WAC 182-565-0420. Eligibility

To be eligible to receive covered services through community care hubs, a person must be enrolled in Washington apple health and: (1) Meet one or more of the following social risk factors: (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); (b) Meet the U.S. Department of Agriculture's (USDA) definition of low food security or very low food security; (c) Be experiencing poverty or near poverty, as defined by income below 200 percent of the federal poverty level (FPL); or (d) Screen positive for a health-related social need; and (2) Have at least one of the following clinical risk factors: (a) Complex behavioral health needs; (b) Developmental disability needs; (c) Assessed as having a complex physical health need; (d) Experienced interpersonal violence; (e) Repeated emergency department use and crisis encounters; (f) Be pregnant or up to 12 months postpartum; or (g) Be a child age six or younger who currently has at least one of the following conditions: (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; (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 ); (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 ); (iv) Low birth weight; (v) A mental health condition; or (vi) Health conditions, including behavioral health and developmental syndromes, stemming from trauma, child abuse, and neglect; or (h) Be an adult age 65 or older who currently has at least one of the following: (i) Two or more chronic conditions as defined in RCW 74.09.010 ; (ii) Social isolation, which may place the person at risk for early death, neurocognitive disorders, sleep disruption, cardiovascular disease, or elder abuse; (iii) Malnutrition as a clinical risk factor for case management related to nutrition services only; (iv) Health conditions, including behavioral health and developmental syndromes, stemming from trauma, child abuse, and neglect; or (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 (i) Be eligible under one of the following programs: (i) Medicaid personal care (MPC) as described in WAC 388-106-0210 ; (ii) Nursing facility care services as described in WAC 388-106-0355 ; or (iii) Long-term care services as described in WAC 388-106-0045 .