Denials

Revised date
Purpose statement

To explain what the agency considers when denying an application.

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

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. 

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

If the applicant provides only part of the information we need per the timelines in WAC 182-503-0060, take the following actions:

  1. Review the case to see if we can determine eligibility for each program based on what we have received; and
  2. Send the person one of the following letters advising of our reconsideration decision for each program:
    1. An approval letter if we can determine that the person is eligible;
    2. A denial letter if we determine the person is not eligible for the original reason or for a different reason.

Note: When partial information is submitted during a reconsideration period, do not pend for additional information. If the applicant is not eligible based on the information provided, the original denial still stands.

Example: We request verification of income and residency due by 5/15/19. This is not provided, and we send a denial letter on 5/20/19. Applicant then provides the residency and income verification on 5/30/19. This is within 30 days of the denial, and is sufficient to determine eligibility. We approve coverage from the appropriate date.

Example: Same as above, but the applicant provides only the income verification. This information shows the person to be over the program’s income standard. We send a new denial letter to the person advising of the change in denial reason.

Example: Same as above, but the applicant provides only the residency verification. We cannot determine eligibility without the income information. We send a letter to the person advising that we received the partial information, but the denial from 5/20/19 stands as we still do not have the income verification we require.

ACES procedures

For ACES processing details, visit the ACES Information Center in ACES online.

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