Administrative hearing coordinator

Review each hearing request to determine eligibility for continued benefits. An individual may have noted on the request that they do not want continued coverage. If an individual is eligible for continued coverage: Reopen health care coverage. Document in ACES why coverage was reopened; Send a notice to the individual with the following text: You have requested an administrative hearing and will receive continued health care coverage unless you tell us you do not want it ( WAC 182-504-0130 ). You may have to pay back the agency’s costs for the two months of continued coverage after you requested a hearing if the Administrative Law Judge (ALJ) agrees with our decision ( WAC 182-520-0010 ). You will receive continued coverage through the end of the month an administrative hearing decision is sent to you unless: An ALJ or our presiding officer serves an order ending continued coverage; or You: Tell us in writing that you do not want continued health care coverage; or Withdraw your request for an administrative hearing in writing or during the hearing.

If an individual is not eligible for continued coverage: Document in ACES why they are not eligible; and Send a notice to the individual with the following text: “You have requested an administrative hearing regarding your health care coverage. Your request has been sent to the Office of Administrative Hearings. You requested continued coverage pending the outcome of your appeal. You are not eligible because _______. See WAC 182-504-0130 . If you disagree with the decision to deny continued coverage, you may contact the Office of Administrative Hearings at 360-407-2700 and request a prehearing conference. The prehearing conference will be with an Administrative Law Judge who will determine only if you are or are not eligible for continued coverage.”

If the individual is on continued coverage for any long-term care, COPES or other services through ALTSA, notify the case manager of the reopening of coverage pending the appeal.

Example: Mohamed is on WAH for adults. He is terminated 6/30 for being over income. He submits a request for a hearing on 6/29. He is eligible for continued coverage.

Example: Gloria receives WAH for her children. Coverage ends 1/31. She submits a request for a hearing on 2/15. Deny continued coverage as the request was not timely.

Example: Giuseppe receives WAH for adults. Coverage ends Sunday, 12/31. He submits a request for a hearing on 1/2. He is eligible for continued coverage as the last day of the month falls on a weekend, the next day is a holiday, and the hearing request was received on the next business day.

Example: Jacques applies for WAH and is denied for not meeting the immigration criteria. He submits a timely appeal and wants continued coverage. He is not eligible because he was not a recipient of WAH at the time of the denial.

Example: Walter was on an active WAH MN spenddown for 9/14 to 11/30. He submits an appeal on 11/15 about having to meet a new spenddown as of 12/1. He asks for continued coverage. He is not eligible as continued coverage for MN programs does not extend past the certification period end date.