General eligibility requirements that apply to all Apple Health programs

Civil rights and complaints

Revised Date: 
July 25, 2014

Purpose: To describe the civil rights rules, accompanying responsibilities, and how to file a civil rights complaint.

WAC 182-503-0100 Washington apple health -- Rights and responsibilities.

Effective March 31, 2014.

For the purposes of this chapter, "we" refers to the agency or its designee and "you" refers to the applicant for, or recipient of, health care coverage.

  1. If you are applying for or receiving health care coverage, you have the right to:
    1. Have your rights and responsibilities explained to you and given in writing;
    2. Be treated politely and fairly without regard to your race, color, political beliefs, national origin, religion, age, gender (including gender identity and sex stereotyping), sexual orientation, disability, honorably discharged veteran or military status, or birthplace;
    3. Ask for health care coverage using any method listed under WAC 182-503-0010 (if you ask us for a receipt or confirmation, we will provide one to you);
    4. Get help completing your application if you ask for it;
    5. Have an application processed promptly and no later than the timelines described in WAC 182-503-0060;
    6. Have at least ten calendar days to give the agency or its designee information needed to determine eligibility and be given more time if asked for;
    7. Have personal information kept confidential; we may share information with other state and federal agencies for purposes of eligibility and enrollment in Washington apple health;
    8. Get written notice, in most cases, at least ten calendar days before the agency or its designee denies, terminates, or changes coverage;
    9. Ask for an appeal if you disagree with a decision we make. You can also ask a supervisor or administrator to review our decision or action without affecting your right to a fair hearing;
    10. Ask for and get interpreter or translator services at no cost and without delay;
    11. Ask for voter registration assistance;
    12. Refuse to speak to an investigator if we audit your case. You do not have to let an investigator into your home. You may ask the investigator to come back at another time. Such a request will not affect your eligibility for health care coverage;
    13. Get equal access services under WAC 182-503-0120 if you are eligible;
    14. Ask for support enforcement services through the division of child support; and
    15. Refuse to cooperate with us in identifying, using, or collecting third-party benefits (such as medical support) if you fear, and can verify, that your cooperating with us could result in serious physical or emotional harm to you, your children, or a child in your care. Verification may include one of the following:
      1. A statement you sign, outlining your fears and concerns;
      2. Civil or criminal court orders (such as domestic violence protection orders, restraining orders, and no-contact orders);
      3. Medical, police, or court reports; or
      4. Written statement from clergy, friends, relatives, neighbors, or co-workers.
  2. You are responsible to:
    1. Report changes in your household or family circumstances as required under WAC 182-504-0105 and 182-504-0110;
    2. Give us any information or proof needed to determine eligibility. If you have trouble getting proof, we help you get the proof or contact other persons or agencies for it;
    3. Assign the right to medical support as described in WAC 182-505-0540, unless you can submit verification (which may include one of the items listed in subsection (1)(o) of this section) that your cooperating with us could result in serious physical or emotional harm to you, your children, or a child in your care;
    4. Complete renewals when asked;
    5. Apply for and make a reasonable effort to get potential income from other sources when available;
    6. Give medical providers information needed to bill us for health care services; and
    7. Cooperate with quality assurance or post enrollment review staff when asked.

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

Civil Rights Complaints Filed with the Health Care Authority:

The Investigations and Reasonable Accommodation Unit (IRAU) investigates complaints we receive on discrimination. Someone may file a complaint with the IRAU using one of the toll free numbers below or by sending the complaint to IRAU.

Investigations and Reasonable Accommodation Unit (IRAU)
1115 S. Washington, OB2 2nd Floor NE Wing
PO Box 45839
Olympia, WA 98504-5839

Toll Free 800-521-8060

Toll Free TDD 800-521-8061

Filing A Complaint with the Office of Civil Rights

If you believe that you or someone you care about has been discriminated against by the agency or one of its agents or contractors you may file a complaint with the Office for Civil Rights. You may file a complaint for yourself or for someone else. Access additional information on filing a complaint with the Office of Civil Rights.

Hearings/Judicial Review

If we receive a complaint that a future hearing or judicial review covers, we may tell the person that the hearing or review will resolve the issue.

Equal Access

See WAC 182-503-0120 for information related to Equal Access services.

Limited English Proficient (LEP)

See WAC 182-503-0110 for information related to Limited English Proficient (LEP) services.

Managed Care

See WAC 182-538-0110 for information related to Apple Health Managed Care contractors.

See WAC 388-877-0600 for information related to behavior health care services.

Worker Responsibilities

  1. Explain why we made the decision:
    If someone doesn't like a decision we made or action we took, explain why we took the action and the rules we used to make the decision.
  2. Tell people about their options:
    If someone disagrees with a decision, tell them the options they have to review our decision, including:
    1. How to make a complaint;
    2. Their right to talk to a supervisor; and
    3. Their right to ask for a fair hearing.
  3. Verbal complaints of discrimination:
    If someone verbally complains that they were discriminated against, write down the details of the complaint for them.
  4. When someone wants to make a complaint that he or she was discriminated against:
    1. Help them write down their complaint as needed; and
    2. Get the complaint to the person who supervises the client's worker right away.
  5. Civil rights complaints:
    1. Tell the person that they can file a discrimination complaint directly with the U.S. Department of Health and Human Services, or Regional Manager, Office of Civil Rights, U.S. Department of Health and Human Services, 2201 Sixth Ave. – M/S: RX-11, Seattle, WA 98121-1831 (voice phone 800-368-1019, fax 206-615-2297, TDD 800-537-7697).
    2. Help the person with the complaint as needed.
  6. Discrimination complaints log:
    HCA's MEDS unit must keep a discrimination complaints log. The log must record the following information:
    1. Date of complaint;
    2. Name, address, telephone number, and client ID of the person making the complaint;
    3. Type of complaint (race, color, sex, political beliefs, etc.);
    4. The names, titles, and business addresses of people who may know about the action or decision in the complaint;
    5. How we addressed the complaint and the date we did this; and
    6. A copy of the written response to the complaint.
  7. Mandatory Civil Rights Training:
    Every year, all staff must complete civil rights training. Completion of this training is monitored, and staff receive a reminder if the training is not completed timely.