Section 182-511-1050. Health care for workers with disabilities (HWD)—Program requirements.

This section describes requirements a person must meet to be eligible for the health care for workers with disabilities (HWD) program.

(1) To qualify for the HWD program, a person must:

(a) Meet the general requirements for a medical program described in WAC 182-503-0505 (3)(a) through (f);

(b) Be age sixteen through sixty-four;

(c) Meet the federal disability requirements described in WAC 182-511-1150;

(d) Have net income at or below two hundred twenty percent of the federal poverty level (FPL) (see WAC 182-511-1060 for FPL amounts for medical programs); and

(e) Be employed full or part time (including self-employment) as described in WAC 182-511-1200.

(2) To determine net income, the medicaid agency applies the following rules to total gross household income in this order:

(a) Deduct income exclusions described in WAC 182-512-0800, 182-512-0820, 182-512-0840, and 182-512-0860; and

(b) Follow the CN income rules described in:

(i) WAC 182-512-0600, SSI-related medical—Definition of income;

(ii) WAC 182-512-0650, SSI-related medical—Available income;

(iii) WAC 182-512-0700 (1) through (5), SSI-related medical—Income eligibility;

(iv) WAC 182-512-0750, SSI-related medical—Countable unearned income; and

(v) WAC 182-512-0960, SSI-related medical clients.

(3) The HWD program does not require an asset test.

(4) Once approved for HWD coverage, a person must pay the monthly premium in the following manner to continue to qualify for the program:

(a) The agency calculates the premium for HWD coverage according to WAC 182-511-1250;

(b) If a person does not pay four consecutive monthly premiums, the person is not eligible for HWD coverage for the next four months and must pay all premium amounts owed before HWD coverage can be approved again; and

(c) Once approved for HWD coverage, a person who experiences a job loss can choose to continue HWD coverage through the original twelve months of eligibility, if the following requirements are met:

(i) The job loss results from an involuntary dismissal or health crisis; and

(ii) The person continues to pay the monthly premium.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 15-14-080, § 182-511-1050, filed 6/29/15, effective 7/30/15. WSR 11-24-018, recodified as § 182-511-1050, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.08.090, 34.05.353 and Section 1902 (a)(10)(A)(ii) of the Social Security Act. WSR 04-15-002, § 388-475-1050, filed 7/7/04, effective 8/7/04. Statutory Authority: RCW 74.08.090, Section 1902 (a)(10)(A)(ii) of the Social Security Act, and 2001 c 7 § 209(5), Part II. WSR 02-01-073, § 388-475-1050, filed 12/14/01, effective 1/14/02.]

RCW 41.05.021 and 41.05.160. WSR 15-14-080, § 182-511-1050, filed 6/29/15, effective 7/30/15. WSR 11-24-018, recodified as § 182-511-1050, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.08.090, 34.05.353 and Section 1902 (a)(10)(A)(ii) of the Social Security Act. WSR 04-15-002, § 388-475-1050, filed 7/7/04, effective 8/7/04. Statutory Authority: RCW 74.08.090, Section 1902 (a)(10)(A)(ii) of the Social Security Act, and 2001 c 7 § 209(5), Part II. WSR 02-01-073, § 388-475-1050, filed 12/14/01, effective 1/14/02.

Rules

182-503-0505,182-511-1150,182-511-1060,182-511-1200,182-512-0800,182-512-0820,182-512-0840,182-512-0860,182-512-0600,182-512-0650,182-512-0700,182-512-0750,182-512-0960,182-511-1250,