WAC 182-504-0015 Washington apple health -- Certification periods for categorically needy programs.

Effective October 25, 2024

1. A certification period is the period of time we determine that you are eligible for a categorically needy (CN) Washington apple health program. Unless otherwise stated in this section, the certification period begins on the first day of the month of application and continues through the end of the last month of the certification period.
2. Newborn coverage begins on the child's date of birth and continues through the end of the month of the child's first birthday.
3. If you are eligible for apple health based on pregnancy, the certification period continues through the last day of the month the pregnancy ends. After-pregnancy coverage begins the first day of the month, following the ends of the pregnancy, and ends the last day of the 12th month from the time after-pregnancy coverage began.
4. If you are newly eligible for apple health coverage and had a pregnancy end within the last 12 months, your certification period for after-pregnancy coverage:
   1. Begins the first day of the month you are eligible; and
   2. Ends the last day of the 12th month following the end of your pregnancy.
5. If you are eligible for the refugee program, the certification period ends at the end of the 12th month following your date of entry to the United States.
6. If you are a child under age six receiving apple health for kids without a premium, your certification period ends the month of your sixth birthday.
7. If you are eligible for newborn coverage, your coverage continues through the last day of the month of your first birthday. Apple health for kids coverage begins the first day of the month after your newborn coverage ends and the certification period ends the last day of the month of your sixth birthday.
8. For all other CN coverage, the certification period is 12 months.
9. If you are a child, eligibility is continuous throughout the certification period regardless of a change in circumstances, unless you:
   1. Turn age 19;
   2. Move out-of-state; or
   3. Die.
10. When you turn 19, the certification period ends after the redetermination process described in WAC 182-504-0125 is completed, even if the 12-month period is not over, unless:
    1. You are receiving inpatient  services (described in WAC 182-514-0230) on the last day of the month you turn 19;
    2. The inpatient stay continues into the following month or months; and
    3. You remain eligible except for turning age 19.
11. A retroactive certification period is described in WAC 182-504-0005.
12. Coverage under premium-based programs included in apple health for kids as described in chapter 182-505 WAC begins no sooner than the month after creditable coverage ends.

WAC 182-504-0020 Certification periods for the noninstitutional medically needy program.

Effective July 11, 2015

1. The certification period for the noninstitutional medically needy (MN) program for clients with countable income equal to or below the medically needy income level (MNIL):
   1. Begins on the first day of the month in which eligibility is established; and
   2. Is approved for twelve calendar months.
2. The certification period for the noninstitutional MN program for clients with countable income above the MNIL:
   1. Begins on the day that spenddown is met; and
   2. Continues through the last day of the final month of the base period as described in WAC 182-519-0110.
3. A retroactive MN certification period may be established for up to three months preceding the month of application.
4. Expenses used to meet the spenddown liability for the current or the retroactive certification periods are the responsibility of the client. The agency is not responsible for paying any expense or portion of an expense which has been used to meet the spenddown liability. See WAC 182-519-0110.
5. A new application must be submitted for each subsequent certification period for which medically needy coverage is requested.

WAC 182-504-0025 Medicare savings program certification periods.

Effective December 1, 2011

Certification periods for the different kinds of Medicare Savings Programs are not all the same. The chart below explains the differences.

WAC 182-504-0005 Washington apple health -- Retroactive certification period.

Effective November 14, 2022.

1. The medicaid agency approves a retroactive Washington apple health (WAH) certification period for the three months immediately before the month of application when an individual:
   1. Requests retroactive WAH on the application, within the certification period following the retroactive period, or before the determination of benefits and any appeal process is final;
   2. Would have been eligible for WAH for any or all of the three months if the individual had applied during the retroactive period; and
   3. The individual received covered medical services as described in WAC 182-501-0060 and 182-501-0065.
2. When an individual is eligible only during the three-month retroactive certification period, that period is the only period of certification, except when:
   1. A pregnant individual is eligible in one of the three months immediately before the month of application, but no earlier than the month of conception. Eligibility continues as described in WAC 182-504-0015 (3) and (4).
   2. An individual who is applying within 12 months of their last pregnancy end date is eligible for after pregnancy coverage in any of the three months immediately before the month of application. Continuous eligibility begins from the earliest month the individual is found eligible as described in WAC 182-504-0015 (3) and (4).
   3. A child is eligible for categorically needy (CN) WAH as described in WAC 182-505-0210 (1) through (5) and (7) in at least one of the three months immediately before the month of application. Eligibility after the retroactive period continues as described in WAC 182-504-0015 (9).
3. An individual applying for the medically needy (MN) spenddown program may be eligible for a retroactive certification period as described in WAC 182-504-0020.
4. An individual applying for a medicare savings program may be eligible for a retroactive certification period as described in WAC 182-504-0025.