Change of Circumstances - Effect on Medical
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Change of Circumstances - Effect on Medical

Revised April 29, 2008

Purpose:
WAC 388-418-0025Effect of changes on medical program eligibility.

WAC 388-418-0025
WAC 388-418-0025

Effective March 14, 2008

WAC 388-418-0025 Effect of changes on medical program eligibility.

  1. You continue to be eligible for medical assistance until the department determines your ineligibility or eligibility for another medical program.  This applies to you if, during a certification period, you become ineligible for, or are terminated from, or request termination from:

    1. A CN Medicaid program;

    2. A children's healthcare program; or 

    3. Any of the following cash grants:

      1. TANF;

      2. SSI; or

      3. GA-X.  See  WAC 388-434-0005  for changes reported during eligibility review.

  2. If you become ineligible for refugee cash assistance, refugee medical assistance can be continued through the eight month limit, as described in  WAC 388-400-0035(4).

  3. If you receive a TANF cash grant or family medical, you are eligible for a medical extension, as described under WAC 388-523-0100, when your cash grant or family medical program is terminated as a result of:

    1. Earned income; or

    2. Collection of child or spousal support.

  4. A change in income during a certification period does affect eligibility for all medical programs except:

    1. Pregnant women's medical programs;

    2. Children's healthcare programs, except as specified in subsection (5);

    3. The first six months of the medical extension benefits.

  5. For a child receiving benefits under the premium-based children's healthcare programs as described in WAC 388-505-0210 and chapter 388-542 WAC, the department must redetermine eligibility for a nonpremium-based medical program when the family reports:

    1. Family income has decreased to less than two hundred percent Federal Poverty Level (FPL);

    2. The child becomes pregnant;

    3. A change in family size; or

    4. The child receives SSI.

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

 

  1. When a pregnancy ends, regardless of the reason, medical coverage continues through the end of the month containing the sixtieth day from the day pregnancy ends. See PREGNANCY.

  2. A working TANF recipient is eligible for family medical even when he/she chooses to terminate cash assistance to save cash TANF months.  The client is eligible for family medical (F04) as long as countable income is less than the CNIL.


EXAMPLE

A mother and her two children receive TANF cash benefits.  The mother starts working. To 'bank' cash assistance months she requests termination.  Redetermine eligibility for TANF-related family medical (F04).


  1. See MEDICAL EXTENSIONS for:

    1. Medical Extension Report; or

    2. A change resulting in eligibility for a medical extension.

  2. If changes in income increase the spenddown liability, the change is effective the first of the month after the change.  An increase in resources may affect MN eligibility.

  3. Children found eligible for a CN medical program are continuously eligible for 12 months from the date of their last application or review.  The only exceptions are aging out of the program, moving out of state, failing to pay a required premium, incarceration, or death.  See WAC 388-416-0015.

  4. See WAC 388-505-0211 and WAC 388-542-0050 for information on closure of premium-based children's healthcare coverage for a client who:

    1. Fails to pay their premiums, or

    2. Had creditable health insurance coverage at the time of their application or review.

WORKER RESPONSIBILITIES

If the client has not met the increased spenddown liability, terminate MN or MI giving advance and adequate notice. See SPENDDOWN.

ACES PROCEDURES

Interview: See  Interview
Add a Person: See Add a Person
Add a Program: See Add a Program
Update AU / Client Data: See Update Assistance Unit / Client Data
Terminating an AUs / Client's Benefits: See Close Assistance Unit / Client
Adverse Action:

See Update Assistance Unit / Client Data

See Deny an Assistance Unit / Client
Trickling and Sprouting:  See Trickle and Sprout

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Modification Date: April 29, 2008
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