WAC 182-505-0115 Washington apple health -- Eligibility for pregnancy and after-pregnancy coverage.

Effective June 24, 2022.

1. A pregnant person is eligible for Washington apple health pregnancy coverage if the person:
   1. Meets citizenship or immigration status under WAC 182-503-0535;
   2. Meets Social Security number requirements under WAC 182-503-0115;
   3. Meets Washington state residency requirements under WAC 182-503-0520 and 182-503-0525; and
   4. Has countable income at or below the limit described in:
      1. WAC 182-505-0100 to be eligible for categorically needy (CN) coverage; or
      2. WAC 182-505-0100 to be eligible for medically needy (MN) coverage. MN coverage begins when the pregnant person meets any required spenddown liability as described in WAC 182-519-0110.
2. A noncitizen pregnant person who does not meet the requirements in subsection (1)(a) or (b) of this section is eligible for apple health pregnancy coverage if they meet countable income standards for CN or MN coverage as described in subsection (1)(d) of this section.
3. The assignment of medical support rights as described in WAC 182-503-0540 does not apply to pregnant people.
4. A person who was eligible for and covered under any CN or MN scope of coverage apple health program on the last day of pregnancy remains continuously eligible for after-pregnancy coverage for 12 months, beginning the month after their pregnancy ends. This includes people who meet an MN spenddown liability with expenses incurred no later than the date the pregnancy ends.
5. Pregnancy coverage has CN scope of care for all people except those enrolled through the MN program who have MN scope of care. A person's after-pregnancy coverage has the same scope of coverage as their pregnancy coverage.
6. A person who does not meet the requirements in subsection (4) of this section may qualify for after-pregnancy coverage if they:
   1. Apply for and meet all requirements of the apple health pregnancy coverage program other than pregnancy; and
   2. Apply any time during their 12-month postpartum period to receive ongoing medical coverage until the end of the 12th month after their pregnancy ends.

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.