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.

388-424-0010

388-424-0016

388-424-0015

Need to specify which persons in AU do not meet citizenship requirements.

182-503-0535

 

201

Living Arrangement - Medical Assistance

Due to your living arrangement, we do not consider you a member of the household.

388-408-0015

388-408-0020

388-408-0025

388-408-0060

388-408-0070

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).

182-505-0210

182-505-0240

182-506-0015

182-507-0110

 

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.

388-400-0070

388-424-0005

388-424-0010

388-424-0015

388-424-0020

388-424-0025

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.

182-503-0505

182-503-0535

182-505-0115

182-508-0001

 

208

We don't have one of the following:

  • A valid Social Security number (SSN)
  • Proof of a recent application for a SSN

388-476-0005

388-503-0505

None Required

182-505-0115

182-505-0210

182-505-0240

182-508-0001

182-503-0505

182-503-0515

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):

388-400-0030

388-400-0035

388-466-0005

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.

388-400-0005

388-400-0070

388-454-0015

388-468-0005

388-492-0020

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

182-503-0505

185-503-0520

182-503-0525

182-505-0115

182-505-0240

182-508-0001

None Required

212

HPF

No Relationship

You do not meet the relationship criteria to apply for Washington Apple Health coverage for this individual

   

182-503-0010

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):

388-515-1505

You must be __ to get benefits from this program.

182-508-0001

182-505-0210

182-505-0211

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

182-510-0005

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.

388-472-0005

388-490-0005

388-400-0070

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.

388-434-0005

388-434-0010

388-492-0110

388-492-0100

388-492-0090

388-447-0070
 

None Required

182-504-0035

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.

182-503-0505

388-408-0005

388-408-0035

388-492-0030

Specify the person who died.

182-503-0505

None Required

245

No Eligible Household Members

No one in your household meets the requirements to get assistance. See WAC rule (Washington Administrative Code):

388-408-0005

388-408-0010

388-408-0015

388-408-0020

388-408-0025

388-408-0035

388-447-0070

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):

388-464-0001

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.

   

182-503-0010

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.

   

182-503-0505

182-505-0210

182-505-0115

182-505-0240

182-503-0520

182-503-0525

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

182-508-0001

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

182-503-0540

None

Required

275

No Longer Receiving SSI

You no longer get SSI (Supplemental Security Income).

182-510-0005

388-492-0030

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.

388-438-0100

388-500-0005

182-500-0030

182-507-0110
 

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):

182-517-0300

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):

388-515-1505

388-515-1510

388-515-1530

   

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):

182-505-0210

   

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):

388-416-0020

388-416-0030

   

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).

182-505-0100

182-505-0210

   

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):

182-517-0300

   

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):

182-505-0115

   

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.

388-542-0150

182-505-0210

   

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):

388-542-0150

   

None Required