500 Series reason codes

Revised Date: 
July 25, 2014

Purpose: 500 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

520

Change in Federal law

There has been a change in the Federal law that regulates this program.

None

None required

182-518-0005 None required

525

No Eligibility Review Form - We haven't received your eligibility review or renewal form.

HPF

You have not completed your renewal for Washington Apple Health

388-434-0005

388-434-0010

388-492-0090

388-492-0110

388-492-0100

388-400-0070

None required

182-504-0035

None required

528

Eligibility Review Form incomplete

The eligibility review or renewal form we received wasn't complete.

HPF

The renewal form that you sent to us was not complete.

We need you to complete the form before we can determine your eligibility.

388-492-0110

388-492-0100

388-400-0070

388-434-0005

388-492-0090

You must return the completed form to us by 00/00/00 in order for your benefits to continue.

182-504-0035

None required

529

Termination/Denial due to nonpayment of premium

Health coverage stopped for the children listed above because you are three months behind in premium payments. Washington Apple Health with premiums coverage can't start again until the premiums are paid.

    182-505-0225 None required

531

Voluntary withdrawal for excess resources

You withdrew your request for assistance because you have too many resources to get assistance right now.

388-513-1350

388-406-0050

None required

   
532

State-funded LTC - Program Full

The state-funded long-term care services program is subject to caseload limits. The program is currently full. We aren’t enrolling new members at this time. See WAC rule (Washington Administrative Code):

    182-507-0125 None required

534

Family Medical To 12-month medical extension

Your cash benefits will stop because of earnings. Medical benefits for your family will continue under the Medical Extension Benefit program. You will get a separate letter to tell you about this program. See WAC rule (Washington Administrative Code):

Not applicable

Not applicable

   

535

Error in initial eligibility - Removed continuous tracking for child - For administrative use only

None

Specify the reason for termination and a WAC related to that reason.

   
538

TSOA Closure

You can’t receive services under this program when you are eligible for certain Medicaid programs. See WAC rule (Washington Administrative Code):

    182-513-1615 None required

542

We got your change report form. Some information is still missing. We sent you a letter telling you what you need to give to us. We did not get it.

388-418-0011

Specify what is missing.

   

544

Your bank didn't honor your premium payment.

None

None required

   

550

Voluntary withdrawal

You withdrew your request for assistance. See WAC rule (Washington Administrative Code):

HPF

You withdrew your request for Washington Apple Health

388-406-0050

388-492-0020

None required

 

182-503-0080

None required

551

Whereabouts unknown

We don’t know where you are. See WAC rule (Washington Administrative Code):

388-458-0030

388-492-0020

None required

182-518-0005

182-503-0520

182-503-0525

182-504-0105

 

552

Failed to provide verification

You did not give us the information we needed.

HPF

You didn't give us the information we asked for.

182-503-0050

388-400-0070

388-472-0005

388-490-0005

388-458-0020

388-492-0020

On 00/00/00, I asked you to provide some information by 00/00/00. I still need:

List of items

182-503-0050

__________???

554

RCL Error in Initial Eligibility

You didn’t meet Medicaid eligibility on the day of your discharge from a medical institution. See WAC rule (Washington Administrative Code):

    182-513-1235 Describe the reason the client was not initially eligible for Medicaid.

555

Application opened in error - For administrative use only

None

None required

   

557

AU requests closure

You asked us to stop your assistance.

HPF

You asked us to stop your Washington Apple Health coverage

None

 

None required

 

182-503-0080

None required

558

Failed to cooperate in securing other income and resources

You have income or resources that you could use but you haven’t made a reasonable effort to get them. If there is a good reason why you have not done this, please tell us. See WAC rule (Washington Administrative Code):

388-400-0070

388-458-0020

388-472-0005

388-490-0005

388-492-0020

You told us that you have (type of income/resource). To become eligible, you must try to make it available by __ (specify what they must do to make income or resource available).

182-503-0050  

559

Client already received assistance in another AU for this benefit month

Although you can belong to more than one assistance unit, you can only get benefits from one at a time.

388-400-0005

388-400-0010

388-400-0025

388-400-0030

388-400-0040

388-400-0045

388-400-0060

388-400-0070

You are already getting medical assistance.

   

561

AU screened in error - System generated only

None

None required

   

562

Due to your child(ren)'s immigration status they do not qualify for Medicaid. The Children's Health Program is now full and your child(ren) are on a waiting list. When an opening occurs, you will be contacted to review family circumstances. See WAC rule (Washington Administrative Code)

 

Specify which children.

182-505-0210  

564

Noncooperation with TPL process

You did not cooperate in obtaining another source of coverage for your medical care. See WAC rule (Washington Administrative Code):

 

You told us that you could get help with medical from (specify TPL source).

   

566

Refused to cooperate with application process

You refused to cooperate in the application process. Based on the information we have, we are unable to determine your eligibility. See WAC rule (Washington Administrative Code):

HPF

You have not cooperated with the application process. Based on the information we have, we are unable to determine your eligibility.

388-400-0070

388-406-0025

388-406-0035

388-406-0050

388-406-0060

388-452-0005

388-492-0020

388-406-0050

 

You did not __ . If you need help, let me know and I will try to assist you.

182-503-0080

 

572

User voided application - For administrative use only

None

None required

   

577

Missed application deadline - For administrative use only

None

None required

   

587

Already eligible for program in different AU - For administrative use only

388-408-0035

388-412-0005

The following persons aren't eligible for medical assistance for [MM/YYYY] because they already received medical assistance in another household:

list name of ineligible persons

NOTE: You may need to manually create a denial or termination letter or add text to the ACES system-generated letter.

   

588

Ineligible ESLMB already receiving MA

You are not eligible for the ESLMB program because you are receiving Medicaid benefits. See WAC rule (Washington Administrative Code):

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.

 

None required

182-517-0300  

589

Based on your current medical information, you are no longer disabled under Social Security rules. See WAC rule (Washington Administrative Code):

388-511-1105

None required

   

590

You have a penalty period because you gave away a non exempt asset or sold it for less than fair market value.

You, your representative or guardian, or with your consent, the facility where you live, may request an undue hardship waiver if you can show that without LTC services you will be deprived of housing, food, clothing or medical care and that your health or life will be endangered.

The request must be:

  • In writing
  • State the basis for requesting the undue hardship waiver
  • Be signed by the requestor and include the requestor's name, address and telephone number and
  • Be made within 90 days of the date of denial or termination of LTC services.

388-513-1363

388-513-1364

388-513-1365

388-513-1367

Explain the amount of the transfer used to determine the penalty or penalties periods. Indicate the dates the penalty period starts and ends.

   

596

Failure to pursue Medicaid

You aren't eligible for ABD cash or Housing and Essential Needs (HEN) Referral because you failed to pursue Medicaid.

388-400-0060

388-400-0070

(Social Service Specialist provides mandatory free form text via 14-118)

   

599

Other - For user generation only

None

None required

(If used for ABD or HEN Referral denial or termination, Social Service Specialist provides mandatory free form text via 14-118)