Residency

Revised date
Purpose statement

Most Apple Health programs are limited to Washington residents. This chapter explains how the agency determines who meets the residency requirement.

WAC 182-503-0520 Washington apple health -- Residency requirements -- Persons who are not residing in an institution.

WAC 182-503-0520 Washington apple health -- Residency requirements -- Persons who are not residing in an institution.

Effective August 29, 2014.

  1. A resident is a person (including an emancipated person under age eighteen and a married person under age eighteen who is capable of indicating intent) who currently lives in Washington and:
    1. Intends to reside here, including persons without a fixed address; or
    2. Entered the state looking for a job; or
    3. Entered the state with a job commitment.
  2. A person does not need to live in the state for a specific period of time prior to meeting the requirements in subsection (1) of this section before being considered a resident.
  3. A child under age eighteen who is not covered by subsection (1) of this section, is a resident if:
    1. The child lives in the state, with or without a fixed address, including with a custodial parent or caretaker; or
    2. The child's parent or caretaker is a resident as defined in subsection (1) of this section.
  4. A resident applying for or receiving health care coverage can temporarily be out of the state for more than one month without their health care coverage being denied or terminated, if the person:
    1. Intends to return to the state once the purpose of his or her absence has been accomplished and provides adequate information of this intent after a request by the agency or its designee; and
    2. Has not been determined eligible for medicaid or state-funded health care coverage in another state (other than coverage in another state for incidental or emergency health care).
  5. A person who enters Washington state only for health care is not a resident and is not eligible for any medical program. The only exception is for a person who moves from another state directly into an institution in Washington state. Residency rules for institutionalized persons are described in WAC 182-503-0525.
  6. A person of any age who receives a state supplemental payment (SSP) is considered a resident of the state that is making the payment.
  7. A person who receives federal payments for foster or adoption assistance is considered a resident of the state where the person physically resides even if:
    1. The person does not live in the state that is making the foster or adoption assistance payment; or
    2. The person does not live in the state where the adoption agreement was entered.
  8. In a dispute between states, the state of residence is the state in which the person is physically located.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-503-0525 Washington apple health -- Residency requirements for an institutionalized person.

WAC 182-503-0525 Washington apple health -- Residency requirements for an institutionalized person.

Effective August 29, 2014.

  1. An institutionalized person is a person who resides in an institution as defined in WAC 182-500-0050. The term "person" used in this section means an "institutionalized person" unless otherwise indicated. It does not include persons who receive services under a home and community-based waiver program. When a state is making a placement for a person in another state, the term institution also includes foster care homes, licensed as described in 45 C.F.R. 1355.20.
  2. The agency must determine whether a person is capable of indicating their intent to reside in Washington state when deciding whether that person is a resident of the state. The agency determines that persons who meet the following criteria are deemed incapable of indicating intent to reside in the state:
    1. The person is judged legally incompetent by a court of law;
    2. A physician, psychologist or licensed medical professional in the field of intellectual disabilities has determined that the person is incapable of indicating intent; or
    3. The person is incapable of declaring intent due to a documented medical condition.
  3. When a person is placed in an out-of-state institution by the agency, its designee or by a department of social and health services-contracted agency, the state arranging the placement is considered the person's state of residence, unless the person is capable of expressing intent and:
    1. Indicates a desire to change his or her state of residence; or
    2. Asks the current state of residence for help in relocating. This may include assistance in locating an institutional placement in the new state of residence.
  4. If another state has not authorized the placement in the institution, as described in subsection (3) of this section, the agency or its designee uses one of the following criteria to determine the state of residence for a person who is age twenty or younger:
    1. The state of residence is the state where the parent or legal guardian is a resident at the time of the placement in the institution. To determine a parent's or legal guardian's place of residence, follow rules described in WAC 182-503-0520 for a noninstitutionalized person.
    2. The state of residence is the state where the parent or legal guardian currently is a resident if the person resides in an institution in that state.
    3. If the parents of the person are separated and live in different states, the state of residence is that of the parent filing the application.
    4. If the parental rights are terminated and the person has a legal guardian, the state of residence is where the legal guardian is a resident.
    5. If the person has both a guardian of the estate and a guardian of the person, the state of residence is where the guardian of the person is a resident, unless the state has laws which delegate guardianship to a state official or agency for persons who are admitted to state institutions. In that case, the state of residence for the person is the state where the institution is located (unless another state has authorized the placement).
    6. If the person has been abandoned by the parents or legal guardian, and an application is filed on their behalf by another party, the state of residence is the state where the person is institutionalized. The term abandoned also includes situations where the parents or legal guardian are deceased.
  5. A person age twenty-one or older that is capable of indicating intent is considered a resident of the state where he or she is living and intends to reside.
  6. A person age twenty-one or older who became incapable of indicating intent at age twenty-one or older is considered a resident of the state where the person is physically residing, unless the person has been placed in the institution by another state.
  7. A person age twenty-one or older who became incapable of indicating intent before the age of twenty-one is considered a resident of the state where the parents or legal guardian were residents at the time of the placement in the institution.
  8. If a noninstitutionalized person moves directly from another state to an institution in Washington state, it is not necessary for the person to establish residency in Washington state prior to entering the facility. The person is considered a resident if he or she intends to reside in the state unless the placement was made by the other state.
  9. A person of any age who receives a state supplemental payment (SSP) is considered a resident of the state that is making the payment.
  10. In a dispute between states, the state of residence is the state in which the person is physically located. 

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying information

A resident is someone who currently lives in Washington state AND:

  1. Intends to continue living in Washington permanently or for an open-ended period of time; OR
  2. Entered the state looking for a job; OR
  3. Entered the state with a job commitment.

Residency depends on a person's intent or purpose in coming to Washington state at the time of application and renewal.

An individual is not considered a resident of Washington if they entered the state only for medical care. The only exception is for someone who is moving directly to a nursing facility in Washington.

Migrant/seasonal farmworkers working in Washington and maintaining a residence in another state are considered Washington state residents. The individual meets Washington's residency requirements because they currently live in Washington and entered the state looking for a job or with a job commitment.

The Residency flowchart provides more information about how to determine an individual's residency status.

Individuals who are temporarily in Washington

Individuals visiting Washington are not considered residents of Washington. Examples of those who are NOT residents include:

  1. An individual just moved to Washington without a job commitment, is not looking for work and does not intend to stay.
  2. An individual is attending a college in Washington state from out of state and intends to return home after completing school.
  3. An individual is a temporary visa holder. Generally, a temporary visa holder is not a Washington State resident, unless they:
    1. Intend to reside in Washington after the visa expires,
    2. Entered the state with a job commitment (most typical with business visas), or
    3. Entered the state looking for a job.

Business visa holders who enter the state with a job commitment meet residency requirements because the visa holder has a job commitment, even if the visa is temporary.

Tourist/visitor visa holders may meet residency requirements if they declare intent to continue residing in Washington after the visa expires. 

Residency of minors for Washington Apple Health

A minor (under age 18) is a resident of the state in which they are living (other than on a temporary basis) or the state in which the parent or caretaker is looking for or has a job. If a minor is living in Washington, the minor is considered a resident unless the parent/guardian or the minor declares that they plan to leave the state.

For a minor who is able to declare intent, such as minors aged 13 and older, the minor can attest to their residency.

For a minor unable to declare intent, the minor’s residency follows the minor’s parent or guardian’s residency status.

Temporarily out of state

An individual may be temporarily out of state. There is no specified period before the individual loses Washington State residency. However, they must demonstrate intent to continue to reside in Washington after their purpose for leaving the state is completed. 

Special exception for nursing facilities

Individuals may come to Washington solely for medical care in a nursing facility may be considered residents of Washington. They can even maintain a residence in another state if they hope to return. However, if a person is placed in a nursing facility by another state, they are considered a resident of the state that placed them.

Apple Health eligibility continues for a Washington resident who is absent temporarily and will return. For example, an individual who goes from Washington State to a border facility for rehabilitation for 4 to 6 weeks and will return to Washington is considered a resident.

Receipt of Medicaid coverage in another state

When an individual moves to Washington state, they may be determined eligible for Washington Medicaid before the Medicaid is closed in another state. The individual must contact the other state to report the move and close out-of-state Medicaid coverage.

Access to care outside of Washington for active recipients

Active recipients who are temporarily out of state who need care should contact their managed care plan or Health Care Authority’s Medical Assistance Customer Service Center (MACSC) at 1-800-562-3022.

Examples

Example - Migrant farm worker
A person lives in Arizona but comes to Washington State with his family for a 3-4 month crop season. They plan to return to Arizona when the season is over. Because they entered the state with a job commitment, they are residents.

Example - Temporarily out of state to care for relative
A person receiving Apple Health coverage must stay with her ill grandmother in another state. She expects to be gone for several months. She is still a resident of Washington.

Example - Temporarily out of state for job
A person leaves Washington to take a temporary job in another state. She is planning to return to live with her parents when the job ends, which may be in about 3 to 6 months. She will be renting an apartment in the other state. She is still a resident of Washington State because she plans to return to Washington after her temporary job ends.

Example - Apple Health coverage for SSI recipients who move to Washington
When an SSI recipient moves to Washington and continues to receive their state supplemental payment (SSP) benefit from the other state, the state paying the benefit is considered to be the person’s state of residence. However, if the other state refuses to provide medical services in Washington, then the person can be approved for Apple Health. The person needs to contact the Social Security Administration at 1-800-772-1213 to change their address.

Example - Residency of child separate from residency of parents
Mom and dad are in the US on student visas, attending college. They have a teenage child who is in the country under her parents’ student visas. The child moves out of the parents' house and in with a friend and applies for Apple Health. The parents intend to return to their home country when they finish with school, but the child says that she is staying. Even though the parents do not intend to live in Washington, the child does intend to stay and is considered a resident.

Example - Applicant temporarily in Washington on student visa
Dad and mom are in the US on student visas, attending college, and have one US-born child, age 2. The parents apply for Apple Health. When asked, they declare they intend to return to their home country with their child when they finish school. Since the parents do not intend to live in Washington indefinitely, the parents and child are not considered residents.

Example - Applicant who entered Washington for medical care
A family came to Washington State from Montana for cancer treatment at a local children’s hospital and plans to return as soon as their child completes treatment. The family will be here for a minimum of six months and could possibly be longer depending on the progress the child makes from the treatment. Since the family entered the state for medical care and they plan to return home, they are not considered residents.

Example – Applicant visiting the US gives birth
A woman enters the US from overseas with a tourist visa. She gives birth to a child and both return home after a two-week stay. Neither the mother nor child are considered residents.

Worker responsibilities

A person’s residency may be questionable when other information does not match their attestation. For example, a person lists his address in another state, country, or housing at facilities for hospitalized patients. Determine whether they are residents by asking questions, such as:

  1. Temporary visa holders: what has changed in your circumstances to change your intent that you filed with your current visa?
    No verification is needed -- document the intent and determine if the intent is reasonable.
  2. Other questionable circumstances: Is the person keeping a home, property, or residence in the state/country that person left?
    1. If not, the person meets residency requirements with the declared intent.
    2. If yes, did the person enter Washington State with a job commitment or looking for a job? If yes, the person meets residency requirements.
    3. If the person is still maintaining his or her residence and the explanation is not reasonable, the person is not a Washington resident.

ACES procedures

For Classic Medicaid programs, see the Client Details screen in ACES 3G.

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