Section 182-504-0130. Washington apple health—Continued coverage pending an appeal.

(1) Continued coverage is when you continue to receive Washington apple health benefits while appealing a medicaid agency adverse action to terminate, suspend, or reduce your:

(a) Medicaid eligibility; or

(b) Authorization for a covered service.

(2) To qualify for continued coverage, you must request a hearing on the adverse action no later than:

(a) The tenth day after we (the medicaid agency or its designee) sent a notice of the action to you; or

(b) The last day of the month before the action takes effect.

(3) If your last day to request a hearing and still qualify for continued coverage falls on a Saturday, Sunday, or a designated holiday under WAC 357-31-005, you have until 5:00 p.m. on the next business day to request the hearing.

(4) Continued coverage ends when:

(a) You state in writing you no longer wish to receive continued coverage;

(b) You withdraw the appeal;

(c) You default and an order of dismissal is entered;

(d) An administrative law judge or a review judge issues an adverse ruling or written decision:

(i) Terminating your continued coverage; or

(ii) Ruling you do not qualify for benefits.

(5) You cannot receive continued coverage if the adverse action was due solely to a change in statute, federal regulation, or administrative rule, unless there is a question about whether you are in the class of people affected by the change.

(6) If you are receiving medically needy coverage, you cannot receive continued coverage past the end of the certification period described in WAC 182-504-0020.

(7) If you are receiving coverage under an alien medical program, you cannot receive continued coverage past the end of the certification period described in chapter 182-507 WAC.

[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 16-22-060, § 182-504-0130, filed 10/31/16, effective 12/1/16. Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (P.L. 111-148), 42 C.F.R. §§ 431, 435, and 457, and 45 C.F.R. § 155. WSR 14-06-068, § 182-504-0130, filed 2/28/14, effective 3/31/14.]

RCW 41.05.021, 41.05.160. WSR 16-22-060, § 182-504-0130, filed 10/31/16, effective 12/1/16. Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (P.L. 111-148), 42 C.F.R. §§ 431, 435, and 457, and 45 C.F.R. § 155. WSR 14-06-068, § 182-504-0130, filed 2/28/14, effective 3/31/14.

Rules

357-31-005,182-504-0020,182-507,