In crisis?
As of Wednesday, March 18, HCA’s lobby will be closed. In-person customer services for Apple Health and the PEBB and SEBB Programs will not be available. Learn more.
200 Series reason codes
Revised Date:
December 1, 2014
Purpose: 200 Series Reason Code Protocols
Go to the Reason Code Link chart to link directly to a specific reason code or scroll through the list below.
For ACES Procedures go to ACES Letters in the ACES User Manual.
| Reason Code | Reason Code Description | WAC References - Classic Medicaid | Free Form Text - Classic Medicaid | WAC References - MAGI-Based Medicaid | Free Form Text - MAGI-Based Medicaid |
|---|---|---|---|---|---|
|
200 |
Noncitizen Medicaid Ineligibility (F-Track Only) You do not meet the citizenship requirements to receive federal Medicaid. You can get federal Medicaid only after living in the U.S. with legal status for five years or by becoming a naturalized citizen. For information on becoming a naturalized citizen visit the web at USCIS website about Naturalization. HPF - Noncitizen Medicaid - lawfully present but not met 5 year bar You don't meet the citizenship requirements to receive Washington Apple Health. You are ineligible for Medicaid for 5 years from your date of entry to the U.S. |
Need to specify which persons in AU do not meet citizenship requirements. |
|||
|
201 |
Living Arrangement - Medical Assistance Due to your living arrangement, we do not consider you a member of the household. |
Your living arrangement does not meet our requirements because (specify relevant requirement and how the individual's living situation does not meet that requirement). (Note to Users: This reason code is based on the valid value entered in the living arrangement field on the DEM1 screen). |
|||
|
202 |
Citizenship / Alien Status Immigrant requirements have not been met to receive these benefits. HBF You do not meet the citizenship or alien status requirements for Washington Apple Health. |
If client submitted verification of alien status: You do not meet the requirements because (specify relevant requirement and how client's alien status does not meet that requirement). If client didn't submit verification of status: We can't determine if you meet our requirements because we do not have verification of your citizenship status. |
|||
|
208 |
We don't have one of the following:
|
|
None Required |
None Required | |
|
209 |
Failed Refugee Requirement Refugees and asylees must meet certain requirements to get benefits from this program. You do not meet the requirements. See WAC rule (Washington Administrative Code): |
For refugees: You entered the United States on 00/00/00. (Specify why this doesn't meet the requirements.) or For asylees: You were granted asylee status on 00/00/00. (Specify why this doesn't meet the requirement.) |
|
Reason Code |
Reason Code Description |
WAC References - Classic Medicaid |
Free Form Text - Classic Medicaid |
WAC References - MAGI-Based Medicaid |
Free Form Text - MAGI-Based Medicaid |
|---|---|---|---|---|---|
|
210 |
Failed Residency Requirement We do not consider you a resident of Washington. |
You do not meet the residency requirements because (specify client individual facts showing why an individual is not considered a WA resident). |
We do not consider you a resident of Washington |
None Required |
|
|
212 |
HPF No Relationship You do not meet the relationship criteria to apply for Washington Apple Health coverage for this individual |
None Required |
|
Reason Code |
Reason Code Description |
WAC References - Classic Medicaid |
Free Form Text - Classic Medicaid |
WAC References - MAGI-Based Medicaid |
Free Form Text - MAGI-Based Medicaid |
|---|---|---|---|---|---|
|
220 |
Failed Age Requirement - Medical You do not meet the age requirement for this program. See WAC rule (Washington Administrative Code): |
You must be __ to get benefits from this program. |
None Required |
||
|
225 |
Now Receiving SSI When you get SSI (Supplemental Security Income) you also get medical benefits from DSHS. You will get a letter telling you about SSI Medical. If you have questions, please call 800-562-3022. See WAC rule (Washington Administrative Code): HPF When you get SSI (Supplemental Security Income) you are eligible for health care coverage under the SSI program. You will get a separate letter telling you about SSI Medical. |
None Required |
None Required |
|
Reason Code |
Reason Code Description |
WAC References - Classic Medicaid |
Free Form Text - Classic Medicaid |
WAC References - MAGI-Based Medicaid |
Free Form Text - MAGI-Based Medicaid |
|---|---|---|---|---|---|
|
230 |
Verification You did not give us the information we asked for. We can't figure out if you are eligible without it. |
On 00/00/00, I asked you to provide the following items by 00/00/00: List of items |
|||
|
235 |
Review Not Complete We did not get your review form. If we get it before the end of the month, we will reconsider our decision. If you have already sent it, let me know. See WAC rule (Washington Administrative Code): HPF You have not completed your renewal for Washington Apple Health. |
None Required |
None Required |
|
Reason Code |
Reason Code Description |
WAC References - Classic Medicaid |
Free Form Text - Classic Medicaid |
WAC References - MAGI-Based Medicaid |
Free Form Text - MAGI-Based Medicaid |
|---|---|---|---|---|---|
|
244 |
Death We were notified someone passed away. Please accept our condolences for your loss. HPF We were notified someone passed away. Please accept our condolences for your loss. Washington Apple Health coverage has been closed for this person. |
Specify the person who died. |
None Required |
||
|
245 |
No Eligible Household Members No one in your household meets the requirements to get assistance. See WAC rule (Washington Administrative Code): |
If no other reason code or letter: No one is eligible because (specify the requirement if not met. If more than one specify the one that applies to all members or the one that primarily prevented eligibility) __ . |
|||
|
247 |
[Under Previous Noncooperation With QC Penalty Your penalty period is not yet over. Ask your worker what to do to get out of sanction. See WAC rule (Washington Administrative Code): |
You cannot get benefits for # months because (specify what action caused the penalty) __ . You can regain your eligibility by (specify actions needed to be eligible again __ . If you have any questions about this, call the Quality Assurance worker at 000-000-0000. |
|||
|
248 |
HPF HOH Not Eligible The person listed as the primary applicant on your Washington Apple Health coverage is no longer eligible. |
None Required |
|||
|
249 |
HPF You already received health care coverage from another state this month. You can't get health care coverage from Washington and another state in the same month. |
None Required |
| Reason Code | Reason Code Description | WAC References - Classic Medicaid | Free Form Text - Classic Medicaid | WAC References - MAGI-Based Medicaid | Free Form Text - MAGI-Based Medicaid |
|---|---|---|---|---|---|
|
250 |
Not Aged, Blind Or Disabled - Medical You cannot get medical benefits under this program because you do not meet the rules set by the Social Security Administration (SSA). The rules say you must be age 65 or older, blind, or disabled. See WAC rule (Washington Administrative Code): |
None Required |
None Required |
|
Reason Code |
Reason Code Description |
WAC References - Classic Medicaid |
Free Form Text - Classic Medicaid |
WAC References - MAGI-Based Medicaid |
Free Form Text - MAGI-Based Medicaid |
|---|---|---|---|---|---|
|
266 |
Noncooperation With TPL We did not get your form about other coverage for your medical bills. You cannot get medical benefits from DSHS until we have the information. Your children can still get medical assistance. See WAC rule (Washington Administrative Code): |
None Required |
None Required |
|
275 |
No Longer Receiving SSI You no longer get SSI (Supplemental Security Income). |
None Required |
|||
|
276 |
DSHS doesn't define your medical condition as an emergency.
HPF No Medical Emergency for AEM Your medical condition does not meet the emergency medical requirements for Washington Apple Health Alien Emergency Medical coverage. |
None Required None Required
|
|||
|
279 |
QMBStart Date - Administrative Use Only |
None |
None Required |
||
|
280 |
Not Entitled To Medicare Part A DSHS cannot pay for your Medicare Part B premium because you are not eligible for Medicare Part A. If you have questions about your Medicare coverage, call your Social Security Office. See WAC rule (Washington Administrative Code): |
None Required |
|
281 |
Waiver Not Approved You need an approved plan of care before we can help pay for your care provider. See WAC rule (Washington Administrative Code): |
We do not have a plan of care for your (type of home or community based (HCB) program). |
|||
|
283 |
Newborn Not Living With Mother [Your baby no longer lives with you. See WAC rule (Washington Administrative Code): |
None Required |
|||
|
284 |
Failed To Meet Spenddown Requirement You didn't give us enough medical bills to meet your spenddown. You can reapply for medical at any time. See WAC rule (Washington Administrative Code): |
None Required |
|||
|
285 |
Income Exceeds 250% Of FPL (CHIP) The amount of your countable income is more than the maximum for the Children's Health Insurance Program (CHIP). |
The income limit for your family size is $ _____ |
|||
|
288 |
Ineligible ESLMB Already Receiving MA You are not eligible for the Qualified Individual (QI-1) Program because you are receiving Medicaid Benefits. You are eligible for the State-funded Buy-In Program. We will pay for your Medicare Part A premiums, if you have any, as well as your Part B premiums, coinsurance, and deductibles. See WAC rule (Washington Administrative Code): |
None Required |
|
294 |
Changed To Family Planning Since you are no longer pregnant, the type of medical coverage you receive has changed. You will start receiving coverage for only family planning services. See WAC rule (Washington Administrative Code): |
None Required |
|||
|
295 |
Dependent Has Creditable Medical Coverage (CHIP) Your child/children have other medical coverage. See WAC rule (Washington Administrative Code): HPF Your child/children have other creditable medical coverage. |
None Required |
|||
|
298 |
AU Stopped Employer Sponsored Health Care Coverage (CHIP) You stopped your employer sponsored health care coverage for your child/children. If you had a reason for stopping the coverage, contact us at Customer Service Support so we can determine if you meet the Good Cause reason for stopping the coverage. |
182-505-0230 |
None Required |
||
|
299 |
Premiums Not Paid (CHIP) You are losing CHIP coverage because you have not paid the premiums for 4 months or more. To keep CHIP, your past due premium must be paid before the ending date listed above. Mail your payment to the Office of Financial Recovery, PO Box 3951, Olympia, WA 98503. See WAC rule (Washington Administrative Code): |
None Required |