Washington State Health Care Authority Community-Based Training

Module 1: Overview of Washington Apple Health (Medicaid)

  • Administering Agency: The Health Care Authority (HCA) administers MAGI-based programs.

  • Apple Health categories:

    • Classic Medicaid (for elderly, blind, or disabled) – administered in partnership with the Department of Social and Health Services (DSHS).

    • MAGI-Based Medicaid (based on Modified Adjusted Gross Income) – administered by HCA.

  • Application methods:

    • Classic Medicaid: Washington Connection website, phone (1-877-501-2233), paper forms, in-person at local community service offices.

    • MAGI-Based Medicaid: Washington Healthplanfinder, mobile app (WAPlanfinder), fax, mail.

  • Authorized Representatives (AREP) can assist with applications.

  • Specialized Programs Administered by HCA:

    • Breast & Cervical Cancer Treatment Program

    • Refugee Medical Assistance

Module 2: Modified Adjusted Gross Income (MAGI)

  • Unearned Income Examples:

    • Title II Social Security benefits

    • Unemployment compensation

    • Interest income

    • Pensions, annuities, IRAs

    • Dividends

    • Military retirements

    • Alimony (Countable income for MAGI eligibility – TRUE)

    • Rental income

  • 5-Year Bar: Applies to a Nonqualified Non-Citizen (TRUE).

  • 5% FPL Income Disregard: Applied to countable MAGI to determine net income.

  • Income of tax dependents or children age 18 or younger: Only countable when income meets tax filing threshold (TRUE).

  • Tribal gaming payments made to a tribal member: Countable income (TRUE).

Module 3: Household Composition

  • Medical Assistance Units (MAU) are based on:

    • Tax filing status

    • Relationship

    • Age

  • Washington State Residency:

    • No specific period required before being considered a resident (TRUE).

    • Individuals who move directly into a Washington nursing facility are considered residents (TRUE).

  • Programs That Do Not Require an SSN:

    • Apple Health for Pregnant Individuals

    • Apple Health for Kids

    • Alien Emergency Medical

    • Refugee Medical Assistance

    • Breast and Cervical Cancer Treatment Program

Module 4: Application & Eligibility Process

  • Applications can be submitted online, by phone, by mail, or in person.

  • Post-Eligibility Review (PER):

    • Stands for Post-Eligibility Review (PER).

    • Individuals have 15 days to provide requested information for PER.

  • Eligibility Renewal:

    • All Apple Health programs must renew eligibility every 12 months (TRUE).

    • Individuals can renew coverage up to 90 days after it has ended (TRUE).

Module 5: Special Health Programs

  • Programs include:

    • Apple Health for Pregnant Individuals (Coverage starts at application and lasts through pregnancy + 12 months postpartum).

    • After-Pregnancy Coverage (APC) (Postpartum coverage for those not on Apple Health during pregnancy).

    • Medically Needy Program (For individuals above income limits but with high medical expenses).

    • Breast & Cervical Cancer Treatment Program (For uninsured women diagnosed with cancer).

    • Refugee Medical Assistance (Short-term medical coverage for refugees).

Module 6: Changes, Appeals & Retroactive Coverage

  • Required Reporting:

    • Individuals approved for MAGI-based Apple Health must report changes in residential or mailing address within 30 days (TRUE).

  • Administrative Hearings:

    • An individual may continue coverage during the administrative hearing process (TRUE).

  • Retroactive Coverage:

    • Individuals eligible for Washington Apple Health can request up to 3 months (90 days) of retroactive coverage (FALSE for 60 days).

Module 7: Washington Healthplanfinder Security Training

  • Healthplanfinder portal must be accessed only for authorized purposes.

  • Volunteers must protect Personal Health Information (PHI) and Personally Identifiable Information (PII).

  • Secure passwords, log out after use, and report security incidents immediately.

  • Annual security training is required for continued access.

  • Insurance Fraud Penalties:

    • Fines

    • Criminal prosecution

    • Civil penalties

    • Disqualification from future coverage

    • Repayment of benefits obtained fraudulently

Final Notes:

  • Completing the 7-module training, passing the assessment, and fulfilling registration requirements allows access to Washington Healthplanfinder as a Volunteer Assister.

  • Knowledge of Medicaid policies, eligibility criteria, and reporting changes is crucial for assisting applicants effectively.