WAC 182-505-0225 Children's Washington apple health with premiums - Calculation and determination of premium amount.

Effective July 1, 2017.

  1. For the purposes of this chapter, "premium" means an amount paid for health care coverage under WAC 182-505-0215.
  2. Premium requirement.  Eligibility for Washington apple health premium-based program under WAC 182-505-0215 requires payment of a monthly premium. 
    1. The first monthly premium is due in the month following the determination of eligibility.
    2. There is no premium requirement for health care coverage received in the month eligibility is determined or in any prior month.
    3. A child who is American Indian or Alaska native is exempt from the monthly premium requirement.
  3. Monthly premium amount.
    1. The premium amount for the medical assistance unit (MAU) is based on countable income under chapter 182-509 WAC and the number of people in the MAU under chapter 182-506 WAC.
    2. The premium amount is as follows:
      1. If the MAU's countable income exceeds two hundred ten percent of the federal poverty level (FPL) but does not exceed two hundred sixty percent of the FPL, the monthly premium for each child is $20.
      2. If the MAU's countable income exceeds two hundred sixty percent of the FPL but does not exceed three hundred twelve percent of the FPL, the monthly premium for each child is $30.
      3. The medicaid agency charges a monthly premium for no more than two children per household.
      4. Payment of the full premium is required. Partial payments cannot be designated for a specific child or month.
      5. Any third party may pay the premium on behalf of the household. Failure of a third party to pay the premium does not eliminate the obligation of the household to pay past due premiums.
    3. A change that affects the premium amount takes effect the month after the change is reported.
  4. Nonpayment of premiums.
    1. Premium-based coverage ends for all children in the household if the required premiums are not paid for three consecutive months.
    2. Premium-based coverage is restored back to the month coverage ended if the unpaid premiums are fully paid before the certification period ends.
    3. The household may reapply for premium-based coverage ninety days after the coverage ended for nonpayment.
    4. The agency writes off past-due premiums after twelve months.

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.