WAC 182-512-0200 SSI-related medical -- Definition of resources.

Effective December 1, 2011

1. A resource is any cash, other personal property, or real property that an applicant, recipient or other financially responsible person:
   1. Owns;
   2. Has the right, authority, or power to convert to cash (if not already cash); and
   3. Has the legal right to use for his/her support and maintenance.
2. The value of a resource may change. However, the property (personal or real) still remains a resource.
3. Some assets are not resources. Any asset that does not meet the criteria in subsection (1) above is not a resource.
4. When an SSI related client owns a bank account or time deposit jointly with others who are also SSI related clients, we consider the funds as being available to the SSI related individuals in equal shares, unless sufficient evidence to the contrary is provided.
5. When an SSI related client owns a bank account or time deposit jointly with others who are not SSI related, we consider all funds in the joint account as available to the client unless sufficient evidence to the contrary is provided.
6. When an SSI related client jointly owns either real or personal property other than bank accounts or time deposits, the department considers that the client owns and has available only his or her fractional interest in the property unless sufficient evidence to the contrary is provided.
7. A resource is countable toward the resource limit only if it is available and is not excluded.

WAC 182-512-0250 SSI-related medical — Ownership and availability of resources.

Effective April 27, 2020.

1. The agency considers personal and real property to be available to a Washington apple health applicant or recipient if the applicant or recipient:
   1. Owns the property;
   2. Has the authority to convert the property into cash;
   3. Can expect to convert the property to cash within twenty working days; and
   4. May legally use the property for his or her support.
2. The agency counts the resources of financially responsible persons (as defined in WAC 182-506-0015) who live in the home even if those persons do not receive Washington apple health coverage.
3. For long-term care (LTC) services, cash and other resources transferred by a Washington apple health applicant or recipient or his or her spouse to another to pay for the Washington apple health applicant or recipient's LTC services are considered resources available to the applicant or recipient unless otherwise excluded in this chapter, chapter 182-513 WAC, or chapter 182-516 WAC.
4. A resource is considered available on the first day of the month following the month of receipt unless a rule about a specific type of resource provides for a different time period.
5. A resource that ordinarily cannot be converted to cash within twenty working days is considered unavailable as long as a reasonable effort is being made to convert the resource to cash.
6. A person may provide evidence showing that a resource is unavailable. A resource is not counted if the person shows sufficient evidence that the resource is unavailable.
7. We do not count the resources of victims of family violence, as defined in WAC 388-452-0010, when:
   1. The resource is owned jointly with members of the former household;
   2. Availability of the resource depends on an agreement of the joint owner; or
   3. Making the resource available would place the person at risk of harm.
8. The value of a resource is its fair market value minus encumbrances.
9. Refer to WAC 182-512-0260 to consider additional resources when an alien has a sponsor.

WAC 182-512-0260 SSI-related medical -- How to count a sponsor's resources.

Effective April 14, 2014.

1. The agency counts part of a sponsor's resources as available to an applicant or recipient of Washington apple health (WAH) SSI-related health care coverage if:
   1. The person is a sponsored immigrant as defined in WAC 182-512-0785; and
   2. The person is not exempt from deeming under WAC 182-512-0790.
2. The agency determines the amount of the sponsor's resources to count by:
   1. Totaling the countable resources of the sponsor and the sponsor's spouse (if the spouse signed the affidavit of support);
   2. Subtracting fifteen hundred dollars; and
   3. Counting the remaining amount as a resource that is available to the person.
3. When a sponsor has sponsored other people as well, the agency divides the result by the total number of people sponsored.
4. A sponsor's resources are counted when determining eligibility for WAH coverage until the person becomes exempt from deeming under WAC 182-512-0790.

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

Effective June 11, 2025

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

WAC 182-510-0001 Supplemental security income and associated categorically needy coverage.

Effective July 11, 2015.

1. Supplemental security income (SSI) is a federal cash benefit administered by the Social Security Administration (SSA) under the Social Security Act, 42 U.S.C. Sec. 1381-1383f. The SSI program replaces state programs for the aged, blind and disabled individuals beginning January 1974. An individual who received state assistance in December 1973 who became eligible for SSI in January 1974 is considered a grandfathered client by the medicaid agency, and a mandatory income level (MIL) client by SSI. The individual must continue to meet the definition of blind or disabled that was in effect under the state plan in December 1973. See chapter 182-500 WAC for additional definitions.
2. An essential person is someone needed in the home to care for an SSI recipient. An essential person is eligible for categorically needy (CN) coverage as long as he or she has lived continuously with the eligible person since January 1974.
3. An ineligible spouse is the spouse of an SSI recipient who is not eligible for SSI-related CN coverage. An ineligible spouse must have his or her eligibility for Washington apple health (WAH) determined separately under WAC 182-519-0100.
4. When an individual receives SSI, the agency accepts the SSA's determination of medicaid entitlement. The individual is eligible for CN coverage without submitting an additional application as long as he or she:
   1. Remains entitled to SSI;
   2. Is no longer entitled to SSI, but the SSA is in the process of determining eligibility under the Social Security Act, 42 U.S.C. Sec. 1619(b); or
   3. Currently has 1619(b) status as described in WAC 182-512-0880(3).
5. An SSI recipient may be terminated from CN coverage when he or she:
   1. Does not provide the agency with information necessary for the agency to determine if he or she has other medical insurance; or
   2. Does not assign the right to recover insurance funds to the agency as required in WAC 182-503-0540.
6. CN coverage eligibility continues if the SSA stops an individual's SSI for one of the following reasons:
   1. The individual's countable income exceeds the SSI income standard due solely to the annual cost-of-living adjustment (COLA) under WAC 182-512-0880(1);
   2. The individual is a "deemed" eligible SSI recipient on the basis of eligibility for a special income disregard under WAC 182-512-0880; or
   3. The individual has an appeal of an SSA termination pending which has not yet resulted in a final determination.
7. If an individual's SSI stops due to an SSA determination that the individual is no longer disabled, and any appeal of this determination has resulted in a final decision, the agency:
   1. Redetermines eligibility for all other WAH programs that are not based on receipt of SSI; and
   2. Continues CN coverage until the agency completes the redetermination process described in WAC 182-504-0125.
8. If an individual's SSI stops for a reason not addressed elsewhere in this section, the agency considers the individual to meet disability requirements through the SSA's original disability review date. The agency:
   1. Redetermines eligibility for other WAH programs, which may or may not be based on disability; and
   2. Continues CN coverage until the agency completes the redetermination process in WAC 182-504-0125.

WAC 182-510-0005 Supplemental security income, essential person, and ineligible spouse.

Effective July 11, 2015

1. If you are a supplemental security income (SSI) recipient, you automatically get categorically needy (CN) coverage (WAC 182-512-0100) unless you:
   1. Refuse to provide private medical insurance information; or
   2. Refuse to assign the right to recover insurance funds to the agency (WAC 182-503-0540).
2. If you are an essential person as described in WAC 182-510-0001 you get CN coverage as long as you continue to live with the SSI recipient.
3. If you are an ineligible spouse you are not considered an SSI recipient. You must have your Washington apple health eligibility determined separately.

WAC 182-510-0010 Eligibility after supplemental security income ends.

Effective July 11, 2015

1. Your categorically needy (CN) coverage (WAC 182-512-0100) continues after supplemental security income (SSI) ends if:
   1. Countable income exceeds the SSI income standard due solely to the annual cost-of-living adjustment (COLA); or
   2. A timely request for a hearing has been filed. CN coverage is continued until the Social Security Administration (SSA) makes a final decision on the hearing request and on any subsequent timely appeals.
2. If your SSI ends, your CN coverage continues for a period of up to one hundred twenty days while the agency reviews your eligibility for other cash or medical programs.
3. If you are a terminated SSI or SSI-related recipient, the agency will review your disability status when:
   1. You present new medical evidence;
   2. Your medical condition changes significantly; or
   3. Your termination from SSI was not based on a review of current medical evidence.
4. Children terminated from SSI due to loss of disabled status may be eligible for medical benefits under WAC 182-505-0210.

WAC 182-504-0105 Washington apple health -- Changes that must be reported.

Effective August 29, 2014.

1. You must report changes in your household and family circumstances to us (the agency or its designee) timely according to WAC 182-504-0110.
2. We tell you what you are required to report at the time you are approved for WAH coverage. We also will tell you if the reporting requirements change.
3. You must report the following:
   1. Change in residential address;
   2. Change in mailing address;
   3. Change in marital status;
   4. When family members or dependents move in or out of the residence;
   5. Pregnancy;
   6. Incarceration;
   7. Change in institutional status;
   8. Change in health insurance coverage including medicare eligibility; and
   9. Change in immigration or citizenship status.
4. If you are eligible for a WAH long-term care program described in chapter 182-513 or 182-515 WAC, you must also report changes to the following:
   1. Income;
   2. Resources;
   3. Medical expenses; and
   4. Spouse or dependent changes in income or shelter cost when expenses are allowed for either.
5. If you get WAH parent or caretaker (as described in WAC 182-505-0240) or WAH modified adjusted gross income (MAGI)-based adult coverage (as described in WAC 182-505-0250), you must also report changes to the following:
   1. When total income increases or total deductions decrease by one hundred fifty dollars or more a month and the change will continue for at least two months;
   2. Your federal income tax filing status that you expect to use when you file your taxes for the current tax filing year (such as changing from "married filing separately" to "married filing jointly"); and
   3. The tax dependents you expect to claim when you file your federal income tax return for the current tax filing year.
6. If you get WAH based on age, blindness, or disability (SSI-related medical), then you must also report changes to the following:
   1. Income; and
   2. Resources. 

WAC 182-504-0110 Washington apple health -- When to report changes.

Effective August 29, 2014.

1. All changes you report to us (the agency or its designee), as required by WAC 182-504-0105, are used to decide if you can receive or keep receiving Washington apple health (WAH) coverage.
2. You must report changes during your certification period within thirty days of when the change happened.
3. You must report all changes during application, renewal, or redetermination of your WAH eligibility, regardless of when the change happened.
4. For a change in income, the date a change happened is the first date you received income based on the change. For example, the date you receive your first paycheck for a new job or the date you got a paycheck with a wage increase is the date the change happened.
5. If you do not report a change or you report a change late, we will decide if you can receive or keep receiving WAH coverage based on the date the change was required to be reported.
6. If you do not report a change or you report a change late, and if it affects the amount you must pay toward your cost of care as described in WAC 182-513-1380 or chapter 182-515 WAC, you may become liable for overpayments we make on your behalf and you may need to pay more to your care provider.
7. If you do not report a change or you report a change late, it may result in us overpaying you and you having to pay us back for the health care costs we overpaid. See chapter 182-520 WAC.

WAC 182-512-0300 SSI-related medical -- Resources eligibility.

Effective January 27, 2019

1. At 12:00 a.m. on the first day of the month a client's countable resources must be at or below the resource standard to be eligible for noninstitutional medical benefits for that month. If the total of the client's countable resources is above the resource standard at 12:00 a.m. on the first day of the month, the client is ineligible for noninstitutional medical benefits for that entire month regardless of resource status at the time of application during that month. For resource eligibility relating to long term care eligibility see chapter 182-513 WAC.
2. An excluded resource converted to another excluded resource remains excluded.
3. Cash received from the sale of an excluded resource becomes a countable resource the first of the month following conversion unless the cash is:
   1. Used to replace the excluded resource;
   2. Invested in another excluded resource in the same month or within the longer time allowed for home sales under WAC 182-512-0350; or
   3. Spent.
4. The unspent portion of a nonrecurring lump sum payment is counted as a resource on the first of the month following its receipt with the following exception: the unspent portion of any Title II (SSA) or Title XVI (SSI) retroactive payment is excluded as a resource for nine months following the month of receipt. These exclusions apply to lump sums received by the client, client's spouse or any other person who is financially responsible for the client.
5. Clients applying for SSI related medical coverage for long term care (LTC) services must meet different resource rules. See chapter 182-513 WAC for LTC rules.
6. The transfer of a resource without adequate consideration does not affect medical program eligibility except for LTC services described in chapters 182-513 and 182-515 WAC. In those programs, the transfer may make a client ineligible for medical benefits for a period of time. See WAC 182-513-1363 for LTC rules.

WAC 182-513-1315 General eligibility requirements for long-term care (LTC) programs.

Effective February 20, 2017

This section lists the sections in this chapter that describe how the agency determines a person's eligibility for long-term care services. These sections are:

1. WAC 182-513-1316 General eligibility requirements for long-term care (LTC) programs.
2. WAC 182-513-1317 Income and resource criteria for an institutionalized person.
3. WAC 182-513-1318 Income and resource criteria for home and community based (HCB) waiver programs and hospice.
4. WAC 182-513-1319 State-funded programs for noncitizens who are not eligible for a federally funded program.

WAC 182-513-1316 General eligibility requirements for long-term care (LTC) programs.

Effective February 20, 2017

1. To be eligible for long-term care (LTC) services, a person must:
   1. Meet the general eligibility requirements for medical programs under WAC 182-503-0505, except:
      1. An adult age nineteen or older must meet citizenship and immigration status requirements under WAC 182-503-0535 (2)(a) or (b);
      2. A person under age nineteen must meet citizenship and immigration status requirements under WAC 182-503-0535 (2)(a), (b), (c), or (d); and
      3. If a person does not meet the requirements in (a)(i) or (ii) of this subsection, the person is not eligible for medicaid and must have eligibility determined under WAC 182-513-1319.
   2. Attain institutional status under WAC 182-513-1320;
   3. Meet the functional eligibility under:
      1. Chapter 388-106 WAC for a home and community services (HCS) home and community based (HCB) waiver or nursing facility coverage; or
      2. Chapter 388-828 WAC for developmental disabilities administration (DDA) HCB waiver or institutional services; and
   4. Meet either:
      1. SSI-related criteria under WAC 182-512-0050; or
      2. MAGI-based criteria under WAC 182-503-0510(2), if residing in a medical institution. A person who is eligible for MAGI-based coverage is not subject to the provisions under subsection (2) of this section.
2. A supplemental security income (SSI) recipient or a person meeting SSI-related criteria who needs LTC services must also:
   1. Not have a penalty period of ineligibility due to the transfer of assets under WAC 182-513-1363;
   2. Not have equity interest in a primary residence greater than the home equity standard under WAC 182-513-1350; and
   3. Disclose to the agency or its designee any interest the applicant or spouse has in an annuity, which must meet annuity requirements under chapter 182-516 WAC.
3. A person who receives SSI must submit a signed health care coverage application form attesting to the provisions under subsection (2) of this section. A signed and completed eligibility review for LTC benefits can be accepted for people receiving SSI who are applying for long-term care services.
4. To be eligible for HCB waiver services, a person must also meet the program requirements under:
   1. WAC 182-515-1505 through 182-515-1509 for HCS HCB waivers; or
   2. WAC 182-515-1510 through 182-515-1514 for DDA HCB waivers.

WAC 182-513-1317 Income and resource criteria for an institutionalized person.

Effective February 20, 2017

1. This section provides an overview of the income and resource eligibility rules for a person who lives in an institutional setting.
2. To determine income eligibility for an SSI-related long-term care (LTC) applicant under the categorically needy (CN) program, the agency or its designee:
   1. Determines available income under WAC 182-513-1325 and 182-513-1330;
   2. Excludes income under WAC 182-513-1340; and
   3. Compares remaining available income to the special income level (SIL) defined under WAC 182-513-1100. A person's available income must be equal to or less than the SIL to be eligible for CN coverage.
3. To determine income eligibility for an SSI-related LTC client under the medically needy (MN) program, the agency or its designee follows the income standards and eligibility rules under WAC 182-513-1395.
4. To be resource eligible under the SSI-related LTC CN or MN program, the person must:
   1. Meet the resource eligibility requirements under WAC 182-513-1350;
   2. Not have a penalty period of ineligibility due to a transfer of assets under WAC 182-513-1363;
   3. Disclose to the state any interest the person or the person's spouse has in an annuity, which must meet the annuity requirements under chapter 182-516 WAC.
5. A resident of eastern or western state hospital is eligible for medicaid if the person:
   1. Has attained institutional status under WAC 182-513-1320; and
   2. Is under age twenty-one; or
   3. Applies for or receives inpatient psychiatric treatment in the month of the person's twenty-first birthday that will likely continue through the person's twenty-first birthday, and can receive coverage until:
      1. The facility discharges the person; or
      2. The end of the month in which the person turns age twenty-two, whichever occurs first; or(d) Is at least age sixty-five.
6. To determine long-term care CN or MN income eligibility for a person eligible under a MAGI-based program, the agency or its designee follows the rules under chapter 182-514 WAC.
7. There is no asset test for MAGI-based LTC programs under WAC 182-514-0245.
8. The agency or its designee determines a person's total responsibility to pay toward the cost of care for LTC services as follows:
   1. For an SSI-related person residing in a medical institution, see WAC 182-513-1380;
   2. For an SSI-related person on a home and community based waiver, see chapter 182-515 WAC.

WAC 182-513-1318 Income and resource criteria for home and community based (HCB) waiver programs and hospice.

Effective February 20, 2017

1. This section provides an overview of the income and resource eligibility rules for a person to be eligible for a categorically needy (CN) home and community based (HCB) waiver program under chapter 182-515 WAC or the hospice program under WAC 182-513-1240 and 182-513-1245.
2. To determine income eligibility for an SSI-related long-term care (LTC) HCB waiver, the agency or its designee:
   1. Determines income available under WAC 182-513-1325 and 182-513-1330;
   2. Excludes income under WAC 182-513-1340;
   3. Compares remaining gross nonexcluded income to:
      1. The special income level (SIL) defined under WAC 182-513-1100; or
      2. For HCB service programs authorized by the aging and long-term supports administration (ALTSA), a higher standard is determined following the rules under WAC 182-515-1508 if a client's income is above the SIL but net income is below the medically needy income level (MNIL).
3. A person who receives MAGI-based coverage is not eligible for HCB waiver services unless found eligible based on program rules in chapter 182-515 WAC.
4. To be resource eligible under the HCB waiver program, the person must:
   1. Meet the resource eligibility requirements and standards under WAC 182-513-1350;
   2. Not be in a period of ineligibility due to a transfer of asset penalty under WAC 182-513-1363;
   3. Disclose to the state any interest the person or that person's spouse has in an annuity and meet the annuity requirements under chapter 182-516 WAC.
5. The agency or its designee determines a person's responsibility to pay toward the cost of care for LTC services as follows:
   1. For people receiving HCS HCB waiver services, see WAC 182-515-1509;
   2. For people receiving DDA HCB waiver services, see WAC 182-515-1514.
6. To be eligible for the CN hospice program, see WAC 182-513-1240.
7. To be eligible for the MN hospice program in a medical institution, see WAC 182-513-1245.

WAC 182-513-1319 State-funded programs for noncitizens who are not eligible for a federally funded program.

Effective February 20, 2017

1. This section describes the state-funded programs available to a person who does not meet the citizenship and immigration status criteria under WAC 182-513-1316 for federally funded coverage.
2. If a person meets the eligibility and incapacity criteria of the medical care services (MCS) program under WAC 182-508-0005, the person may receive nursing facility care or state-funded residential services in an alternate living facility (ALF).
3. Noncitizens age nineteen or older may be eligible for the state-funded long-term care services program under WAC 182-507-0125. A person must be preapproved by the aging and long-term support administration (ALTSA) for this program due to enrollment limits.
4. Noncitizens under age nineteen who meet citizenship and immigration status under WAC 182-503-0535 (2)(e) are eligible for:
   1. Nursing facility services if the person meets nursing facility level of care; or
   2. State-funded personal care services if functionally eligible based on a department assessment under chapter 388-106 or 388-845 WAC.

WAC 182-512-0350 SSI-related medical -- Property and contracts excluded as resources.

Effective November 14, 2019.

1. The agency excludes the following resources when determining eligibility for SSI-related medical assistance:
   1. A client's household goods and personal effects;
   2. One home (which can be any shelter), including the land on which the dwelling is located, and all contiguous property and related out-buildings in which the client has ownership interest for long-term care programs, see WAC 182-513-1350 for home equity limits, when:
      1. The client uses the home as a primary residence;
      2. The client's spouse lives in the home;
      3. The client does not currently live in the home, but the client or the client's representative has stated the client intends to return to the home; or
      4. A relative, who is financially or medically dependent on the client, lives in the home and either the dependency is documented or a written statement of dependency is provided by the client, the client's authorized representative, or by the client's dependent relative.
   3. The value of ownership interest in jointly owned real property is an excluded resource for as long as sale of the property would cause undue hardship to a co-owner due to loss of housing. Undue hardship would result if the co-owner:
      1. Uses the property as the client's principal place of residence;
      2. Would have to move if the property were sold; and
      3. Has no other readily available housing.
2. Proceeds from the sale of an interest described in subsection (1)(b) of this section, are excluded as a resource if the client uses the proceeds to purchase another home by the end of the third month after receiving the proceeds from the sale.
3. An installment contract from the sale of the home described in subsection (1)(b) above is not a resource as long as the client plans to use the entire down payment and the entire principal portion of a given installment payment to buy another excluded home, and does so within three months after the month of receiving such down payment or installment payment.
4. The value of sales contracts is excluded when the:
   1. Current market value of the contract is zero;
   2. Contract cannot be sold; or
   3. Current market value of the sales contract combined with other resources does not exceed the resource limits.
5. Sales contracts executed before December 1, 1993, are excluded resources as long as they are not transferred to someone other than a spouse.
6. A sales contract for the sale of the client's principal place of residence executed between December 1, 1993, and May 31, 2004, is an excluded resource unless it has been transferred to someone other than a spouse and it:
   1. Provides interest income within the prevailing interest rate at the time of the sale;
   2. Requires the repayment of a principal amount equal to the fair market value of the property; and
   3. The term of the contract does not exceed thirty years.
7. A sales contract executed on or after June 1, 2004, on a home that was the principal place of residence for the client at the time of institutionalization is an excluded resource as long as it is not transferred to someone other than a spouse and it:
   1. Provides interest income within the prevailing interest rate at the time of the sale;
   2. Requires the repayment of a principal amount equal to the fair market value of the property within the anticipated life expectancy of the client; and
   3. The term of the contract does not exceed thirty years.
8. Payments received on sales contracts of the home described in subsection (1)(b) of this section are treated as follows:
   1. The interest portion of the payment is treated as unearned income in the month of receipt of the payment;
   2. The principal portion of the payment is treated as an excluded resource if reinvested in the purchase of a new home within three months after the month of receipt;
   3. If the principal portion of the payment is not reinvested in the purchase of a new home within three months after the month of receipt, that portion of the payment is a liquid resource as of the date of receipt.
9. Payments received on sales contracts described in subsection (4) of this section are treated as follows:
   1. The principal portion of the payment on the contract is treated as a resource and counted toward the resource limit to the extent retained at the first moment of the month following the month of receipt of the payment; and
   2. The interest portion is treated as unearned income the month of receipt of the payment.
10. For sales contracts that meet the criteria in subsection (5), (6), or (7) of this section but do not meet the criteria in subsection (3) or (4) of this section, both the principal and interest portions of the payment are treated as unearned income in the month of receipt.
11. Property essential to self-support (PESS) is excluded as a resource within certain limits. There are three categories of PESS:
    1. Real and personal property used in a trade or business:
       1. That is a resource defined under WAC 182-512-0200;
       2. That is in current use as described under the Social Security Administration's Program Operations Manual System (POMS) SI 01130.504; and
       3. Where the trade or business is a sole proprietorship or simple partnership.
    2. Nonbusiness income-producing property (i.e., property not used in a trade or business), such as:
       1. Houses or apartments for rent; and
       2. Land, other than home property.
    3. Property used to produce goods or services essential to a client's daily activities, such as land used to produce vegetables or livestock, which is used only for personal consumption in the client's household. This includes personal property necessary to perform daily functions including vehicles such as boats for subsistence fishing and garden tractors for subsistence farming, but does not include other vehicles such as those that qualify as automobiles (e.g., cars, trucks).
12. The agency excludes a client's real and personal property used in a trade or business, described under subsection (11)(a) of this section, regardless of value as long as it is in current use (as described under POMS SI 01130.504) in the trade or business and remains used in the trade or business.
13. The agency excludes up to $6,000 of a client's equity in nonbusiness income-producing property, described under subsection (11)(b) of this section, if it produces a net annual income to the client of at least six percent of the excluded equity.
    1. If a client's equity in the property is over $6,000, only the amount over $6,000 is counted toward the resource limit, as long as the net annual income requirement of six percent is met on the excluded equity.
    2. If the six percent requirement is not met due to circumstances beyond the client's control (e.g., illness), and there is a reasonable expectation that the activities will again meet the six percent rule, the same exclusions as in subsection (13)(a) of this section apply.
    3. If a client has more than one piece of real property in this category, each is independently evaluated to see if it meets the six percent return, and the total equities of all those properties are added to see if the total is over $6,000. If the total is over the $6,000 limit, the amount exceeding the limit is counted toward the resource limit.
    4. The equity in each property that does not meet the six percent annual net income limit is counted toward the resource limit, with the exception of property that represents the authority granted by a governmental agency to engage in an income-producing activity if it is:
       1. Used in a trade or business or nonbusiness income-producing activity; or
       2. Not used due to circumstances beyond the client's control (e.g., illness), and there is a reasonable expectation that the use will resume.
14. Property used to produce goods or services essential to a client's daily activities is excluded if the client's equity in the property does not exceed $6,000.
15. Personal property used by a client as an employee for work is not counted toward the resource limit, regardless of value, while in current use (as described under POMS SI 01130.504), or if the required use for work is reasonably expected to resume.
16. Interests in trust or in restricted Indian land owned by a client who is of Indian descent from a federally recognized Indian tribe or held by the spouse or widow/er of that client, is not counted toward the resource limit if permission of the other people, the tribe, or an agency of the federal government must be received in order to dispose of the land.
17. Receipt of money by a member of a federally recognized tribe from exercising federally protected rights or extraction of excluded resources, such as fishing, shell-fishing, or selling timber from protected land, is considered conversion of an excluded resource during the month of receipt. Any amount remaining from the conversion of this excluded resource on the first of the month after the month of receipt will remain excluded if it is used to purchase another excluded resource. Any amount remaining in the form of a countable resource (such as in a checking or savings account) on the first of the month after receipt, will be added to other countable resources for eligibility determinations.

WAC 182-512-0400 SSI-related medical -- Vehicles excluded as resources.

Effective February 20, 2017.

1. For SSI-related medical programs, a vehicle is defined as anything used for transportation. In addition to cars and trucks, a vehicle can include boats, snowmobiles, and animal-drawn vehicles.
2. One vehicle is excluded regardless of its value, if it is used to provide transportation for the SSI-related person or a member of the person's household.
3. A vehicle used as the person's primary residence is excluded as the home, and does not count as the one excluded vehicle under subsection (2) of this section.

WAC 182-512-0450 SSI-related medical -- Life insurance excluded as a resource.

Effective April 14, 2014.

1. The agency excludes life insurance policies that do not have or cannot accrue a cash surrender value (CSV) in determining whether owned policies exceed the life insurance exclusion limits for resources and in determining burial fund exclusion limits.
2. Policies owned by each spouse are evaluated and counted separately.
3. If the total face value of all policies with a CSV potential that a person owns on the same insured is equal to or less than fifteen hundred dollars, the resource is excluded.
4. If the total face value of all policies with a CSV potential that a person owns on the same insured is more than fifteen hundred dollars, the total CSV of the policies is counted toward the resource limit, unless the person designates such policies as burial funds. If they are designated as burial funds, they must be evaluated under the burial fund exclusion described in WAC 182-512-0500.

WAC 182-512-0500 SSI-related medical -- Burial funds, contracts and spaces excluded as resources.

Effective June 11, 2023.

1. For the purposes of this section, burial funds are funds set aside and clearly designated solely for burial and related expenses, and kept separate from all other resources not intended for burial. These include:
   1. Revocable burial contracts;
   2. Revocable burial trusts; or
   3. Other revocable burial arrangements. The designation is effective the first day of the month in which the person intended the funds to be set aside for burial.
2. Burial funds in a revocable burial contract, burial trust, cash accounts, or other financial instruments with a definite cash value are excluded as resources for the person and their spouse, up to $1,500 each, when set aside solely for burial or cremation and related expenses.
3. Interest earned in burial funds and appreciation in the value of excluded burial arrangements in subsection (2) of this section are excluded from resources and are not counted as income if left to accumulate and become part of the separate burial fund.
4. An irrevocable burial account, burial trust, or other irrevocable burial arrangement, set aside solely for burial and related expenses, is not considered a resource. To be excluded, the amount set aside must be reasonably related to the anticipated death-related expenses.
5. The $1,500 exclusion for burial funds described in subsection (2) of this section is reduced by:
   1. The face value of life insurance with CSV excluded in WAC 182-512-0450; and
   2. Amounts that meet the requirements of subsection (4) of this section.
6. A person's burial funds are no longer excluded when they are mixed with other resources that are not related to burial.
7. When excluded burial funds are spent for other purposes, the spent amount is added to other countable resources and any amount exceeding the resource limit is considered available income on the first of the month it is used. The amount remaining in the burial fund remains excluded.
8. Burial space and accessories for the person and any member of the person's immediate family described in subsection (9) of this section are excluded. Burial space and accessories include:
   1. Conventional gravesites;
   2. Crypts, niches, and mausoleums;
   3. Urns, caskets and other repositories customarily used for the remains of deceased persons;
   4. Necessary and reasonable improvements to the burial space including, but not limited to:
      1. Vaults and burial containers;
      2. Headstones, markers and plaques;
      3. Arrangements for the opening and closing of the gravesite; and
      4. Contracts for care and maintenance of the gravesite.
   5. A burial space purchase agreement that is fully or partially paid, and any accrued interest.
9. Immediate family, for the purposes of subsection (8) of this section includes the person's:
   1. Spouse;
   2. Parents and adoptive parents;
   3. Minor and adult children, including adoptive and stepchildren;
   4. Siblings (brothers and sisters), including adoptive and stepsiblings;
   5. Spouses of any of the above.

None of the family members listed above, need to be dependent on or living with the person, to be considered immediate family members.

WAC 182-512-0550 SSI-related medical — All other excluded resources.

Effective June 4, 2021.

All resources described in this section are excluded resources for SSI-related medical programs. Unless otherwise stated, interest earned on the resource amount is counted as unearned income.

1. Resources necessary for a person who is blind or disabled to fulfill a self-sufficiency plan approved by the agency.
2. Retroactive payments from SSI or old age, survivors, and disability insurance (OASDI), including benefits a person receives under the interim assistance reimbursement agreement with the Social Security Administration, are excluded for nine months following the month of receipt. This exclusion applies to:
   1. Payments received by the person, the person's spouse, or any other person financially responsible for the person;
   2. SSI payments for benefits due for the month(s) before the month of continuing payment;
   3. OASDI payments for benefits due for a month that is two or more months before the month of continuing payment; and
   4. Proceeds from these payments as long as they are held as cash, or in a checking or savings account. The funds may be commingled with other funds, but must remain identifiable from the other funds for this exclusion to apply. This exclusion does not apply once the payments have been converted to any other type of resource.
3. All resources specifically excluded by federal law, such as those described in subsections (4) through (11) of this section as long as such funds are identifiable.
4. Payments made under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.
5. The excluded resources described in WAC 182-512-0770 and other resources of American Indians/Alaska Natives that are excluded by federal law.
6. Restitution payment and any interest earned from this payment to persons of Japanese or Aleut ancestry who were relocated and interned during war time under the Civil Liberties Act of 1988 and the Aleutian and Pribilof Islands Restitution Act.
7. Funds received from the Agent Orange Settlement Fund or any other funds established to settle Agent Orange liability claims.
8. Payments or interest accrued on payments received under the Radiation Exposure Compensation Act received by the injured person, the surviving spouse, children, grandchildren, or grandparents.
9. Payments or interest accrued on payments received under the Energy Employees Occupational Illness Compensation Act of 2000 (EEOICA) received by the injured person, the surviving spouse, children, grandchildren, or grandparents.
10. Payments from:
    1. The Dutch government under the Netherlands' Act on Benefits for Victims of Persecution (WUV).
    2. The Victims of Nazi Persecution Act of 1994 to survivors of the Holocaust.
    3. Susan Walker vs. Bayer Corporation, et al., 96-C-5024 (N.D. Ill.) (May 8, 1997) settlement funds.
    4. Ricky Ray Hemophilia Relief Fund Act of 1998 P.L. 105-369.
11. The unspent social insurance payments received due to wage credits granted under sections 500 through 506 of the Austrian General Social Insurance Act.
12. Tax refunds and earned income tax credit refunds and payments are excluded as resources for twelve months after the month of receipt.
13. Payments from a state administered victim's compensation program for a period of nine calendar months after the month of receipt.
14. Cash or in-kind items received as a settlement for the purpose of repairing or replacing a specific excluded resource are excluded:
    1. For nine months. This includes relocation assistance provided by state or local government.
    2. Up to a maximum of thirty months, when:
       1. The person intends to repair or replace the excluded resource; and
       2. Circumstances beyond the control of the settlement recipient prevented the repair or replacement of the excluded resource within the first or second nine months of receipt of the settlement.
    3. For an indefinite period, if the settlement is from federal relocation assistance.
    4. Permanently, if the settlement is assistance received under the Disaster Relief and Emergency Assistance Act or other assistance provided under a federal statute because of a catastrophe which is declared to be a major disaster by the President of the United States, or is comparable assistance received from a state or local government or from a disaster assistance organization. Interest earned on this assistance is also excluded from resources. Any cash or in-kind items received as a settlement and excluded under this subsection are available resources when not used within the allowable time periods.
15. Insurance proceeds or other assets recovered by a Holocaust survivor.
16. Pension funds owned by an ineligible spouse. Pension funds are defined as funds held in a(n):
    1. Individual retirement account (IRA) as described by the IRS code; or
    2. Work-related pension plan (including plans for self-employed persons, known as Keogh plans).
17. Cash payments received from a medical or social service agency to pay for medical or social services are excluded for one calendar month following the month of receipt.
18. SSA- or division of vocational rehabilitation (DVR)-approved plans for achieving self-support (PASS) accounts, allowing blind or disabled persons to set aside resources necessary for the achievement of the plan's goals, are excluded.
19. Food and nutrition programs with federal involvement. This includes Washington Basic Food, school reduced and free meals and milk programs and WIC.
20. Gifts to, or for the benefit of, a person under eighteen years old who has a life-threatening condition, from an organization described in section 501 (c)(3) of the Internal Revenue Code of 1986 which is exempt from taxation under section 501(a) of that code, as follows:
    1. In-kind gifts that are not converted to cash; or
    2. Cash gifts up to a total of two thousand dollars in a calendar year.
21. Veteran's payments made to, or on behalf of, natural children of Vietnam veterans regardless of their age or marital status, for any disability resulting from spina bifida suffered by these children.
22. The following are among assets that are not resources and as such are neither excluded nor counted:
    1. Home energy assistance/support and maintenance assistance;
    2. Retroactive in-home supportive services payments to ineligible spouses and parents; and
    3. Gifts of domestic travel tickets.
23. Resources accumulated in a separate account, designated by the client, that result from work activity during the client's enrollment in apple health for workers with disabilities (HWD) program under chapter 182-511 WAC.
24. Limited to clients who have been or continue to be subject to participation as defined in WAC 182-513-1100 during the public health emergency (PHE), resources accumulated due to not increasing participation in response to section 6008(b) of the Families First Coronavirus Response Act (FFCRA) are excluded for:
    1. The duration of the PHE; and
    2. A period of twelve months after the PHE ends.
25. Resources listed in the program operations manual system (POMS), not otherwise excluded under this section, are excluded (see SSA POMS Section SI 01130.050 https://secure.ssa.gov/apps10/poms.nsf/lnx/0501130050).

WAC 182-512-0770 SSI-related medical -- American Indian or Alaska Native excluded income and resources.

Effective April 16, 2015.

1. The agency excludes the following types of income from being considered when determining eligibility for Washington apple health (WAH) categorically needy (CN) and medically needy (MN) SSI-related programs for American Indians or Alaska Natives:
   1. Distributions from Alaska Native corporations and settlement trusts;
   2. Distributions from any property held in trust, subject to federal restrictions, located within the most recent boundaries of a prior federal reservation, or otherwise under the supervision of the Secretary of the Interior;
   3. Distributions and payments from rents, leases, rights of way, royalties, usage rights, or natural resource extraction and harvest from:
      1. Rights of ownership or possession in any lands described in (b) of this subsection; or
      2. Federally protected rights regarding off-reservation hunting, fishing, gathering, or usage of natural resources.
   4. Distributions resulting from real property ownership interests related to natural resources and improvements that are:
      1. Located on or near a reservation or within the most recent boundaries of a prior federal reservation; or
      2. Resulting from the exercise of federally protected rights related to such real property ownership interests.
   5. Payments resulting from:
      1. Ownership interests in or usage rights to items that have unique religious, spiritual, traditional, or cultural significance; or
      2. Rights that support subsistence or a traditional lifestyle according to applicable tribal law or custom.
   6. Student financial assistance provided under the Bureau of Indian Affairs education programs; and
   7. Any other applicable income exclusion as provided by federal law, regulation, or rule.
2. The agency excludes the following types of resources from being considered when determining eligibility for WAH-CN and WAH-MN SSI-related programs for American Indians or Alaska Natives:
   1. Property, including real property and improvements, that is:
      1. Held in trust, subject to federal restrictions, or otherwise under the supervision of the Secretary of the Interior; and
      2. Located on a reservation, including any federally recognized Indian tribe's reservation, pueblo, or colony, including:
         1. Former reservations in Oklahoma;
         2. Alaska Native regions established by the Alaska Native Claims Settlement Act; and
         3. Indian allotments on or near a reservation as designated and approved by the Bureau of Indian Affairs of the Department of the Interior.
   2. Property located within the most recent boundaries of a prior federal reservation for any federally recognized tribe not described in (a) of this subsection;
   3. Ownership interests in rents, leases, royalties, or usage rights related to natural resources (including, but not limited to, extraction of natural resources or harvesting of timber, other plants and plant products, animals, fish and shellfish) resulting from the exercise of federally protected rights; and
   4. Ownership interests in or usage rights to items not covered in (a), (b), or (c) of this subsection that have unique religious, spiritual, traditional, or cultural significance or rights that support subsistence or a traditional lifestyle according to applicable tribal law or custom.
3. When determining eligibility for WAH-CN and WAH-MN SSI-related programs for American Indians or Alaska Natives, the agency counts or excludes amounts received by tribal members from exercise of gaming revenues (per capita distributions) that are retained after the month of receipt based on the type of resource in which the money is retained.  If the amounts are retained in a countable resource (for example, cash, checking account, or savings account), the agency treats the amounts as a countable resource.  If the amounts are converted to an excluded resource (for example, personal property like a refrigerator), the agency treats the amounts as excluded resources.

WAC 182-503-0005 Washington apple health -- How to apply.

Effective June 4, 2023

1. You may apply for Washington apple health at any time.
2. For apple health programs for children, pregnant people, parents and caretaker relatives, and adults age 64 and under without medicare, (including people who have a disability or are blind), you may apply:
   1. Online via the Washington Healthplanfinder at www.wahealthplanfinder.org;
   2. By calling the Washington Healthplanfinder customer support center and completing an application by telephone;
   3. By completing the application for health care coverage (HCA 18-001P), and mailing or faxing to Washington Healthplanfinder; or 
   4. At a department of social and health services (DSHS) community services office (CSO).
3. ​If you seek apple health coverage and are age 65 or older, have a disability, are blind, need assistance with medicare costs, or seek coverage of long-term services and supports, you may apply:
   1. Online via Washington Connection at www.WashingtonConnection.org;
   2. By completing the application for aged, blind, disabled/long-term care coverage (HCA 18-005) and mailing or faxing it to DSHS;
   3. By calling the DSHS customer service contact center and completing an application by telephone;
   4. In person at a local DSHS CSO or home and community services (HCS) office; or
   5. As specified in subsection (2) of this section, if you are a child, pregnant, a parent or caretaker relative, or an adult age 64 and under without medicare.
4. You may receive help filing an application.
   1. For households containing people described in subsection (2) of this section:
      1. Call the Washington Healthplanfinder customer support center number listed on the application for health care coverage form (HCA 18-001P); or 
      2. Contact a navigator, health care authority volunteer assistor, or broker.
   2. For people described in subsection (3) of this section who are not applying with a household containing people described in subsection (2) of this section:
      1. Call or visit a local DSHS CSO or HCS office; or 
      2. Call the DSHS community services customer service contact center number listed on the medicaid application form. 
5. To apply for tailored supports for older adults (TSOA), see WAC 182-513-1625.
6. You must apply directly with the service provider for the following programs:
   1. The breast and cervical cancer treatment program under WAC 182-505-0120;
   2. The family planning only programs under chapter 182-532 WAC; and
   3. The kidney disease program under chapter 182-540 WAC.
7. For the confidential pregnant minor program under WAC 182-505-0117 and for minors living independently, you must complete a separate application directly with us (the medicaid agency). More information on how to give us an application may be found at the agency's web site:  www.hca.wa.gov/free-or-low-cost-health-care (search for "teen").
8. As the primary applicant or head of household, you may start an application for apple health by providing your:
   1. Full name;
   2. Date of birth; 
   3. Physical address, and mailing addresses (if different); and
   4. Signature.
9. To complete an application for apple health, you must also give us all of the other information requested on the application.
10. You may have an authorized representative apply on your behalf as described in WAC 182-503-0130.
11. We help you with your application or renewal for apple health in a manner that is accessible to you. We provide equal access (EA) services as described in WAC 182-503-0120 if you:
    1. ​Ask for EA services, you apply for or receive long-term services and supports, or we determine that you would benefit from EA services; or
    2. Have limited-English proficiency as described in WAC 182-503-0110. 

WAC 182-503-0010 Washington apple health -- Who may apply.

Effective January 16, 2020.

1. You may apply for Washington apple health for yourself.
2. You may apply for apple health for another person if you are:
   1. A legal guardian;
   2. An authorized representative (as described in WAC 182-503-0130);
   3. A parent or caretaker relative of a child age eighteen or younger;
   4. A tax filer applying for a tax dependent;
   5. A spouse; or
   6. A person applying for someone who is unable to apply on their own due to a medical condition and who is in need of long-term care services.
3. If you reside in an institution of mental diseases (as defined in WAC 182-500-0050(1)) or a public institution (as defined in WAC 182-500-0050(4)), including a Washington state department of corrections facility, city, tribal, or county jail, or secure community transition facility or total confinement facility (as defined in RCW 71.09.020), you, your representative, or the facility may apply for you to get the apple health coverage for which you are determined eligible.
4. You are automatically enrolled in apple health and do not need to submit an application if you are a:
   1. Supplemental security income (SSI) recipient;
   2. Person deemed to be an SSI recipient under 1619(b) of the SSA;
   3. Newborn as described in WAC 182-505-0210; or
   4. Child in foster care placement as described in WAC 182-505-0211.
5. You are the primary applicant on an application if you complete and sign the application on behalf of your household.
6. If you are an SSI recipient, then you, your authorized representative as defined in WAC 182-500-0010, or another person applying on your behalf as described in subsection (2) of this section, must turn in a signed application to apply for long-term care services as described in WAC 182-513-1315.

WAC 182-503-0040 Washington apple health -- Interview requirements.

Effective July 25, 2013

1. An individual applying for Washington apple health (WAH) (as defined in WAC 182-500-0120) is not required to have an in-person interview to determine eligibility.
2. The agency or its designee may contact an individual by phone or in writing to gather any additional information that is needed to make an eligibility determination.
3. A phone or in-person interview is required to determine initial financial eligibility for WAH long-term care services.
4. The interview requirement described in subsection (3) of this section may be waived if the applicant is unable to comply:
   1. Due to his or her medical condition; or
   2. Because the applicant does not have a family member or another individual that is able to conduct the interview on his or her behalf.

WAC 182-503-0060 Washington apple health -- Application processing times.

Effective August 8, 2021

1. We process applications for Washington apple health medicaid within forty-five calendar days, with the following exceptions:
   1. If you are pregnant, we process your application within fifteen calendar days;
   2. If you are applying for a program that requires a disability decision, we process your application within sixty calendar days; or
   3. The modified adjusted gross income (MAGI)-based apple health application process using Washington Healthplanfinder may provide faster or real-time determination of eligibility for medicaid.
2. For calculating time limits, "day one" is the day we get an application from you that includes at least the information described in WAC 182-503-0005(8). If you give us your paper application during business hours, "day one" is the day you give us your application. If you give us your paper application outside of business hours, "day one" is the next business day. If you experience technical difficulties while attempting to give us your application in Washington Healthplanfinder, "day one" is the day we are able to determine, based on the evidence available, that you first tried to submit an application that included at least the information described in WAC 182-503-0005(8).
3. We determine eligibility as quickly as possible and respond promptly to applications and information received. We do not delay a decision by using the time limits in this section as a waiting period.
4. If we need more information to decide if you can get apple health coverage, we will send you a letter within twenty calendar days of your initial application that:
   1. Follows the rules in chapter 182-518 WAC;
   2. States the additional information we need; and
   3. Allows at least ten calendar days to provide it. We will allow you more time if you ask for more time or need an accommodation due to disability or limited-English proficiency.
5. Good cause for a delay in processing the application exists when we acted as promptly as possible but:
   1. The delay was the result of an emergency beyond our control;
   2. The delay was the result of needing more information or documents that could not be readily obtained;
   3. You did not give us the information within the time frame specified in subsection (1) of this section.
6. Good cause for a delay in processing the application does NOT exist when:
   1. We caused the delay in processing by:
      1. Failing to ask you for information timely; or
      2. Failing to act promptly on requested information when you provided it timely; or
   2. We did not document the good cause reason before missing a time frame specified in subsection (1) of this section. 

WAC 182-503-0070 Washington apple health (WAH)-- When coverage begins.

Effective August 29, 2014.

1. Your Washington apple health (WAH) coverage starts on the first day of the month you applied for and we decided you are eligible to receive coverage, unless one of the exceptions in subsection (4) of this section applies to you.
2. Sometimes we can start your coverage up to three months before the month you applied (see WAC 182-504-0005).
3. If you are confined or incarcerated as described in WAC 182-503-0010, your coverage cannot start before the day you are discharged, except when:
   1. You are hospitalized during your confinement; and
   2. The hospital requires you to stay overnight.
4. Your WAH coverage may not begin on the first day of the month if:
   1. Subsection (3) of this section applies to you. In that case, your coverage would start on the first day of your hospital stay;
   2. You must meet a medically needy spenddown liability (see WAC 182-519-0110). In that case, your coverage would start on the day your spenddown is met; or
   3. You are eligible under the WAH alien emergency medical program (see WAC 182-507-0115). In that case, your coverage would start on the day your emergent hospital stay begins.
5. For long-term care, the date your services start is described in WAC 388-106-0045.

WAC 182-503-0080 Washington apple health -- Application denials and withdrawals.

Effective November 3, 2019. 

1. We follow the rules about notices and letters in chapter 182-518 WAC. We follow the rules about timelines in WAC 182-503-0060.
2. We deny your application for apple health coverage when:
   1. You tell us either orally or in writing to withdraw your request for coverage; or
   2. Based on all information we have received from you and other sources within the time frames stated in WAC 182-503-0060, including any extra time given at your request or to accommodate a disability or limited-English proficiency:
      1. We are unable to determine that you are eligible; or
      2. We determine that you are not eligible.
   3. You are subject to asset verification and do not provide authorization as described in WAC 182-503-0055.
3. We send you a written notice explaining why we denied your application (per chapter 182-518 WAC).
4. We reconsider our decision to deny your apple health coverage without a new application from you when:
   1. We receive the information that we need to decide if you are eligible within thirty days of the date on the denial notice;
   2. You give us authorization to verify your assets as described in WAC 182-503-0055 within thirty days of the date on the denial notice;
   3. You request a hearing within ninety days of the date on the denial letter and an administrative law judge (ALJ) or HCA review judge decides our denial was wrong (per chapter 182-526 WAC).
5. If you disagree with our decision, you can ask for a hearing. If we denied your application because we do not have enough information, the ALJ will consider the information we already have and any more information you give us. The ALJ does not consider the previous absence of information or failure to respond in determining if you are eligible.