Revised Code of Washington
Chapter 74.09 - Medical Care.
74.09.510 - Medical assistance—Eligibility.

RCW 74.09.510
Medical assistance—Eligibility.

Medical assistance may be provided in accordance with eligibility requirements established by the authority, as defined in the social security Title XIX state plan for mandatory categorically needy persons and:
(1) Individuals who would be eligible for cash assistance except for their institutional status;
(2) Individuals who are under twenty-one years of age, who would be eligible for medicaid, but do not qualify as dependent children and who are in (a) foster care, (b) subsidized adoption, (c) a nursing facility or an intermediate care facility for persons with intellectual disabilities, or (d) inpatient psychiatric facilities;
(3) Individuals who:
(a) Are under twenty-one years of age;
(b) On or after July 22, 2007, were in foster care under the legal responsibility of the department of social and health services, the department of children, youth, and families, or a federally recognized tribe located within the state; and
(c) On their eighteenth birthday, were in foster care under the legal responsibility of the department of children, youth, and families or a federally recognized tribe located within the state;
(4) Persons who are aged, blind, or disabled who: (a) Receive only a state supplement, or (b) would not be eligible for cash assistance if they were not institutionalized;
(5) Categorically eligible individuals who meet the income and resource requirements of the cash assistance programs;
(6) Individuals who are enrolled in managed health care systems, who have otherwise lost eligibility for medical assistance, but who have not completed a current six-month enrollment in a managed health care system, and who are eligible for federal financial participation under Title XIX of the social security act;
(7) Children and pregnant women allowed by federal statute for whom funding is appropriated;
(8) Working individuals with disabilities authorized under section 1902(a)(10)(A)(ii) of the social security act for whom funding is appropriated;
(9) Other individuals eligible for medical services under RCW 74.09.700 for whom federal financial participation is available under Title XIX of the social security act;
(10) Persons allowed by section 1931 of the social security act for whom funding is appropriated; and
(11) Women who: (a) Are under sixty-five years of age; (b) have been screened for breast and cervical cancer under the national breast and cervical cancer early detection program administered by the department of health or tribal entity and have been identified as needing treatment for breast or cervical cancer; and (c) are not otherwise covered by health insurance. Medical assistance provided under this subsection is limited to the period during which the woman requires treatment for breast or cervical cancer, and is subject to any conditions or limitations specified in the omnibus appropriations act.

[ 2017 3rd sp.s. c 6 § 337; 2013 2nd sp.s. c 10 § 6. Prior: 2011 1st sp.s. c 36 § 9; 2011 1st sp.s. c 15 § 25; 2010 c 94 § 24; 2007 c 315 § 1; prior: 2001 2nd sp.s. c 15 § 3; 2001 1st sp.s. c 4 § 1; prior: 1997 c 59 § 14; 1997 c 58 § 201; 1991 sp.s. c 8 § 8; 1989 1st ex.s. c 10 § 8; 1989 c 87 § 2; 1985 c 5 § 2; 1981 2nd ex.s. c 3 § 5; 1981 1st ex.s. c 6 § 20; 1981 c 8 § 19; 1971 ex.s. c 169 § 4; 1970 ex.s. c 60 § 1; 1967 ex.s. c 30 § 4.]
NOTES:

Effective date—2017 3rd sp.s. c 6 §§ 102, 104-115, 201-227, 301-337, 401-419, 501-513, 801-803, and 805-822: See note following RCW 43.216.025.


Conflict with federal requirements—2017 3rd sp.s. c 6: See RCW 43.216.908.


Effective date—2013 2nd sp.s. c 10: See note following RCW 74.62.030.


Findings—Intent—2011 1st sp.s. c 36: See RCW 74.62.005.


Effective date—2011 1st sp.s. c 36: See note following RCW 74.62.005.


Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.


Purpose—2010 c 94: See note following RCW 44.04.280.


Conflict with federal requirements—2007 c 315: "If any part of this act is found to be in conflict with federal requirements that are a prescribed condition to the allocation of federal funds to the state, the conflicting part of this act is inoperative solely to the extent of the conflict and with respect to the agencies directly affected, and this finding does not affect the operation of the remainder of this act in its application to the agencies concerned. Rules adopted under this act must meet federal requirements that are a necessary condition to the receipt of federal funds by the state." [ 2007 c 315 § 3.]


Findings—Intent—2001 2nd sp.s. c 15: See note following RCW 74.09.540.


Effective date—2001 1st sp.s. c 4: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 2001." [ 2001 1st sp.s. c 4 § 2.]


Short title—Part headings, captions, table of contents not law—Exemptions and waivers from federal law—Conflict with federal requirements—Severability—1997 c 58: See RCW 74.08A.900 through 74.08A.904.


Effective date—1991 sp.s. c 8: See note following RCW 18.51.050.


Effective dates—1989 c 87: "(1) Sections 7 and 8 of this act are necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect July 1, 1989.
(2) Sections 1 through 5 of this act shall take effect October 1, 1989." [ 1989 c 87 § 9.]


Severability—1981 2nd ex.s. c 3: "If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected." [ 1981 2nd ex.s. c 3 § 8.]


Effective date—Severability—1981 1st ex.s. c 6: See notes following RCW 74.04.005.

Structure Revised Code of Washington

Revised Code of Washington

Title 74 - Public Assistance

Chapter 74.09 - Medical Care.

74.09.010 - Definitions.

74.09.015 - Nurse hotline, when funded.

74.09.035 - Medical care services—Eligibility, standards—Limits.

74.09.037 - Identification card—Social security number restriction.

74.09.050 - Director's powers and duties—Personnel—Medical screeners—Medical director.

74.09.053 - Annual reporting requirement (as amended by 2009 c 479).

74.09.055 - Copayment, deductible, coinsurance, other cost-sharing requirements authorized.

74.09.075 - Employability and disability evaluation—Medical condition—Medical reports—Medical consultations and assistance.

74.09.080 - Methods of performing administrative responsibilities.

74.09.120 - Purchases of services, care, supplies—Nursing homes—Veterans' homes—Institutions for persons with intellectual disabilities—Institutions for mental diseases.

74.09.150 - Personnel to be under existing merit system.

74.09.160 - Presentment of charges by contractors.

74.09.171 - Contracts for medicaid services—Border communities.

74.09.180 - Chapter does not apply if another party is liable—Exception—Subrogation—Lien—Reimbursement—Delegation of lien and subrogation rights.

74.09.185 - Third party has legal liability to make payments—State acquires rights—Lien—Equitable subrogation does not apply.

74.09.190 - Religious beliefs—Construction of chapter.

74.09.195 - Audits of health care providers by the authority—Requirements—Procedure.

74.09.200 - Audits and investigations—Legislative declaration—State authority.

74.09.210 - Fraudulent practices—Penalties.

74.09.215 - Medicaid fraud penalty account.

74.09.220 - Liability for receipt of excess payments.

74.09.230 - False statements, fraud—Penalties.

74.09.240 - Bribes, kickbacks, rebates—Self-referrals—Penalties.

74.09.250 - False statements regarding institutions, facilities—Penalties.

74.09.260 - Excessive charges, payments—Penalties.

74.09.270 - Failure to maintain trust funds in separate account—Penalties.

74.09.280 - False verification of written statements—Penalties.

74.09.290 - Audits and investigations of providers—Patient records—Penalties.

74.09.295 - Disclosure of involuntary commitment information.

74.09.300 - Department to report penalties to appropriate licensing agency or disciplinary board.

74.09.315 - Whistleblowers—Workplace reprisal or retaliatory action.

74.09.325 - Reimbursement of a health care service provided through telemedicine or store and forward technology—Audio-only telemedicine.

74.09.327 - Audio-only telemedicine—Fee-for-service reimbursement.

74.09.328 - Use of substitute providers—When permitted—Reimbursement requirements.

74.09.330 - Reimbursement methodology for ambulance services—Transport of a medical assistance enrollee to a mental health facility or chemical dependency program.

74.09.335 - Reimbursement of health care services provided by fire departments—Adoption of standards.

74.09.340 - Personal needs allowance, adjusted.

74.09.390 - Access to baby and child dentistry program—Coverage for eligible children—Authority's duties—Report to legislature.

74.09.395 - Access to baby and child dentistry program—Outreach and engagement—Stakeholder collaboration.

74.09.402 - Children's health care—Findings—Intent.

74.09.460 - Children's affordable health coverage—Findings—Intent.

74.09.470 - Children's affordable health coverage—Authority duties.

74.09.4701 - Apple health for kids—Unemployment compensation.

74.09.475 - Newborn delivery services to medical assistance clients—Policies and procedures—Reporting.

74.09.480 - Performance measures—Provider rate increases—Report.

74.09.490 - Children's mental health—Improving medication management and care coordination.

74.09.495 - Access to children's behavioral health services—Report to legislature.

74.09.4951 - Children and youth behavioral health work group—Advisory groups—Report to governor and legislature.

74.09.497 - Authority review of payment codes available to health plans and providers related to primary care and behavioral health—Requirements—Principles considered—Matrices—Reporting.

74.09.500 - Medical assistance—Established.

74.09.510 - Medical assistance—Eligibility.

74.09.515 - Medical assistance—Coverage for youth released from confinement.

74.09.520 - Medical assistance—Care and services included—Funding limitations.

74.09.522 - Medical assistance—Agreements with managed health care systems for provision of services to medicaid recipients—Principles to be applied in purchasing managed health care.

74.09.5222 - Medical assistance—Section 1115 demonstration waiver request.

74.09.5223 - Findings—Chronic care management.

74.09.5225 - Medical assistance—Payments for services provided by rural hospitals—Participation in Washington rural health access preservation pilot.

74.09.5229 - Primary care health homes—Chronic care management—Findings—Intent.

74.09.523 - PACE program—Definitions—Requirements.

74.09.530 - Medical assistance—Powers and duties of authority.

74.09.540 - Medical assistance—Working individuals with disabilities—Intent.

74.09.545 - Medical assistance or limited casualty program—Eligibility—Agreements between spouses to transfer future income—Community income.

74.09.555 - Medical assistance—Reinstatement upon release from confinement—Expedited eligibility determinations.

74.09.557 - Medical assistance—Complex rehabilitation technology products.

74.09.565 - Medical assistance for institutionalized persons—Treatment of income between spouses.

74.09.575 - Medical assistance for institutionalized persons—Treatment of resources.

74.09.585 - Medical assistance for institutionalized persons—Period of ineligibility for transfer of resources.

74.09.595 - Medical assistance for institutionalized persons—Due process procedures.

74.09.597 - Medical assistance—Durable medical equipment and medical supplies—Providers.

74.09.600 - Post audit examinations by state auditor.

74.09.605 - Incorporation of outcomes/criteria into contracts with managed care organizations.

74.09.611 - Hospital quality incentive payments—Noncritical access hospitals.

74.09.630 - Opioid overdose reversal medications—Reimbursement.

74.09.632 - Opioid overdose reversal medications—Technical assistance—Written materials.

74.09.634 - Opioid overdose reversal medications—Bulk purchasing and distribution program.

74.09.640 - Opioid use disorder—Nonpharmacologic treatments.

74.09.645 - Opioid use disorder—Coverage without prior authorization.

74.09.650 - Prescription drug assistance program.

74.09.653 - Drug reimbursement policy recommendations.

74.09.655 - Smoking cessation assistance.

74.09.657 - Findings—Family planning services expansion.

74.09.658 - Home health—Reimbursement—Telemedicine.

74.09.659 - Family planning waiver program request.

74.09.660 - Prescription drug education for seniors—Grant qualifications.

74.09.670 - Medical assistance benefits—Incarcerated or committed persons—Suspension.

74.09.671 - Incarcerated persons—Local jails—Behavioral health services—Federal funding.

74.09.672 - Inmates of a public institution—Exclusion from medicaid coverage—Work release and partial confinement programs.

74.09.675 - Gender affirming care services—Prohibited discrimination.

74.09.700 - Medical care—Limited casualty program.

74.09.710 - Chronic care management programs—Medical homes—Definitions.

74.09.715 - Access to dental care.

74.09.717 - Dental health aide therapist services—Federal funding.

74.09.719 - Compact of free association islander dental care program.

74.09.720 - Prevention of blindness program.

74.09.725 - Prostate cancer screening.

74.09.730 - Disproportionate share hospital adjustment.

74.09.741 - Adjudicative proceedings.

74.09.745 - Medicaid funding for home visiting services—Recommendations to legislature.

74.09.748 - Regional service areas—Certain reimbursements required or allowed upon adoption of fully integrated managed health care system.

74.09.756 - Medicaid and state children's health insurance program demonstration project.

74.09.758 - Medicaid procurement of services—Value-based contracting for medicaid and public employee purchasing.

74.09.760 - Short title—1989 1st ex.s. c 10.

74.09.770 - Maternity care access system established.

74.09.780 - Reservation of legislative power.

74.09.790 - Definitions.

74.09.800 - Maternity care access program established.

74.09.810 - Alternative maternity care service delivery system established—Remedial action report.

74.09.820 - Maternity care provider's loan repayment program.

74.09.825 - Donor human milk—Standards—Federal funding.

74.09.830 - Postpartum health care coverage.

74.09.850 - Conflict with federal requirements.

74.09.860 - Request for proposals—Foster children—Integrated managed health and behavioral health care—Continuation of health care benefits following reunification.

74.09.870 - Regional service areas—Establishment.

74.09.871 - Behavioral health services—Contracting process.

74.09.875 - Reproductive health care services—Prohibited discrimination.

74.09.877 - Statewide plan to implement coordinated specialty care programs providing early identification and intervention for psychosis.

74.09.880 - Z code collection—Incentives and funding.

74.09.885 - Apple health and homes program—Definitions.

74.09.886 - Apple health and homes program—Establishment—Eligibility—Services.

74.09.888 - Apple health and homes program—Authority duties—Funding—Reports to legislature.

74.09.900 - Other laws applicable.

74.09.920 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.