(1) Effective on or after January 1, 2014, a person is eligible for Washington apple health (WAH) modified adjusted gross income (MAGI)-based adult coverage when he or she meets the following requirements:
- (a) Is age nineteen or older and under the age of sixty-five;
- (b) Is not entitled to, or enrolled in, medicare benefits under Part A or B of Title XVIII of the Social Security Act;
(c) Is not otherwise eligible for and enrolled in mandatory coverage under one of the following programs:
- (i) WAH SSI-related categorically needy (CN);
- (ii) WAH foster care program; or
- (iii) WAH adoption support program;
- (d) Meets citizenship and immigration status requirements described in WAC 182-503-0535;
- (e) Meets general eligibility requirements described in WAC 182-503-0505; and
- (f) Has net countable income that is at or below one hundred thirty-three percent of the federal poverty level for a household of the applicable size.
- (2) Parents or caretaker relatives of an eligible dependent child as described in WAC 182-503-0565 are first considered for WAH for families as described in WAC 182-505-0240. A person whose countable income exceeds the standard to qualify for family coverage is considered for coverage under this section.
- (3) Persons who are eligible under this section are eligible for WAH alternative benefit plan as defined in WAC 182-500-0010 coverage. A person described in this section is not eligible for medically needy WAH.
- (4) Other coverage options for adults not eligible under this section are described in WAC 182-508-0001.
[Statutory Authority: RCW 41.05.021, 41.05.160, Public Law 111-148, 42 C.F.R. § 431, 435, and 457, and 45 C.F.R. § 155. WSR 14-16-052, § 182-505-0250, filed 7/29/14, effective 8/29/14.]