General eligibility requirements that apply to all Apple Health programs

Equal Access services

Revised Date: 
July 25, 2014

Purpose: To provide staff with basic information on the steps to identify individuals who need extra help (an accommodation) to access or maintain health care coverage resulting from any disability or learning or literacy issue.

WAC 182-503-0120 Washington apple health -- Equal access services.

Effective March 31, 2014.

  1. When you have a mental, neurological, cognitive, physical or sensory impairment, or limitation that prevents you from receiving health care coverage, we provide services to help you apply for, maintain, and understand the health care coverage options available and eligibility decisions we make. These services are called equal access (EA) services.
  2. We provide EA services on an ongoing basis to ensure that you are able to maintain health care coverage and access to services we provide. EA services include, but are not limited to:
    1. Helping you to:
      1. Apply for or renew coverage;
      2. Complete and submit forms;
      3. Give us information to determine or continue your eligibility;
      4. Ask for continued coverage;
      5. Ask for reinstated (restarted) coverage after your coverage ends; and
      6. Ask for and participate in a hearing.
    2. Giving you additional time, when needed, for you to give us information before we reduce or end your health care coverage;
    3. Explaining our decision to change, reduce, end, or deny your health care coverage;
    4. Working with your authorized representative, if you have one, and giving that person copies of notices and letters we send you; and
    5. Providing you the services of a sign language interpreter/transliterator who is certified by the Registry of Interpreters for the Deaf at the appropriate level of certification.
      1. These services may include in-person sign language interpreter services, relay interpreter services, and video interpreter services, as well as other services; we decide which services to offer you based on your communication needs and preferences.
      2. We offer these services as a reasonable accommodation, free of charge, if you are deaf, hard-of-hearing, or a deaf-blind person who uses sign language to communicate.
    6. Not taking adverse action in your case, or automatically reinstating your coverage for up to three months after the adverse action was taken, if we determine that your impairment or limitation was the cause of your failure to follow through on something you need to do to get or keep your Washington apple health coverage, such as:
      1. Applying for or renewing coverage;
      2. Completing and submitting forms;
      3. Giving us information to determine or continue your eligibility;
      4. Asking for continued or reinstated coverage; or
      5. Asking for and participating in a hearing.
  3. We inform you of your right to EA services listed in subsection (2) of this section:
    1. On printed applications and notices, including the printed rights and responsibilities form;
    2. In the Washington healthplanfinder web site, including the electronic rights and responsibilities form; and
    3. During contact with us.
  4. We provide you the EA services listed in subsection (2) of this section if you ask for EA services, you are receiving services through the aging and long-term support administration, or we determine that you would benefit from EA services. We determine you would benefit from EA services if you:
    1. Appear to have or claim to have any impairment or limitation described in subsection (1) of this section;
    2. Have a developmental disability;
    3. Are disabled by alcohol or drug addiction;
    4. Are unable to read or write in any language;
    5. Appear to have limitations in your ability to communicate, understand, remember, process information, exercise judgment and make decisions, perform routine tasks, or relate appropriately with others (whether or not you have a disability) that may prevent you from understanding the nature of EA services or affect your ability to access our programs; or
    6. Are a minor not residing with your parents.
  5. If we determine that you are eligible for EA services, we develop and document an EA plan appropriate to your needs. The plan may be updated or changed at any time based on your request or a change in your needs.
  6. You may at any time refuse the EA services offered to you.
  7. We reinstate your coverage when:
    1. We end coverage because we were unable to determine if you continue to qualify; and
    2. You provide proof that you are still qualified for coverage within twenty calendar days from when we ended your coverage. We restore your coverage retroactive to the first of the month so there is no break in your coverage.
  8. If you believe that we have discriminated against you on the basis of a disability or another protected status, the person may file a complaint with the U.S. Department of Health and Human Services at http://www.hhs.gov/ocr/civilrights/complaints or Region Manager, Office for 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).

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.

Worker Responsibilities

If you know that a particular individual needs assistance, it is your ethical and legal responsibility to help the individual identify if he or she needs Equal Access (EA) services and what services are needed (and to confirm if he or she still needs EA services and what those EA services are).

  1. When department staff work with individuals identified as needing EA services, it is critical that the EA Plan be readily available and used to ensure the individual is able to fully access services and maintain eligibility.
  2. Continually be alert to cues that might indicate an individual is in need of EA services.
  3. Conduct an EA assessment and develop an EA Plan if one has not been done.
  4. Provide accommodations whenever appropriate.

Note: Most accommodations are easily provided when the need for accommodation is understood. Other service providers, such as DVR may be able to assist in providing accommodations when the individual is eligible for DVR services. In some cases, DVR may have adaptive devices that can be shared, such as access to a TRS for communication with persons with hearing impairments.

Screening

Apple Health Classic Medicaid Programs MAGI-Based Apple Health Programs
  1. Upon application, all applicants for, and recipients of, Washington Apple Health are assessed for their need for EA services.
  2. Individuals are screened using the ACES Online EA Screens to determine the need for accommodations and the plan for delivery of services.
  3. Most EA screenings and plan development are done by reception, financial or WorkFirst Program Specialists.
  4. Social Service Specialists are called upon for their expertise in screening and plan development when necessary.
MEDS/Community-Based Assistants document the need for an EA Plan and what accommodations are needed for the EA Plan as follows:
  1. With applicant on the phone or in-person, ask if he or she would like help to complete the application or renewal. If the applicant/recipient says “Yes”, then do the following:
    1. If applicant/recipient is active on a DSHS program, the EA screening questions are viewable in ACES. Ask the ACES questions and document in ACES if EA was discussed and needed/requested.
    2. If applicant/recipient is not active on a DSHS program, the ACES screening questions are not viewable. Go to “Client” tab in Barcode, ask the EA screening questions, and document if EA was discussed and needed/requested.
  2. If the individual is currently on a DSHS program, the EA screening and EA Plan development will likely have been done by reception, a DSHS financial worker or a WorkFirst Program Specialist. However, the worker needs to ask at every contact if the individual or applicant would like help completing the application or renewal.

When an individual applies for or receives Apple Health they are entitled to EA services whether they self-identify or agency staff identify the need. Staff should make EA determinations and take appropriate action on a case-by-case basis until the process can be automated in Healthplanfinder.

For policies on equal access for clients receiving LTSS see Equal Access - Necessary Supplemental Accommodation (NSA) and long-term services and supports.

If you have any questions, please contact HCA Regional Representative.