WAC 182-504-0130 Washington apple health -- Continued coverage pending an appeal.
Effective December 1, 2016
- Continued coverage is when you continue to receive Washington apple health benefits while appealing a medicaid agency adverse action to terminate, suspend, or reduce your:
- Medicaid eligibility; or
- Authorization for a covered service.
- To qualify for continued coverage, you must request a hearing on the adverse action no later than:
- The tenth day after we (the medicaid agency or its designee) sent a notice of the action to you; or
- The last day of the month before the action takes effect.
- If your last day to request a hearing and still qualify for continued coverage falls on a Saturday, Sunday, or a designated holiday under WAC 357-31-005, you have until 5:00 p.m. on the next business day to request the hearing.
- Continued coverage ends when:
- You state in writing you no longer wish to receive continued coverage;
- You withdraw the appeal;
- You default and an order of dismissal is entered;
- An administrative law judge or a review judge issues an adverse ruling or written decision:
- Terminating your continued coverage; or
- Ruling you do not qualify for benefits.
- You cannot receive continued coverage if the adverse action was solely to a change in statute, federal regulation, or administrative rule, unless there is a question about whether you are in the class of people affected by the change.
- If you are receiving medically needy coverage, you cannot receive continued coverage past the end of the certification period described in WAC 182-504-0020.
- If you are receiving coverage under an alien medical program, you cannot receive continued coverage past the end of the certification period described in chapter 182-507 WAC.