500 Series reason codes

500 Series Reason Code Protocols

Go to the Reason Code Link chart to link directly to a specific reason code or scroll through the list below.

For ACES procedures go to ACES Letters in the ACES User Manual.

Reason code Reason code description WAC references - Classic Medicaid Free form text - Classic Medicaid WAC references - MAGI-Based Medicaid Free form text - MAGI-Based Medicaid 520 Change in Federal law There has been a change in the Federal law that regulates this program. None None required 182-518-0005 None required 525 No Eligibility Review Form - We haven't received your eligibility review or renewal form. HPF You have not completed your renewal for Washington Apple Health 388-434-0005 388-434-0010 388-492-0090 388-492-0110 388-492-0100 388-400-0070 None required 182-504-0035 None required 528 Eligibility Review Form incomplete The eligibility review or renewal form we received wasn't complete. HPF The renewal form that you sent to us was not complete. We need you to complete the form before we can determine your eligibility. 388-492-0110 388-492-0100 388-400-0070 388-434-0005 388-492-0090 You must return the completed form to us by 00/00/00 in order for your benefits to continue. 182-504-0035 None required 529 Termination/Denial due to nonpayment of premium Health coverage stopped for the children listed above because you are three months behind in premium payments. Washington Apple Health with premiums coverage can't start again until the premiums are paid. 182-505-0225 None required 531 Voluntary withdrawal for excess resources You withdrew your request for assistance because you have too many resources to get assistance right now. 388-513-1350 388-406-0050 None required 532 State-funded LTC - Program Full The state-funded long-term care services program is subject to caseload limits. The program is currently full. We aren’t enrolling new members at this time. See WAC rule (Washington Administrative Code): 182-507-0125 None required 534 Family Medical To 12-month medical extension Your cash benefits will stop because of earnings. Medical benefits for your family will continue under the Medical Extension Benefit program. You will get a separate letter to tell you about this program. See WAC rule (Washington Administrative Code): Not applicable Not applicable 535 Error in initial eligibility - Removed continuous tracking for child - For administrative use only None Specify the reason for termination and a WAC related to that reason. 538 TSOA Closure You can’t receive services under this program when you are eligible for certain Medicaid programs. See WAC rule (Washington Administrative Code): 182-513-1615 None required 542 We got your change report form. Some information is still missing. We sent you a letter telling you what you need to give to us. We did not get it. 388-418-0011 Specify what is missing. 544 Your bank didn't honor your premium payment. None None required 550 Voluntary withdrawal You withdrew your request for assistance. See WAC rule (Washington Administrative Code): HPF You withdrew your request for Washington Apple Health 388-406-0050 388-492-0020 None required 182-503-0080 None required 551 Whereabouts unknown We don’t know where you are. See WAC rule (Washington Administrative Code): 388-458-0030 388-492-0020 None required 182-518-0005 182-503-0520 182-503-0525 182-504-0105 552 Failed to provide verification You did not give us the information we needed. HPF You didn't give us the information we asked for. 182-503-0050 388-400-0070 388-472-0005 388-490-0005 388-458-0020 388-492-0020 On 00/00/00, I asked you to provide some information by 00/00/00. I still need: List of items 182-503-0050 __________??? 554 RCL Error in Initial Eligibility You didn’t meet Medicaid eligibility on the day of your discharge from a medical institution. See WAC rule (Washington Administrative Code): 182-513-1235 Describe the reason the client was not initially eligible for Medicaid. 555 Application opened in error - For administrative use only None None required 557 AU requests closure You asked us to stop your assistance. HPF You asked us to stop your Washington Apple Health coverage None None required 182-503-0080 None required 558 Failed to cooperate in securing other income and resources You have income or resources that you could use but you haven’t made a reasonable effort to get them. If there is a good reason why you have not done this, please tell us. See WAC rule (Washington Administrative Code): 388-400-0070 388-458-0020 388-472-0005 388-490-0005 388-492-0020 You told us that you have (type of income/resource). To become eligible, you must try to make it available by __ (specify what they must do to make income or resource available). 182-503-0050 559 Client already received assistance in another AU for this benefit month Although you can belong to more than one assistance unit, you can only get benefits from one at a time. 388-400-0005 388-400-0010 388-400-0025 388-400-0030 388-400-0040 388-400-0045 388-400-0060 388-400-0070 You are already getting medical assistance. 561 AU screened in error - System generated only None None required 562 Due to your child(ren)'s immigration status they do not qualify for Medicaid. The Children's Health Program is now full and your child(ren) are on a waiting list. When an opening occurs, you will be contacted to review family circumstances. See WAC rule (Washington Administrative Code) Specify which children. 182-505-0210 564 Noncooperation with TPL process You did not cooperate in obtaining another source of coverage for your medical care. See WAC rule (Washington Administrative Code): You told us that you could get help with medical from (specify TPL source). 566 Refused to cooperate with application process You refused to cooperate in the application process. Based on the information we have, we are unable to determine your eligibility. See WAC rule (Washington Administrative Code): HPF You have not cooperated with the application process. Based on the information we have, we are unable to determine your eligibility. 388-400-0070 388-406-0025 388-406-0035 388-406-0050 388-406-0060 388-452-0005 388-492-0020 388-406-0050 You did not __ . If you need help, let me know and I will try to assist you. 182-503-0080 572 User voided application - For administrative use only None None required 577 Missed application deadline - For administrative use only None None required 587 Already eligible for program in different AU - For administrative use only 388-408-0035 388-412-0005 The following persons aren't eligible for medical assistance for [MM/YYYY] because they already received medical assistance in another household: list name of ineligible persons NOTE: You may need to manually create a denial or termination letter or add text to the ACES system-generated letter. 588 Ineligible ESLMB already receiving MA You are not eligible for the ESLMB program because you are receiving Medicaid benefits. See WAC rule (Washington Administrative Code): You are not eligible for the Qualified Individual (QI-1) Program because you are receiving Medicaid Benefits. You are eligible for the State-funded Buy-In Program. We will pay for your Medicare Part A premiums, if you have any, as well as your Part B premiums, coinsurance, and deductibles. None required 182-517-0300 589 Based on your current medical information, you are no longer disabled under Social Security rules. See WAC rule (Washington Administrative Code): 388-511-1105 None required 590 You have a penalty period because you gave away a non exempt asset or sold it for less than fair market value. You, your representative or guardian, or with your consent, the facility where you live, may request an undue hardship waiver if you can show that without LTC services you will be deprived of housing, food, clothing or medical care and that your health or life will be endangered. The request must be: In writing State the basis for requesting the undue hardship waiver Be signed by the requestor and include the requestor's name, address and telephone number and Be made within 90 days of the date of denial or termination of LTC services. 388-513-1363 388-513-1364 388-513-1365 388-513-1367 Explain the amount of the transfer used to determine the penalty or penalties periods. Indicate the dates the penalty period starts and ends. 596 Failure to pursue Medicaid You aren't eligible for ABD cash or Housing and Essential Needs (HEN) Referral because you failed to pursue Medicaid. 388-400-0060 388-400-0070 (Social Service Specialist provides mandatory free form text via 14-118) 599 Other - For user generation only None None required (If used for ABD or HEN Referral denial or termination, Social Service Specialist provides mandatory free form text via 14-118)