Change of circumstance. Countable income and lump sum payments. Free-form text for ACES letters. Health Insurance Premium program. Health care for aged, blind, or disabled. Income Best Estimate guide. Income allocation and deeming. Income overview 1: income eligibility.
Income overview 2: income eligibility continued. Income overview 3: exclusions and allocations. Income overview 4: exclusions and allocations continued.
Income ownership and availability. Income special disregards. Medicare Savings Program. Medicare and Spenddown. Other Programs.
Public programs. Reason code quick links. Resource exclusions. Resource ownership and availability. Resources overview. Supplemental security income SSI recipients. Treatment of Income chart. Revised Date:. July 15, Clarifying Information What is Medicare and who can get Medicare? Medicare provides health care coverage for people who: Have worked under the Social Security or Railroad Retirement systems for more Railroad Retirement information, see Worker Responsibilities, section 2 below and: Are age 65 or older; or Have been receiving Social Security or Railroad disability benefits for at least 24 months; or Need continuing dialysis for permanent renal failure; or Have received a kidney transplant within the last thirty-six months; or Are receiving Supplemental Security Income SSI and; Meet the citizenship and alien status requirements in chapter ; and Are age 65 or older or can draw Medicare based on having sufficient work quarters on their own or through a disabled parent.
An individual can apply for Medicare online at Social Security Administration's website. The Medicare program includes four kinds of health insurance coverage: Part A - Hospital Insurance Part A is free for people who have worked and: Have earned the required number of work quarters, or Have a spouse who has earned the required number of work quarters.
Part A is also available at a cost for Medicare-entitled individuals who do not have the required number of work quarters for free Medicare Part A. Part A entitlements are also listed in Aces. Part B entitlements are also available in Aces. Several Part C plans doing business in Washington do not charge a monthly premium. HCA no longer pays Part C premiums.
CMS automatically enrolls dual-eligible i. Dual-eligible individuals begin receiving most of their prescription drug benefits through Medicare and not Medicaid when they gain dual-eligibility status CN or MN plus Medicare. Medicare has contracted with Limited Income Net Humana to provide prescription drug coverage for Medicaid individuals newly entitled to Medicare and not yet enrolled in a Part D plan.
Medicaid individuals must show proof of Medicaid eligibility and Medicare entitlement to the pharmacist. A Medicaid award letter is sufficient proof of Medicaid and a Medicare card or letter from SSA stating the effective date of Medicare is sufficient proof of Medicare entitlement.
The Limited Income Net Humana plan can be reached at For more information specific to long-term care individuals, see Medicare and Long-term Care. To participate in PACE, an individual must be 55 years of age or older, require nursing home level of care but be able to live safely in the community at time of enrollment with the services of PACE, and reside in the service area of a PACE organization.
PACE participants may disenroll from the program at any time and for any reason and those with Medicare or Medicaid who disenroll will be assisted in returning to their former health care coverage. PACE provides its participants with all services covered by Medicare and Medicaid, without the limitations normally imposed by these programs.
It also provides any other services deemed necessary by the interdisciplinary team that would allow program participants to remain in the community. Services provided by PACE include, but are not limited to, primary care including doctor, dental and nursing services , prescription drugs, adult day health care, home and personal care services, nutrition services, and hospital and nursing home care if and when needed.
Transportation to and from the center and all off-site medical appointments is also provided. PACE organizations receive a set amount of Medicare and Medicaid funds each month to ensure participant care, whether services are provided in the home, community or in a nursing home setting. This capitated funding arrangement rewards providers who are flexible and creative in providing high quality care and gives them the ability to coordinate care across settings and medical disciplines.
The program also accepts participants who pay privately. You must live in their coverage area see zip codes to participate. Lane St. Seattle, WA Revised Date:. December 12, Purpose: To clarify the Medicaid eligibility requirement to apply for Medicare. WAC Washington apple health -- General eligibility requirements. Effective April 27, When you apply for Washington apple health programs established under chapter When you apply for apple health, we first consider you for federally funded or federally matched programs.
We consider you for state-funded programs after we have determined that you are ineligible for federally funded and federally matched programs. Unless otherwise specified in a program specific WAC, the eligibility criteria for each program are as follows: Age WAC ; Residence in Washington state WAC and ; Citizenship or immigration status in the United States WAC ; Possession of a valid Social Security account number WAC ; Assignment of medical support rights to the state of Washington WAC ; Application for medicare and enrollment into medicare's prescription drug program if: You are likely entitled to medicare; and We have authority to pay medicare cost sharing as described in chapter WAC.
In addition to the general eligibility requirements in subsection 3 of this section, each program has specific eligibility requirements as described in applicable WAC. If you are in a public institution, including a correctional facility, you are not eligible for full scope apple health coverage, except in the following situations: If you are age twenty-one or younger or age sixty-five or older and are a patient in an institution for mental disease see WAC 5 ; or You receive inpatient hospital services outside of the public institution or correctional facility.
We limit coverage for people who become residents in a public institution, under subsection 5 of this section, until they are released. If you are terminated from SSI or lose eligibility for categorically needy CN or alternative benefits plan ABP coverage, you receive coverage under the apple health program with the highest scope of care for which you may be eligible while we determine your eligibility for other health care programs.
See WAC Clarifying Information Application for Medicare Application for and enrollment into Medicare is a condition of eligibility for individuals who apply for Apple Health coverage, as long as the agency is able to pick up the cost of the premiums on the individual's behalf.
Worker Responsibilities Every month Apple Health eligible individuals age 65 and older not already receiving Medicare are asked to provide proof of application for Medicare. The following process is followed: Individuals are mailed a letter generated by barcode around the 20th of the month asking for proof of application for Medicare. The letter is provided in the individual's primary language and in English to the individual and to the individual's authorized representative.
Only the English version is stored in DMS. All letters have a business reply postage paid return envelope addressed to the Medicare Buy-in Unit for returning the proof of Medicare application. Thirty days or more after the first letter is sent, the Medicare Buy-in Unit works the ticklers to review for proof of application for Medicare. If no proof is received, a second letter is sent to the individual requesting proof of application for Medicare and again ticklers are set for the Medicare Buy-in Unit to review the case for proof.
Proof Received After Termination — If the former recipient provides verification of application for Medicare their Medicaid case can be reactivated.
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