End Stage Renal Disease
The Medicare Buy-in Unit also sends letters requesting proof of application for Medicare under the End Stage Renal Disease Program (ESRD) to selected Medicaid kidney dialysis individuals who receive three consecutive months of treatment. The same process outlined above is used. The individual's letter is slightly different but still requires the individual to provide proof of application. The individual's kidney dialysis provider, (for example Northwest Kidney Dialysis Center), is also notified that they need to assist their individual with the Medicare/ESRD application process.
Individuals who fail to provide proof of application for Medicare to the Medicare Buy-in Unit under the authority of WAC 182-504-0505 and WAC 182-504-0540 can be terminated from Apple Health assistance, including individuals who receive SSI or long-term care services. Individuals closed for noncooperation with application to Medicare will show in ACES and ProviderOne as closed for reason code 266, noncooperation with TPL.
Timeline to termination request
The Medicare Buy-in Unit gives nearly 90 days in the two-letter process before they send an action request in BarCode to DSHS to propose termination of Apple Health coverage.