Classic (non-MAGI) based programs manual

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Medical Care Services (MCS) program

Revised Date: 
March 24, 2016

Purpose: The Medical Care Services (MCS) Program provides health care coverage to legally present recipients of Aged, Blind, or Disabled (ABD) cash assistance and the Housing and Essential Needs (HEN) Referral program who are unable to access other Washington Apple Health (WAH) programs due to their citizenship / immigration status.

WAC 182-508-0005 Eligibility for Washington apple health medical care services eligibility and scope of coverage.

WAC 182-508-0005 Eligibility for Washington apple health medical care services eligibility and scope of coverage.

Effective August 24, 2014

  1. A person is eligible for state-funded Washington apple health (WAH) medical care services (MCS) coverage to the extent of available funds if the person is:
    1. Determined by the department of social and health services to be eligible for benefits under either the aged, blind, or disabled program as described in WAC 388-400-0060 or the housing and essential needs referral program as described in WAC 388-400-0070; and
    2. Not eligible for another federally funded categorically needy (CN) (as defined in WAC 182-500-0020) or alternative benefits plan (ABP) (as defined in WAC 182-500-0010) WAH program.
  2. If an enrollment cap exists under WAC 182-508-0150, a waiting list of persons may be established.
  3. A person's period of eligibility for MCS is the same as either the person's period of eligibility for the aged, blind, or disabled program as described in WAC 388-449-0150 or the person's incapacity authorization period for the housing and essential needs referral program as described in WAC 388-447-0110.
  4. The MCS program covers only the medically necessary services defined in WAC 182-501-0060.
  5. The MCS program does not cover medical services received outside the state of Washington unless the medical services are provided in a border city listed in WAC 182-501-0175.

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

  1. In order to receive Medical Care Services (MCS) an individual must meet:
    1. ABD cash assistance or HEN Referral eligibility requirements outlined in WAC 388-400-0060 and 388-400-0070;
    2. Income and resource requirements outlined in Chapter 388-450 WAC and the citizenship and immigration requirements outlined in WAC 388-424-0015; and
    3. ABD cash disability requirements outlined in WAC 388-449-0001 or HEN Referral incapacity requirements outlined in WAC 388-447-0001.
  2. Individuals access MCS by submitting an application for cash assistance online through Washington Connection or in person at their local DSHS Community Services Office.
  3. The actual monthly income limits for ABD cash and HEN Referrals are outlined in WAC 388-478-0090.
  4. The ABD cash program provides SSI Facilitation services and a maximum cash grant of $197 for a one person assistance unit, or $248 for a two person assistance unit, as outlined in WAC 388-478-0033.
    Note: Because ABD cash maximum income limits are higher than the program payment standard, an individual may be eligible for ABD cash without receiving cash grant. These individuals may be eligible for MCS if they are not eligible for a federally-funded CN or ABP WAH program.
  5. The HEN Referral program does not provide a cash grant. HEN Referral recipients are eligible for essential needs items (e.g. hygiene and cleaning supplies) and potential housing assistance from the Department of Commerce through its network of local providers.
  6. MCS eligibility begins when ABD cash or HEN Referral eligibility begins. MCS eligibility ends when ABD cash or HEN Referral eligibility ends.
  7. ABD cash and HEN Referral recipients are subject to both financial eligibility and disability/incapacity reviews. Financial eligibility reviews are conducted every 6 to 12 months as required by WAC 388-434-0005 and 388-418-0011. ABD cash disability reviews are conducted at least every 24 months as required by WAC 388-449-0150. A HEN Referral incapacity review is conducted at least every 12 months as required by WAC 388-447-0110.
  8. There is a potential enrollment cap for MCS outlined in 182-508-0150. Since the enrollment cap was put into law, the agency has not had to implement any limits or disenrollment actions because there has been adequate funding to serve the enrolled population.

Worker Responsibilities

Worker Responsibilities are carried out by CSD staff

  1. When an individual is approved for ABD cash assistance or HEN Referral, review this case to determine if they are Federally Qualified to receive Medicaid.
  2. If the individual is not Federally Qualified to receive Medicaid, screen in an A-track Assistance Unit (AU) and approve MCS for the same certification period as ABD / HEN Referral.
  3. At the time of Mid-Certification Review, Eligibility Review, or Disability / Incapacity Review, extend MCS eligibility if the individual remains eligible for ABD or HEN Referral.
  4. Terminate MCS when eligibility for ABD / HEN Referral ends.

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