WAC 182-532-510 Family Planning only program - Client eligibility

WAC 182-532-510 Family planning only program—Client eligibility

Effective March 28, 2025

For the purposes of this section, "full-scope coverage" means coverage under either the categorically needy (CN) program, the broadest, most comprehensive scope of health care services covered or the alternative benefits plan (ABP), the same scope of care as CN, applicable to the apple health for adults program.

To be eligible for family planning only services, as defined in WAC 182-532-001, a client must:

1. Provide a valid Social Security number (SSN) or proof of application to receive an SSN, be exempt from the requirement to provide an SSN as provided in WAC 182-503-0515, or meet good cause criteria listed in WAC 182-503-0515(2);
2. Be a Washington state resident, as described under WAC 182-503-0520;
3. Have an income at or below two hundred sixty percent of the federal poverty level, as described under WAC 182-505-0100;
4. Need family planning services; and
5. Have been denied apple health coverage within the last 30 days, unless the applicant:
   1. Has made an informed choice to not apply for full-scope coverage as described in WAC 182-500-0035 and 182-501-0060, including family planning;
   2. Is age 18 or younger and seeking services in confidence;
   3. Is a domestic violence victim who is seeking services in confidence; or
   4. Has an income of 150 percent to 260 percent of the federal poverty level, as described in WAC 182-505-0100.
6. A client is not eligible for family planning only medical if the client is:
   1. Pregnant;
   2. Sterilized;
   3. Covered under another apple health program that includes family planning services; or
   4. Covered by concurrent creditable coverage, as defined in RCW 48.66.020, unless they meet criteria in (1) (e) of this subsection.
7. The agency does not limit the number of times a client may reapply for coverage.