Public health emergency and Apple Health

Revised date
Purpose statement

The Consolidated Appropriations Act, 2023 separated the Medicaid continuous enrollment provisions from the PHE allowing state Medicaid agencies to begin normal operations. HCA and DSHS resumed Medicaid terminations April 30th 2023, based on reported changes that created ineligibility or from a non-response to a request for needed verification.

Beginning May 31st, HCA and DSHS resumed Medicaid terminations related to non-receipt of a renewal.

WAC 182-521-0200 provides updates to HCA and DSHS policies regarding treatment of income, renewals, resumption of premiums, accumulated resources, and continuous enrollment.

The following Purpose statement was enacted during the Public Health emergency and is being left in the AH manual as a resource while cases are being redetermined. We anticipate consolidating these sections after April 2024.

In response to a public health or other emergencies beyond the agency’s control, the Health Care Authority (HCA) may invoke the following options via a State Plan Amendment, Disaster State Plan Amendment, waiver, or other federal regulation in the administration of the Medicaid program to implement changes to existing rule(s):

  1. Renewal dates may be extended for Apple Health coverage.
  2. Medically Needy (MN) coverage for individuals may be extended and attestation of medical expenses may be taken to meet spenddown amounts.  
  3.  Attestation of income and resources may be accepted to determine new and continued eligibility for all Apple Health programs. 
  4. HCA may provide additional flexibility for clients when HCA is requesting information to process an application or a change of circumstances, including:
    1. Allowing more time to provide needed verifications;
    2. Allowing use of alternative verifications to verify circumstances; or
    3. Allowing flexibility for self-attestation in some situations including attesting to a disabling condition that could result in eligibility or documenting level of care.
  5. Premiums for the Apple Health for Workers with Disabilities and Apple Health for Kids with Premiums programs may be deferred, suspended, or waived, including past-due premiums.
  6. The treatment of income in the post eligibility process for long-term care may be adjusted in order to benefit clients.
  7. HCA may provide additional flexibility for individuals who file administrative hearing requests including:
    1. Suspending adverse actions resulting from an administrative hearing;
    2. Providing additional time for individuals to request an administrative hearing and to complete the administrative hearings process; and 
    3. Allowing flexibility in requests for continued benefits.
  8. Terminations dates may be suspended or extended.  When a termination is suspended or extended to a later date, HCA will follow existing notice and redetermination procedures before the termination may take effect.
  9. HCA may allow additional use of presumptive eligibility.

Changes to rules apply during the declared emergency period and expire upon termination of the emergency period including any extensions.

All changes to rules shall be applied uniformly.

WAC 182-521-0100 Disregarded income

WAC 182-521-0100 Noncountable income and resources during the COVID-19 public health emergency.

Effective December 1, 2021

  1. This section describes certain types of income and resources received as a result of the COVID-19 public health emergency that the health care authority (agency) does not count as income or resources when determining apple health eligibility. This includes certain unemployment income; any Federal Pandemic Unemployment Compensation (FPUC) or Recovery Rebates authorized under the Coronavirus Aid, Relief, and Economic Security (CARES) Act; and other needs-based and disaster-related benefits authorized as a result of the COVID-19 public health emergency. The noncountable income and resources in this section are in addition to other noncountable income and resources in this title, such as those described in WAC 182-509-0320, 182-512-0860, and 182-513-1340.
  2. For all apple health programs, including both modified adjusted gross income-based (MAGI) and nonmodified adjusted gross income based (non-MAGI) programs, the agency does not count as income for Apple Health determinations of eligibility or cost-sharing calculations any of the following:
    1. Federal pandemic unemployment compensation benefits of six hundred dollars per week issued for the period of March 18, 2020, through July 31, 2020;
    2.  Federal pandemic unemployment compensation benefits of three hundred dollars per week issued for the period of December 26, 2020, through September 6, 2021;
    3. Lost wages assistance unemployment compensation benefits of three hundred dollars per week issued for the period of weeks ending August 1, 2020, through September 6, 2021, due to the federal Disaster Relief Fund authorized for states to offset lost wages due to the COVID-19 pandemic, known as Lost Wage Assistance (LWA);
    4. Payments from the pandemic relief payment program as authorized by Governor Jay Inslee on December 27, 2020;
    5. Pandemic Recovery Rebates (also known as stimulus checks or economic impact payments);
    6. Needs-based and disaster-related benefits from other agencies, organizations, or tribal entities including, but not limited to:
      1. Federal Emergency Management Agency (FEMA) programs, such as FEMA COVID-19 Funeral Assistance;
      2. State programs, such as disaster cash assistance and the Washington immigrant relief fund; and
      3. Local/municipal programs, such as the city of Seattle hospitality workers relief fund and disaster relief fund for immigrants; and
    7. Pandemic-related changes to federal refundable tax credits including, but not limited to, the child tax credit, the earned income tax credit, and the child and dependent tax care credit.
  3. For non-MAGI programs, the agency does not count as income any unemployment compensation received during the public health emergency.
  4. The agency does not count for apple health premium calculations all income not counted for eligibility determinations for apple health programs. The agency waives monthly premiums until the first of the month following the calendar quarter in which the COVID-19 public health emergency ends.
  5. All income the agency does not count for eligibility determinations for non-MAGI programs, the agency also does not count in post eligibility treatment of income (PETI) calculations for long-term services and supports. The agency does not count such income whether it is paid to the community spouse or to the spouse seeking or receiving long-term services and supports. The agency does not count such income when determining the spousal allowance or in any other part of the post-eligibility calculation process.
  6. For non-MAGI programs, the agency does not count as a resource:
    1. The value of property essential for self-support (PESS) described in 20 C.F.R. 416.1222 that is subject to the requirement of producing net annual income of at least six percent of the PESS value during the period of the presidential and secretarial emergency declarations related to the COVID-19 outbreak;
    2. Pandemic recovery rebates and all other assistance described in Social Security Administration guidance; and
    3. Assistance including, but not limited to, the Temporary Expansion of the Child Tax Credit of 2021 that is not counted as income and treated under Social Security Administration guidance as not counted as resources for a period of 12 months after receipt.
  7. The agency reviews cases on an individual basis and does not count as resources any disaster assistance identified as excludable under federal law for an indefinite period.
  8. The agency does not count as income or resources any other payments for pandemic assistance not described in this section to the fullest extent provided for under state or federal law.
  9. Any income received as unemployment compensation not described within this section is otherwise countable and the agency counts it when determining MAGI-based apple health eligibility, unless otherwise specified under state or federal law.
  10. The agency does not terminate an enrollee's eligibility due to changes to an enrollee's income or resources.
  11. These rules are in effect until the later of:
    1. The date the client is receiving any benefits described in this rule; or
    2. The end of the month the Secretary of the U.S. Department of Health and Human Services declares the COVID-19 public health emergency to be over. 

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.

The Federal Pandemic Economic Unemployment Compensation and Recovery Rebates issued by the federal government under the Cares Act is not countable as income for any Medicaid program.  Recovery rebates are exempt as a resource for 12 months.

Other changes to rules during the COVID-19 pandemic include, expansion to coverage under the Alien Emergency rule and the Refugee Medical Assistance rule.

RMA clarifying: The agency is adopting emergency amendments to 182-507-0130, the Refugee medical assistance program, based on a federal waiver that expands the duration of medical assistance benefits during the PHE. The waiver allows receipt of more than 8 months of RMA. 

AEM clarifying: The proposed emergency rule expands the scope of covered services to include COVID-19 testing, assessment, and treatment of conditions that pose a potential threat to public health.

WAC 182-521-0200 Coverage after the public health emergency (PHE) ends

WAC 182-521-0200 Coverage after the public health emergency (PHE) ends.

Effective September 1, 2023

  1. In response to the coronavirus (COVID-19) public health emergency (PHE) declared by the Secretary of the U.S. Department of Health and Human Services (HHS) and in response to Section 6008 of the Families First Coronavirus Response Act (Public Law 116-127), the medicaid agency:
    1. Continues your Washington apple health coverage unless your eligibility determination was made incorrectly, or you:
      1. Are deceased;
      2. Move out-of-state;
      3. Request termination of your coverage; or
      4. No longer meet citizenship or immigration requirements as described in WAC 182-503-0535.
    2. Waives and suspends the collection of premiums through the last day of the calendar quarter in which the PHE ends for:
      1. Apple health for kids with premiums (CHIP), as described in WAC 182-505-0215; and
      2. Health care for workers with disabilities (HWD) program, as described in WAC 182-511-1250.
    3. As required by Social Security Administration guidance, excludes permanently from resources federal, state, and local pandemic-related disaster assistance that has been retained.
    4. Excludes, for the duration of the PHE and a period of 12 months after the PHE ends, any resources not permanently excluded under (c) of this subsection and which accumulated from participation that did not increase in response to Section 6008(b) of the Families First Coronavirus Response Act (FFCRA), as described in WAC 182-512-0550 (24).
  2. Based on Section 5131 of the Consolidated Appropriations Act, 2023 (Public Law 117-328), effective April 1, 2023, if you receive continued apple health due to the suspension of certain eligibility rules during the PHE, the agency will, after April 1, 2023:
    1. Redetermine your eligibility for ongoing coverage using the process and timelines described in WAC 182-504-0035 and notify you as required under chapter 182-518 WAC. You may update any information needed to complete a redetermination of eligibility, as described in WAC 182-504-0035.
      1. If you are no longer eligible for apple health, or you do not respond to our renewal request notice, you will receive at least 10 calendar days' advance notice before your coverage is terminated, as described in WAC 182-518-0025.
      2. If your modified adjusted gross income (MAGI)-based coverage ends because you did not renew it, you have 90 calendar days from the termination date to complete your renewal. If you are still eligible for apple health, your benefits will be restored without a gap in coverage.
      3. If your coverage is terminated, you have a right to an administrative hearing, as described in chapter 182-526 WAC.
    2. Begin collecting premiums for CHIP and HWD clients prospectively, beginning with the month following the quarter in which the PHE ends, based upon reported circumstances, and without collecting arrears. 
    3. Resume eligibility verification based on the factors described in WAC 182-503-0050.

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.

Worker responsibilities

Please follow your administration's specific instructions regarding PHE unwind policies and procedures. PHE unwinding will continue through April 2024.

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