Purpose: This section contains information about certification periods for cash assistance clients, categorically needy (CN) medical, medically needy (MN) non-institutionalized persons, and the Medicare Savings Programs.
Medical certification periods for recipients of cash assistance programs.
WAC 388-416-0010
WAC 388-416-0010
Effective September 12, 2005
WAC 388-416-0010 Medical certification periods for recipients of cash assistance programs.
The certification period for medical services begins on the first day of the month of application when the client is determined eligible for cash assistance for one of the following programs:
Temporary assistance for needy families (TANF);
Supplemental Security Income (SSI); or
Refugee assistance.
The certification period for the medical programs associated with the cash programs in subsection (1) of this section continues as long as eligibility for these programs lasts. When a client's cash assistance is terminated, eligibility for medical assistance is continued until eligibility is redetermined as described in WAC 388-418-0025.
The certification period for medical can begin up to three months prior to the month of application for clients described in subsection (1) of this section if the conditions in WAC 388-416-0015(6) apply.
The certification period for medical care services begins on the date eligibility begins for the following cash assistance programs:
General assistance for unemployable persons (GA-U); or
Alcohol and drug abuse treatment and support act (ADATSA) programs, when the client is either receiving a grant or waiting for treatment to begin.
The certification period for medical care services for clients in subsection (4) of this section runs concurrently with the period of eligibility for the client's cash assistance program.
Certification periods for categorically needy (CN) medical and state children's health insurance program (SCHIP).
WAC 388-416-0015
WAC 388-416-0015
Effective March 14, 2008
WAC 388-416-0015 Certification periods for categorically needy (CN) scope of care medical assistance programs.
A certification period is the period of time a person is determined eligible for a categorically needy (CN) scope of care medical program. Unless otherwise stated in this section, the certification period begins on the first day of the month of application and continues to the last day of the last month of the certification period.
For a child eligible for the newborn medical program, the certification period begins on the child's date of birth and continues through the end of the month of the child's first birthday.
For a woman eligible for a medical program based on pregnancy, the certification period ends the last day of the month that includes the sixtieth day from the day the pregnancy ends.
For families the certification period is twelve months with a six-month report required as a condition of eligibility as described in WAC 388-418-0011.
For children, the certification period is twelve months. Eligibility is continuous without regard to changes in circumstances other than aging out of the program, moving out of state, failing to pay a required premium(s), incarceration or death.
When the child turns nineteen the certification period ends even if the twelve-month period is not over. The certification period may be extended past the end of the month the child turns nineteen when:
The child is receiving inpatient services (see WAC 388-505-0230 ) on the last day of the month the child turns nineteen;
The inpatient stay continues into the following month or months; and
The child remains eligible except for exceeding age nineteen.
For an SSI-related person the certification period is twelve months.
When the medical assistance unit is also receiving benefits under a cash or food assistance program, the medical certification period will begin anew at each:
Approved application for cash or food assistance; or
Completed eligibility review.
A retroactive certification period can begin up to three months immediately before the month of application when:
The client would have been eligible for medical assistance if the client had applied; and
If the client is eligible only during the three-month retroactive period, that period is the only period of certification.
Any months of a retroactive certification period are added to the designated certification periods described in this section.
There is no retroactive eligibility for premium-based children's healthcare as described in WAC 388-505-0210 and chapter 388-542 WAC. If creditable coverage exists at the time of application, the certification period begins the month after creditable coverage ends.
Eligibility must be determined separately for any retroactive CN certification periods. It is possible for a client to be ineligible in the month of application, but eligible within the previous three months.
A client approved for GA-X medical coverage may receive three months retroactive coverage. The client must meet all financial and categorical requirements for the GA-U program and have a GA-X approval date for the retro month(s).
EXAMPLE
Client applies for GAU on January 17th and is approved on January 29th. In February the worker receives notification that GA-X has been approved back to December 1. The worker verifies the client met all the categorical and financial requirements of GAU program for December. If eligible, the worker should issue CN retro coverage for December.
3. When a pregnant woman is ineligible in the application month for factors other than medical need, but met eligibility in one of the three previous months, authorize from that period through the postpartum period.
EXAMPLE
Pregnant woman applies in March, but her countable income exceeds the standard. Her countable income in January was below the standard. Since she was also pregnant in January, one of the previous three months, she is eligible from January 1 through the entire pregnancy and the postpartum extension. The certification period is for that entire period.
4. Medical eligibility for pregnant women and children is continuous, except for aging out of the program, moving out of state, failing to pay a required premium, incarceration, or death. If mail is returned, see if a forwarding address is provided.
If one is provided, update the address. No further action is necessary.
If one is not provided, terminate the assistance for lost of contact/wherebouts unknown. Advance notice in not necessary.
If the client provides an updated Washington address at any time during the original certification period, the assistance unit is reinstated from the month of termination through the end of the original certification period. A new application is not necessary.
EXAMPLE
A household is receiving medical assistance for their children under the F06 program. The original certification period is January through December. In April, mail is returned with no forwarding address. The medical assistance is closed for loss of contact/whereabouts unknown effective 4/30/xx, and a termination letter is sent. In June, the client calls the worker and reports a new Washington address. The worker reinstates the assistance unit from Mary through December without requiring a new application.
