Washington Medicaid Requirements And Eligibility
People looking to apply for Medicaid in Washington can do so in person, by phone, by mail, or online. The Washington Medicaid Application can be found at the Washington HealthPlan Finder site for those who wish to apply online. For a paper application to fill out and send in or to take to your local Medicaid office, you can click here.
What Is Health Insurance
Health insurance is essential for students because it protects you from paying the full cost of health care. There are two main kinds of health insurance that are relevant to students:
- Private health insurance plans are contracts between you and an insurer. All plans include out-of-pocket costs like premiums, deductibles and coinsurance. You might have private insurance through an employer, parent, or spouse. You can also purchase private insurance as an individual. In Washington State, private insurance is only available for purchase through Washington Health Plan Finder .
- Medicaid , a government health insurance plan for low-income people who are US citizens or green card holders of 5 years or more. The state and federal government cover the cost of care for people who are enrolled in Medicaid. In Washington State, Medicaid contracts with insurance companies, called managed care organizations, to handle billing and other administrative functions for people with who are eligible. Each person on Medicaid chooses one of these companies as their Apple Health plan.
Most UW students have in-state or out-of-state private insurance. About 25% of Seattle students have Washington State Medicaid, also known as Apple Health. Students with private health insurance should be prepared for out-of-pocket costs, such as premiums, deductibles and coinsurance. Medicaid has no costs associated with it as long as you only seek covered services with contracted providers.
Choosing A Residency Program
There are 4 tracks within an internal medicine residency program: transitional, preliminary, categorical and primary care.
It is best to choose the program that best suits ones individual needs and goals.
- Transitional programs rotate 1st-year residents through hospitals every 23 months. A transitional program counts as 1 year of training, but it may not provide enough credits to move to the 2nd year of training.
- Preliminary programs are 1-year programs for those wishing to specialize and who need a year of internal medicine training.
- Categorical programs are considered more traditional and hospital-based. These are 3-year programs that may allow residents to train up to board eligibility if performance is satisfactory.
- Primary care programs provide increased emphasis on ambulatory care experience in the community and are becoming more prevalent. Those who are sure that they will be working as a generalist are advised to apply to a primary care program.
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Effective Date Of Coverage
Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.
Transferring Medicaid Benefits To Another State
Technically, theres no formal program or option that allows you to transfer your Medicaid coverage from one state to another. Therefore, if youre relocating, youll need to reapply for Medicaid in the new states.
The good news is that youre allowed to apply for Medicaid in your new state immediately after relocating, and doing so can help you avoid a lapse in benefits. It generally takes anywhere from 15 to 90 days to receive a letter of approval once you apply for Medicaid, and you can usually submit your application online.
One thing you should know about Medicaid is that you cant be covered by it in two different states at the same time. Therefore, to transfer your coverage so to speak youll need to first terminate your original Medicaid coverage and then apply in your new state once youve relocated.
Most states offer retroactive Medicaid coverage, which allows you to receive coverage for up to three months prior to the date of your applications approval. However, you may be forced to pay for healthcare services out of pocket until that retroactive coverage kicks in and renders you eligible for reimbursement. To this end, make sure to retain copies of all medical receipts for services received during your coverage gap.
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Qualifying For A Residency Program
International medical graduates who have received a visa are eligible to apply for a residency program in the United States. It is strongly encouraged that international medical graduates participate in an observership rotation in a clinical setting before applying to a residency program. This allows international medical graduates to become familiar with clinical practice settings and meet physicians who can be used as references during the residency application process.
Recommended Process For Transferring Medicaid
To limit the challenges associated with moving from one state to another while under Medicaid coverage , the following steps are recommended.
1) Research both the old states and the new states Medicaid level of care requirements. Sincesome states have a higher level of care need, it may be possible that your loved one will not be eligible.Consider having a loved one assessed medically in the new state before giving up the old statescoverage.
2) If it is determined that a loved one will be medically eligible, then research the new states Medicaidfinancial eligibility requirements well in advanceof the move to make sure a loved one is qualified.
3) Work with a Medicaid planning professional to ensure theapplicant is eligible in the new state and prepare all the necessary paperwork for application beforemoving.
4) Be aware that the applicant will very likely have to pay out-of-pocket for their care for several weeks ormonths. Therefore, applicants should find affordable care in their new state of residence beforemaking the move. Often, they can be reimbursed by Medicaid but know that the Medicaid reimbursementrates are not high. Therefore, it is important to find affordable care providers inthe new state.
6) Submit the application in the new state immediately upon moving to the new state.
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How Do I Know If My Program Is State
If you completed a program through an institution outside of Washington State, you must check with the institution to be sure their program is/was state-approved at the time you completed the program. Washington accepts all other states’ programs having state approval for purposes of educational certification or licensure for serving in the role in K-12 schools.
Learn About Medicaid Asset Limits And Eligibility Requirements
Although Medicaid is federally funded, it is administered at the state level, and each state has its own set of rules and regulations of this program. The income and asset levels allowed differ from one state to another, so be sure to find out where your balance sheet falls in relation to the threshold.
If you are single, you generally cannot have more than $2,000 worth of cash or other assets outside of your residence, vehicle, and other necessary items unless your state has a higher limit.
If you are married and your spouse is still able to live independently, they are allowed to retain 50% of your joint assets up to a threshhold of $130,380 as of January 2021. Your single or joint income usually cannot exceed 138% of the federal poverty level, although several states have thresholds above this amount.
In nearly all cases, you will also have to prove via medical documents that you are disabled. However, certain exceptions apply . You must also be either a U.S. citizen or have a green card and prove your residency within the state.
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How Do I Apply For Medicaid In Washington
In Washington State, most Medicaid enrollment is managed through the state-run exchange, Washington Healthplanfinder. Unlike private health plans, Medicaid enrollment continues year-round there is no specific time during the year that you must enroll.
One of the benefits of the streamlined exchange application process is that its dramatically expedited compared with the pre-2014 enrollment system. The state notes that eligibility determination in the past took about 45 days, and they now take about 45 minutes.
But if youre 65 or older or have Medicare, use this website to apply for Medicaid and several other social services benefits. You can also request an application by calling 1-877-501-2233. Visit a Department of Social and Health Services Community Services Office to apply for Medicaid for the aged, blind and disabled in person visit a Home and Community Services Office to apply for long-term care benefits.
Are You A Washington Resident Attending A Washington School
If you are a Washington resident attending a Washington school, its likely that whatever coverage you currently have whether thats your parents health insurance plan, Medicaid coverage, or a plan through the state-based ACA Washington Health Benefit Exchange will provide the same coverage while youre in school.
If youre a resident of another state whos coming to Washington to study, your current insurance plan may not provide coverage if you get care from the doctors and hospitals near your school.
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What If You Skip Health Insurance
If you get sick or injured, you risk incurring medical debt if you dont have health insurance. You may be able to access basic primary and preventive care services at a student health center. Nearly all Washington schools provide campus-based services for minor health issues like flu, sprains and infections, or partner with a local primary care clinic to provide them. At most schools, students taking a minimum number of credit hours pay a flat fee for these health services as part of their tuition and other fees. But if you need medical care that the student health center doesnt provide, you could be in for some major bills.
Special Exception For Nursing Facilities
Persons who come to Washington solely for medical care in a nursing facility may be considered residents of Washington. They can even maintain a residence in another state if they hope to return. However, if a person is placed in a nursing facility by another state, the person is considered a resident of the state that placed them.
Apple Health eligibility continues for a Washington resident who is absent temporarily and will return. For example, a person who goes from Washington State to a border facility for rehabilitation for 4 to 6 weeks and will return to Washington is considered a resident.
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Persons Who Are Temporarily In Washington
Persons visiting Washington are not considered residents of Washington. Examples of those who are NOT residents include:
Business visa holders who enter the state with a job commitment meet residency requirements because the visa holder has a job commitment, even if the visa is temporary.
Tourist/visitor visa holders may meet residency requirements if they declare intent to continue residing in Washington after the visa expires. When questionable, one way in which tourist/visitor visa holders may show they intend to reside in Washington is to apply for adjustment with the United States Citizenship and Immigration Services/Department of Homeland Security . However, applying for adjustment with USCIS is not required.
Resources For Washington Students
Eastern Washington University provides information about student health insurance and student health services
Washington Medicaid Program includes eligibility requirements and applications
Western Washington University provides information about student health insurance and student health services
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Transferring Medicaid When On Hcbs Or 1915 Waivers
While transferring Medicaid from state to state is difficult, it is even more challenging for those individualswho are receiving Home and Community Based Services through a Medicaid Waiver program.
Medicaid waivers are different in every state and often times there is not a corresponding waiver between states.
Medicaid Waivers are programs that allow individuals who would typically require nursing home care to receive care services at home, in assisted living residences, adult foster care homes, and in adult day care. Each state has its own set of Medicaid Waivers and very often these do not align with waivers in other states. For example, some states do not have assisted living waivers and some states do not have adult foster care. Furthermore, Medicaid Waivers are not entitlements. There are usually a limited number of spaces available for any one waiver and long wait lists or Interest Lists can exist. Therefore, an individual wishing to transfer from one Medicaid Waiver in one state to a similar program in a new state may find there is no comparative program or may be required to spend months or even years on a waiting list for services. Again, a Medicaid planner may be able to tell you if there is a compatible Waiver in the new state, if there is a wait list, and how prioritization works for the wait list.
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Washington Mac And Tsoa Family Caregiver Support Programs
Washington’s Medicaid Alternative Care program provides support to individuals at home and their caregivers, helping recipients continue living in their homes or the homes of relatives. The MAC program has eligibility requirements related to age, living arrangement, function, and finances, including requirements that apply to both the participant and his or her caregiver. Those who are eligible to receive services under the MAC program must choose between receiving those benefits or more traditional LTC services, such as those offered through the COPES and CFCO waiver programs.
Through the MAC program, Medicaid-eligible individuals can receive services such as light housecleaning, grocery shopping and delivered meals, respite care, adult day care, personal emergency response systems, and transportation. Visit the DSHS web site for more information about the MAC program, and apply by visiting your local Community Living Connections office.
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Washington Has Accepted Federal Medicaid Expansion
- 1,965,401 Number of Washingtonians covered by Medicaid/CHIP as of May 2021
- 847,825 Increase in the number of Washingtonians covered by Medicaid/CHIP fall 2013 to May 2021
- 54% Reduction in the uninsured rate from 2010 to 2019
- 76% Increase in total Medicaid/CHIP enrollment in Washington since 2013
Medicaid Asset Rules In Washington
Medicaid for LTC has different resource rules than those for other Apple Health programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, IRAs, bank accounts and cash. You will have to total up all of these to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 in resources with a few allowable exclusions such as a car and your home . If you are married, your non-applicant spouse at home can keep up to $126,420 worth of joint assets.
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Medicaid State Transfer Rules Overview
Much to the surprise and dismay of many, Medicaid coverage and benefits cannot be simply switched from one stateto another. While Medicaid is often thought of as a federal program, each state is given the flexibility to settheir own eligibility requirements. Therefore, each state evaluates its applicants independently from each otherstate. Those wishing to transfer their coverage must re-apply for Medicaid in the new state.
Further complicating matters is the fact that someone cannot be eligible for Medicaid in two states at the sametime. Therefore, in order to be accepted by Medicaid in a new state, the individual must first close out theirMedicaid coverage with the old state. However, retroactive coverage exists in the majority of the states.Therefore, most senior readers should not be alarmed by a potential coverage gap. Simply put, retroactivecoverage allows a Medicaid applicant to receive Medicaid coverage for as many as three months prior to the dateof ones application. However, as mentioned above, not all states allow this type of coverage for seniors. Forexample, in February 2019, Florida eliminated 3-month retroactive coverage for all adults except for pregnantwomen. Therefore, it is crucial one research if retroactive coverage exists inthe state in which one wishes to relocate. Read more about retroactiveeligibility.
The process of transferring between states is difficult, but not impossible.
I Just Moved From State A To State B I Dont Have A Permanent Home Yet Am Staying With A Friend Until I Find A Job And Can Get Settled But I Need Health Insurance Right Away How Can I Establish/document Residency In State B
The fact that you dont have a permanent home should not affect your eligibility in State B as long as you are currently residing there and intend to remain there.
In HealthCare.gov states, you will be required to document your move. You will have to submit documents showing your former address . As for your new address, you can submit a signed statement to the Marketplace stating that you are living with your friend and you arent just visiting temporarily. Your friend will also have to submit documents, such as those described above, to prove their own residency.
Also, in HealthCare.gov states, to qualify for a special enrollment due to a permanent move, you must have had been enrolled in other minimum essential coverage, such as under a job-based health plan, another Marketplace plan, or Medicaid. You must have been enrolled in such coverage for at least one day during the 60-day period leading up to your move. There are exceptions to this rule for people moving from another country and for American Indians and Alaska Natives.
In addition, in HealthCare.gov states, the Marketplace will not make this special enrollment period available to you until you have actually moved.
Contact your state Marketplace for more information about the permanent move special enrollment period.
Browse more questions in the section.
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