Eligibility for Other Programs

Financial Assistance: Reduce the amount of an overpayment by the amount of cash assistance a client would have received if eligible for another cash program during the period of the overpayment.

Medical Assistance: Redetermine eligibility for medical assistance beginning the first of the month in which ineligibility occurs. If the assistance unit was ineligible for any medical assistance, all medical expenses paid by the Health Care Authority (HCA) for the period of ineligibility are an overpayment. If the assistance unit was eligible for the Medically Needy Program the overpayment is: The amount the assistance unit would have been required to spend-down before medical expenses would have been paid for the overpayment period. The difference between those medical payments covered by the CN program and those covered by the MN program. Scope of care determinations are referred to HCA. If the assistance unit was eligible for the Psychiatric Indigent Inpatient Program (PII), the overpayment is: The amount paid by HCA up to the deductible; plus Any additional amount the assistance unit would have been required to spend down; plus The difference between medical payments covered by the CN program and those covered under the PII program.

Establishing Overpayments for vendors

If it is determined that a vendor has been overpaid, an overpayment must be established. Overpayments for vendors are processed by the Office of Financial Recovery (OFR). Staff will complete form DSHS 18-398A and email the form to OFR at vendorop@dshs.wa.gov . OFR will establish the overpayment in their system and mail a copy of the DSHS 18-398A to the vendor.

ACES Procedures

Benefit Error Group (BEG) - Confirm a BEG Overpayment

Benefit Error Group (BEG) - Modify a BEG – Overpayment or Underpayment