WAC 388-505-0210   Children's healthcare programs.  Funding for children's healthcare coverage may come through Title XIX (medicaid) or Title XXI for the Social Security Act (SCHIP), or through state-funded programs. There are no resource limits for children's medical programs, but children must meet the eligibility criteria below to qualify for these programs.

     (1) Newborns are eligible for federally matched categorically needy (CN) coverage through their first birthday when:

     (a) The child's mother was eligible for and receiving medical assistance at the time of the child's birth; and

     (b) The child remains with the mother and resides in the state.

     (2) Children under the age of nineteen who are U.S. citizens, U.S. nationals, or qualified aliens as described in WAC 388-424-0001 and 388-424-0006 (1) and (4) are eligible for federally matched CN coverage under children's healthcare programs when they meet the following criteria:

     (a) State residence as described in chapter 388-468 WAC;

     (b) A Social Security number or application as described in chapter 388-476 WAC;

     (c) Proof of citizenship or immigrant status and identity as required by WAC 388-490-0005(11);

     (d) Family income is at or below two hundred percent federal poverty level (FPL), as described in WAC 388-478-0075 at each application or review; or

     (e) They received supplemental security income (SSI) cash payments in August 1996 and would continue to be eligible for those payments except for the August 1996 passage of amendments to federal disability definitions; or

     (f) They are eligible for SSI-related CN or MN coverage.

     (3) Noncitizen children under the age of nineteen, who do not meet qualified alien status as described in WAC 388-424-0006 (1) or (4), or are ineligible due to the five-year ban as described in WAC 388-424-0006(3), are eligible for state-funded CN coverage under children's healthcare programs when they meet the following criteria:

     (a) State residence as described in chapter 388-468 WAC; and

     (b) Family income is at or below two hundred percent FPL at each application or review.

     (4) Children under the age of nineteen are eligible for premium-based CN coverage under children's healthcare programs as described in chapter 388-542 WAC when they meet the following criteria:

     (a) State residence as described in chapter 388-468 WAC;

     (b) Family income is over two hundred percent FPL, as described in WAC 388-478-0075, but not over two hundred fifty percent FPL at each application or review;

     (c) They do not have other creditable health insurance as described in WAC 388-542-0050; and

     (d) They pay the required monthly premiums as described in WAC 388-505-0211

     (5) Children under age nineteen are eligible for the medically needy (MN) medicaid program when they meet:

     (a) Citizenship or immigrant status, state residence, and Social Security number requirements as described in subsection (2)(a), (b), and (c); and

     (b) They are ineligible for other federal medicaid programs; and

     (c) Meet their spenddown obligation as described in WAC 388-519-0100 and 388-519-0110.

     (6) Children under the age of twenty-one who reside or expect to reside in a medical institution, intermediate care facility for the mentally retarded (ICF/MR), hospice care center, nursing home, or psychiatric facility may be eligible for medical coverage. See WAC 388-505-0230 "Family related institutional medical" and WAC 388-513-1320 "Determining institutional status for long-term care."

     (7) Children who are in foster care under the legal responsibility of the state, or a federally recognized tribe located within the state, are eligible for federally matched CN medicaid coverage through the month of their:

     (a) Eighteenth birthday;

     (b) Twenty-first birthday if children's administration determines they remain eligible for continued foster care services; or

     (c) Twenty-first birthday if they were in foster care on their eighteenth birthday and that birthday was on or after July 22, 2007.

     (8) Children who receive subsidized adoption services are eligible for federally matched CN medicaid coverage.

     (9) Children under age of nineteen may also be eligible for:

     (a) Family medical as described in WAC 388-505-0220;

     (b) Medical extensions as described in WAC 388-523-0100; or

     (c) SSI-related MN if they:

     (i) Meet the blind and/or disability criteria of the federal SSI program, or the condition of subsection (2)(e); and

     (ii) Have countable income above the level described in WAC 388-478-0070(1).

     (10) Children who are ineligible for other children's healthcare programs due to citizenship or immigrant status requirements may be eligible for the alien emergency medical program (AEM) if they meet the following criteria:

     (a) They have a documented emergent medical condition as defined in WAC 388-500-0005;

     (b) They meet the other AEM program requirements as described in WAC 388-438-0110; and

     (c) They have income that exceeds children's healthcare program standards; or

     (d) They are disqualified from receiving premium-based children's healthcare coverage as described in subsection (4) of this section because of creditable coverage or nonpayment of premiums.

     (11) Except for a client described in subsection (6), an inmate of a public institution, as defined in WAC 388-500-0005, is not eligible for children's healthcare programs.



[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530, 74.09.700, and 2007 c 5. 08-05-018, § 388-505-0210, filed 2/12/08, effective 3/14/08. Statutory Authority: RCW 74.08.090, 74.09.530, and 74.09.415. 05-23-013, § 388-505-0210, filed 11/4/05, effective 1/1/06. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 04-15-057, § 388-505-0210, filed 7/13/04, effective 8/13/04. Statutory Authority: RCW 74.08.090 and 74.04.050. 03-14-107, § 388-505-0210, filed 6/30/03, effective 7/31/03. Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-505-0210, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.08.090, 74.04.050, [74.04.]055, and[74.04.]057 . 01-11-110, § 388-505-0210, filed 5/21/01, effective 6/21/01. Statutory Authority: RCW 74.08.090 and 74.08A.100. 99-17-023, § 388-505-0210, filed 8/10/99, effective 9/10/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-505-0210, filed 7/31/98, effective 9/1/98. Formerly WAC 388-509-0905, 388-509-0910 and 388-509-0920.]