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STATE OF WASHINGTON
DEPARTMENT OF SOCIAL AND HEALTH SERVICES
Aging and Long-Term Support Administration
Home and Community Services Division
PO Box 45600, Olympia, WA 98504-5600
H14-030 - Information
May 23, 2014
|TO: |Area Agency on Aging (AAA) Directors |
| |Home and Community Services (HCS) Division Regional Administrators Developmental Disabilities Administration |
| |(DDA) Regional Administrators |
|FROM: |Bea Rector, Director, Home and Community Services Division |
| |Don Clintsman, Deputy Assistant Secretary, Developmental Disabilities Administration |
|SUBJECT: |New “Classic Medicaid” Washington Apple Health Application Form |
|Purpose: |To inform HCS, AAA, and DDA staff of changes to the Washington Apple Health Supplemental Form. |
|Background: |The Health Care Authority (HCA) is changing the HCA 18-005 Washington Apple Health Supplemental Form. |
| |Effective 05/01/14, a new version of the form will be used as a stand-alone Washington Apple Health |
| |Application for Long Term Care/Aged, Blind, Disabled Coverage. |
|What’s new, changed, or |Individuals may now apply for the following “Classic Medicaid” programs using the new form: |
|Clarified | |
| |Long-term care services |
| |Coverage for those age 65 or older |
| |Disability-based coverage |
| |Medicare Savings Program |
| |This new form enables direct routing of applications for clients who need long-term care services or |
| |disability-based health coverage to the local HCS or AAA office to make the eligibility determinations. |
| | |
| |“Classic Medicaid” applicants no longer need to complete both the HCA 18-001 Application for Health Care |
| |Coverage and the old HCA 18-005 forms if they use the new stand-alone application. Clients may continue to |
| |apply online via Washington Connection at . |
| | |
| |There is no change to the HCA 18-001 Application for Health Care Coverage used by individuals to apply for |
| |MAGI-based Family, Children’s, Pregnancy, and Adult medical programs. These applications may continue to be |
| |submitted online via Washington Healthplanfinder at . |
|ACTION: |Stakeholders, community partners, JRP’s, AAA offices, DDA offices, and HCS offices are asked to destroy all |
| |old stock of form HCA 18-005 (5/13) Washington Apple Health Supplemental Form and replace it with the new HCA|
| |18-005 (3/14) version effective May 1st, 2014. |
| | |
| |This new form can be found online at hca.medicaid/forms/Pages/index.aspx in English and the eight |
| |supported languages on April 28th for use beginning May 1st |
|ATTACHMENT(S): |[pic] |
|CONTACT(S): |Catherine Fisher, Financial Unit Manager |
| |HCS |
| |(360) 725-2318 |
| |Catherine.Fisher@dshs. |
| | |
| |Shannon Manion |
| |DDA |
| |360.725.3454 |
| |ManioSK@dshs. |
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