WAC 182-505-0225 Children's Washington apple health with premiums - Calculation and determination of premium amount.

Effective October 25, 2024.

For the purposes of this chapter, "premium" means an amount paid for health care coverage under WAC 182-505-0215 .

Premium requirement. The Washington apple health premium-based program under WAC 182-505-0215 requires payment of a monthly premium. The first monthly premium is due in the month following the determination of eligibility. There is no premium requirement for health care coverage received in the month eligibility is determined or in any prior month. A child who is American Indian or Alaska native is exempt from the monthly premium requirement.

Monthly premium amount. The premium amount for the medical assistance unit (MAU) is based on countable income under chapter 182-509 WAC and the number of people in the MAU under chapter 182-506 WAC. The premium amount is as follows: If the MAU's countable income exceeds 210 percent of the federal poverty level (FPL) but does not exceed 260 percent of the FPL, the monthly premium for each child is $20. If the MAU's countable income exceeds 260 percent of the FPL but does not exceed 312 percent of the FPL, the monthly premium for each child is $30. The medicaid agency charges a monthly premium for no more than two children per household. Payment of the full premium is required. Partial payments cannot be designated for a specific child or month. Any third party may pay the premium on behalf of the household. Failure of a third party to pay the premium does not eliminate the obligation of the household to pay past due premiums. A change that affects the premium amount takes effect the month after the change is reported.

Nonpayment of premiums. The agency writes off past-due premiums after 12 months.

This is a reprint of the official rule as published by the Office of the Code Reviser . If there are previous versions of this rule, they can be found using the Legislative Search page .

Clarifying information

Medical coverage for parenting adults of minor dependent children has been "delinked" from cash assistance. Parenting adults need to complete a separate application for medical coverage.

Adults who are over income for Apple Health for Families (N01) may be eligible for Apple Health for Adults (N05) as described in WAC 182-505-0250 .

Adults who are ineligible for Apple Health for Families (N01) based on citizenship may be eligible for Alien Emergency Medical (N21) as described in WAC 182-507-0110 .

Parenting adults are eligible for Apple Health for Families (N01) even if they are eligible for Medicare and/or age 65 or older.

Individuals may apply for MAGI Medicaid using the following options:

Online: Washington Healthplanfinder

Paper: HCA Form 18-001 (Application for Health Care Coverage) , can be submitted via: Mail: Washington Healthplanfinder, PO Box 946, Olympia WA 98507 Fax: 1-855-867-4467

Phone: 1-855-923-4633

If an individual wants help applying for MAGI Medicaid, he or she can work with a Navigator or call Healthplanfinder Customer Support at 1-855-923-4633.

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