Trusts continued

Revised date
Purpose statement

Describe and clarify rules on how trusts affect Apple Health (Medicaid) eligibility.

WAC 182-516-0110 Self-settled trusts overview

WAC 182-516-0110 Self-settled trusts overview.

Effective March 2, 2018

  1. A trust containing the assets of a beneficiary's spouse may be a self-settled trust based on the date it was established. For specific rules regard­ ing this, see WAC 182-516-0130.
  2. To determine whether the assets of the self-settled trust should be counted as income, a resource, or an asset transfer, the medicaid agency or the agency's designee applies the following rules based on when the trust was established:
    1. For revocable self-settled trusts, see WAC 182-516-0115.
    2. For irrevocable self-settled trusts for a disabled client under age sixty-five established on or after August 11, 1993, see WAC 182-516-0120.
    3. For irrevocable pooled self-settled trusts for a disabled client established on or after August 11, 1993, see WAC 182-516-0125.
    4. For all other irrevocable self-settled trusts:
      1. Established on or after August 11, 1993, see WAC 182-516-0130.
      2. Established before August 11, 1993, see WAC 182-516-0135.

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

A trust’s establishment date is the date the first asset was placed into the trust, not the date the trust was signed.

Before using the self-settled trust rules ensure the trust you are evaluating is self-settled. Trusts established after July 31, 2003 are self-settled even when all assets in the trust were owned by the client’s spouse.

A trust is still self-settled even when the beneficiary/grantor had no control over the establishment of the trust with their assets.

Example: Settlement funds from a lawsuit directed into a trust by a court or a guardian establishing a trust for an incapacitated individual with the individual's assets are both self-settled trusts.

WAC 182-516-0115 Revocable self-settled trusts established on or after August 11, 1993

WAC 182-516-0115 Revocable self-settled trusts established on or after August 11, 1993.

Effective March 2, 2018

  1. This section applies to revocable trusts that are self-settled and established on or after August 11, 1993.
  2. This section does not apply to assets in a revocable trust established before August 11, 1993.
  3. A revocable trust is a self-settled trust if:
    1. The assets of the trust are at least partially from the bene­ficiary or the beneficiary's spouse;
    2. The trust is not established by will; and
    3. The trust was established by:
      1. The beneficiary or that beneficiary's spouse;
      2. A person, including a court or administrative body, with legal authority to act in place or on behalf of the beneficiary or that beneficiary's spouse; or
      3. A person, including a court or administrative body, acting at the direction or upon the request of the beneficiary or that beneficiary's spouse.
  4. The medicaid agency or the agency's designee treats assets in a revocable self-settled trust under this section as follows:
    1. Assets are subject to the resource exclusions under chapter 182-512 WAC; however, for an institutionalized individual, the resource exclusion for the home under WAC 182-512-0350 does not apply; and
    2. Assets not excluded under chapter 182-512 WAC are available resources.
  5. Payments from assets in the trust under this section to or for the benefit of the beneficiary are unearned income of the beneficiary.
  6. If unearned income under subsection (5) of this section was from an available resource under subsection (4) of this section, then the value of the available resource will be reduced by the amount of unearned income under subsection (5) of this section.
  7. Any payments from the revocable trust, other than payments under subsections (5) and (6) of this section, are uncompensated asset transfers.

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

Generally, a revocable trust can be treated just the same as if the client or spouse (or both) owns the assets directly. This is because they have a choice whether to reacquire the assets in the trust or not.

Resource Example: As of the first of the month, a client has personal property, a car for transportation, and $50,000 in cash in a trust. The countable resource value of the trust is $50,000 because the personal property and car are excluded resources.

Income Example: Using the same trust above, the trustee buys a plane ticket for the client for $1,000 from the trust in February 2018. This withdraw is countable unearned income for February 2018, even if the client did not directly receive the cash. Because the $1,000 in income was withdrawn from the $50,000 in cash, resources for February 2018 would be reduced by $1,000.

Institutionalization Example: Same trust as above, but the client also has their home in the trust. If the client is applying for a noninstitutional Medicaid program (for example, S02 or L52), the home is an excluded resource. However, if the client is institutionalized in a nursing home and is applying for nursing home coverage, or the client is applying for a home and community-based (HCB) waiver, the home is not excluded and is an available resource.

 

WAC 182-516-0120 Irrevocable self-settled trusts for a disabled client under age sixty-five established on or after August 11, 1993.

WAC 182-516-0120 Irrevocable self-settled trusts for a disabled client under age sixty-five established on or after August 11, 1993.

Effective March 2, 2018

  1. This section governs how the agency or the agency's designee treats self-settled trusts, for a disabled client under age sixty-five established under 42 U.S.C. 1396p(d)(4)(a) on or after August 11, 1993, for medicaid eligibility purposes.
  2. A self-settled trust established on or after August 11, 1993, is not an available resource if:
    1. The beneficiary is under age sixty-five and disabled under WAC 182-512-0050 (1)(c) when the trust is established;
    2. The trust is irrevocable;
    3. The trust was established for the sole benefit of that bene­ficiary;
    4. The trust was established by the beneficiary's parent, the beneficiary's grandparent, the beneficiary's legal guardian, by a court, or on or after December 13, 2016, the beneficiary; and
    5. The trust says that the states that have spent medicaid funds for the beneficiary will receive all amounts remaining in the trust up to the amount of medicaid funds spent for the beneficiary.
      1. For trusts established from August 11, 1993, to July 31, 2003, the trust must pay the states when the beneficiary dies.
      2. For trusts established on or after August 1, 2003, the trust must pay the states when the beneficiary dies, the trust terminates, or the beneficiary's disability ends.
  3. The medicaid agency or the agency's designee does not apply a penalty period to a beneficiary for asset transfers into a trust, described under subsection (2) of this section, when the beneficiary is under age sixty-five as of the date of the transfer.
  4. Assets in trusts under subsection (2) of this section contin­ue to be unavailable resources, even after the beneficiary turns age sixty-five.
  5. Asset transfers to the trust from the beneficiary, after the beneficiary turns age sixty-five, may be subject to a transfer penalty under WAC 182-513-1363.
  6. If a trust does not meet the requirements under subsection (2) of this section, see WAC 182-516-0130.

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.

WAC 182-516-0125 Irrevocable pooled self-settled trusts for a disabled client established on or after August 11, 1993.

WAC 182-516-0125 Irrevocable pooled self-settled trusts for a disabled client established on or after August 11, 1993.

Effective March 2, 2018

  1. This section governs how the agency or the agency's designee treats pooled self-settled trusts, for a disabled client established under 42 U.S.C.1396p(d)(4)(c) on or after August 11, 1993, for medicaid eligibility purposes.
  2. A pooled self-settled trust established on or after August 11, 1993, is not an available resource if:
    1. The beneficiary is disabled under WAC 182-512-0050 (1)(c) when the trust is established;
    2. The trust is irrevocable;
    3. An account in the trust was established for the sole benefit of that beneficiary;
    4. An account in the trust was established by that beneficiary, the beneficiary's parent, grandparent, legal guardian, or by a court;
    5. The trust was established by and is managed by a nonprofit association;
    6. A separate account is maintained for each beneficiary of the trust, but, for the purposes of the investment and management of funds, the trust pools these accounts; and
    7. The trust says that:
      1. Upon the death of the beneficiary, or, for trust accounts es­tablished on or after August 1, 2003, when the trust account terminates or the beneficiary's disability ends, the funds will remain in the trust to benefit other disabled beneficiaries; or
      2. The states that have spent medicaid funds for the beneficia­ry will receive all amounts remaining in the trust account for that beneficiary up to the amount of medicaid funds spent for the beneficiary.
        1. For trust accounts established from August 11, 1993, to July 31, 2003, the trust must pay the states when the beneficiary dies.
        2. For trust accounts established on or after August 1, 2003, the trust must pay the states when the beneficiary dies, the trust terminates, or the beneficiary's disability ends.
  3. The medicaid agency or the agency's designee does not apply a penalty period to a beneficiary for asset transfers into a trust, described under subsection (2) of this section, when the beneficiary is under age sixty-five as of the date of the transfer.
  4. Assets in trusts under subsection (2) of this section continue to be unavailable resources, even after the beneficiary turns age sixty-five.
  5. Asset transfers to the trust from the beneficiary, after the beneficiary turns age sixty-five, may be subject to a transfer penalty under WAC 182-513-1363.
  6. If a trust does not meet the requirements under subsection (2) of this section, see WAC 182-516-0130.

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

There are two exceptions to the normal counting an irrevocable self-settled trust as an available resource. We refer to these trusts by shorthand citation to their statuses in the Social Security Act - a "d4A" trust or a "d4C" trust:

  • 42 U.S.C. 1396p(d)(4)(A) - a self-settled irrevocable trust for a disabled individual established before that individual is age 65.
  • 42 U.S.C. 1396p(d)(4)(C) - a self-settled irrevocable pooled trust for a disabled individual of any age.

These are the only two trusts that require some form of payback language in order to be excluded for Medicaid.

If a trust does not meet the requirements of WAC 182-516-0120 (d4A) or WAC 182-516-0125 (d4C), then rules under WAC 182-516-0130 apply.

WAC 182-516-0130 Irrevocable self-settled trusts established on or after August 11, 1993.

WAC 182-516-0130 Irrevocable self-settled trusts established on or after August 11, 1993.

Effective March 3, 2018

  1. This section governs irrevocable self-settled trusts established on or after August 11, 1993, that do not meet the rules under either WAC 182-516-0120 or 182-516-0125.
  2. A trust established on or after August 1, 2003, is a self-settled trust if:
    1. The assets of the trust are at least partially from the bene­ficiary or the beneficiary's spouse, or would have been owned by the beneficiary or the beneficiary's spouse unless diverted by the beneficiary, the beneficiary's spouse, the court, or someone acting on be­half of the beneficiary or the beneficiary's spouse;
    2. The trust is not established by will; and
    3. The trust was established by:
      1. The beneficiary or that beneficiary's spouse;
      2. A person, including a court or administrative body, with le­ gal authority to act in place or on behalf of the beneficiary or that beneficiary's spouse; or
      3. A person, including a court or administrative body, acting at the direction or upon the request of the beneficiary or that beneficiary's spouse.
  3. A trust established from August 11, 1993, to July 31, 2003, is a self-settled trust if:
    1. The assets of the trust are at least partially from the bene­ficiary, or would have been owned by the beneficiary unless diverted by the beneficiary, the court, or someone acting on behalf of the beneficiary;
    2. The trust is not established by will; and
    3. The trust was established by:
      1. The beneficiary;
      2. A person, including a court or administrative body, with le­gal authority to act in place or on behalf of the beneficiary; or
      3. A person, including a court or administrative body, acting at the direction or upon the request of the beneficiary.
  4. This section applies only to the assets contributed to a trust:
    1. Under subsection (2) of this section, by either the benefi­ciary or that beneficiary's spouse; or
    2. Under subsection (3) of this section, by the beneficiary.
  5. The medicaid agency or the agency's designee applies the rules of this section without regard to:
    1. The purpose for establishing a trust;
    2. Whether the trustees have or may exercise any discretion un­der the terms of the trust;
    3. Restrictions on when or whether distributions may be made from the trust; and
    4. Restrictions on the use of distributions from the trust.
  6. Treatment of payments or benefits from trusts established un­ der this section.
    1. Subject to subsection (7) of this section, if there are any circumstances under which payment or benefit from the trust could be made to or for the benefit of the beneficiary, the portion of the principal from which, or the income on the principal from which, payment to the beneficiary could be made is an available resource to the beneficiary, and the payment or benefit from that portion:
      1. Is unearned income when payment or benefit is to or for the benefit of the beneficiary; and
      2. Is an uncompensated asset transfer, if payment or benefit is for any other purpose.
    2. If there are no circumstances under which any payment or any benefit from the trust could be made to or for the benefit of the ben­eficiary, the part of the trust or income of that trust, from which payment or benefit cannot be made, is an uncompensated asset transfer.
  7. For the purposes of subsection (6)(a) of this section, "available resource" means a resource after the resource exclusions under chapter 182-512 WAC are applied; however, for an institutional­ized individual, the resource exclusion for the home under WAC 182-512-0350 does not apply.
  8. If unearned income under subsection (6)(a)(i) of this section was from an available resource under subsection (6)(a) of this section, then the value of the available resource will be reduced by the amount of unearned income under subsection (6)(a)(i) 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

General

By definition, a self-settled trust is established for the benefit of the grantor/beneficiary. When reviewing trusts under this rule, the agency essentially ignores any restrictions or requirements written into the trust. This includes disregarding:

  • The purpose for establishing a trust;
  • Whether the trustees have or may exercise any discretion under the terms of the trust;
  • Restrictions on when or whether distributions may be made from the trust; and
  • Restrictions on the use of distributions from the trust.

After disregarding the above, whether an irrevocable self-settled trust is a resource or not is whether the trust principle or income can be used for the beneficiary. It will be extremely rare, if possible at all, that a self-settled irrevocable trust cannot be used for the benefit of the beneficiary.

Can/Cannot Example 1: An irrevocable self-settled trust states the trust cannot be used for medical expenses for the beneficiary. We disregard this restriction, the trust can be used for the grantor/beneficiary.

Can/Cannot Example 2: An irrevocable self-settled trust gives the trustee complete discretion on when to use trust assets. The trustee states they will never use the trust assets. We disregard the trustee’s discretion, the trust can be used for the grantor/beneficiary.

Once it is determine whether a trust can be used for the beneficiary, we must evaluate the trust’s resources and income.

Resource Example: As of the first of the month, a client has personal property, a car for transportation, and $50,000 in cash in a trust. The countable resource value of the trust is $50,000 because the personal property and car are excluded resources.

Income Example: Using the same trust above, the trustee buys a plane ticket for the client for $1,000 from the trust in February 2018. This withdraw is countable unearned income for February 2018, even if the client did not directly receive the cash. Because the $1,000 in income was withdrawn from the $50,000 in cash, resources for February 2018 would be reduced by $1,000.

Institutionalization Example: Same trust as above, but the client also has their home in the trust. If the client is applying for a noninstitutional Medicaid program (for example, S02 or L52), the home is an excluded resource. However, if the client is institutionalized in a nursing home and is applying for nursing home coverage, or the client is applying for a home and community-based (HCB) waiver, the home is not excluded.

The August 1, 2003 Cutoff

From August 11, 1993, to July 31, 2003, the definition of a self-settled trust for a married individual was narrower than it is today. A trust was only self-settled if all or a portion of the assets in the trust were from the client. This means that if all assets in the trust were solely the spouse’s assets, and the client is the beneficiary, the trust would be third-party. However, we would still analyze whether the trust was a countable resource for the spouse (assuming the spouse could also receive some benefit from the trust). Further, we would need sufficient evidence that all assets in the trust were separate property of the spouse, and not community property.

As of August 1, 2003, it does not matter whose assets of the married couple is in the trust. If the trust is for the benefit of the client, and at least some assets in the trust were from the client or the client’s spouse, it is a self-settled trust.

Additional information about Trusts can be found on the Trusts page.

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Overview: long-term services and supports program administration

Revised date
Purpose statement

To give an overview of program administration for Long-Term Services and Supports (LTSS) for individuals in medical institutions or receiving Home and Community Based services authorized by:

  • Developmental Disabilities Administration (DDA) or
  • Home and Community Services (HCS) or
  • Hospice as a program

What is an institutional Medicaid program and what are Long-Term Care Services?

The definition of institutional is described in Institutional status | Washington State Health Care Authority

Long-term Care (LTC) and Long-term Services and Supports (LTSS) are defined in:  Definitions: long-term services and supports | Washington State Health Care Authority

LTC Apple Health has initial eligibility for Medicaid and post-eligibility treatment of income (PETI) to determine if the client pays toward the cost of care. LTC is:

The LTSS group includes all LTC programs indicated above and non-institutional programs and services:

In ACES, the LTSS medical programs are:

  • L01, L02, L95, L99, (nursing facility (NF), Residential Habilitation Centers (RHC) and Hospice Care Center (HCC)
  • L21, and L22 DDA and HCS HCBS Waivers
  • L04 and L24 state funded LTSS for non-citizens
  • L31 and L32 PACE or Hospice as a program
  • L41 and L42 RCL program. 
  • L51 and L52 non-institutional Community First Choice (CFC) or Medicaid Personal Care (MPC).

LTSS services not under L track in ACES:

  • T02, Tailored Supports for Older Adults (TSOA, does not include Medicaid Coverage)
  • A01, A05, A24 Medical Care Services (MCS) based on ABD cash or HEN eligibility covers NF and HCS state funded residential.  
  • S08, Apple health for Workers with Disabilities (HWD) on HCS or DDA services remain on the S08 program with the service coded.  Apple Health for Workers with Disabilities | Washington State Health Care Authority
  • N track, Modified Adjusted Gross Income (MAGI) programs when authorized CFC, MPC, MAC, RCL due to categorically needy (CN) or Alternate Benefit Plan (ABP) scope of care (maintained by Health Care Authority (HCA).
  • D track, Foster Care. Can authorize CFC, MPC or MAC but the medical is maintained by HCA.
  • S30 Breast and Cervical Cancer program. Can authorize CFC, MPC or MAC but the medical is maintained by HCA.

Note:

Medical Program chart for HCS and DDA is located on the Financial Eligibility and Policy SharePoint under desk aids.

Basic guidelines:

DSHS maintains SSI, SSI related and Medicare Savings Programs (MSP) programs for the aged, blind, and disabled per the DSHS and HCA operating agreement.  DSHS has 3 entities determining eligibility for this group:   

  • Home and Community Services (HCS) determines eligibility and maintains cases for those on HCS services, this includes their spouse even if the spouse is not on services. In addition, authorizes basic food and WASHCAP for those on HCS services.
  • Developmental Disability Administration (DDA) determines eligibility and maintains cases on DDA services.  In addition, DDA does:
    • HWD cases not on HCS or DDA services
    • Hospice as a program when institutional rules are needed.
  • Community Service Division (CSD) maintains:
    •  All remaining SSI, SSI related, and Medicare Savings Program cases are not on HCS or DDA services.
    • All cash programs except for ABD cash when a client is on DDA or HCS services.  This is a shared case.
    • Food benefits for the household when the DDA client is a minor child.

Health Care Authority (HCA) maintains the remaining Apple Health programs that are not SSI, SSI related or Medicare Savings Programs.

If a client submits an application that requests a variety of services, including Nursing Facility (NF), ALF and hospice, but the client hasn’t elected hospice yet, HCS determines eligibility and keeps the case until a hospice election is received.

The Apple Health Expansion state-funded program effective 7/1/2024 does not include long-term services and supports authorized by HCS or DDA.   

What is an institutional medicaid program and what are long-term care services?

The term "institutional" medicaid means institutional medicaid rules are used in eligibility. This group has initial eligibility for the medicaid and post-eligibility that determines if the client pays toward the cost of care. These clients are either residing in a medical institution or on a HCB Waiver. Some programs may use the same rules as a HCB Waiver such as Hospice, PACE and RCL and may pay toward the cost of care.  

In ACES, the institutional medical programs are under the L01, L02, L95, L99, L21, and L22 (ABD) programs, L04 and L24 state-funded long term care, or K-track (Modified adjusted gross income, MAGI) for children and families. PACE and Hospice as a program is under the L31 and L32 program.  RCL is under the L41 and L42 program.  Under MAGI, clients can be on the Hospice or RCL program.  Institutional rules are only used if the client is not eligible for another CN or ABP program.  

Long-term care (LTC) programs provide services for the aged and disabled in need of institutional care. Some individuals who receive LTC services are able to continue living in their home or in an alternate living facility (ALF) on a Home and Community based (HCB) Waiver authorized by Home and Community Services (HCS) or the Development Disabilities Administration (DDA). LTSS programs that are not considered “institutional” programs are Medicaid Personal Care (MPC) and Community First Choice (CFC). 

Basic guidelines:

ABD medical programs are the aged, blind, disabled (ABD) or SSI-related medical programs. MAGI medical is done through the Health Plan Finder/Health Benefit Exchange. 

TANF/Refugee cash and related food benefits are always maintained by Community Services Division (CSD).

HCS and DDA LTC specialty financial workers do not maintain MAGI medical or TANF/Refugee cash assistance and the related food benefits.

HCS and DDA LTC specialty workers always maintain ABD medical programs for clients receiving HCS and DDA services.  They also maintain the ABD medical program for a spouse when the other spouse is on LTSS.  If the client on LTSS is an adult, the HCS or DDA financial worker maintains the WASHCAP or food benefits for the HH.

DDA LTC specialty workers do not maintain related food benefits when the only client on DDA services is a minor.

ACES is programmed for shared cases based on the program responsibility chart.

Financial workers will manually assign Hospice cases and Health Care for Workers with Disabilities (HWD) cases that are not on HCS services to the DDA Long Term Care (LTC) Specialty Unit (017).

If a client submits an application that requests a variety of services, including NF, ALF and hospice, but the client hasn’t elected hospice yet, then HCS determines eligibility and keeps the case until a hospice election is received.

Find more information in the Long-term Services and Supports chart. 

Medical Program - LTSS Chart

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WAC 182-501-0175 Medical care provided in bordering cities.

WAC 182-501-0175 Medical care provided in bordering cities.

Effective July 1, 2011

  1. An eligible Washington state resident may receive medical care in a recognized out-of-state bordering city on the same basis as in-state care.
  2. The only recognized bordering cities are:
    1. Coeur d'Alene, Moscow, Sandpoint, Priest River, and Lewiston, Idaho; and
    2. Portland, The Dalles, Hermiston, Hood River, Rainier, Milton-Freewater, and Astoria, Oregon.

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.

WAC 182-532-790 TAKE CHARGE program - Good cause exemption from billing third party insurance.

WAC 182-532-790 TAKE CHARGE program - Good cause exemption from billing third party insurance.

Effective September 1, 2013

  1. Under the TAKE CHARGE program, two groups of clients may request an exemption from the medicaid requirement to bill third-party insurance due to "good cause." The two groups are:
    1. TAKE CHARGE applicants who:
      1. Are eighteen years of age or younger;
      2. Are covered under their parents' health insurance; and
      3. Do not want their parents to know that they are seeking and/or receiving family planning services.
    2. Individuals who are domestic violence victims and are covered under the perpetrator's health insurance.
  2. "Good cause" means that the use of the third-party coverage would violate a client's confidentiality because the third party:
    1. Routinely sends verification of services to the third-party subscriber and that subscriber is someone other than the applicant; and/or
    2. Requires the applicant to use a primary care provider who is likely to report the applicant's request for family planning services to the subscriber.

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.

WAC 182-501-0165 Medical and dental coverage - Fee-for-service (FFS) prior authorization - Determination process for payment

WAC 182-501-0165 Medical and dental coverage—Fee-for-service (FFS) prior authorization—Determination process for payment.

Effective August 9, 2015

  1. This section applies to fee-for-service (FFS) requests for medical or dental services and medical equipment that:
    1. Are identified as covered services or early and periodic screening, diagnosis, and treatment services; and
    2. Require prior authorization by the medicaid agency.
  2. The following definitions and those found in chapter 182-500 WAC apply to this section:

           "Controlled studies" - Studies in which defined groups are compared with each other to reduce bias.

           "Credible evidence" - Type I-IV evidence or evidence-based information from any of the following sources:

           • Clinical guidelines

           • Government sources

          • Independent medical evaluation (IME)

          • Independent review organization (IRO)

          • Independent technology assessment organizations

          • Medical and hospital associations

         • Policies of other health plans

         • Regulating agencies (for example, the Federal Drug Administration or Department of Health)

         • Treating provider

          • Treatment pathways

        "Evidence-based" - The ordered and explicit use of the best evidence available (see "hierarchy of evidence" in subsection (6)(a) of this section) when making health care decisions.

        "Health outcome" - Changes in health status (mortality and morbidity) which result from the provision of health care services.

         "Institutional review board (IRB)" - A board or committee responsible for reviewing research protocols and determining whether:

         (1) The rights and welfare of human subjects are adequately protected;

         (2) The risks to people are minimized and are not unreasonable;

         (3)The risks to people are outweighed by the potential benefit to them or by the knowledge to be gained; and

         (4)The proposed study design and methods are adequate and appropriate in the light of stated study objectives.

"Independent review organization (IRO)" - A panel of medical and benefit experts intended to provide unbiased, independent, clinical, evidence-based reviews of adverse decisions.

"Independent medical evaluation (IME)" - An objective medical examination of the client to establish the medical facts.

"Provider" - The person who is responsible for diagnosing, prescribing, and providing medical, dental, or mental health services to agency clients.

(3) The agency authorizes, on a case-by-case basis, requests described in subsection (1) of this section when the agency determines the service or equipment is medically necessary as defined in WAC 182-500-070. The process the agency uses to assess medical necessity is based on:

(a) The evaluation of submitted and obtainable medical, dental, or mental health evidence as described in subsections (4) and (5) of this section; and

(b) The application of the evidence-based rating process described in subsection (6) of this section.

(4) The agency reviews available evidence relevant to a medical, dental, or mental health service or equipment to:

(a) Determine its efficacy, effectiveness, and safety;

(b) Determine its impact on health outcomes;

(c) Identify indications for use;

(d) Evaluate pertinent client information;

(e) Compare to alternative technologies; and

(f) Identify sources of credible evidence that use and report evidence-based information.

(5) The agency considers and evaluates all available clinical information and credible evidence relevant to the client's condition. The provider responsible for the client's diagnosis, or treatment, or both, must submit with the request credible evidence specifically related to the client's condition including, but not limited to:

(a) A physiological description of the client's disease, injury, impairment, or other ailment;

(b) Pertinent laboratory findings;

(c) Pertinent X-ray and/or imaging reports;

(d) Individual patient records pertinent to the case or request;

(e) Photographs, or videos, or both, if requested; and

(f) Objective medical/dental/mental health information such as medically/dentally acceptable clinical findings and diagnoses resulting from physical or mental examinations.

(6) The agency uses the following processes to determine whether a requested service described in subsection (1) is medically necessary:

(a) Hierarchy of evidence - How defined. The agency uses a hierarchy of evidence to determine the weight given to available data. The weight of medical evidence depends on objective indicators of its validity and reliability including the nature and source of the evidence, the empirical characteristics of the studies or trials upon which the evidence is based, and the consistency of the outcome with comparable studies. The hierarchy (in descending order with Type I given the greatest weight) is:

(i) Type I: Meta-analysis done with multiple, well-designed controlled studies;

(ii) Type II: One or more well-designed experimental studies;

(iii) Type III: Well-designed, quasi-experimental studies such as nonrandomized controlled, single group pre-post, cohort, time series, or matched case-controlled studies;

(iv) Type IV: Well-designed, nonexperimental studies, such as comparative and correlation descriptive, and case studies (uncontrolled); and

(v) Type V: Credible evidence submitted by the provider.

(b) Hierarchy of evidence - How classified. Based on the quality of available evidence, the agency determines if the requested service is effective and safe for the client by classifying it as an "A,""B,""C," or "D" level of evidence:

(i) "A" level evidence: Shows the requested service or equipment is a proven benefit to the client's condition by strong scientific literature and well-designed clinical trials such as Type I evidence or multiple Type II evidence or combinations of Type II, III or IV evidence with consistent results (An "A" rating cannot be based on Type III or Type IV evidence alone).

(ii) "B" level evidence: Shows the requested service or equipment has some proven benefit supported by:

(A) Multiple Type II or III evidence or combinations of Type II, III or IV evidence with generally consistent findings of effectiveness and safety (A "B" rating cannot be based on Type IV evidence alone); or

(B) Singular Type II, III, or IV evidence in combination with agency-recognized:

(I) Clinical guidelines;

(II) Treatment pathways; or

(III) Other guidelines that use the hierarchy of evidence in establishing the rationale for existing standards.

(iii) "C" level evidence: Shows only weak and inconclusive evidence regarding safety, or efficacy, or both. For example:

(A) Type II, III, or IV evidence with inconsistent findings; or

(B) Only Type V evidence is available.

(iv) "D" level evidence: Is not supported by any evidence regarding its safety and efficacy, for example that which is considered investigational or experimental.

(c) Hierarchy of evidence - How applied. After classifying the available evidence, the agency:

(i) Approves "A" and "B" rated requests if the service or equipment:

(A) Does not place the client at a greater risk of mortality or morbidity than an equally effective alternative treatment; and

(B) Is not more costly than an equally effective alternative treatment.

(ii) Approves a "C" rated request only if the provider shows the requested service is the optimal intervention for meeting the client's specific condition or treatment needs, and:

(A) Does not place the client at a greater risk of mortality or morbidity than an equally effective alternative treatment;

(B) Is less costly to the agency than an equally effective alternative treatment; and

(C) Is the next reasonable step for the client in a well-documented tried-and-failed attempt at evidence-based care.

(iii) Denies "D" rated requests unless:

(A) The requested service or equipment has a humanitarian device exemption from the Food and Drug Administration (FDA); or

(B) There is a local institutional review board (IRB) protocol addressing issues of efficacy and safety of the requested service that satisfies both the agency and the requesting provider.

(7) Within fifteen days of receiving the request from the client's provider, the agency reviews all evidence submitted and:

(a) Approves the request;

(b) Denies the request if the requested service is not medically necessary; or

(c) Requests the provider submit additional justifying information. The agency sends a copy of the request to the client at the same time.

(i) The provider must submit the additional information within thirty days of the agency's request.

(ii) The agency approves or denies the request within five business days of the receipt of the additional information.

(iii) If the provider fails to provide the additional information, the agency will deny the requested service.

(8) When the agency denies all or part of a request for a covered service or equipment, the agency sends the client and the provider written notice, within ten business days of the date the information is received, that:

(a) Includes a statement of the action the agency intends to take;

(b) Includes the specific factual basis for the intended action;

(c) Includes reference to the specific WAC provision upon which the denial is based;

(d) Is in sufficient detail to enable the recipient to:

(i) Learn why the agency's action was taken; and

(ii) Prepare an appropriate response.

(e) Is in sufficient detail to determine what additional or different information might be provided to challenge the agency's determination;

(f) Includes the client's administrative hearing rights;

(g) Includes an explanation of the circumstances under which the denied service is continued or reinstated if a hearing is requested; and

(h) Includes examples(s) of "lesser cost alternatives" that permit the affected party to prepare an appropriate response.

(9) If an administrative hearing is requested, the agency or the client may request an independent review organization (IRO) or independent medical examination (IME) to provide an opinion regarding whether the requested service or equipment is medically necessary. The agency pays for the independent assessment if the agency agrees that it is necessary, or an administrative law judge orders the assessment.

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.

WAC 182-501-0055 Health care coverage - How the agency determines coverage of services for its health care programs using health technology assessments

WAC 182-501-0055 Health care coverage—How the agency determines coverage of services for its health care programs using health technology assessments.

Effective August 9, 2015

  1. The medicaid agency uses health technology assessments to determine whether a new technology, new indication, or existing technology approved by the Food and Drug Administration (FDA) is a covered service under agency health care programs. The agency only uses health technology assessments when coverage is not mandated by federal or state law. A health technology assessment may be conducted by or on behalf of:
    1. The agency; or
    2. The health technology assessment clinical committee (HTACC) under RCW 70.14.080 through 70.14.140.
  2. The agency reviews available evidence relevant to a medical or dental service or health care-related equipment and uses a technology evaluation matrix to:
    1. Determine its efficacy, effectiveness, and safety;
    2. Determine its impact on health outcomes;
    3. Identify indications for use;
    4. Identify potential for misuse or abuse; and
    5. Compare to alternative technologies to assess benefit vs. harm and cost effectiveness.
  3. The agency may determine the technology, device, or technology-related supply is:
    1. Covered (see WAC 182-501-0060 for the scope of coverage under Washington apple health (WAH) programs);
    2. Covered with authorization (see WAC 182-501-0165 for the process on how authorization is determined);
    3. Covered with limitations (see WAC 182-501-0169 for how limitations can be extended); or
    4. Noncovered (see WAC 182-501-0070 for noncovered services).
  4. The agency may periodically review existing technologies, devices, or technology-related supplies and reassign authorization requirements as necessary using the provisions in this section for new technologies, devices, or technology-related supplies.
  5. The agency evaluates the evidence and criteria from HTACC to determine whether a service is covered under WAC 182-501-0050 (9) and (10) and 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.

COFA Islander Health Care program

Revised date
Purpose statement

Compact of Free Association (COFA) Islander Health Care is a state-funded sponsorship program offered by the Health Care Authority (HCA). HCA pays the monthly premiums and out-of-pocket expenses under a silver level Qualified Health Plan for eligible COFA islanders. The program serves COFA islanders which includes people from the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau.

COFA islanders are only eligible for federally funded Washington Apple Health (Medicaid) if they are under age 19 or pregnant. They may also be eligible for limited medical coverage if the Department of Social and Health Services (DSHS) determines them to be incapacitated or under the Alien Emergency Medical (AEM) program.

WAC 182-524-0100 General

WAC 182-524-0100 General.

Effective June 17, 2019

  1. Compact of Free Association (COFA) islander health care is a state-funded program administered by the health care authority (the agency) to pay the monthly premiums and out-of-pocket expenses for silver level qualified health plans for eligible COFA islanders.
  2. For the purpose of this chapter, "our," "us," and "we" refer to the agency or the agency's designee and "you" refers to the applicant for, or recipient of, COFA islander health care.
  3. You have the right to appeal any adverse agency action regarding COFA islander health care as described in chapter 182-526 WAC. For coordinated appeals with the Washington health benefit exchange, as described under WAC 182-526-0102, we treat appeals made to either the Washington health benefit exchange or us as filed on the same day. You will not have to submit any information that you have previously submitted to either the Washington health benefit exchange or us.

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.

WAC 182-524-0200 Definitions

WAC 182-524-0200 Definitions.

Effective June 17, 2019

This section defines terms used in this chapter. See chapter 182-500 WAC for additional definitions.

"Advance premium tax credit (APTC)" - A tax credit taken in advance to lower a monthly health insurance payment (or premium).

"COFA islander" – A person who is a citizen of the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau.

"COFA islander health care" – An agency-administered program that pays the premium and out-of-pocket costs for a silver level qualified health plan for eligible COFA islanders.

"Compact of Free Association (COFA)" – A legal agreement between the government of the United States and the governments of the Federated States of Micronesia (U.S. Pub. L. 108-188); the Republic of the Marshall Islands (U.S. Pub. L. 108-188); and the Republic of Palau (U.S. Pub. L. 99-658).

"Cost-sharing funds" – Agency-provided funds for out-of-pocket costs.

"Out-of-pocket costs" – Copayments, coinsurance, deductibles, and other cost-sharing requirements imposed under a qualified health plan for services, pharmaceuticals, devices, and other health benefits covered by the plan and rendered as in-network. Excludes premiums, balance billing amounts for out-of-network providers, and spending for noncovered services.

"Premium cost" – A person's premium for a qualified health plan, minus the amount of the person's advanced premium tax credit.

"Silver level qualified health plan (QHP)" – Silver level indicates the category of a qualified health plan (QHP) offered by the Washington health benefit exchange (HBE). For a definition of QHP, see WAC 182-500-0090.

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.

WAC 182-524-0250 How to apply.

WAC 182-524-0250 How to apply.

Effective June 10, 2019

  1. COFA islanders age nineteen and older may apply for a qualified health plan (QHP) by:
    1. Completing the application via the Washington Healthplanfinder web site at www.wahealthplanfinder.org;
    2. Calling the Washington health benefit exchange (HBE) customer support center and completing an application by telephone;
    3. Calling the COFA islander health care support line and completing an application by telephone; or
    4. Completing the application for health care coverage (HCA 18-001P), and mailing or faxing to the HBE.
  2. When you submit an application for a QHP through HBE using any of the methods listed in subsection (1) of this section, you are automatically considered for COFA islander health care.

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.

WAC 182-524-0300 Eligibility

WAC 182-524-0300 Eligibility.

Effective June 17, 2019

In order to be eligible for state-funded COFA islander health care, you must enroll in a silver level qualified health plan (QHP) through the Washington health benefit exchange (HBE) during open enrollment or when you qualify for a special enrollment period as described in 45 C.F.R. 155.410 and 45 C.F.R. 155.420.

  1. You are eligible for state-funded COFA islander health care administered by us no earlier than January 1, 2019, if you:
    1. Are a COFA islander;
    2. Meet the residency requirements as described under WAC 182-524-0400;
    3. Have household income, as defined under 26 C.F.R. 1.36B-1(e), under one hundred thirty-three percent of the federal poverty level (FPL);
    4. Do not qualify for another federal or state medical assistance programs under chapter 74.09 RCW, that provides minimum essential coverage;
    5. Qualify for, and accept, the maximum advance premium tax credit available under 45 C.F.R. 155.305(f); and
    6. Are enrolled in a silver level QHP.
  2. Eligibility for COFA islander health care is subject to the availability of amounts appropriated for the program.
  3. You will be terminated from COFA islander health care if you:
    1. Do not meet the eligibility criteria under subsection (1) of this section; or
    2. Request termination.
  4. You may be terminated from COFA islander health care if you:
    1. Perform an act, practice, or omission that constitutes fraud, and an insurer rescinds your QHP policy; or
    2. Use your COFA islander health care cost-sharing funds to pay for anything other than out-of-pocket costs.
  5. We will reinstate your COFA islander health care if you were:
    1. Terminated in error; or
    2. Successful in your appeal of a termination.
  6. Your COFA islander health care begins the first day of the month your silver level QHP coverage begins and you meet the other eligibility requirements as described in subsection (1) of this section.
  7. If you report a change that makes you eligible for COFA islander health care, your sponsorship begins either:
    1. The first day of the following month if the change was reported before the fifteenth of the month; or
    2. The first day of the second month if the change was reported after the fifteenth of the month.
  8. Your COFA islander health care ends the day your enrollment in a silver level QHP ends or the last day of the month your COFA islander health care eligibility ends, whichever is earlier.

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.

WAC 182-524-0400 Residency requirements

WAC 182-524-0400 Residency requirements.

Revised June 17, 2019

  1. This section applies only to residency requirement for COFA islander health care.
  2. A resident is a person who currently lives in Washington and:
    1. Intends to reside here, including people without a fixed address; or
    2. Entered the state looking for a job; or
    3. Entered the state with a job commitment.
  3. You do not need to live in the state for a specific period of time to meet the requirements in subsection (2) of this section.
  4. You can be temporarily out-of-state and remain on COFA islander health care if you:
    1. Intend to return once the purpose of your absence concludes; and
    2. Meet the eligibility requirements as described under WAC 182-524-0300.

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.

WAC 182-524-0500 Notice requirements

WAC 182-524-0500 Notice requirements.

Revised June 17, 2019

  1. The provisions in chapter 182-518 WAC apply to COFA islander health care, where applicable. This section applies only to notices and letters that we send regarding COFA islander health care.
  2. We send you written notices (letters) when we:
    1. Approve you for COFA islander health care;
    2. Deny you for COFA islander health care;
    3. Change or terminate your eligibility from COFA islander health care;
    4. Ask you for more information; and
    5. Reimburse you for premium costs, as determined by WAC 182-524-0600.
  3. All written notices we send to you include:
    1. The date of the notice;
    2. Specific contact information for you to use if you have questions or need help with the notice;
    3. The nature of the action;
    4. The effective date of the action;
    5. The facts and reasons for the action;
    6. The specific regulation on which the action is based;
    7. Your appeal rights, if an appeal is available; and
    8. Other information required by the state.
  4. If we request information from you, we allow at least ten calendar days for you to submit requested information. If you ask, we may allow you more time to get us the information.
    1. If the due date falls on a weekend or a legal holiday as described in RCW 1.16.050, the due date is the next business day.
    2. We do not deny or terminate your eligibility when we ask you to provide information.
    3. If we do not receive your information by the due date, we make a determination based on all the information available.
  5. We send a written notice to you at least ten days before taking any adverse action. The ten-day notice period starts on the day we send the notice.
  6. We may send a notice fewer than ten days before the date of the adverse action if:
    1. You request the action;
    2. You request termination;
    3. A change in statute, federal regulation, or administrative rule is the sole cause of the action;
    4. You are incarcerated and expect to remain incarcerated at least thirty days;
    5. Mail sent to you is returned without a forwarding address and we do not have a more current address for you;
    6. You move out-of-state;
    7. Your plan ends because you move to a county where your current silver level qualified health plan (QHP) is not available and you fail to select a new plan;
    8. You die;
    9. You begin receiving other state or federal medical assistance that provides minimum essential coverage; or
    10. Your silver level QHP is closed and you do not enroll in another silver level QHP.

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.

WAC 182-524-0600 Payments

WAC 182-524-0600 Payments.

Revised June 17, 2019

  1. We pay your silver level qualified health plan (QHP) premium costs directly to the QHP carrier unless we determine good cause exists to reimburse you for the premium costs.
  2. We pay your mandatory out-of-pocket costs separate from your premium costs through cost-sharing funds.
  3. Cost-sharing funds are only for your out-of-pocket costs.
  4. We will not pay for, or reimburse you for, costs not considered as out-of-pocket costs or expenses incurred by people not covered under COFA islander health care.
  5. You are responsible for ensuring the services you receive are covered under your QHP and rendered as in-network.
  6. We may stop payments of your silver level QHP premium costs and your cost-sharing funds when you:
    1. Fail to provide verification of payments through us or an agency-contracted vendor;
    2. Fail to respond to a request for information from us or an agency-contracted vendor;
    3. Misuse your cost-sharing funds by:
      1. Purchasing anything not considered an out-of-pocket cost; or
      2. Allowing another person access to your cost-sharing funds.
    4. Are no longer eligible for COFA islander health care as de-scribed under WAC 182-524-0300.
  7. You must follow the requirements of any agency-contracted vendor that provides services enabling you to access your cost-sharing funds.
  8. We monitor payments and cost-sharing transactions under COFA islander health care.

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.

How can COFA Islander Health Care help?

  • By paying for your monthly insurance premium you can have access to essential health benefits such as doctor visits, hospital stays, prescription drugs, preventive services, etc.
  • By providing you the funds to pay your out-of-pocket expenses such as copays, coinsurance, and deductibles.  

Do I qualify for COFA Islander Health Care?

You may be eligible for COFA Islander Health Care if you:

  • Are a COFA islander
  • Have income less than 133 percent of the federal poverty level (FPL)
  • Live in Washington
  • Enroll into a silver level Qualified Health Plan through the Health Benefit Exchange
  • Agree to file federal taxes (even if you do not meet tax filing requirements)
  • If you are married, agree to file taxes jointly with your spouse
  • Are not receiving other federal or state medical coverage, including affordable employer-sponsored insurance, Medical Care Services, Medicare, etc.

How do I apply for COFA Islander Health Care?

How do I file an Appeal?

To qualify for COFA Islander Health Care, you must first qualify for a silver level qualified health plan with tax credits through the Healthplanfinder. If you are not eligible for a qualified health plan with tax credits and you want to appeal that decision, do one of the following:

  • Email: appeals@wahbexchange.org
  • Phone: 1-855-859-2512
  • Mail: Washington Health Benefit Exchange
    ATTN: Legal Division
    PO Box 1757
    Olympia, WA 98507

If you are eligible for and enrolled in a qualified health plan with tax credits but are not eligible for COFA Islander Health Care, you can appeal this decision to us by doing one of the following:

  • Mail: Health Care Authority
    PO Box 45531
    Olympia, WA 98504-5531
  • Phone: 1-800-562-3022 or 1-800-547-3109

How can I contact COFA Islander Health Care or find more information?

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WAC 182-524-0600 Payments

WAC 182-524-0600 Payments.

Revised June 17, 2019

  1. We pay your silver level qualified health plan (QHP) premium costs directly to the QHP carrier unless we determine good cause exists to reimburse you for the premium costs.
  2. We pay your mandatory out-of-pocket costs separate from your premium costs through cost-sharing funds.
  3. Cost-sharing funds are only for your out-of-pocket costs.
  4. We will not pay for, or reimburse you for, costs not considered as out-of-pocket costs or expenses incurred by people not covered under COFA islander health care.
  5. You are responsible for ensuring the services you receive are covered under your QHP and rendered as in-network.
  6. We may stop payments of your silver level QHP premium costs and your cost-sharing funds when you:
    1. Fail to provide verification of payments through us or an agency-contracted vendor;
    2. Fail to respond to a request for information from us or an agency-contracted vendor;
    3. Misuse your cost-sharing funds by:
      1. Purchasing anything not considered an out-of-pocket cost; or
      2. Allowing another person access to your cost-sharing funds.
    4. Are no longer eligible for COFA islander health care as de-scribed under WAC 182-524-0300.
  7. You must follow the requirements of any agency-contracted vendor that provides services enabling you to access your cost-sharing funds.
  8. We monitor payments and cost-sharing transactions under COFA islander health care.

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.

WAC 182-524-0500 Notice requirements

WAC 182-524-0500 Notice requirements.

Revised June 17, 2019

  1. The provisions in chapter 182-518 WAC apply to COFA islander health care, where applicable. This section applies only to notices and letters that we send regarding COFA islander health care.
  2. We send you written notices (letters) when we:
    1. Approve you for COFA islander health care;
    2. Deny you for COFA islander health care;
    3. Change or terminate your eligibility from COFA islander health care;
    4. Ask you for more information; and
    5. Reimburse you for premium costs, as determined by WAC 182-524-0600.
  3. All written notices we send to you include:
    1. The date of the notice;
    2. Specific contact information for you to use if you have questions or need help with the notice;
    3. The nature of the action;
    4. The effective date of the action;
    5. The facts and reasons for the action;
    6. The specific regulation on which the action is based;
    7. Your appeal rights, if an appeal is available; and
    8. Other information required by the state.
  4. If we request information from you, we allow at least ten calendar days for you to submit requested information. If you ask, we may allow you more time to get us the information.
    1. If the due date falls on a weekend or a legal holiday as described in RCW 1.16.050, the due date is the next business day.
    2. We do not deny or terminate your eligibility when we ask you to provide information.
    3. If we do not receive your information by the due date, we make a determination based on all the information available.
  5. We send a written notice to you at least ten days before taking any adverse action. The ten-day notice period starts on the day we send the notice.
  6. We may send a notice fewer than ten days before the date of the adverse action if:
    1. You request the action;
    2. You request termination;
    3. A change in statute, federal regulation, or administrative rule is the sole cause of the action;
    4. You are incarcerated and expect to remain incarcerated at least thirty days;
    5. Mail sent to you is returned without a forwarding address and we do not have a more current address for you;
    6. You move out-of-state;
    7. Your plan ends because you move to a county where your current silver level qualified health plan (QHP) is not available and you fail to select a new plan;
    8. You die;
    9. You begin receiving other state or federal medical assistance that provides minimum essential coverage; or
    10. Your silver level QHP is closed and you do not enroll in another silver level QHP.

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.

WAC 182-524-0400 Residency requirements

WAC 182-524-0400 Residency requirements.

Revised June 17, 2019

  1. This section applies only to residency requirement for COFA islander health care.
  2. A resident is a person who currently lives in Washington and:
    1. Intends to reside here, including people without a fixed address; or
    2. Entered the state looking for a job; or
    3. Entered the state with a job commitment.
  3. You do not need to live in the state for a specific period of time to meet the requirements in subsection (2) of this section.
  4. You can be temporarily out-of-state and remain on COFA islander health care if you:
    1. Intend to return once the purpose of your absence concludes; and
    2. Meet the eligibility requirements as described under WAC 182-524-0300.

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.

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