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Public health emergency and Apple Health

Revised Date: 
July 27, 2020

In response to a public health or other emergencies beyond the agency’s control, the Health Care Authority (HCA) may invoke the following options via a State Plan Amendment, Disaster State Plan Amendment, waiver, or other federal regulation in the administration of the Medicaid program to implement changes to existing rule(s):

  1. Renewal dates may be extended for Apple Health coverage.
  2. Medically Needy (MN) coverage for individuals may be extended and attestation of medical expenses may be taken to meet spenddown amounts.  
  3.  Attestation of income and resources may be accepted to determine new and continued eligibility for all Apple Health programs. 
  4. HCA may provide additional flexibility for clients when HCA is requesting information to process an application or a change of circumstances, including:
    1. Allowing more time to provide needed verifications;
    2. Allowing use of alternative verifications to verify circumstances; or
    3. Allowing flexibility for self-attestation in some situations including attesting to a disabling condition that could result in eligibility or documenting level of care.
  5. Premiums for the Apple Health for Workers with Disabilities and Apple Health for Kids with Premiums programs may be deferred, suspended, or waived, including past-due premiums.
  6. The treatment of income in the post eligibility process for long-term care may be adjusted in order to benefit clients.
  7. HCA may provide additional flexibility for individuals who file administrative hearing requests including:
    1. Suspending adverse actions resulting from an administrative hearing;
    2. Providing additional time for individuals to request an administrative hearing and to complete the administrative hearings process; and 
    3. Allowing flexibility in requests for continued benefits.
  8. Terminations dates may be suspended or extended.  When a termination is suspended or extended to a later date, HCA will follow existing notice and redetermination procedures before the termination may take effect.
  9. HCA may allow additional use of presumptive eligibility.

Changes to rules apply during the declared emergency period and expire upon termination of the emergency period including any extensions.

All changes to rules shall be applied uniformly.

WAC 182-521-0100 Disregarded income

Revised October 2, 2020

  1. The health care authority (agency) does not count as income when determining apple health eligibility any Federal Pandemic Unemployment Compensation (FPUC) or Recovery Rebates authorized under the CARES Act or other needs-based assistance authorized as a result of the COVID-19 emergency as described in this section.
  2. The agency disregards an emergency increase in unemployment compensation benefits of an additional six hundred dollars per week issued as compensation for the period of March 18, 2020, through July 31, 2020, as income for medicaid determinations and post-eligibility cost-sharing calculations.
  3. The agency disregards all unemployment compensation issued as a result of the federal Disaster Relief Fund authorized for states to off-set lost wages due to the COVID-19 pandemic, known as Lost Wage Assistance (LWA). This income is intended for weeks ending August 1, 2020, forward until funds are exhausted. The weekly benefit amount for this benefit is three hundred dollars per week.
  4. The agency considers Pandemic Recovery Rebates (stimulus checks) to be exempt as income and does not count them as a resource for twelve months after receipt.
  5. The agency considers needs-based assistance from other agencies or tribal entities to be exempt as income.
  6. The agency excludes income described in this section from the post-eligibility treatment of income (PETI) calculation.
  7. Any income received as unemployment compensation not described within this section is otherwise countable and the agency counts it when determining MAGI-based apple health eligibility.
  8. These rules are in effect until the later of:
    1. The date the client is receiving any benefits described in this rule; or
    2. The date on which the Secretary of the U.S. Department of Health and Human Services declares the COVID-19 public health emergency to be over.

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.

The Federal Pandemic Economic Unemployment Compensation and Recovery Rebates issued by the federal government under the Cares Act is not countable as income for any Medicaid program.  Recovery rebates are exempt as a resource for 12 months.

Other changes to rules during the COVID-19 pandemic include, expansion to coverage under the Alien Emergency rule and the Refugee Medical Assistance rule.

RMA clarifying: The agency is adopting emergency amendments to 182-507-0130, the Refugee medical assistance program, based on a federal waiver that expands the duration of medical assistance benefits during the PHE. The waiver allows receipt of more than 8 months of RMA. 

AEM clarifying: The proposed emergency rule expands the scope of covered services to include COVID-19 testing, assessment, and treatment of conditions that pose a potential threat to public health.