Time to process

Revised Date:

July 25, 2014

Purpose: To provide the time limits for processing applications for health care coverage.

WAC 182-503-0060 Washington apple health (WAH)-- Application processing times.

Effective August 29, 2014.

We process applications for Washington apple health (WAH) within forty-five calendar days, with the following exceptions:
1. If you are pregnant, we process your application within fifteen calendar days;
2. If you are applying for a program that requires a disability decision, we process your application within sixty calendar days; or
3. The modified adjusted gross income (MAGI)-based WAH application process using Washington Healthplanfinder may provide faster or real-time determination of eligibility for medicaid.
For calculating time limits, "day one" is the day we get an application from you that includes at least the information described in WAC 182-503-0005(2). If you give us your paper application during business hours, "day one" is the day you give us your application. If you give us your paper application outside of business hours, "day one" is the next business day. If you experience technical difficulties while attempting to give us your application in Washington Healthplanfinder, "day one" is the day we are able to determine, based on the evidence available, that you first tried to submit an application that included at least the information described in WAC 182-503-0005(2).
We determine eligibility as quickly as possible and respond promptly to applications and information received. We do not delay a decision by using the time limits in this section as a waiting period.
If we need more information to decide if you can get WAH coverage, we will send you a letter within twenty calendar days of your initial application that:
1. Follows the rules in chapter 182-518 WAC;
2. States the additional information we need; and
3. Allows at least ten calendar days to provide it. We will allow you more time if you ask for more time or need an accommodation due to disability or limited-English proficiency.
Good cause for a delay in processing the application exists when we acted as promptly as possible but:
1. The delay was the result of an emergency beyond our control;
2. The delay was the result of needing more information or documents that could not be readily obtained;
3. You did not give us the information within the time frame specified in subsection (1) of this section.
Good cause for a delay in processing the application does NOT exist when:
1. We caused the delay in processing by:
  1. Failing to ask you for information timely; or
  2. Failing to act promptly on requested information when you provided it timely; or
2. We did not document the good cause reason before missing a time frame specified in subsection (1) of this section.

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

Example: Olaf applies for SSI-Related Apple Health due to a disability. DSHS finds that he is financially eligible but Olaf does not provide any medical documentation. DSHS refers the application to the Division of Disability Determination Services (DDDS). DDDS sends a request for the medical information to Olaf’s doctor. The doctor does not respond. DDDS sends another request for the missing information, and the doctor gives the medical information more than 60 days after Olaf applied. There is good cause for not processing the application within 60 days because Olaf and his doctor, and not DSHS or DDDS, caused the delay.