To be eligible to receive covered services through community care hubs, a person must be enrolled in Washington apple health and:

1. (1) Meet one or more of the following social risk factors:

   1. (a) Be homeless or at risk of homelessness, as defined by 24 C.F.R. § 91.5, except for the annual income requirement in 24 C.F.R. § 91.5 (1)(i);
   2. (b) Meet the U.S. Department of Agriculture's (USDA) definition of low food security or very low food security;
   3. (c) Be experiencing poverty or near poverty, as defined by income below 200 percent of the federal poverty level (FPL); or
   4. (d) Screen positive for a health-related social need; and

2. (2) Have at least one of the following clinical risk factors:

   1. (a) Complex behavioral health needs;
   2. (b) Developmental disability needs;
   3. (c) Assessed as having a complex physical health need;
   4. (d) Experienced interpersonal violence;
   5. (e) Repeated emergency department use and crisis encounters;
   6. (f) Be pregnant or up to 12 months postpartum; or

   7. (g) Be a child age six or younger who currently has at least one of the following conditions:

      1. (i) Malnutrition, risk of developmental or growth delay, or impairment because of insufficient nutrition as a clinical risk factor for case management related to nutrition services only;
      2. (ii) Child maltreatment, as defined by the Centers for Disease Control and Prevention. (See https://www.cdc.gov/violence-prevention/?CDC_AAref_Val=https://www.cdc.gov/violenceprevention/pdf/%2520CM_Surveillancea.pdf);
      3. (iii) Is a child with a special health care need (CYSHCN) as defined by the Health Resources and Services Administration. (See https://mchb.hrsa.gov/programs-impact/focus-areas/children-youth-special-health-care-needs-cyshcn);
      4. (iv) Low birth weight;
      5. (v) A mental health condition; or
      6. (vi) Health conditions, including behavioral health and developmental syndromes, stemming from trauma, child abuse, and neglect; or
   8. (h) Be an adult age 65 or older who currently has at least one of the following:
   9. (i) Two or more chronic conditions as defined in RCW 74.09.010;
   10. (ii) Social isolation, which may place the person at risk for early death, neurocognitive disorders, sleep disruption, cardiovascular disease, or elder abuse;
   11. (iii) Malnutrition as a clinical risk factor for case management related to nutrition services only;
   12. (iv) Health conditions, including behavioral health and developmental syndromes, stemming from trauma, child abuse, and neglect; or
   13. (v) Requires assistance with activities of daily living as defined in WAC 182-565-0110 or instrumental activities of daily living as defined in WAC 388-106-0010; or
   14. (i) Be eligible under one of the following programs:
   15. (i) Medicaid personal care (MPC) as described in WAC 388-106-0210;
   16. (ii) Nursing facility care services as described in WAC 388-106-0355; or
   17. (iii) Long-term care services as described in WAC 388-106-0045.

[Statutory Authority: RCW 41.05.021, 41.05.160, and 41.05.021 (1)(m)(iv). WSR 26-04-117, s 182-565-0420, filed 2/3/26, effective 3/6/26.]