Assisting People Disenrolled
from Basic Health
This bulletin, prepared by Northwest Health Law Advocates and the Northwest Justice Project, is intended to inform you about the Basic Health disenrollments that take effect March 1. Please understand that not all of the details of the process are clear to us. We are still hoping to get responses to a number of questions from the Health Care Authority. We provide you with the best information available at this time since the disenrollments take effect so soon.
Background
The early action budget passed by the Legislature on February 18 has resulted in the immediate disenrollment of at least 17,000 Basic Health enrollees. Click here for the form notices of disenrollment and information sent out by the Health Care Authority (HCA). HCA sent the notices the same day as the budget change, for disenrollment effective March 1. The mass notices contain very limited information about the basis for the decisions. Notices were not translated into languages other than Spanish.
New eligibility limitations
Eligibility for Basic Health will now be restricted to those who qualify under the new Medicaid waiver granted in January that re-finances Basic Health (and Medical Care Services) through the Medicaid program. The legislature instructed HCA to disenroll those who do not meet the waiver criteria. These are:
- Adults who do not meet Medicaid immigration status requirements. Citizens and the following non-citizens should still be eligible: US Nationals, "qualified aliens," and others that meet the Medicaid adult immigrant status requirements. People are subject to the 5-year bar unless exempt. Click here for a chart of “qualified alien” statuses and associated immigration documents. People who have questions about whether they meet the requirements may contact Northwest Justice Project’s CLEAR line, 1-888-201-1014.
Basic Health has never asked for information about immigration status. They have based their decisions on whether or not they have a Social Security Number (SSN) on file. However, this process would not have caught all the people who are citizens or qualified aliens. It is important not to assume the notice is correct, and to provide documentation to HCA as soon as possible. - Adults over the waiver income threshold. Eligibility is limited to those whose countable income is below 133% of the Federal Income Guidelines (FIG, also known as FPL). This should be calculated for all adults based on the TANF-related family Medicaid income exclusions, deductions and assistance units, such as the 50% earnings disregard, full employment-related dependent care costs, etc. Those with earned income up to 200% FPL should generally continue to be eligible because of the 50% disregard although a few may be ineligible due to differing household composition/deeming rules. People with unemployment or other non-exempt unearned income over 133% FPL may not be eligible under the new criteria. Some types of unearned income may not be counted, however. If you need help determining income eligibility, contact Northwest Justice Project’s CLEAR line, 1-888-201-1014.
- Adults over 65. We are told that the vast majority also do not meet immigration status requirements above.
- Children under age 19. They will be disenrolled and transferred to Apple Health for Kids effective April 1.
Appeals and Legal Assistance
As noted above, people were disenrolled based on information that Basic Health already had. However, in many cases this may not have been sufficient to make accurate decisions. If a disenrolled person has a claim that they are still potentially eligible, they should both appeal and contact Basic Health and provide documentation as soon as possible to straighten things out. With the huge number of disenrollees, it may hard to get through on the phone or fax. People may also try using the web chat system and print out their conversation.
A person seeking legal assistance may contact Northwest Justice Project’s CLEAR line, 1-888-201-1014. NJP has Spanish-speaking attorneys and can arrange for interpreters.
Click here for a description of the Basic Health appeals process containing information about how to seek an appeal. Requesting an appeal within 30 days of the date of the decision (by Friday March 18) will allow you to continue receiving Basic Health pending the appeal.
Other Programs
The disenrollment letters suggest resources for people who are no longer eligible for Basic Health. In addition, we want to point out that some immigrants with emergency medical conditions, in cancer treatment, or needing kidney dialysis, may qualify for programs through the Department of Social and Health Services (DSHS). These programs do not require any particular immigration status but do have other eligibility requirements.
If you have any other information that might be useful to people facing disenrollment, please contact me.
Janet Varon
Executive Director
Northwest Health Law Advocates
4759 15th Ave. NE, Suite 305
Seattle, WA 98105
206-325-6464
janet(at)nohla.org
Basic Health Disenrollment Letters
21-310 Notice of Disenrollment FINAL SAMPLE.PDF - Immigration status disenrollment
21-310s Notice of Disenrollment FINAL SAMPLE.PDF - in Spanish
21-313 Non-Transition Eligible 65_ SAMPLE.PDF - Age 65+ disenrollement
21-313s Non-Transition Eligible 65_ SAMPLE.PDF - in Spanish
21-314 Non-Transition Eligible over 133 SAMPLE.PDF - Income over 133% disenrollment
21-314s Non-Transition Eligible over 133 SAMPLE.PDF - in Spanish
Information sent out by the Health Care Authority (HCA)
Hot Sheet - Disenrollment Notification FINAL - Plans_Sponsors.pdf
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