WAC 182-503-0565 Washington apple health -- Age requirements for medical programs based on modified adjusted gross income (MAGI).

​Effective August 29, 2014

The following age requirements apply to persons whose eligibility for Washington apple health (WAH) is based on modified adjusted gross income (MAGI) methodology per WAC 182-509-0305.

1. You must be age sixty-four or younger to be eligible for WAH MAGI-based adult coverage as described in WAC 182-505-0250.
2. Your household must include an eligible dependent child age seventeen or younger to be eligible for WAH parent or caretaker relative coverage as described in WAC 182-505-0240. For purposes of this subsection, an "eligible dependent child" is a child related to you in one of the ways described in WAC 182-500-0020.
3. A child must be age eighteen or younger to be eligible for WAH for kids as described in WAC 182-505-0210 with the following exceptions:
   1. An institutionalized child may still qualify under a children's health care program through the age of twenty-one (see WAC 182-514-0230);
   2. A foster care child may qualify for WAH foster care coverage through the age of twenty-six (see WAC 182-505-0211).

WAC 182-503-0540 Assignment of rights and cooperation.

Effective January 27, 2019.

1. When you become eligible for any of the agency's health care programs, you assign certain rights to the state of Washington. You assign all rights to any type of coverage or payment for health care that comes from:
   1. A court order;
   2. An administrative agency order; or
   3. Any third-party benefits or payment obligations for medical care which are the result of subrogation or contract (see WAC 182-501-0100).
2. When you sign the application you assign the rights described in subsection (1) of this section to the state for:
   1. Yourself; and
   2. Any eligible person for whom you can legally make such assignment.
3. You must cooperate with us in identifying, using or collecting third-party benefits. If you do not cooperate, your health care coverage may end unless you can show good reason not to cooperate with us. Examples of good reason include, but are not limited to:
   1. Your reasonable belief that cooperating with us would result in serious physical or emotional harm to you, a child in your care, or a child related to you; and
   2. Your being incapacitated without the ability to cooperate with us.
4. Your WAH coverage will not end due solely to the noncooperation of any third party.
5. You will have to pay for your health care services if you:
   1. Received and kept the third-party payment for those services; or
   2. Refused to give to the provider of care your legal signature on insurance forms.
6. The state is limited to the recovery of its own costs for health care costs paid on behalf of a recipient of health care coverage. The legal term which describes the method by which the state acquires the rights of a person for whom the state has paid costs is called subrogation.

WAC 182-503-0535 Washington apple health -- Citizenship and immigration status.

Effective October 3, 2025

1. Definitions.
   1. Nonqualified alien means someone who is lawfully present in the United States (U.S.) but who is not a qualified alien, a U.S. citizen, a U.S. national, or a qualifying American Indian born abroad.
   2. Qualified alien means someone who is lawfully present in the United States and who is one or more of the following:
      1. A person lawfully admitted for permanent residence (LPR).
      2. An abused spouse or child, a parent of an abused child, or a child of an abused spouse who no longer resides with the person who committed the abuse, and who has one of the following:
         1. A pending or approved I-130 petition or application to immigrate as an immediate relative of a U.S. citizen or as the spouse of an unmarried LPR younger than 21 years of age.
         2. Proof of a pending application for suspension of deportation or cancellation of removal under the Violence Against Women Act (VAWA).
         3. A notice of prima facie approval of a pending self-petition under VAWA. An abused spouse's petition covers his or her child if the child is younger than 21 years of age. In that case, the child retains qualified alien status even after he or she turns 21 years of age.
      3. A person who has been granted parole into the U.S. for one year or more, under the Immigration and Nationality Act (INA) Section 212 (d)(5), including public interest parolees.
      4. A member of a Hmong or Highland Laotian tribe that rendered military assistance to the U.S. between August 5, 1964, and May 7, 1975, including the spouse, unremarried widow or widower, and unmarried dependent child of the tribal member.
      5. A person who was admitted into the U.S. as a conditional entrant under INA Section 203 (a)(7) before April 1, 1980.
      6. A person admitted to the U.S. as a refugee under INA Section 207.
      7. A person who has been granted asylum under INA Section 208.
      8. A person granted withholding of deportation or removal under INA Section 243(h) or 241 (b)(3).
      9. A Cuban or Haitian national who was paroled into the U.S. or given other special status.
      10. An Amerasian child of a U.S. citizen under 8 C.F.R. Section 204.4(a).
      11. A person from Iraq or Afghanistan who has been granted one of the following:
          1. Special immigrant status under INA Section 101 (a) (27);
          2. Special immigrant conditional permanent resident; or
          3. Parole under Section 602 (b) (1) of the Afghan Allies Protection Act of 2009 or Section 1059(a) of the National Defense Authorization Act of 2006.
      12. An Afghan granted humanitarian parole between July 31, 2021, and September 30, 2023, their spouse or child, or a parent or guardian of an unaccompanied minor who is granted parole after September 30, 2022, under Section 2502 of the Extending Government Funding and Delivering Emergency Assistance Act of 2021.
      13. A citizen or national of Ukraine (or a person who last habitually resided in Ukraine) who, under section 401 of the Additional Ukrainian Supplemental Appropriations Act, 2022 (AUSAA) and the Ukraine Security Supplemental Appropriations Act, 2024 (USSAA), is evaluated as a qualified alien until the end of their parole term when:
          1. Granted parole into the United States between February 24, 2022, and September 30, 2024; or
          2. Granted parole into the United States after September 30, 2024, and is:
             1. The spouse or child of a person described in (b)(xiii)(A) of this subsection; or
             2. The parent or guardian of a person described in (b)(xiii)(A) of this subsection who is an unaccompanied minor.
      14. A person who has been certified or approved as a victim of trafficking by the federal office of refugee resettlement, or who is:
          1. The spouse or child of a trafficking victim of any age; or
          2. The parent or minor sibling of a trafficking victim who is younger than 21 years of age. 
      15. A person from the Federated States of Micronesia, the Republic of Palau, or the Republic of the Marshall Islands living in the United States in accordance with the Compacts of Free Association. 
   3. U.S. citizen means someone who is a United States citizen under federal law.
   4. U.S. national means someone who is a United States national under federal law.
   5. Undocumented person means someone who is not lawfully present in the U.S.
   6. Qualifying American Indian born abroad means someone who:
      1. Was born in Canada and has at least 50 percent American Indian blood, regardless of tribal membership; or
      2. Was born outside of the United States and is a member of a federally recognized tribe or an Alaska Native enrolled by the Secretary of the Interior under the Alaska Native Claims Settlement Act.
2. Eligibility.
   1. A U.S. citizen, U.S. national or qualifying American Indian born abroad may be eligible for:
      1. Apple health for adults;
      2. Apple health for kids;
      3. Apple health for pregnant women; or
      4. Classic medicaid.
   2. A qualified alien who meets or is exempt from the five-year bar may be eligible for:
      1. Apple health for adults;
      2. Apple health for kids;
      3. Apple health for pregnant women; or
      4. Classic medicaid.
   3. A qualified alien who neither meets nor is exempt from the five-year bar may be eligible for:
      1. Alien medical programs;
      2. Apple health for kids;
      3. Apple health for pregnant women; or
      4. Medical care services.
   4. A nonqualified alien may be eligible for:
      1. Alien medical programs;
      2. Apple health for kids;
      3. Apple health for pregnant women; or
      4. Medical care services.
   5. An undocumented person may be eligible for:
      1. Alien medical programs;
      2. State-only funded apple health for kids; 
      3. State-only funded apple health for pregnant women; or
      4. State-only funded apple health expansion.
3. The five-year bar.
   1. A qualified alien meets the five-year bar if he or she:
      1. Continuously resided in the U.S. for five years or more from the date he or she became a qualified alien; or
      2. Entered the U.S. before August 22, 1996, and:
         1. Became a qualified alien before August 22, 1996; or
         2. Became a qualified alien on or after August 22, 1996, and has continuously resided in the U.S. between the date of entry into the U.S. and the date he or she became a qualified alien.
   2. A qualified alien is exempt from the five-year bar if he or she is:
      1. A qualified alien as defined in subsections (1)(b)(vi) through (xv) of this section;
      2. An LPR, parolee, or abused person, who is also an armed services member or veteran, or a family member of an armed services member or veteran, as described below:
         1. An active-duty member of the U.S. military, other than active-duty for training;
         2. An honorably discharged U.S. veteran;
         3. A veteran of the military forces of the Philippines who served before July 1, 1946, as described in Title 38 U.S.C. Section 107; or
         4. The spouse, unremarried widow or widower, or unmarried dependent child of an honorably discharged U.S. veteran or active-duty member of the U.S. military.

WAC 182-503-0525 Washington apple health -- Residency requirements for an institutionalized person.

Effective August 29, 2014.

1. An institutionalized person is a person who resides in an institution as defined in WAC 182-500-0050. The term "person" used in this section means an "institutionalized person" unless otherwise indicated. It does not include persons who receive services under a home and community-based waiver program. When a state is making a placement for a person in another state, the term institution also includes foster care homes, licensed as described in 45 C.F.R. 1355.20.
2. The agency must determine whether a person is capable of indicating their intent to reside in Washington state when deciding whether that person is a resident of the state. The agency determines that persons who meet the following criteria are deemed incapable of indicating intent to reside in the state:
   1. The person is judged legally incompetent by a court of law;
   2. A physician, psychologist or licensed medical professional in the field of intellectual disabilities has determined that the person is incapable of indicating intent; or
   3. The person is incapable of declaring intent due to a documented medical condition.
3. When a person is placed in an out-of-state institution by the agency, its designee or by a department of social and health services-contracted agency, the state arranging the placement is considered the person's state of residence, unless the person is capable of expressing intent and:
   1. Indicates a desire to change his or her state of residence; or
   2. Asks the current state of residence for help in relocating. This may include assistance in locating an institutional placement in the new state of residence.
4. If another state has not authorized the placement in the institution, as described in subsection (3) of this section, the agency or its designee uses one of the following criteria to determine the state of residence for a person who is age twenty or younger:
   1. The state of residence is the state where the parent or legal guardian is a resident at the time of the placement in the institution. To determine a parent's or legal guardian's place of residence, follow rules described in WAC 182-503-0520 for a noninstitutionalized person.
   2. The state of residence is the state where the parent or legal guardian currently is a resident if the person resides in an institution in that state.
   3. If the parents of the person are separated and live in different states, the state of residence is that of the parent filing the application.
   4. If the parental rights are terminated and the person has a legal guardian, the state of residence is where the legal guardian is a resident.
   5. If the person has both a guardian of the estate and a guardian of the person, the state of residence is where the guardian of the person is a resident, unless the state has laws which delegate guardianship to a state official or agency for persons who are admitted to state institutions. In that case, the state of residence for the person is the state where the institution is located (unless another state has authorized the placement).
   6. If the person has been abandoned by the parents or legal guardian, and an application is filed on their behalf by another party, the state of residence is the state where the person is institutionalized. The term abandoned also includes situations where the parents or legal guardian are deceased.
5. A person age twenty-one or older that is capable of indicating intent is considered a resident of the state where he or she is living and intends to reside.
6. A person age twenty-one or older who became incapable of indicating intent at age twenty-one or older is considered a resident of the state where the person is physically residing, unless the person has been placed in the institution by another state.
7. A person age twenty-one or older who became incapable of indicating intent before the age of twenty-one is considered a resident of the state where the parents or legal guardian were residents at the time of the placement in the institution.
8. If a noninstitutionalized person moves directly from another state to an institution in Washington state, it is not necessary for the person to establish residency in Washington state prior to entering the facility. The person is considered a resident if he or she intends to reside in the state unless the placement was made by the other state.
9. A person of any age who receives a state supplemental payment (SSP) is considered a resident of the state that is making the payment.
10. In a dispute between states, the state of residence is the state in which the person is physically located. 

WAC 182-503-0520 Washington apple health -- Residency requirements -- Persons who are not residing in an institution.

Effective August 29, 2014.

1. A resident is a person (including an emancipated person under age eighteen and a married person under age eighteen who is capable of indicating intent) who currently lives in Washington and:
   1. Intends to reside here, including persons without a fixed address; or
   2. Entered the state looking for a job; or
   3. Entered the state with a job commitment.
2. A person does not need to live in the state for a specific period of time prior to meeting the requirements in subsection (1) of this section before being considered a resident.
3. A child under age eighteen who is not covered by subsection (1) of this section, is a resident if:
   1. The child lives in the state, with or without a fixed address, including with a custodial parent or caretaker; or
   2. The child's parent or caretaker is a resident as defined in subsection (1) of this section.
4. A resident applying for or receiving health care coverage can temporarily be out of the state for more than one month without their health care coverage being denied or terminated, if the person:
   1. Intends to return to the state once the purpose of his or her absence has been accomplished and provides adequate information of this intent after a request by the agency or its designee; and
   2. Has not been determined eligible for medicaid or state-funded health care coverage in another state (other than coverage in another state for incidental or emergency health care).
5. A person who enters Washington state only for health care is not a resident and is not eligible for any medical program. The only exception is for a person who moves from another state directly into an institution in Washington state. Residency rules for institutionalized persons are described in WAC 182-503-0525.
6. A person of any age who receives a state supplemental payment (SSP) is considered a resident of the state that is making the payment.
7. A person who receives federal payments for foster or adoption assistance is considered a resident of the state where the person physically resides even if:
   1. The person does not live in the state that is making the foster or adoption assistance payment; or
   2. The person does not live in the state where the adoption agreement was entered.
8. In a dispute between states, the state of residence is the state in which the person is physically located.

WAC 182-503-0515 Washington apple health -- Social Security number requirements.

Effective January 26, 2026

1. To be eligible for Washington apple health (medicaid), or tailored supports for older adults (TSOA) described in WAC 182-513-1610, you (the applicant or recipient) must provide your valid Social Security number (SSN) or proof of application for an SSN to the medicaid agency or the agency's designee, except as provided in subsections (2) and (6) of this section.
2. An SSN is not required if you are:
   1. Not eligible to receive an SSN or may only be issued or may only be issued an SSN for a valid nonwork reason described in 20 C.F.R. 422.104;
   2. A household member who is not applying for apple health coverage, unless verification of that household member's resources is required to determine the eligibility of the client;
   3. Refusing to obtain an SSN for well-established religious objections as defined in 42 C.F.R. 435.910 (h) (3); or
   4. Not able to obtain or provide an SSN because you are a victim of domestic violence.
3. If you are receiving coverage because you meet an exception under either subsection (2) (c) or (d) of this section, we (the agency) will confirm with you at your apple health renewal, consistent with WAC 182-503-0050, that you still meet the exception.
4. If we ask for confirmation that you continue to meet an exception in subsection (2) of this section and you do not respond in accordance with subsection (3) of this section, or if you no longer meet an exception and do not provide your SSN, we will terminate your apple health coverage according to WAC 182-518-0025.
5. If you are not able to provide your SSN, either because you do not know it or it has not been issued, you must provide:
   1. Proof from the Social Security Administration (SSA) that you turned in an application for an SSN; and
   2. The SSN when you receive it.
      1. Your apple health coverage will not be delayed, denied, or terminated while waiting for SSA to send you your SSN. If you need help applying for an SSN, assistance will be provided to you.
      2. We will ask you every ninety days if your SSN has been issued.
6. An SSN is not required for the following apple health programs:
   1. Refugee medical assistance program described in WAC 182-507-0120, and 182-507-0125;
   2. Alien medical programs described in WAC 182-507-0115, 182-507-0120, and 182-507-0125;
   3. Newborn medical program described in WAC 182-505-0210 (2)(a);
   4. Foster care program for a child age eighteen and younger as described in WAC 182-505-0211(1); or
   5. Medical programs for children and pregnant women who do not meet citizenship or immigration status described in WAC 182-503-0535 (2)(e)(ii) and (iii);
   6. Family planning only program described in WAC 182-532-510 if you do not meet citizenship or immigration status for Washington apple health or you have made an informed choice to apply for family planning services only; or
   7. Washington apple health expansion program described in chapter 182-525 WAC.
7. If you are required to provide an SSN under this section, and you do not meet an exception under subsection (2) of this section, failure to provide an SSN may result in:
   1. Denial of your application or termination of your coverage because we cannot determine your household's eligibility; or
   2. Inability to apply the community spouse resource allocation (CSRA) or monthly maintenance needs allowance (MMNA) for a client of long-term services and supports (LTSS).

WAC 182-503-0510 Washington apple health -- Program summary.

Effective January 26, 2026

1. The agency categorizes Washington apple health programs into three groups based on the income methodology used to determine eligibility:
   1. Those that use a modified adjusted gross income (MAGI)-based methodology described in WAC 182-509-0300, called MAGI-based apple health programs;
   2. Those that use an income methodology other than MAGI, called non-MAGI-based apple health programs, which include:
      1. Supplemental security income (SSI)-related apple health programs;
      2. Temporary assistance for needy families (TANF)-related apple health programs; and
      3. Other apple health programs not based on MAGI, SSI, or TANF methodologies.
   3. Those that provide coverage based on a specific status or entitlement in federal rule and not on countable income, called deemed eligible apple health programs.
2. MAGI-based apple health programs include the following:
   1. Apple health parent and caretaker relative program described in WAC 182-505-0240;
   2. MAGI-based apple health adult medical program described in WAC 182-505-0250, for which the scope of coverage is called the alternative benefits plan (ABP) described in WAC 182-500-0010;
   3. Apple health pregnancy and after-pregnancy coverage described in WAC 182-505-0115;
   4. Apple health for kids program described in WAC 182-505-0210 (3)(a);
   5. Premium-based apple health for kids described in WAC 182-505-0215;
   6. Apple health long-term care for children and adults described in chapter 182-514 WAC; 
   7. Apple health alien emergency medical program described in WAC 182-507-0110 through 182-507-0125 when the person is eligible based on criteria for a MAGI-based apple health program; and
   8. Apple health expansion program for people who are age 64 or younger as described in chapter 182-525 WAC.
3. Non-MAGI-based apple health programs include the following:
   1. SSI-related programs which use the income methodologies of the SSI program (except where the agency has adopted more liberal rules than SSI) described in chapter 182-512 WAC to determine eligibility:
      1. Apple health for workers with disabilities (HWD) described in chapter 182-511 WAC;
      2. Apple health SSI-related programs described in chapters 182-512 and 182-519 WAC;
      3. Apple health long-term care and hospice programs described in chapters 182-513 and 182-515 WAC;
      4. Apple health medicare savings programs described in chapter 182-517 WAC; 
      5. Apple health alien emergency medical (AEM) programs described in WAC 182-507-0110 and 182-507-0125 when the person meets the age, blindness or disability criteria specified in WAC 182-512-0050; and
      6. Apple health expansion program for people who are age 65 and older as described in chapter 182-512 WAC.
   2. TANF-related programs which use the income methodologies based on the TANF cash program described in WAC 388-450-0170 to determine eligibility, with variations as specified in WAC 182-509-0001(5) and program specific rules:
      1. Refugee medical assistance (RMA) program described in WAC 182-507-0130; and
      2. Apple health medically needy (MN) coverage for pregnant people and children who do not meet SSI-related criteria.
   3. Other programs:
      1. Breast and cervical cancer program described in WAC 182-505-0120;
      2. Family planning only programs described in chapter 182-532;
      3. Medical care services described in WAC 182-508-0005;
      4. Apple health for pregnant minors described in WAC 182-505-0117; and
      5. Apple health kidney disease program described in chapter 182-540 WAC.
4. Deemed eligible apple health programs include:
   1. Apple health SSI medical program described in chapter 182-510 WAC, or a person who meets the medicaid eligibility criteria in 1619b of the Social Security Act;
   2. Newborn medical program described in WAC 182-505-0210(2);
   3. Foster care program described in WAC 182-505-0211;
   4. Medical extension program described in WAC 182-523-0100; and
   5. Family planning extension described in WAC 182-505-0115(5).
5. A person is eligible for categorically needy (CN) health care coverage when the household's countable income is at or below the categorically needy income level (CNIL) for the specific program.
6. If income is above the CNIL, a person is eligible for the MN program if the person is:
   1. A child;
   2. A pregnant person; or
   3. SSI-related (aged sixty-five, blind or disabled).
7. MN health care coverage is not available to parents, caretaker relatives, or adults unless they are eligible under subsection (6) of this section.
8. A person who is eligible for the apple health MAGI-based adult program listed in subsection (2)(b) of this section is eligible for ABP health care coverage as defined in WAC 182-500-0010. Such a person may apply for more comprehensive coverage through another apple health program at any time.
9. For the other specific program requirements a person must meet to qualify for apple health, see chapters 182-503 through 182-527 WAC.

WAC 182-503-0505 Washington apple health -- General eligibility requirements.

Effective April 27, 2019.

1. When you apply for Washington apple health programs established under chapter 74.09 RCW, you must meet the eligibility criteria in chapters 182-500 through 182-527 WAC.
2. When you apply for apple health, we first consider you for federally funded or federally matched programs. We consider you for state-funded programs after we have determined that you are ineligible for federally funded and federally matched programs.
3. Unless otherwise specified in a program specific WAC, the eligibility criteria for each program are as follows:
   1. Age (WAC 182-503-0050);
   2. Residence in Washington state (WAC 182-503-0520 and 182-503-0525);
   3. Citizenship or immigration status in the United States (WAC 182-503-0535);
   4. Possession of a valid Social Security account number (WAC 182-503-0515);
   5. Assignment of medical support rights to the state of Washington (WAC 182-503-0540);
   6. Application for medicare and enrollment into medicare's prescription drug program if:
      1. You are likely entitled to medicare; and
      2. We have authority to pay medicare cost sharing as described in chapter 182-517 WAC.
   7. If your eligibility is not based on modified adjusted gross income (MAGI) methodology, your countable resources must be within specific program limits (chapters 182-512, 182-513, 182-515, 182-517, and 182-519 WAC); and
   8. Countable income within program limits:
      1. For MAGI-based programs, see WAC 182-505-0100;
      2. For the refugee program, see WAC 182-507-0130;
      3. For the medical care services program, see WAC 182-508-0005;
      4. For the health care for workers with disabilities (HWD) program, see WAC 182-511-1000;
      5. For the SSI-related program, see WAC 182-512-0010;
      6. For long-term care programs, see chapters 182-513 and 182-515 WAC;
      7. For medicare savings programs, see WAC 182-517-0100; and
      8. For the medically needy program, see WAC 182-519-0050.
4. In addition to the general eligibility requirements in subsection (3) of this section, each program has specific eligibility requirements as described in applicable WAC.
5. If you are in a public institution, including a correctional facility, you are not eligible for full scope apple health coverage, except in the following situations:
   1. If you are age twenty-one or younger or age sixty-five or older and are a patient in an institution for mental disease (see WAC 182-513-1317(5)); or
   2. You receive inpatient hospital services outside of the public institution or correctional facility.
6. We limit coverage for people who become residents in a public institution, under subsection (5) of this section, until they are released.
7. If you are terminated from SSI or lose eligibility for categorically needy (CN) or alternative benefits plan (ABP) coverage, you receive coverage under the apple health program with the highest scope of care for which you may be eligible while we determine your eligibility for other health care programs. See WAC 182-504-0125.

WAC 182-503-0130 Authorized representative.

Effective August 17, 2015

1. ​Designating an authorized representative (AREP).
   1. A person may designate an AREP to act on his or her behalf in eligibility-related interactions with the medicaid agency by completing the agency's Authorized Representative Designation Form (DSHS 14-532), or through any of the methods described in 42 C.F.R. 435.907(a) and 42 C.F.R. 435.923. The Authorized Representative Designation Form is available online at https://www.dshs.wa.gov/fsa/forms.
   2. A court-appointed legal guardian with authority to make financial decisions on a person's behalf is that person's AREP.
   3. An agreement creating power of attorney (POA) that grants decision-making authority regarding the person's financial interactions with the agency establishes the POA as the AREP.
   4. If a person is unable to designate an AREP due to a medical condition, an individual may designate himself or herself as the AREP by signing the agency's Authorized Representative Designation Form (DSHS 14-532).
2. Serving as an AREP. To serve as an AREP, an individual or organization must:
   1. Have a good-faith belief that the information he or she provides to the agency is correct.
   2. Report any change in circumstance required under WAC 182-504-0105 unless doing so would exceed the scope of authorized representation or violate state or federal law.
   3. A provider, staff member, or volunteer of an organization must also comply with 42 C.F.R. 435.923(d-e).
3. Terminating authorized representation.
   1. The person or the AREP may terminate the authorized representation at any time for any reason by notifying the agency verbally or in writing.
   2. Authorized representation terminates automatically when the person dies.

WAC 182-503-0120 Washington apple health -- Equal access services.

Effective December 3, 2025.

1. When you have a mental, neurological, cognitive, physical or sensory impairment, or limitation that prevents you from receiving health care coverage, we provide services to help you apply for, maintain, and understand the health care coverage options available and eligibility decisions we make. These services are called equal access (EA) services.
2. We provide EA services on an ongoing basis to ensure that you are able to maintain health care coverage and access to services we provide. EA services include, but are not limited to:
   1. Helping you to:
      1. Apply for or renew coverage;
      2. Complete and submit forms;
      3. Give us information to determine or continue your eligibility;
      4. Ask for continued coverage;
      5. Ask for reinstated (restarted) coverage after your coverage ends; and
      6. Ask for and participate in a hearing.
   2. Giving you additional time, when needed, for you to give us information before we reduce or end your health care coverage;
   3. Explaining our decision to change, reduce, end, or deny your health care coverage;
   4. Working with your authorized representative, if you have one, and giving that person copies of notices and letters we send you; and
   5. Providing you the services of a sign language interpreter/transliterator who is certified by the Registry of Interpreters for the Deaf at the appropriate level of certification.
      1. These services may include in-person sign language interpreter services, relay interpreter services, and video interpreter services, as well as other services; we decide which services to offer you based on your communication needs and preferences.
      2. We offer these services as a reasonable accommodation, free of charge, if you are deaf, hard-of-hearing, or a deaf-blind person who uses sign language to communicate.
   6. Not taking adverse action in your case, or automatically reinstating your coverage for up to three months after the adverse action was taken, if we determine that your impairment or limitation was the cause of your failure to follow through on something you need to do to get or keep your Washington apple health coverage, such as:
      1. Applying for or renewing coverage;
      2. Completing and submitting forms;
      3. Giving us information to determine or continue your eligibility;
      4. Asking for continued or reinstated coverage; or
      5. Asking for and participating in a hearing.
3. We inform you of your right to EA services listed in subsection (2) of this section:
   1. On printed applications and notices, including the printed rights and responsibilities form;
   2. In the Washington healthplanfinder web site, including the electronic rights and responsibilities form; and
   3. During contact with us.
4. We provide you the EA services listed in subsection (2) of this section if you ask for EA services, you are receiving services through the home and community living administration, or we determine that you would benefit from EA services. We determine you would benefit from EA services if you:
   1. Appear to have or claim to have any impairment or limitation described in subsection (1) of this section;
   2. Have a developmental disability;
   3. Are disabled by alcohol or drug addiction;
   4. Are unable to read or write in any language;
   5. Appear to have limitations in your ability to communicate, understand, remember, process information, exercise judgment and make decisions, perform routine tasks, or relate appropriately with others (whether or not you have a disability) that may prevent you from understanding the nature of EA services or affect your ability to access our programs; or
   6. Are a minor not residing with your parents.
5. If we determine that you are eligible for EA services, we develop and document an EA plan appropriate to your needs. The plan may be updated or changed at any time based on your request or a change in your needs.
6. You may at any time refuse the EA services offered to you.
7. We reinstate your coverage when:
   1. We end coverage because we were unable to determine if you continue to qualify; and
   2. You provide proof that you are still qualified for coverage within 20 calendar days from when we ended your coverage. We restore your coverage retroactive to the first of the month so there is no break in your coverage.
8. If you believe that we have discriminated against you on the basis of a disability or another protected status, the person may file a complaint with the U.S. Department of Health and Human Services at https://www.hhs.gov/civil-rights/filing-a-complaint/complaint-process/ or Region Manager, Office for Civil Rights, U.S. Department of Health and Human Services, 2201 Sixth Ave. – M/S: RX-11, Seattle, WA 98121-1831 (voice phone 800-368-1019, fax 206-615-2297, TDD 800-537-7697).