Apple Health Kidney Disease Program (KDP)

Revised date

What is the Kidney Disease Program?

The Kidney Disease Program (KDP) is a state-funded program that helps low-income, eligible clients with treatment costs for end-stage renal disease.

Client eligibility is determined by each contracted kidney center. Eligibility is based on the program's residential and medical criteria in addition to income and asset standards.

Contracted kidney centers require clients to apply for medical programs that provide medical coverage such as Medicaid, Medicare, supplemental insurance, or employer sponsored insurance.

Program manuals

Program information

Income and resource standards

For program questions, please email the Kidney Disease Program.

Please report broken links or content problems.

Medicare Part D staff handout

Revised date
Purpose statement

This section has the text of the Prescription Drug Coverage handouts used by HCS staff.

If you receive Medicaid and Become Eligible for Medicare-Recipient

Once you become eligible for Medicare, you no longer use your Med ID card to pay for most of your prescription drugs. You will now get most of your prescription drugs through Medicare Part D and the Prescription Drug Plan (PDP) you enroll in.

It is important that you enroll in a PDP so that the plan will be effective the month you become eligible for Medicare.

Getting enrolled in a Prescription Drug Plan (PDP)

The Centers for Medicare and Medicaid Services (CMS) sends you an enrollment packet “Welcome to Medicare” before you become eligible for Medicare. The explanation for how to enroll in a PDP is in this packet.

A PDP is insurance that covers both brand name and generic prescription drugs at participating pharmacies in your area. There are many different types of plans to choose from that vary in cost, coverage, and yearly deductibles.

Be sure to ask about the premium and copays when comparing plans. Not all PDP premiums are fully paid for by Medicare. If you choose a PDP that is not fully paid for by Medicare, you may have to pay a portion of your plan’s premium and higher copays.

If you do not enroll in a PDP, CMS automatically enrolls you in a premium free plan. You may have a period of time that you can’t get prescriptions unless you enroll in a plan through the emergency system, WellPoint.

Emergency prescription drug coverage

If you are not enrolled in a PDP and need prescriptions right away, most major pharmacies can enroll you through a national emergency system called WellPoint. Bring your Medicare card and Medicaid coupon to the pharmacy to get your prescriptions. You will be enrolled into the WellCare plan. WellCare will be your PDP. If WellCare doesn’t work for you, you can change plans.

Changing Plans

You can change plans at any time. If you change plans, the new plan takes effect the next month after the month you enroll. If you do change plans, you need to let Medicare staff know. Call 1-800-Medicare (1-800-633-4227) or TRS 711 through Washington Relay and let them know. You also need to tell a representative from your new plan that you are changing plans and which plan CMS had selected for you.

Resources that can help you pick a plan

  • Below are resources that can help you decide which plan is best for you.
    The Washington State Office of the Insurance Commissioner’s Statewide Health Insurance Benefits Advisors (SHIBA) HelpLine can help you understand your options. Call them at 1-800-562-6900.
  • Visit the federal Medicare website at www.medicare.gov. The site has several tools to help you understand, compare, and choose a plan. You can also talk with Medicare staff by calling 1-800-Medicare (1-800-633-4227) or TRS: 711 through Washington Relay.
  • Your local Senior Information and Assistance Office (I&A). To find your local I&A office, visit the AAA website and click on “local AAAs” or look for the Area Agency on Aging office in the yellow pages of your telephone book under “Senior Services”.

Frequently Asked Questions

Can I Keep My Medicaid Drug Coverage?

No. Once you are eligible for Medicare, Medicaid will not continue the drug coverage it currently provides.

What if I have prescription drug coverage from another type of insurance (employer, union or retirement plan)?

If your other insurance plan is not as good as the Medicare prescription drug coverage, talk to your insurance carrier about your options. You may not be able to join a Medicare PDP without dropping your current health coverage (doctor and hospital). If you drop your current insurance, you may not be able to get it back.

You do not need to enroll in a Medicare PDP if your other insurance plan provides benefits equal to or better than the Medicare PDP. Your insurance provider should tell you if your current insurance plan is equal to or better than the Medicare PDP. To keep your current insurance plan, you need to decline or disenroll in any Medicare PDP. You need to talk with Medicare staff to do this. Call 1-800-Medicare (1-800-633-4227) or TRS: 711 through Washington Relay to decline or disenroll in the Medicare PDP.

What if I move to or live in a nursing home?

If you move to a nursing home, you still have a choice of what PDP you want to use. You can also switch plans at any time. If you want help deciding which plan is best for you, use the resources listed above. You might also want to talk with staff at the nursing home and ask them for their suggestions.

What if I pay part of my income for the cost of my long-term care (participation)?

If you are enrolled in a PDP where you have to pay part or all of your copays and premium, it is considered a medical expense and may be used to reduce your participation.

Report the amount you pay for copays and premiums to your local Home and Community Services (HCS) financial worker. If you don’t remember who your financial worker is, call your local HCS Office. The financial worker will need to see receipts for the amount you report.

If you get food assistance, copays and other medical expenses that exceed $35.00 per month may be used to give you more food benefits. Report the amount you pay to your financial worker and provide receipts for the amount you report.

Prescription Drug Coverage If you are new to receiving Medicaid and are eligible for Medicare-Applicants

If you already receive Medicare or are eligible for it, you will get most of your prescription drugs through Medicare Part D and the Prescription Drug Plan (PDP) you enroll in. You need to enroll in a PDP if you haven’t done so (see below). Medicaid does not pay for most of your prescription drugs.

If you need to enroll in Medicare, contact your local Social Security Office. To find the nearest office, look in the “Federal Government” pages of your phone book or on the web at www.socialsecurity.gov.

Getting enrolled in a Prescription Drug Plan (PDP)

A PDP is insurance that covers both brand name and generic prescription drugs at participating pharmacies in your area. There are many different types of plans to choose from that vary in cost, coverage, and yearly deductibles.

Be sure to ask about the premium and copays when comparing plans. Not all PDP premiums are fully paid for by Medicare. If you choose a PDP that is not fully paid for by Medicare, you may have to pay a portion of your plan’s premium and higher copays.

If you are not enrolled in a PDP, the Centers for Medicare and Medicaid Services (CMS) automatically enrolls you in a premium free plan shortly after you are authorized for Medicaid. You have 20 days to change PDPs if the plan CMS enrolls you in does not work for you. You may have a period of time that you can’t get prescriptions unless you enroll in a plan through the emergency system, LI Net program operated by Humana.

If you are already enrolled in a PDP and are paying some or all of the premium, it may be time to find and switch to a premium-free plan since you are now receiving Medicaid. This is your choice.

If you do not enroll in a premium-free plan, CMS will enroll you in a premium-free plan shortly after you are authorized to receive Medicaid. You will have 20 days to change plans if the plan CMS enrolls you in does not work for you or if you want to keep the plan you have.

Emergency prescription drug coverage

If you are not enrolled in a PDP and need prescriptions right away, most major pharmacies can enroll you through a national emergency system called LI Net program operated by Humana. Bring your Medicare card and Medicaid service card to the pharmacy to get your prescriptions. You will be enrolled into the Medicaid D prescription drug plan. LI Net will be your PDP. If LI Net doesn’t work for you, you can change plans.

Changing Plans

You can change plans at any time. If you change plans, the new plan takes effect the next month after the month you enroll. If you do change plans, you need to let Medicare staff know. Call 1-800-Medicare (1-800-633-4227) or TRS: 711 through Washington Relay and let them know. You also need to tell a representative from your new plan that you are changing plans and which plan CMS had selected for you.

Resources that can help you pick a plan

Below are resources that can help you decide which plan is best for you.

  • The Washington State Office of the Insurance Commissioner’s Statewide Health Insurance Benefits Advisors (SHIBA) HelpLine can help you understand your options. Call them at 1-800-562-6900.
  • Visit the federal Medicare website at www.medicare.gov. The site has several tools to help you understand, compare, and choose a plan. You can also talk with Medicare staff by calling 1-800-Medicare (1-800-633-4227) or TRS: 711 through Washington Relay.
  • Your local Senior Information and Assistance Office (I&A). To find your local I&A office, visit the AAA website and click on “local AAAs” or look for the Area Agency on Aging office in the yellow pages of your telephone book under “Senior Services”.

Frequently Asked Questions

What if I have prescription drug coverage from another type of insurance (employer, union or retirement plan)?

If your other insurance plan is not as good as the Medicare prescription drug coverage, talk to your insurance carrier about your options. You may not be able to join a Medicare PDP without dropping your current health coverage (doctor and hospital). If you drop your current insurance, you may not be able to get it back.

You do not need to enroll in a Medicare PDP if your other insurance plan provides benefits equal to or better than the Medicare PDP. Your insurance provider should tell you if your current insurance plan is equal to or better than the Medicare PDP. To keep your current insurance plan, decline or disenroll in any Medicare PDP. Call and talk with Medicare staff by calling 1-800-Medicare (1-800-633-4227) or TRS: 711 through Washington Relay to decline or disenroll in the Medicare PDP.

What if I pay part of my income for the cost of my long-term care (participation)?

If you are enrolled in a PDP where you have to pay part or all of your copays and premium, it is considered a medical expense and may be used to reduce your participation.

Report the amount you pay for copays and premiums to your local Home and Community Services (HCS) financial worker. If you don’t remember who your financial worker is, call your local HCS Office. The financial worker will need to see receipts for the amount you report.

If you get food assistance, copays and other medical expenses that exceed $35.00 per month may be used to give you more food benefits. Report the amount you pay to your financial worker and provide receipts for the amount you report.

Please report broken links or content problems.

Foster Care, Relative Placement, Adoption Support, Juvenile Rehabilitation, Unaccompanied Minor Program

Revised date
Purpose statement

To give instructions and contact information when working with children enrolled in Foster Care, Adoption Support, Juvenile Rehabilitation, and Unaccompanied Refugee Minor programs. Children in these programs will be active on D01/D02 medical coverage groups.

WAC 182-505-0211 Washington apple health -- Foster Care.

WAC 182-505-0211 Washington apple health -- Foster Care.

Effective January 1, 2023.

  1. A client under the age of 18 is eligible for Washington apple health foster care coverage when they:
    1. Are in foster care as determined by the department of children, youth, and families (DCYF) under the legal responsibility of the state, or a federally recognized tribe located within the state; and
    2. Meet Washington residency requirements as described in WAC 182-503-0520 or 182-503-0525.
  2. A client age 20 or younger is eligible for coverage when the client meets:
    1. Washington residency requirements as described in WAC 182-503-0520 or 182-503-0525;
    2. Citizenship or immigration status requirements as described in WAC 182-503-0535;
    3. Social Security number requirements as described in WAC 182-503-0515; and
    4. One of the following requirements:
      1. Is in foster care, or is eligible for continued foster care services as determined by the children's administration, under the legal responsibility of the state, or a federally recognized tribe located within the state; or
      2. Receives subsidized adoption services through the children's administration; or
      3. Is enrolled in the unaccompanied refugee minor (URM) program as authorized by the office of refugee and immigrant assistance (ORIA); or
      4. Is living in a community facility (as defined in WAC 110-700-005) operated or contracted by DCYF's juvenile rehabilitation.
  3. A client age 18 or older but under age 26 is eligible for Washington Apple Health coverage when a client:
    1. Was in foster care under the legal responsibility of any state or a federally recognized tribe located within any state.
      1. On the client's 18th birthday; or
      2. At such higher age as to when the state or tribe extends foster care coverage; and
    2. Meets residency, Social Security number, and citizenship requirements as described in subsection (2) of this section.
  4. A client described in subsections (1) through (3) of this section is not eligible for full-scope coverage if the client is confined to a public institution as defined in WAC 182-500-0050, except:
    1. If the client is under age 21;
    2. Resides in an institution for mental disease (IMD); and
    3. Meets the institutional status requirements in WAC 182-513-1320, 182-514-0250, or 182-514-0260.

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

The Foster Care and Adoption Support (FCAS) is responsible for the following cases:

  1. Foster Care (D01/D02): These are children who are placed in a licensed foster care or relative's home by the Children's Administration (CA) or a federally recognized Tribe. The foster care parent receives a monthly payment from CA and the child is eligible for Apple Health.
    1. CA sends an alert to the FCAS to inform them a child has entered foster care. FCAS works the alert and opens a D01 (foster care child receiving SSI) or D02 (foster care) case for the child.
    2. D01/D02 foster care cases:
      1. Are assigned to CSO 076
      2. Display in ACES with asterisks in the address field and AREP screen. The asterisks have been added to insure address confidentiality for the foster care family and child.
      3. Require special coding in the DEM1 living arrangement and DEM1 REL code fields.
    3. When the CSO/CSC and FCAS have a shared D01/D02 case, only the FCAS can finalize or update the case. The CSO can "add a program" to a D01/D02 case, but will not be able to finalize the case. CSO/CSC staff will need to coordinate with the FCAS @ 800-562-3022 ext. 15480 to have them complete case actions. FAX number is 360-725-1158.

      Note: CSO staff should not change the living arrangement or REL code on the foster care child's DEM1 screen or close out a foster care assistance unit. To make any change to a D01/D02 case contact the FCAS @ 800-562-3022 ext. 15480.
       

  2. Former Foster Care Medical Program (D26): The Affordable Care Act expanded Medicaid eligibility for individuals who were in foster care and receiving Medicaid on their 18th birthday to age 26. These individuals have their D02 medical coverage automatically spout to D26 the first of the month following their 18th birthday. They remain eligible for health care coverage under the D26 program until their 26th birthday regardless of changes in income, household composition, or marital status, as long as they remain a Washington resident.
  3. Adoption Support (D01/D02): Is a payment received by an adoptive parent who cares for children who have been placed by Washington State or another state. These children are categorically eligible for Apple Health as long as they are receiving an adoption support payment. Children in adoption support may be eligible up to age 21.
    1. Adoption Support cases are approved by the Children's Administration (DSHS). CA communicates adoption support enrollment to the FCAS. The FCAS opens D01 or D02 medical program.
    2. D01/D02 adoption support cases are:
      1. Assigned to CSO 076
      2. Display in ACES with asterisks in the address field and AREP screen.
      3. Require special coding in the DEM1 living arrangement and the REL code fields.
    3. Changes to adoption support case and any case associated with adoption support can only be made by FCAS.

      Note: A child placed with adoptive parents will often be assigned a new Client Identification (CL ID) number. The assignment of a new CL ID number will help ensure confidentiality.
       

  4. Juvenile Rehabilitation (D01/D02): Children who reside in a Juvenile Rehabilitation Administration (JRA) group home are eligible for Apple Health through the month in which they are paroled.
    1. JRA notifies the FCAS that a child has been placed in a group home. The FCAS opens a D01 or D02 medical case for the child.
    2. JRA cases are:
      1. Assigned to CSO 076
      2. Display in ACES with asterisks in the address field and AREP screen.
      3. Require special coding in the DEM1 living arrangement and REL code fields.
    3. CSO/CSC may see JRA cases in ACES when the child has recently been released from the group home. To add a child back to their family assistance unit or to open new coverage for the child the CSO/CSC must contact FCAS @ 360-725-1519.
  5. Unaccompanied Refugee Minor (URM) Program: The Department of State and the Office of Refugee Immigration Assistance (ORIA) work together to identify minor children who need foster care placement and approve them for resettlement in this country. Children are placed in culturally sensitive foster homes and are eligible for Apple Health. When a child has been placed in the URM Program, the ORIA program manager notifies the FCAS to open Apple Health coverage under D02 program. Children in the URM program remain eligible for Apple Health coverage up to age 21 as long as URM payments are being made.

Please report broken links or content problems.

Hospice agency contacts

Revised date
Purpose statement

This section gives contact information for medical institutions licensed by the State of Washington Department of Health (DOH) as hospice care centers and for all hospice agencies with Medicaid contracts.

Hospice care center contacts

Hospice care center Mailing address Physical address Phone number Provider number
Evergreen Hospice and Home Health P O Box 11610
Tacoma WA 98411		 12822 124th Ave NE
Kirkland WA 98034		 1-425-899-1041 3990231
Franciscan Hospice Care Center Dpt.1010 P O Box 34936
Seattle WA 98124		 1717 S. J St.
Tacoma WA 98405-4944		 1-253-627-4100 3990264
Hospice of Spokane P O Box 2215
Spokane WA 99210		 121 S. Arthur
Spokane WA 99202		 1-509-456-0438 3990165
Hospice Southwest - Ray Hickey House P O Box 1588
Vancouver WA 98668		 3400 Main St.
Vancouver WA 98663		 1-360-256-2000 3990157
Tri-Cities Chaplaincy 2108 W Entiat Ave
Kennewick WA 99336		 2108 W Entiat Ave
Kennewick WA 99336		 1-509-783-7416 3990124
Hospice of Kitsap County The Care Center
P O Box 3416
Silverdale WA 98383		 570 Lebo Boulevard
Bremerton WA		 1-360-698-4611 3990066

Note: The provider numbers listed below are no longer current. Find the correct provider number by going to the INST screen and Shift-F8.

All hospice agencies with a Medicaid contract

Number Provider name Mailing address City State ZIP code Physical address Physical city State ZIP code
3990025 Central WA Hospital Hospice P O Box 1887 Wenatchee WA 98807-1887 903 Red Apple Rd Wenatchee WA 98801-0000
3990033 Community Home Health and Hospice P O Box 2067 Longview WA 98632-8189 14508 NE 20th Ave Suite 201 Vancouver WA 98686-6435
3990041 Good Samaritan Hospice P O Box 1247 Puyallup WA 98371-0000 1317 East Main St Puyallup WA 98372-0000
3990058 Kaiser Permanente 201 16th Ave CMB-C140 Seattle WA 98112-5260 125 16th Ave CMB-C140 Seattle WA 98112-5211
3990066 Hospice of Kitsap County P O Box 3416 Silverdale WA 98383-3416 3100 Bucklin Hill Rd #201 Silverdale WA 98383-3416
3990074 Hospice of Snohomish County 2731 Wetmore Suite 500 Everett WA 98201-0000 2731 Wetmore Suite 500 Everett WA 98201-0000
3990090 Skagit Hospice Services LLC Dept 1081 P O Box 1376 Mount Vernon WA 98273-0000 1971 Highway 20 Sedro-Wooley WA 98284-0000
3990108 Yakima Regional Med and Heart Ctr 7 South 10th Avenue Yakima WA 98902-0000 7 South 10th Avenue Yakima WA 98902-0000
3990124 Tri-Cities Chaplaincy 2108 W Entiat Ave Kennewick WA 99336-3000 2108 W Entiat Ave Kennewick WA 99336-3000
3990132 Walla Walla Community Hospice P O Box 2026 Walla Walla WA 99362-0948 1067 E Isaacs Walla Walla WA 99362-0000
3990157 Hospice Southwest P O Box 1588 Vancouver WA 98668-1600 3400 Main St Vancouver WA 98663-1600
3990165 Hospice of Spokane P O Box 2215 Spokane WA 99210-2215 121 S Arthur St Spokane WA 99202-0000
3990173 Providence Hospice of Seattle P O Box 389672 Seattle WA 98138-9672 425 Pontius Ave N STE 300 Seattle WA 98109-5312
3990181 Hospice of Palouse 700 S Main St Moscow ID 83843-3056 700 S Main St Moscow ID 83843-3056
3990199 Multicare Hospice of Tacoma P O Box 5200 Tacoma WA 98415-0200 315 S ML King Jr Way Tacoma WA 98415-0000
3990207 Harbors Home Health Services 201 7th St Hoquiam WA 98550-2506 201 7th St Hoquiam WA 98550-2506
3990215 Swedish Home Health and Hospice 5701 6th Ave So STE 404 Seattle WA 98108-2522 5701 6th Ave So STE 404 Seattle WA 98108-2522
3990231 Evergreen Hospice and Home Health P O Box 11610 Tacoma WA 98411-6610 12822 124th Lane NE MS #9 Kirkland WA 98034-0000
3990256 Kaiser Permanente Hospice P O Box 4000-95 Portland OR 97208-0000 500 NE Multnomah STE 100 Portland OR 97232-2099
3990264 Franciscan Hospice Dept 1010 P O Box 34936 Seattle WA 98124-1936 1717 S J Street Tacoma WA 98405-4944
3990280 Highline Home Health and Hospice 12844 Military Rd S Seattle WA 98168-0000 2801 S 128th Tacoma WA 98168-0000
3990298 Central Basin Home Health and Hospice 311 W 3rd Ave Moses Lake WA 98837-1905 311 W 3rd Ave Moses Lake WA 98837-1905
3990314 Home Care of Kittitas Valley 401 E Mountain View Ave Ellensburg WA 98926-5803 401 E Mountain View Ave Ellensburg WA 98926-5803
3990322 Lower Valley Hospice 3920 Outlook Rd Sunnyside WA 98944-0000 3920 Outlook Rd Sunnyside WA 98944-0000
3990330 Hospice of the Gorge P O Box 36 Hood River OR 97031-0049 814 13th St Hood River OR 97031-0000
3990355 Providence Sound Homecare P O Box 5008 Lacey WA 98509-0000 P O Box 5008 Lacey WA 98509-0000
3990371 Yakima Valley Memorial Hospital 1019 S 40th Ave Yakima WA 98908-0000 1019 S 40th Ave Yakima WA 98908-0000
3990470 Tri-State Hospital Hospice 1100 Highland Ave Clarkston WA 99403-0000 1100 Highland Ave Clarkston WA 99403-0000
3990496 Horizon Hospice 123 W Cascade Way STE #E Spokane WA 99208-6070 123 W Cascade Way STE #E Spokane WA 99208-6070
3990512 Northwest Healthcare Alliance I P O Box 94316 Seattle WA 98124-6616 1821 Cooks Hill Rd STE 200 Centralia WA 98531-0000
3990652 Okanogan Regional Hospice 800 Jasmine St STE 2 Omak WA 98841-9501 800 South Jasmine STE 2 Omak WA 98841-0000
3990744 Whatcom Hospice P O Box 1238 Bellingham WA 98227-1238 800 E Chestnut St #C-1 Bellingham WA 98225-5241
3990835 Hospice of Jefferson County 834 Sheridan St Port Townsend WA 98368-2443 834 Sheridan St Port Townsend WA 98368-2443
3990884 Odyssey of Cincinnati 4350 Glendale-Milford #110 Blue Ash Hamilton OH 45242-0000 4350 Glendale-Milford #110 Blue Ash Hamilton OH 45242-0000
3990934 Avera Mckennan Hospital P O Box 9191 Minneapolis MN 57105-1016 800 E 21st St Sioux Falls SD 57105-1016
3990967 Bonner Community Hospice P O Box 1448 Sandpoint ID 83864-0877 520 N Third Sandpoint ID 83864-0877
3991031 Family Home Care and Hospice Corp 9922 E Montgomery #3 Spokane Valley WA 99206-0000 9922 E Montgomery #3 Spokane Valley WA 99206-0000

Please report broken links or content problems.

Long-term services and supports authorized under Apple Health

Revised date
Purpose statement

This section describes long-term services and supports (LTSS) authorized under institutional and noninstitutional Apple Health Medicaid programs.

WAC 182-513-1200 Long-term services and supports authorized under Washington Apple Health programs

WAC 182-513-1200 Long-term services and supports authorized under Washington Apple Health programs

Effective February 20, 2017

  1. Long-term services and supports (LTSS) programs available to people eligible for noninstitutional Washington apple health coverage who meet the functional requirements.
    1. Noninstitutional apple health coverage in an alternate living facility (ALF) under WAC 182-513-1205.
    2. Community first choice (CFC) under WAC 182-513-1210.
    3. Medicaid personal care (MPC) under WAC 182-513-1225.
    4. For people who do not meet institutional status under WAC 182-513-1320, skilled nursing or rehabilitation is available under the CN, medically needy (MN) or alternative benefits plan (ABP) scope of care if enrolled into a managed care plan.
  2. Non-HCB waiver LTSS programs that use institutional rules under WAC 182-513-1315 and 182-513-1380 or HCB waiver rules under chapter 182-515 WAC, depending on the person's living arrangement:
    1. Program of all-inclusive care for the elderly (PACE) under WAC 182-513-1230.
    2. Roads to community living (RCL) under WAC 182-513-1235.
    3. Hospice under WAC 182-513-1240.

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

Noninstitutional services are authorized for people who are eligible for a categorically needy (CN) or alternate benefit plan (ABP). These services are:

  1. Medicaid Personal Care (MPC)
  2. Community First Choice (CFC)
  3. Hospice. Hospice services can also be authorized under the medically needy (MN) program.

Noninstitutional medical programs include MAGI-based N-track programs through the Health Benefit Exchange and the non-MAGI medicaid programs such as SSI related, foster care, and breast and cervical cancer.

Institutional services is also called long-term care (LTC). These services are authorized for people living in a medical institution 30 days or more. Home and Community based (HCB) Waivers are considered an institutional medical program. SSI-related institutional programs are subject to a 5 year look back for transfer penalties. There are 3 parts to the eligibility for institutional medical programs:

  1. Initial eligibility for the Medicaid
  2. Functional eligibility for the service
  3. Post-eligibility treatment of income to determine the client responsibility toward the cost of care. This payment is also called participation.

Institutional rules can be used to access LTSS if a person is not eligible for CN using noninstitutional rules. Whenever institutional rules are needed to determine eligibility, the person is subject to the post-eligibility treatment of income to determine the client responsibility toward the cost of care. These services do not have a 5 year look back for transfer penalties like institutional or HCB Waiver programs. These services are:

  1. Program of all-inclusive care for the elderly (PACE)
  2. Roads to Community Living (RCL)
  3. CFC
  4. Hospice.

People residing in a medical institution 30 days or more, with the exception of MAGI-based programs have eligibility determined under WAC 182-513-1315 and WAC 182-513-1380. MAGI-based programs cover nursing facility services as a claim and no program change is done even if residing in a NF 30 days or more.

Home and Community based (HCB) waivers are considered an institutional program. Eligibility is determined under Chapter 182-515 WAC.

Community First Choice (CFC) or Medicaid Personal Care (MPC) can be authorized by HCS or DDA for people who are functionally eligibility and receive a CN or ABP Apple Health program. The eligibility for CN and ABP are based on the following program rules:

  1. Modified adjusted gross income (MAGI) based eligibility through the Health Benefit Exchange (HBE) with the exception of alien emergent medical under N21 and N25. The remaining MAGI programs are under the N track. Notification of services under the N track programs is done through the social service authorization in Provider One.
  2. CN under a Classic (non-MAGI) Apple Health program:
    1. SSI-related noninstitutional programs:
      1. SSI (S01)
      2. SSI related CN (S02)
      3. SSI related CN Health Care for Workers with Disabilities (HWD)(S08
      4. SSI related CN in an Alternate Living Facility (ALF) (G03)
    2. Foster Care (D01, D02)
    3. Breast and Cervical Cancer (S30)

Consult the medical program chart desk tool located in the financial program SharePoint for a complete list of medical coverage groups (MCG) and the type of LTSS service that can be authorized for each MCG.

For MPC, the eligibility is based on any noninstitutional CN or ABP Apple Health program.

For CFC, the eligibility is based on any Apple Health CN or ABP program including eligibility for a HCB Waiver. If eligible person receives both CFC and HCB Waiver, the eligibility rules under Chapter 182-515 WAC apply including the 5 year look back for transfer penalties and post-eligibility treatment of income.

For people receiving CFC only, the 5 year look back for transfer penalties do not apply.

People living in the community, receiving PACE, RCL or Hospice, may have eligibility determined using HCB Waiver rules under Chapter 182-515 WAC. Even though HCB Waiver rules can be used for eligibility, these programs are not HCB Waivers and are not subject to the 5 year look back for transfer penalties. People receiving PACE, RCL or Hospice are considered to have institutional status under WAC 182-513-1320. People receiving PACE or Hospice in a nursing facility have eligibility based on WAC 182-513-1315 and WAC 182-513-1380.

All LTSS services are subject to excess home equity provisions under WAC 182-513-1350.

Worker Responsibilities

Use the following sections to determine eligibility depending on the service authorized and the setting:

  1. Overview- LTSS- Who does what. This section has the program responsibility chart
  2. Applications for LTSS
  3. Eligibility requirements
  4. Home and Community-based (HCB) Waivers. For people needing HCB Waiver rules to access LTSS
  5. Medicaid Personal Care (MPC)
  6. Community First Choice (CFC)
  7. Determining eligibility for noninstitutional coverage in an alternate living facility (G03), (Private pay ALF G95, G99). Includes BHO placements in ALF.
  8. Hospice index
  9. PACE
  10. Roads to Community Living (RCL)
  11. Modified Adjusted Gross Income (MAGI) based institutional. (K track). This program is used when a person is under age 65, not on medicare, and not eligible for a MAGI program through the HBE. The person must reside in a medical institution 30 days or more before this program can be considered.

Please report broken links or content problems.

Patient access and affordability programs

Revised date
Purpose statement

Patient access and affordability programs assist individuals with their prescription drug costs when their prescriptions are not covered by Washington Apple Health or Medicare. In addition to prescription assistance some companies also provide assistance with coverage, medical management, and/or financial assistance.

The following resources may assist with health care affordability issues. These resources are not endorsed by HCA and are just a sample of what is available on the internet.

Please report broken links or content problems.

Resource eligibility index

Revised date
Purpose statement

This section describes how the department looks at an individual's resources (also called assets) when determining eligibility for long-term care programs

Resources

Available Resources

This section describes resource eligibility for institutional Washington Apple Health programs, including home and community based (HCB) waiver programs. The section includes information on how to handle excess resources, vehicles, patient trust accounts at facilities, treatment of the home and the resource calculation of a married couple.

Annuities

Annuity Life Expectancy Tables

Excess Home Equity

This section explains the requirements relating to the amount of equity an individual may have in the home and still qualify for long-term care services.

Estate Recovery

Explains who is subject to Estate Recovery and includes the ALTSA Estate Recovery handout and Legal Services bulletin

Hardship Waivers for long-term care (LTC) services

This section includes information on when the department can look at a hardship waiver, how to request a hardship waiver and what to do if your request is denied. Hardship waivers can be considered any time the department denies a long-term care application due to transfer of assets or due to an individual having excess equity in their home.

How life estates affect eligibility

This section describes how Life Estates affect long term care eligibility

Determining the value of life estates

This section is a chart used to determine the value of a life estate

Long-term Care Partnership

Long-term Care Partnership - Information for Consumers

Long-term Care - Partnership - Frequently Asked Questions

These sections provide information for field staff and consumers regarding the Washington State Long-term care partnership program.

Standards - Long-term care (LTC) Long-term Services and Supports (LTSS) income and resource standards

Chart of current income and resource standards

Lump sum incomes and Long-term Services and Supports (LTSS)

This section provides information on how the department treats the receipt of lump sums of income. Depending upon the source of the income and when it is reported, the lump sum may be treated either as a resource or income.

Allowable medical expenses. Chart of allowable and nonallowable expenses

This section provides information on the type of medical expenses that may be used to reduce the countable resources of an applicant with resources over the limit in the month of application for long-term care services.

Reverse mortgage, promissory notes and loans

This section provides information on how the department treats income received from reverse mortgages, promissory notes and loans and when income received from these sources would be counted towards an individual's resource limit.

Resource ownership and availability

Institutional and HCB Waiver resource eligibility starts with SSI related medical resources. Rules that are specific to long-term care are stated in WAC 182-513-1350

Transfer of an asset

This section describes the process used by the department to determine if an individual has made an impermissible transfer of an asset during the five year look-back period prior to an application for long-term care and describes penalties the department establishes.

Treatment of entrance fees for people residing in continuing care or life care communities

This section explains how to treat life care contracts signed by the client and the facility and/or organization. Treatment of entrance fees in a continuing care retirement community or life care community is considered a resource available to the client in certain conditions

Trusts - How Trusts Affect eligibility for medical programs

This section explains how to treat trusts for the purposes of medicaid eligibility.

Please report broken links or content problems.

Institutional status

Revised date

WAC 182-513-1320 Determining institutional status for long-term care (LTC) services.

WAC 182-513-1320 Determining institutional status for long-term care (LTC) services.

Effective February 17, 2017

  1. To attain institutional status outside a medical institution, a person must be approved for and receive:
    1. Home and community based (HCB) waiver services under chapter 182-515 WAC;
    2. Roads to community living (RCL) services under WAC 182-513-1235;
    3. Program of all-inclusive care for the elderly (PACE) under WAC 182-513-1230;
    4. Hospice services under WAC 182-513-1240(3); or
    5. State-funded long-term care service under WAC 182-507-0125.
  2. To attain institutional status in a medical institution, a person must reside in a medical institution thirty consecutive days or more, or based on a department assessment, be likely to reside in a medical institution thirty consecutive days or more.
  3. Once a person meets institutional status, the person's status is not affected if the person:
    1. Transfers between medical facilities; or
    2. Changes between any of the following programs: HCB waiver, RCL, PACE, hospice or services in a medical institution.
  4. A person loses institutional status if the person is absent from a medical institution, or does not receive HCB waiver, RCL, PACE, or hospice services, for more than twenty-nine consecutive days.

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

The term "institutional status" refers to a minimum period of time a person requires LTC services. An individual attains institutional status when the need for inpatient services in a medical institution is 30 days or more.

A person attains institutional status when they:

  • Reside continuously in a medical institution for 30 consecutive days or longer; 
  • Are likely to remain in a medical institution for 30 consecutive days or longer; or
  • Receives a home and community based (HCB) waiver service through DDA or HCS.
  • Receives program of all-inclusive care for the elderly (PACE); or
  • Elects hospice services; or
  • Receives state-funded long-term care for noncitizens. 

A person loses institutional status when they:

  • Are absent from a medical institution for at least 30 consecutive days, or
  • Doesn't receive DDA or HCS HCB waiver services, PACE, hospice, or state-funded long term care for noncitizens for at least 30 days. 

"Likely to remain" means there is a reasonable expectation the person will be in a medical institution for 30 consecutive days or longer. Once made, the determination holds even if the person doesn't actually remain institutionalized for 30 consecutive days. If an admission into a medical institution is expected to last under 30 days for an evaluation, brief rehabilitation based on current information, then institutional medicaid rules can't be used.

For nursing facilities, the HCS social service worker gives the financial worker by the 14-443 as to whether the person is projected to be in the facility 30 days or more along with a determination of nursing facility level of care (NFLOC).

For State Veteran's nursing facility, the Veteran's Affairs Registered Nurse (VARN) gives the best projection possible as to whether the person is going to remain in the facility 30 days or more along with a determination of NFLOC.

For State IMD Hospitals, IMD social service or nursing staff give the best projection possible as to whether the person is going to remain in the facility 30 days or more.

For DDA institutions, the DDA case manager gives the best projection possible as to whether the person is going to remain in the facility 30 days or more along with a ICF-ID level of care.

The combination of HCB Waiver services, Hospice, state funded LTC for noncitizens or admission into a medical institution, hospitalization, etc. counts toward the 30 day institutionalization if there is no break in service.

What is a Medical Institution?

Not every facility is considered a medical institution. Assisted living, Enhanced Adult Residential Centers (EARC), Adult Residential Centers (ARC), DDA group homes and Adult Family Homes are not considered a medical institution. Clients can be receiving institutional HCB Waiver services in these facilities.

WAC 182-500-0050 defines a medical institution.

Note: Hospice services can be received in a medical facility or in conjunction with waiver services. They are a group of services provided to an individual who is terminally ill. Hospice services do not constitute a waiver program but waiver rules can be used for hospice medicaid eligibility. If residing in a medical institution 30 days or more (nursing facility, hospital, hospice care center) institutional rules must be used See hospice.

Note: Medicaid Personal Care (MPC) and Community First Choice (CFC) are not considered "institutional" programs.
MPC and CFC-only eligibility is tied to noninstitutional categorically needy (CN) medicaid.

Worker Responsibilities

Obtain the determination of whether the person is likely to remain institutionalized for 30 consecutive days from the department-designated social service worker or case manager.

For nursing facility cases, the HCS social service worker notifies financial of the date of request for assessment, whether the person is projected to be in a nursing facility 30 days or more and if the person meets NFLOC.

For those people who meet both 30 day or more institutionalization and NFLOC, institutional Medicaid is considered.

For individual persons who don't meet the 30 day or more institutionalization, institutional Medicaid can't be considered. Eligibility for Medicaid is determined as if the person were in their own home. If the person is eligible for another Medical program, the admission into the medical institution is considered a short stay (29 days or less). See Short Stays.

For active Apple Health clients who lose institutional medicaid status due to discharge from a medical institution or no longer receiving a HCB Waiver service, redetermine eligibility under a noninstitutional medical program.

Please report broken links or content problems.

Definitions: long-term services and supports

Revised date
Purpose statement

Additional medical definitions: The main medical definitions are found on the HCA main WAC index page. This includes a clarification on medical institutions and alternate living facilities. WAC 388-106-0045

WAC 182-513-1100 Definitions related to long-term services and supports (LTSS)

WAC 182-513-1100 Definitions related to long-term services and supports (LTSS)

Revised March 1, 2025

This section defines the meaning of certain terms used in chapters 182-513 and 182-515 WAC. Within these chapters, institutional, home and community-based services (HCB) waiver, program of all-inclusive care for the elderly (PACE), and hospice in a medical institution are referred to collectively as long-term care (LTC). Long-term services and supports (LTSS) is a broader definition which includes institutional, HCB waiver, and other services such as medicaid personal care (MPC), community first choice (CFC), PACE, and hospice in the community.

  • See chapter 182-516 WAC for definitions related to trusts, annuities, life estates, and promissory notes.
  • See chapter 388-106 WAC for long-term care services definitions.
  • See WAC 182-513-1405 for long-term care partnership definitions.
  • See chapter 182-500 WAC for additional definitions.

"Adequate consideration" means that the fair market value (FMV) of the property or services received, in exchange for transferred property, approximates the FMV of the property transferred.

"Administrative costs" or "costs" means necessary costs paid by the guardian or conservator including attorney fees.

"Aging and long-term support administration (ALTSA)" means the administration within the Washington state department of social and health services (DSHS).

"Alternate living facility (ALF)" is not an institution under WAC 182-500-0050; it is one of the following community residential facilities:

(a) Adult family home (AFH) licensed under chapter 70.128 RCW.

(b) Adult residential care facility (ARC) licensed under chapter 18.20 RCW.

(c) Assisted living facility (AL) licensed under chapter 18.20 RCW.

(d) Behavioral health adult residential treatment facility (RTF) licensed under chapter 246-337 WAC.

(e) Intensive behavioral health treatment facility (IBHTF) is an RTF licensed under chapter 246-337 WAC.

(f) Developmental disabilities administration (DDA) group home (GH) licensed as an adult family home under chapter 70.128 RCW or an assisted living facility under chapter 18.20 RCW.

(g) Enhanced adult residential care facility (EARC) licensed as an assisted living facility under chapter 18.20 RCW.

(h) Enhanced service facility (ESF) licensed under chapter 70.97 RCW.

(i) Facility for children and youth 20 years of age and younger where a state-operated living alternative program, as defined under chapter 71A.10 RCW, is operated.

(j) Group care facility for medically complex children licensed under chapter 74.15 RCW.

(k) Staffed residential facility licensed under chapter 74.15 RCW.

"Assets" means all income and resources of a person and of the person's spouse, including any income or resources which that person or that person's spouse would otherwise currently be entitled to but does not receive because of action:

(a) By that person or that person's spouse;

(b) By another person, including a court or administrative body, with legal authority to act in place of or on behalf of the person or the person's spouse; or

(c) By any other person, including any court or administrative body, acting at the direction or upon the request of the person or the person's spouse.

"Authorization date" means the date payment begins for long-term services and supports (LTSS) under WAC 388-106-0045.

"Clothing and personal incidentals (CPI)" means the cash payment (under WAC 388-478-0090, 388-478-0006, and 388-478-0033) issued by the department for clothing and personal items for people living in an ALF or medical institution.

"Community first choice (CFC)" means a medicaid state plan home and community based service developed under the authority of section 1915(k) of the Social Security Act under chapter 388-106 WAC.

"Community options program entry system (COPES)" means a medicaid home and community-based services (HCBS) waiver program developed under the authority of section 1915(c) of the Social Security Act under chapter 388-106 WAC.

"Community spouse (CS)" means the spouse of an institutionalized spouse.

"Community spouse resource allocation (CSRA)" means the resource amount that may be transferred without penalty from:

(a) The institutionalized spouse (IS) to the community spouse (CS); or

(b) The spousal impoverishment protections institutionalized (SIPI) spouse to the spousal impoverishment protections community (SIPC) spouse.

"Community spouse resource evaluation" means the calculation of the total value of the resources owned by a married couple on the first day of the first month of the institutionalized spouse's most recent continuous period of institutionalization.

"Comprehensive assessment reporting evaluation (CARE) assessment" means the evaluation process defined under chapter 388-106 WAC used by a department designated social services worker or a case manager to determine a person's need for long-term services and supports (LTSS).

"Conservator" has the same meaning given in RCW 11.130.010.

"Conservatorship" means the process outlined in chapter 11.130 RCW for appointing a conservator and a conservator's carrying out of any duties pursuant to an order entered under RCW 11.130.360 through 11.130.575.

"Conservatorship fees" or "fees" means necessary fees charged by a conservator for services rendered on behalf of a client.

"Continuing care contract" means a contract to provide a person, for the duration of that person's life or for a term in excess of one year, shelter along with nursing, medical, health-related, or personal care services, which is conditioned upon the transfer of property, the payment of an entrance fee to the provider of such services, or the payment of periodic charges for the care and services involved.

"Continuing care retirement community" means an entity which provides shelter and services under continuing care contracts with its members and which sponsors or includes a health care facility or a health service.

"Dependent" means a minor child, or one of the following who meets the definition of a tax dependent under WAC 182-500-0105: Adult child, parent, or sibling.

"Developmental disabilities administration (DDA)" means an administration within the Washington state department of social and health services (DSHS).

"Developmental disabilities administration (DDA) home and community-based services (HCBS) waiver" means a medicaid HCB waiver program developed under the authority of section 1915(c) of the Social Security Act under chapter 388-845 WAC authorized by DDA. There are five DDA HCB waivers:

(a) Basic Plus;

(b) Core;

(c) Community protection;

(d) Children's intensive in-home behavioral support (CIIBS); and

(e) Individual and family services (IFS).

"Equity" means the fair market value of real or personal property less any encumbrances (mortgages, liens, or judgments) on the property.

"Fair market value (FMV)" means the price an asset may reasonably be expected to sell for on the open market in an agreement, made by two parties freely and independently of each other, in pursuit of their own self-interest, without pressure or duress, and without some special relationship (arm's length transaction), at the time of transfer or assignment.

"Guardian" has the same meaning given in RCW 11.130.010.

"Guardianship" means the process outlined in chapter 11.130 RCW for appointing a guardian and a guardian's carrying out of any duties pursuant to an order entered under RCW 11.130.265 through 11.130.355.

"Guardianship fees" or "fees" means necessary fees charged by a guardian for services rendered on behalf of a client.

"Home and community-based services (HCBS) waiver programs authorized by home and community services (HCS)" means medicaid HCBS waiver programs developed under the authority of Section 1915(c) of the Social Security Act under chapter 388-106 WAC authorized by HCS. There are three HCS HCBS waivers: Community options program entry system (COPES), new freedom consumer directed services (New Freedom), and residential support waiver (RSW).

"Home and community based services (HCBS)" means LTSS provided in the home or a residential setting to persons assessed by the department.

"Institutional services" means services paid for by Washington apple health, and provided:

(a) In a medical institution;

(b) Through an HCBS waiver; or

(c) Through programs based on HCBS waiver rules for post-eligibility treatment of income under chapter 182-515 WAC.

"Institutionalized individual" means a person who has attained institutional status under WAC 182-513-1320.

"Institutionalized spouse" means a person who, regardless of legal or physical separation:

(a) Has attained institutional status under WAC 182-513-1320; and

(b) Is legally married to a person who is not in a medical institution.

"Life care community" see continuing care community.

"Likely to reside" means the agency or its designee reasonably expects a person will remain in a medical institution for 30 consecutive days. Once made, the determination stands, even if the person does not actually remain in the facility for that length of time.

"Long-term care services" see "Institutional services."

"Long-term services and supports (LTSS)" includes institutional and noninstitutional services authorized by the department.

"Medicaid alternative care (MAC)" is a Washington apple health benefit authorized under Section 1115 of the Social Security Act. It enables the medicaid agency and the agency's designees to deliver an array of person-centered long-term services and supports (LTSS) to unpaid caregivers caring for a medicaid-eligible person who meets nursing facility level of care under WAC 388-106-0355 and 182-513-1605.

"Medicaid personal care (MPC)" means a medicaid state plan home and community based service under chapter 388-106 WAC.

"Most recent continuous period of institutionalization (MRCPI)" means the current period an institutionalized spouse has maintained uninterrupted institutional status when the request for a community spouse resource evaluation is made. Institutional status is determined under WAC 182-513-1320.

"Noninstitutional medicaid" means any apple health program not based on HCB waiver rules under chapter 182-515 WAC, or rules based on a person residing in an institution for 30 days or more under chapter 182-513 WAC.

"Nursing facility level of care (NFLOC)" is described in WAC 388-106-0355.

"Participation" means the amount a person must pay each month toward the cost of long-term care services received each month; it is the amount remaining after the post-eligibility process under WAC 182-513-1380, 182-515-1509, or 182-515-1514. Participation is not room and board.

"Penalty period" or "period of ineligibility" means the period of time during which a person is not eligible to receive services that are subject to transfer of asset penalties.

"Personal needs allowance (PNA)" means an amount set aside from a person's income that is intended for personal needs. The amount a person is allowed to keep as a PNA depends on whether the person lives in a medical institution, ALF, or at home.

"Presumptive eligibility (PE)" for long-term services and supports is described in WAC 182-513-1110.

"Program of all-inclusive care for the elderly (PACE)" provides long-term services and supports (LTSS), medical, mental health, and substance use disorder (SUD) treatment through a department-contracted managed care plan using a personalized plan of care for each enrollee.

"Roads to community living (RCL)" is a demonstration project authorized under Section 6071 of the Deficit Reduction Act of 2005 (P.L. 109-171) and extended through the Patient Protection and Affordable Care Act (P.L. 111-148).

"Room and board" means the amount a person must pay each month for food, shelter, and household maintenance requirements when that person resides in an ALF. Room and board is not participation.

"Short stay" means residing in a medical institution for a period of 29 days or fewer.

"Significant financial duress" means, but is not limited to, threatened loss of, or financial burden from, basic shelter, food, or medically necessary health care. It means that a member of a couple has established to the satisfaction of a hearing officer that the community spouse needs income above the level permitted by the community spouse maintenance standard to provide for medical, remedial, or other support needs of the community spouse to permit the community spouse to remain in the community.

"Special income level (SIL)" means the monthly income standard that is 300 percent of the supplemental security income (SSI) federal benefit rate.

"Spousal impoverishment protections" means the financial provisions within Section 1924 of the Social Security Act that protect income and assets of the community spouse through income and resource allocation. The allocation process is used to discourage the impoverishment of a spouse due to the other spouse's need for LTSS. This includes services provided in a medical institution, HCB waivers authorized under 1915(c) of the Social Security Act, and through September 30, 2027, services authorized under 1115 and 1915(k) of the Social Security Act.

"Spousal impoverishment protections community (SIPC) spouse" means the spouse of a SIPI spouse.

"Spousal impoverishment protections institutionalized (SIPI) spouse" means a legally married person who qualifies for the noninstitutional categorically needy (CN) Washington apple health SSI-related program only because of the spousal impoverishment protections under WAC 182-513-1220.

"State spousal resource standard" means the minimum CSRA standard for a CS or SIPC spouse.

"Tailored supports for older adults (TSOA)" is a federally funded program approved under Section 1115 of the Social Security Act. It enables the medicaid agency and the agency's designees to deliver person-centered long-term services and supports (LTSS).

"Third-party resource (TPR)" means funds paid to or on behalf of a person by a third party, where the purpose of the funds is for payment of activities of daily living, medical services, or personal care. The agency does not pay for these services if there is a third-party resource available.

"Transfer" means, in the context of long-term care eligibility, the changing of ownership or title of an asset, such as income, real property, or personal property, by one of the following: (a) An intentional act that changes ownership or title; or(b) A failure to act that results in a change of ownership or title.

"Uncompensated value" means the fair market value (FMV) of an asset on the date of transfer, minus the FMV of the consideration the person receives in exchange for the asset.

"Undue hardship" means a person is not able to meet shelter, food, clothing, or health needs. A person may apply for an undue hardship waiver based on criteria under WAC 182-513-1367.

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.

Please report broken links or content problems.

Eligibility requirements for LTSS

Revised date

Eligibility requirements specific to long-term care

Washington Apple Health (WAH) eligibility WACs Title 182 Health Care Authority (HCA)

WAH includes Modified Adjusted Gross Income (MAGI) programs AND institutional and SSI related Medicaid, also known as "Classic Medicaid".

Please report broken links or content problems.

Subscribe to