General eligibility requirements that apply to all Apple Health programs

Changes of circumstances reporting requirement

Revised Date: 
July 25, 2014

Purpose: To explain the requirements for reporting changes of circumstance.

WAC 182-504-0105 Washington apple health -- Changes that must be reported.

Effective August 29, 2014.

  1. You must report changes in your household and family circumstances to us (the agency or its designee) timely according to WAC 182-504-0110.
  2. We tell you what you are required to report at the time you are approved for WAH coverage. We also will tell you if the reporting requirements change.
  3. You must report the following:
    1. Change in residential address;
    2. Change in mailing address;
    3. Change in marital status;
    4. When family members or dependents move in or out of the residence;
    5. Pregnancy;
    6. Incarceration;
    7. Change in institutional status;
    8. Change in health insurance coverage including medicare eligibility; and
    9. Change in immigration or citizenship status.
  4. If you are eligible for a WAH long-term care program described in chapter 182-513 or 182-515 WAC, you must also report changes to the following:
    1. Income;
    2. Resources;
    3. Medical expenses; and
    4. Spouse or dependent changes in income or shelter cost when expenses are allowed for either.
  5. If you get WAH parent or caretaker (as described in WAC 182-505-0240) or WAH modified adjusted gross income (MAGI)-based adult coverage (as described in WAC 182-505-0250), you must also report changes to the following:
    1. When total income increases or total deductions decrease by one hundred fifty dollars or more a month and the change will continue for at least two months;
    2. Your federal income tax filing status that you expect to use when you file your taxes for the current tax filing year (such as changing from "married filing separately" to "married filing jointly"); and
    3. The tax dependents you expect to claim when you file your federal income tax return for the current tax filing year.
  6. If you get WAH based on age, blindness, or disability (SSI-related medical), then you must also report changes to the following:
    1. Income; and
    2. Resources. 

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.

WAC 182-504-0110 Washington apple health -- When to report changes.

Effective August 29, 2014.

  1. All changes you report to us (the agency or its designee), as required by WAC 182-504-0105, are used to decide if you can receive or keep receiving Washington apple health (WAH) coverage.
  2. You must report changes during your certification period within thirty days of when the change happened.
  3. You must report all changes during application, renewal, or redetermination of your WAH eligibility, regardless of when the change happened.
  4. For a change in income, the date a change happened is the first date you received income based on the change. For example, the date you receive your first paycheck for a new job or the date you got a paycheck with a wage increase is the date the change happened.
  5. If you do not report a change or you report a change late, we will decide if you can receive or keep receiving WAH coverage based on the date the change was required to be reported.
  6. If you do not report a change or you report a change late, and if it affects the amount you must pay toward your cost of care as described in WAC 182-513-1380 or chapter 182-515 WAC, you may become liable for overpayments we make on your behalf and you may need to pay more to your care provider.
  7. If you do not report a change or you report a change late, it may result in us overpaying you and you having to pay us back for the health care costs we overpaid. See chapter 182-520 WAC.

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.

Clarifying Information

Changes That Need to Be Reported for All Apple Health Programs

Change in institutional status

"Institutional status" means an individual residing in an "institution" as described in WAC 182-500-0050 for 30 days or more. A change in institutional status means being admitted to an institution for 30 days or more or being discharged from an institution. If an individual moves from one institution to another without being discharged, that person retains his or her institutional status.

Change in health insurance coverage including Medicare eligibility

Individuals need to report gaining or losing nonpublic health care coverage, such as employee-sponsored insurance, or Medicare coverage.

Individuals on an Apple Health program do not need to report changes from one Apple Health program to another Apple Health program, or from one Apple Health Managed Care Plan to another Apple Health Managed Care Plan.

Worker Responsibilities

MAGI-Based Apple Health and Apple Health for parents and caretaker relatives Classic Medicaid (Aged, Blind, Disabled (SSI-Related and Long-Term Care)

Individuals can report changes:

  1. Log into their Healthplanfinder account, under Quick Links, select "Report a Change in Income or Household," and follow the prompts to report the change.
  2. Call the Healthplanfinder Customer Support Center (HPF CSC) at 1-855-923-4633. The HPF CSC worker will go into the individual's HPF account to enter the changes.
  3. Call the HCA Medical Eligibility Determination Services (MEDS) at 1-800-562-3022.
  4. By mail to P.O. Box 946, Olympia, WA 98507.
  5. By fax to 360-841-7620

Individuals can report changes:

  1. Report the change in Washington Connection, either by logging into their account or clicking on the "Report a Change" link and following the prompts.
  2. Call the Community Service Division Customer Service Center at 1-877-501-2233.
  3. By mail to DSHS, CSD-Customer Service Center, P.O. Box 11699, Tacoma, WA 98411-6699.
  4. By fax to 1-888-338-7410.

Taking action on changes:

  1. When information about someone's circumstances becomes known: determine the impact on the person's benefits. This may include contacting them, contacting other parties, or asking for proof of their circumstances.
  2. Individual Reports: Take action based on changes the person reports by entering the changes into the Healthplanfinder.
  3. Third Party Reports: If we receive information from a third party, follow-up to decide how the information affects the person's/household's health care coverage. This may include contacting the person, contacting other parties, or asking for proof of their circumstances under WAC 182-503-0050 Verification Requirements for Apple Health.

Taking action on changes:

  1. When information about someone's circumstances becomes known: determine the impact on the person's benefits. This may include contacting them, contacting other parties, or asking for proof of their circumstances.
  2. Individual Reports: Take action based on changes the person reports by entering the changes into the Healthplanfinder.
  3. Third Party Reports: If we receive information from a third party, follow-up to decide how the information affects the person's/household's health care coverage. This may include contacting the person, contacting other parties, or asking for proof of their circumstances under WAC 182-503-0050 Verification Requirements for Apple Health.

When a change happens:

  1. The date of the change is normally the date a change occurs, such as when someone gets married, a newborn comes home from the hospital, someone moves to a new home.
  2. However, the date of a change in income is the date someone receives the newly reported income, such as a first paycheck that reflects a wage increase or a first paycheck for a new job.

When a change happens:

  1. The date of the change is normally the date a change occurs, such as when someone gets married, a newborn comes home from the hospital, someone moves to a new home.
  2. However, the date of a change in income is the date someone receives the newly reported income, such as a first paycheck that reflects a wage increase or a first paycheck for a new job.

Effect of a reported change:

  1. If a reported change results in a change in coverage, the change takes place on the first of the month following the month in which the change is reported, after advance and adequate notice has been given.
  2. Unlike in ACES, Healthplanfinder does not have the functionality to enter a change into a specific month. If an individual reports a change early, the worker should keep in mind that the change should not be entered into Healthplanfinder before the month in which the change takes place.

Effect of a reported change:

  1. If a reported change results in a change in coverage, the change takes place on the first of the month following the month in which the change is reported, after advance and adequate notice has been given.
  2. In ACES, the worker can enter a change in the month that the change is reported to take place, including a future month.

Changes reported via Apple Health medical application, renewal or redetermination:

  • The worker can use an application or renewal at any time to update the certification period.
 

AU member moves out of Washington state:

  1. Individuals must be residents of the state in order to be eligible for health care coverage under any Apple Health programs.
  2. If one or more members of the household (but not the entire household) leave the state, they may still be eligible for Apple Health. Refer to WAC 182-503-0520 Residency Requirements, to determine eligibility for the people who left the state.
 

Example: Sandy is hired for a new job on May 31st, begins work on June 10th, and receives her first paycheck on July 5th. As this is an income change, the date of Sandy's first paycheck, July 5th, is the date of the change. Sandy must report this change by August 5th based on WAC 182-504-0105 Reporting Requirements. If Sandy reports this change earlier (other than her reporting the change in Healthplanfinder), the worker should make sure the effective date of the change is when her first check is expected.