General eligibility requirements that apply to all Apple Health programs

Hospice applications - clients eligible for Categorically needy (CN) coverage

Revised Date: 
February 14, 2018

Purpose: Clients who elect hospice in the community who are otherwise eligible for CN or ABP program are financially eligible to receive hospice services at home.

If a client is in a nursing facility or hospice care center:

  • For the Aged/Blind/Disabled group, use the hospice institutional rules if in the institution 30 days or more.
  • For a MAGI coverage group, the client remains on the MAGI program. 

Hospice applications - eligibility for CN coverage

An 18-005 application is used for clients to apply for non-MAGI hospice coverage in a nursing facility, hospital, or hospice care center. The same application is used for noninstitutional aged, blind, or disabled coverage.

The financial worker will process applications following non-MAGI rules. If a client elects hospice outside of a nursing facility, hospital, or hospice care center, the L32 program is not used if client is eligible for CN under a non- institutional CN coverage group, such as S01 or S02.

Note: The N05 coverage group also provides hospice care for those who meet program requirements. An 18-001 application is submitted to WA Health Plan Finder for MAGI coverage. 

If a client elects hospice when residing in a medical facility/care center and is expected to remain there 30 days or more, the L31 coverage group is used for clients who receive SSI cash. For clients who do not receive SSI cash, but are SSI-related based on aged, blind, or disabled requirements, the L32 coverage group is used. This group uses the institutional rules and the 300% Federal Benefit Rate (FBR) income standard when determining eligibility for CN coverage.

The hospice election needs to be updated in ACES when the client is active on a noninstitutional CN program. Code the hospice provider number on the Institutional Care screen in ACES, under the Home and Community Based Services section, and indicate MA (Health Care Authority) as the approval source. ACES uses the provider number to issue copies of the award letter to the hospice agency and ensure that the provider also receives copies of any pending letters sent to the client. This helps them assist the client in gathering any missing verifications.

Follow necessary Equal Access (EA) procedures. This is formerly known as Necessary Supplemental Accommodation (NSA).