Medicaid/CHIP And Basic Health Plan Benefits Medicaid provides free health insurance and long-term care coverage for some low-income people and their children. In Washington, the Children’s Health Insurance Program (CHIP) covers additional children who do not qualify for Medicaid. The Washington State Basic Health Plan (BH) provides health insurance for basic medical needs for people who do not qualify for Medicaid. BH requires a monthly premium payment based on your income. What does Medicaid cover? Medicaid pays the full cost of most necessary medical care for eligible individuals. There are some exclusions, such as cosmetic surgery and chiropractic care. Benefits vary slightly among the programs. All medically necessary services are covered for children. What does CHIP cover? Washington CHIP provides health insurance to children in eligible families. It includes comprehensive medical benefits. Premiums start at $15 per child per month. The maximum premium is $45 per family per month. What does Basic Health cover? Washington State Basic Health (BH) is a health insurance program for basic medical needs. It includes limited mental health and chemical dependency treatment. You must select a health plan. Premiums are based on a sliding scale. The cost starts at $17 per month. The amount depends on income level, ages, number of enrollees, county, and the health plan you choose. There is also a 9- month pre-existing condition waiting period in some cases. How do I apply? To apply for Medicaid or CHIP, call your local DSHS Community Services Office (CSO) at 1-800-865- 7801. For help in applying, call 1-877-KIDS-NOW (1-877-543-7669) or Community Health Access Program (CHAP) at 1-800-756-5437. Applications are available in many languages. To apply for Basic Health, call 1-800-826-2444 or apply online at www.basichealth.hca.wa.gov/ Am I eligible for Medicaid/CHIP/Basic Health? Medicaid/Children’s Medicaid covers many categories of people in financial need: Children (in low-income families) Pregnant women Disabled adults Aged adults (65 and over) Parents and relatives caring for children Children’s Health Insurance Program (CHIP) To be eligible for CHIP, a child: Has income above the Medicaid limit but below 250% of the Federal Poverty Level Cannot be covered by other insurance; and Must pay monthly premiums Basic Health Most children under age 19 qualify for "BHP Plus." No premiums or co-payments are charged for kids whose income is under 200% of the federal poverty level. There are no waiting lists for these children. Co-payments are required for many services for adults. There is also an annual deductible. There is sometimes a waiting list for adults to get in. What are the income limits? The following income standards are general guidelines and do not apply to the elderly, disabled, or other special categories. For Medicaid and CHIP, do not count adults other than parents. Other income deductions may apply. Partial Medicaid coverage may also be available for children over these limits. Number of people Medicaid for CHIP Insurance in family Children/Basic Health Approximate monthly (parents and Approximate monthly income children only) income 1 Up to $1,634 up to $2,042 2 Up to $2,200 up to $2,750 3 Up to $2,767 up to $3,459 Add $567 for each more Add $709 for each additional family member Are non-citizens eligible? Some non-citizens, including refugees and legal permanent residents who have been in the U.S. for more than 5 years, may qualify for Medicaid and CHIP. Some immigrant children who do not qualify for Medicaid may be eligible for the state-funded CHIP or Basic Health. How do I request a fair hearing? If Medicaid coverage is denied or stopped, you may ask for a fair hearing. To ask for a fair hearing, go to your local community services office or write to the Office of Administrative Hearings, P.O. Box 42488, Olympia, WA 98504. If it is an emergency, you may ask to have your hearing held as soon as possible. Call the Office of Administrative Hearings at (360) 664-8717 or 1-800-583-8271. An administrative law judge will decide whether the action was correct. Washington Appleseed Center for Law in the Public Interest. July 2006. Washington Appleseed works to build a just society through education, legal advocacy, community activism and policy expertise, addressing root causes and producing practical solutions. www.waappleseed.org This publication provides general information concerning your rights and responsibilities. It is not intended as a substitute for specific legal advice. Information for this brochure is based on information found at walawhelp.org (Northwest Justice Project) and http://www.nohla.org/ (Northwest Health Law Advocates).
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