WAC 182-521-0200 Coverage after the public health emergency (PHE) ends.

Effective September 1, 2023

1. In response to the coronavirus (COVID-19) public health emergency (PHE) declared by the Secretary of the U.S. Department of Health and Human Services (HHS) and in response to Section 6008 of the Families First Coronavirus Response Act (Public Law 116-127), the medicaid agency:
   1. Continues your Washington apple health coverage unless your eligibility determination was made incorrectly, or you:
      1. Are deceased;
      2. Move out-of-state;
      3. Request termination of your coverage; or
      4. No longer meet citizenship or immigration requirements as described in WAC 182-503-0535.
   2. Waives and suspends the collection of premiums through the last day of the calendar quarter in which the PHE ends for:
      1. Apple health for kids with premiums (CHIP), as described in WAC 182-505-0215; and
      2. Health care for workers with disabilities (HWD) program, as described in WAC 182-511-1250.
   3. As required by Social Security Administration guidance, excludes permanently from resources federal, state, and local pandemic-related disaster assistance that has been retained.
   4. Excludes, for the duration of the PHE and a period of 12 months after the PHE ends, any resources not permanently excluded under (c) of this subsection and which accumulated from participation that did not increase in response to Section 6008(b) of the Families First Coronavirus Response Act (FFCRA), as described in WAC 182-512-0550 (24).
2. Based on Section 5131 of the Consolidated Appropriations Act, 2023 (Public Law 117-328), effective April 1, 2023, if you receive continued apple health due to the suspension of certain eligibility rules during the PHE, the agency will, after April 1, 2023:
   1. Redetermine your eligibility for ongoing coverage using the process and timelines described in WAC 182-504-0035 and notify you as required under chapter 182-518 WAC. You may update any information needed to complete a redetermination of eligibility, as described in WAC 182-504-0035.
      1. If you are no longer eligible for apple health, or you do not respond to our renewal request notice, you will receive at least 10 calendar days' advance notice before your coverage is terminated, as described in WAC 182-518-0025.
      2. If your modified adjusted gross income (MAGI)-based coverage ends because you did not renew it, you have 90 calendar days from the termination date to complete your renewal. If you are still eligible for apple health, your benefits will be restored without a gap in coverage.
      3. If your coverage is terminated, you have a right to an administrative hearing, as described in chapter 182-526 WAC.
   2. Begin collecting premiums for CHIP and HWD clients prospectively, beginning with the month following the quarter in which the PHE ends, based upon reported circumstances, and without collecting arrears. 
   3. Resume eligibility verification based on the factors described in WAC 182-503-0050.

WAC 182-513-1110 Presumptive eligibility (PE) - Long-term services and supports (LTSS) authorized by home and community services (HCS).

Effective January 6, 2024

1. A person may be determined presumptively eligible for long-term services and supports (LTSS) in their own home, as defined in WAC 388-106-0010:
   1. Upon completion of a screening interview; and
   2. When authorized by home and community services (HCS).
2. The screening interview described in subsection (3) of this section may be conducted by either:
   1. A HCS case manager or social worker;
   2. An area agency on aging (AAA) or their subcontractor; or 
   3. A state designated tribal entity.
3. To be presumptively eligible (PE), the person must:
   1. Be determined to meet nursing facility level of care under WAC 388-106-0355 during the screening interview; and
   2. Attest to information that meets the:
      1. Income limits at or below the average monthly state nursing facility rate;
      2. Resource limits defined under WAC 182-513-1350;
      3. Social security requirement under WAC 182-503-0515;
      4. Residency requirement under WAC 182-503-0520; and 
4. The agency or the agency's designee determines how much client responsibility must be paid to the provider for PE home and community-based services authorized by HCS when living at home as outlined in WAC 182-513-1215, 182-515-1507, and 182-515-1509.
5. The client or the client's representative must submit an online application through Washington connection or an HCA 18-005 application for aged, blind, disabled/long-term care coverage to HCS within 10 calendar days of PE determination.
6. The PE period begins on the date the screening interview is completed and:
   1. Ends on the last day of the month following the month of the PE determination if an LTSS application is not completed and submitted within 10 calendar days of PE determination; or
   2. Ends the last day of the month that the final eligibility determination is made if a LTSS application is submitted under subsection (5) of this section within 10 calendar days of PE determination.
7. For application processing times, refer to WAC 182-503-0060.
8. If the applicant is determined not financially eligible for LTSS under WAC 182-513-1315, there is no overpayment for services received during the PE period; however, client responsibility applies as described in WAC 182-513-1215, 182-515-1507, and 182-515-1509. 
9. People who qualify for PE under this section receive categorically needy (CN) medical coverage under WAC 182-501-0060 through the PE period. CN medical coverage begins as described in WAC 182-503-0070 (1).
10. When PE services described in WAC 388-106-1810 and 388-106-1820 are approved or denied, the agency or the agency's designee sends written notice as described in WAC 182-518-0010.
11. A person may receive services under a PE period only once within a consecutive 24-month period.
12. The applicant does not have a right to an administrative hearing on PE decisions under chapter 182-526 WAC.
13. Institutional resource and income standards are found at https://www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply….
14. This section does not apply to medical assistance programs described in WAC 182-507-0125 or 182-508-0005.