defined in WAC 182-12-109 is not eligible
    for TAKE CHARGE unless the applicant is seeking confidential services and
    is either under nineteen years old or is a domestic violence victim
    who is covered under the perpetrator's insurance.
  4. A client is authorized for TAKE CHARGE coverage for one year from
    the date the medicaid agency determines eligibility, or for the duration
    of the waiver, whichever is shorter. Upon reapplication for TAKE
    CHARGE by the client, the medicaid agency may renew the coverage for an
    additional period of up to one year, or for the duration of the waiver,
    whichever is shorter.

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.

Effective April 1, 2017

Household Size Monthly Income Limit
1 $2,613
2 $3,519
3 $4,424
4 $5,330
5 $6,236
6 $7,141

Find additional information about Take Charge.

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