WAC 388-538-0065 Medicaid eligible basic health plan enrollees.

1. Certain children and pregnant women who have applied for, or are enrolled in, managed care through basic health (BH) (chapter 70.47 RCW) are eligible for Medicaid under pediatric and maternity expansion provisions of the Social Security Act. The medical assistance administration (MAA) determines Medicaid eligibility for children and pregnant women who enroll through BH. 

2. The administrative rules and regulations that apply to managed care enrollees also apply to Medicaid-eligible clients enrolled through BH, except as follows:

   1. The process for enrolling in managed care described in WAC 388-538-0060(3) does not apply since enrollment is through the health care authority, the state agency that administers BH;

   2. American Indian/Alaska Native (AI/AN) clients cannot choose fee-for-service or PCCM as described in WAC 388-538-0060(2). They must enroll in a BH-contracted MCO.

   3. If a Medicaid eligible client applying for BH does not choose an MCO within ninety days, the client is transferred from BH to the department of social and health services (DSHS) for assignment to managed care.