- What happens when an employee returns from approved PFML or FMLA?
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When the employee returns from approved PFML or FMLA, the following WACs apply:
- Maintaining eligibility for SEBB benefits (WAC 182-31-040 (4) (d)): A school employee who returns from approved leave without pay will maintain or establish eligibility for the employer contribution toward SEBB benefits if their work schedule, had it been in effect at the start of the school year, would have resulted in the school employee being anticipated to work the minimum hours to meet SEBB eligibility for the employer contribution in the school year. A school employee who regains eligibility under this subsection, establishes eligibility for the employer contribution toward SEBB benefits as of the date they returned from approved leave without pay.
- Eligibility for SEBB benefits ends (WAC 182-31-050 (1) (d)): The school employee who returns from approved leave without pay, who maintained or established eligibility as described in WAC 182-31-040 (4) (d), and who subsequently has a change in work pattern that, had the work pattern been in effect at the start of the school year, would not have resulted in the school employee being anticipated to work the minimum hours to meet SEBB eligibility for the employer contribution in the school year. In this case, eligibility for the employer contribution ends as of the last day of the month in which the change is effective.
- Can being approved for PFML or FMLA impact an employee’s eligibility for SEBB benefits?
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Employers need to determine eligibility for SEBB benefits without considering whether a school employee will or will not take leave that is protected under state and/or federal laws. Working hours that contribute to the minimum necessary for eligibility are not “reduced” by anticipated OR taken PFML or FMLA time. If an employee is already determined to be benefits eligible when they go on PFML or FMLA, those benefits must be maintained during PFML or FMLA.
Effective for claims with dates of service in January 2026, the Health Care Authority (HCA) experienced a system error with patient participation causing HCA to put a temporary hold on all nursing home claims.
Unfortunately, approximately 20 claims were denied before HCA realized the system error and halted all remaining claims.
The larger system error has been resolved and all held claims have been released and scheduled to be paid this week.
The remaining 20 claims that were denied will be reprocessed by HCA with payment expected to occur next week.
If you have any questions or concerns, contact the Medical Assistance Customer Service Center (MACSC) at 1-800-562-3022.