Application for Medicare
Revised April 25, 2014
Purpose: To clarify the Medicaid eligibility requirement to apply for Medicare.
Application for Medicare
Application for and enrollment into Medicare is a condition of eligibility for individuals who apply for Apple Health coverage, as long as the agency is able to pick up the cost of the premiums on the individual's behalf.
End Stage Renal Disease
The Medicare Buy-in Unit also sends letters requesting proof of application for Medicare under the End Stage Renal Disease Program (ESRD) to selected Medicaid kidney dialysis individuals who receive three consecutive months of treatment. The same process outlined above is used. The individual's letter is slightly different but still requires the individual to provide proof of application. The individual's kidney dialysis provider, (for example Northwest Kidney Dialysis Center), is also notified that they need to assist their individual with the Medicare/ESRD application process.
All individuals who fail to provide proof of application for Medicare to the Medicare Buy-in Unit under the authority of the above listed WAC citations, can be terminated from Apple Health assistance, including individuals who receive SSI or long-term care services.
Note: The Medicare Buy-in Unit is careful to give nearly 90 days in the two-letter process before they send an action request to the field to propose termination of Apple Health coverage.
Every month Apple Health eligible individuals age 65 and older are asked to provide proof of application for Medicare. The Medicare Buy-in unit in Olympia (call 1-800-562-3022) manages this workload. The following process is followed:
- Individuals are mailed a letter generated by barcode around the 20th of the month asking for proof of application for Medicare.
- The letter is provided in the individual's primary language and in English to the individual and to the individual's authorized representative. Only the English version is stored in DMS.
- All letters have a stamped return envelope addressed to the Medicare Buy-in Unit for returning the proof of Medicare application.
- Thirty days or more after the first letter is sent, the Medicare Buy-in Unit works the ticklers to review for proof of application for Medicare.
- If no proof is received, a second letter is sent to the individual requesting proof of application for Medicare and again ticklers are set for the Medicare Buy-in Unit to review the case for proof.
- If no proof is received from the second letter, the Medicare Buy-in Unit generates an action request to the worker of record asking that the individual be sent a termination of Medicaid notice under WAC 182-503-0505 General Eligibility and WAC 182-503-0540 Non Cooperation with Third Party Liability.