Revised March 25, 2011
Purpose: The department of social and health services (DSHS) sends you letters to tell you about your case.
Revised January 21, 2020
|
Code |
Reason Code Title / Text |
WAC References |
Recommended Free Form Text |
|---|---|---|---|
|
101 |
ABD Cash/HEN Referral Spouse Ineligible |
None Required |
|
|
102 |
WASHCAP Application Month Denied - For Administrative Use Only |
None |
None Required |
|
103 |
WASHCAP Terminates - Client Has Had Earned Income For More Than Three Months You can't receive Washington State Combined Application Project (WASHCAP) food assistance because you've been working more than 3 months. |
None Required |
|
|
104 |
SSA Terminates WASHCAP Food Assistance |
None Required |
|
|
105 |
WASHCAP Terminates - Client Living Situation Has Changed You can't receive Washington State Combined Application Project (WASHCAP) food benefits because your living arrangement changed. |
None Required |
|
|
106 |
WASHCAP Terminates - Client Getting $1.00 Or Less SSI Money You stopped receiving SSI cash. |
None Required |
|
|
107 |
WASHCAP Terminates - Client Not Eligible For SSI Money Or Medical |
None Required |
|
|
109 |
Not SSP Eligible - Client's SSI Terminated You can't receive a State Supplemental Payment if you’re not receiving a Supplemental Security Income (SSI) payment. |
None Required |
|
|
110 |
Not SSP Eligible - Invalid Living Arrangement You can't receive a State Supplemental Payment (SSP) when you live in an institution. |
None Required |
|
|
111 |
Not SSP Eligible - SSI Eligibility Category Change You can only receive a State Supplemental Payment (SSP) if you receive SSI and one of the following is true:
|
None Required |
|
|
112 |
Receiving Tribal TANF Benefits We believe you are eligible for cash benefits from the tribe |
If you are a client in a household which is eligible for a tribal TANF program, you cannot receive state and tribal TANF in the same month. |
|
|
120 |
Failed to Provide Proof of Citizenship/Identity You did not provide proof of citizenship for a member or members of your household. Proof of citizenship is required before a person can receive medical. |
Specify the persons who are ineligible due to lack of proof of citizenship |
|
| 121 |
Ineligible Spouse of an SSI Recipient – Medical Because your spouse receives SSI, you aren’t eligible for Community First Choice services. |
No Mandatory Freeform Text |
|
|
130 |
Not TFA Eligible – Not Recipient of BF in Prior Month The people listed above won't receive Transitional Food benefits with you because they didn't receive Basic Food benefits with you during the last month you received cash assistance. |
None Required |
|
|
131 |
A Member of the Household is now receiving TANF Someone who gets Transitional Food with you is approved for Temporary Assistance for Needy Families (TANF) or Tribal TANF. We will see if you can get Basic Food. You may need to turn in an eligibility review for us to see if you can get Basic Food. |
Specify the person who is receiving TANF or Tribal TANF. |
|
| 132 |
RCA E&T Participation Refugee Cash Assistance requires participation in an employment and training program. |
None required | |
| 133 |
One Caretaker Relative Recipient Only one caretaker (non-parent) can be recipient on a TANF or SFA grant. |
388-408-0025 | None required |
| 134 |
No WF Orientation The person(s) listed below didn't attend the required WorkFirst Orientation. |
None required | |
|
141 |
Mid-Certification Review Not Returned We did not get your mid-certification report form. If you get us what we need before the end of the month, we will reconsider our decision. You must either: · Turn in the form; or · Call us to report your current circumstances. |
None Required |
|
|
142 |
Incomplete Mid-Certification Review We got your mid-certification report form. Some information is still missing. We sent you a letter telling you what you need to give to us. We did not get it. |
List the missing items. |
|
| 160 |
MCS Enrollment Cap We aren't currently enrolling new members in this program. This medical program isn't accepting new enrollees because of an enrollment cap due to limited funding. |
182-508-0150 | None required |
| 161 |
MCS Enrollment Cap - Client Placed on Wait List We aren't currently enrolling new members in this program. This medical program isn't accepting new enrollees because of limited funding. We added you to the waiting list. Those on the waiting list longest will receive the first opportunity to apply. We'll notify you by mail when space is available. |
182-508-0150 | None required |
| 162 |
MCS Enrollment Cap - Already on Wait List We aren't currently enrolling new members in this program. You are already on the medical coverage waiting list. |
182-508-0150 | None required |
| 163 | Medical Care Services (MCS) is only available for recipients of the AGed, Blind, Disabled, (ABD) cash program, or the Housing and Essential Needs (HEN) Referral program. The household member(s) listed won't be eligible for assistance from these programs. | 182-508-0150 | None required |
| 164 | You entered the U.S. on or after August 22, 1996 and were eligible for limited health care coverage. You have been here legally for 5 years. Your health care coverage is ending. You may be eligible for new health care coverage under the Affordable Care Act. To find out go to www.wahealthplanfinder.org or call 1-855-923-4633. This change does not affect your HEN eligibility. | 182-503-0535 182-508-0001 182-508-0005 388-400-0060 388-400-0070 388-424-0015 |
None required |
| 167 |
TSOA - Invalid Waiver You need an approved plan before we can help you and your caregiver |
182-513-1610 |
No Mandatory Freeform Text |
| 168 |
TSOA – Client Active in a Different AU You can’t receive services under this program when you are eligible for certain Medicaid programs. |
182-513-1615 | No Mandatory Freeform Text |
| 177 |
Missed Food Application Deadline We must make a decision on your eligibility within 30 days from the date you applied. We don’t have enough information to determine your eligibility. We’ve denied your application. |
388-406-0035 388-406-0040 | None required. |
|
187 |
Client Already Received CN Medicaid In Another AU For This Benefit Month - For Administrative Use Only |
None |
None Required |
|
188 |
Medical Review Not Completed Your medical disability review was not completed in time. This is because: We did not get updated medical information; or We got your medical information but it is still being reviewed. |
Specify person who is being terminated. |
|
| 195 |
Failed Blind or Disabled Requirements - HWD You don't meet federal blind or disability requirements based on the medical evidence we have. |
None required |
Revised on: November 29, 2022
|
Code |
Reason Code Title / Text |
WAC References |
Recommended Free Form Text |
|---|---|---|---|
|
200 |
Non-Citizen Medicaid Ineligibility You do not meet the citizenship or alien status requirements to receive Washington Apple Health. |
Need to specify which persons in AU do not meet citizenship requirements. |
|
|
201 |
Living Arrangement - Cash / Medical Assistance |
|
Your living arrangement does not meet our requirements because (specify relevant requirement and how client's living situation does not meet that requirement) . (Note to Users: This reason code is based on the valid value entered in the living arrangement field on the DEM1 screen). |
|
202 |
Citizenship / Alien Status |
|
If client submitted verification of alien status: You do not meet the requirements because (specify relevant requirement and how client's alien status does not meet that requirement). . If client didn't submit verification of status: We can't determine if you meet our requirements because we do not have verification of your citizenship status. |
|
203 |
Receiving SSI |
None Required |
|
|
204 |
No Dependent Child |
If pending medical: We have not figured out if you are eligible for medical assistance because we are still waiting to hear if your condition meets our definition of a disability or emergency medical condition. |
|
|
205 |
Failed Age / School Attendance |
|
(Name) is # years old. S/he cannot get assistance because (specify requirement that client does not meet). . |
|
206 |
Living Arrangement - Food Assistance |
Your living arrangement does not meet our requirements because (specify requirement that client does not meet) . (Note to Users: This reason code is based on the valid value entered in the living arrangement field on the DEM1 screen). |
|
|
207 |
Failed Eligible Student Requirement - Food Assistance |
Specify requirements and why client doesn't meet them. |
|
|
208 |
Failed Social Security Number (SSN) Requirement We don't have one of the following:
|
Need to specify which person(s) in AU we require the SSN for. |
|
|
209 |
Failed Refugee Requirement |
For refugees: or For asylees: |
|
Code |
Reason Code Title / Text |
WAC References |
Free Form Text |
|---|---|---|---|
|
210 |
Failed Residency Requirement |
You do not meet the residency requirements because (specify client facts showing why client is not considered a WA resident) . |
|
|
212 |
No Relationship To receive cash assistance for a child, you must be: A relative, A legal guardian, Acting as the child's parent, or A court ordered custodian. See WAC rule (Washington Administrative Code): |
|
(Caretaker's name) is not a relative of specified degree, legal guardian, acting as a parent or permanent custodian of (Child's Name). (Note to Users: This reason code is based on the valid value entered in the relationship field on the STAT screen). If pending medical: |
|
213 |
Failed Pregnancy Requirement - S Medical & Family Planning Medical |
You are not eligible for post-partum coverage because it has been more than 2 months since your pregnancy ended. or You are not eligible for family planning coverage since it has been more than 12 months since your pregnancy ended. |
|
|
214 |
TANF Pregnancy Only - Father of Unborn Not Eligible |
None Required |
|
|
215 |
Failed Work Registration Requirements |
You did not on 00/00/00. You cannot get benefits from 00/00/00 to 00/00/00 unless you . If you don't do this, you will have to reapply after 00/00/00 and start participating. |
|
|
218 |
Roomer - Food Assistance |
None Required |
|
|
219 |
Voluntary Quit |
You quit your job or reduced your work effort at on 00/00/00. You cannot get benefits until [disqualification period] unless you become exempt from work registration. If you want benefits, you must reapply. You can get food assistance, during this time if you become exempt from work registration. |
|
Code |
Reason Code Title / Text |
WAC References |
Free Form Text |
|---|---|---|---|
|
220 |
Failed Age Requirement - Medical |
You must be to get benefits from this program. |
|
|
221 |
Failed Incapacity Requirement |
During your financial interview on 00/00/0000, you did not report an incapacity. If a 14-118 (IND) is received, use the mandatory free form text included in the 14-118. |
|
|
222 |
Eligibility Not Established For Month |
None Required |
|
|
223 |
Failed E&T Requirements - 2nd Offense |
You did not on 00/00/00. You cannot get benefits until 00/00/00. If you want food assistance after that, you must reapply and start participating. |
|
|
224 |
Failed E&T Requirements - 3rd Offense |
You did not on 00/00/00. You cannot get benefits until 00/00/00. If you want food assistance after that, you must reapply and start participating. |
|
|
225 |
Now Receiving SSI |
None Required |
|
|
226 |
Residing In Inpatient Psychiatric Institution |
388-400-0005
|
None Required |
|
227 |
Under Previous Work Registration Penalty - Food Assistance |
You cannot get benefits until 00/00/00. We told you about this on 00/00/00. |
|
|
228 |
IV-D Non-Cooperation |
DCS told us that you (specify non-cooperation) . |
|
|
229 |
Exceeds Adult Recipient TANF Time Limits An adult or emancipated minor in your assistance unit received 60 months of TANF/SFA cash assistance and doesn't qualify for a time limit hardship extension. |
None Required |
|
Code |
Reason Code Title / Text |
WAC References |
Free Form Text |
|---|---|---|---|
|
230 |
Verification |
On 00/00/00, I asked you to provide the following items by 00/00/00: List of items |
|
|
232 |
IPV Disqualified |
This is the (first/second/third) time that (name) has done this. S/he cannot get benefits again until 00/00/00. |
|
|
233 |
Change In Household Size |
(Name) moved in/out on 00/00/00. or (Name) is now/no longer getting benefits with you because. |
|
|
235 |
Review Not Complete |
None Required |
|
|
237 |
Change In Shelter Cost / Shelter Deduction |
For cash assistance: or For food assistance: |
|
|
238 |
Change In Food Assistance Medical Expenses |
If newly elderly/disabled: Since you are now considered disabled or elderly we are using your medical expenses to figure out how much of your income counts. |
|
Code |
Reason Code Title / Text |
WAC References |
Free Form Text |
|---|---|---|---|
|
240 |
CEAP AUTO Close - For Administrative Use Only |
None |
None Required |
|
242 |
Prior Lump Sum Penalty Period Exists |
You got $ from on 00/00/00. You cannot get benefits until 00/00/00. We told you about this on 00/00/00. |
|
|
244 |
Death |
Specify the person who died. |
|
|
245 |
No Eligible Household Members |
If no other reason code or letter: No one is eligible because (specify the requirement if not met. If more than one specify the one that applies to all members or the one that primarily prevented eligibility) . |
|
|
246 |
Under Previous Penalty |
You cannot get benefits because (specify what action caused the penalty). . We told you about this on 00/00/00. You cannot get benefits until 00/00/00. |
|
|
247 |
Under Previous Non-Cooperation With QC Penalty |
You cannot get benefits for # months because (specify what action caused the penalty) . You can regain your eligibility by (specify actions needed to be eligible again . If you have any questions about this, call the Quality Assurance worker at (000) 000-0000. |
|
|
248 |
Head of Household Not Eligible |
(Name) cannot get benefits because (specify why that person cannot get benefits - requirement not met and why they don't meet it). |
|
|
249 |
Receipt Of Benefits From Another State During Month |
You already got benefits from (Name of State). |
|
Code |
Reason Code Title / Text |
WAC References |
Free Form Text |
|---|---|---|---|
|
250 |
Not Aged, Blind Or Disabled - Medical |
None Required |
|
|
251 |
Already Received Food Assistance |
None Required |
|
|
252 |
Non-Compliance Sanction for not participating in the WorkFirst program as required See WAC rule (Washington Administrative Code): |
(Name) is in non-compliance sanction status. |
|
|
254 |
Under Previous Transfer Of Resources Penalty - Food Assistance |
You transferred your (type of property) on 00/00/00. Since you did not get the fair market value, you cannot get benefits from 00/00/00 to 00/00/00. We told you about this on 00/00/00. |
|
|
255 |
Transfer Penalty Still In Effect (MA) |
You transferred your (type of property) on 00/00/00. Since you did not get the fair market value, you cannot get benefits from 00/00/00 to 00/00/00. We told you about this on 00/00/00. |
|
|
256 |
Fleeing Felon & Parole Violation - CA / FA |
Specify the information used to verify that A/R was fleeing or breaking probation/parole, and what the violation is. A finding that the A/R is breaking probation or parole must be from an administrative body or court. |
|
|
258 |
Failed ABAWD Requirement |
None required. |
|
|
259 |
Temporary Absence Change Not Reported In 5 Days |
(Name of child(ren)) left your house on (date). You knew they were going to be gone for longer than 90 days because (specify information source and how recipient knew this). |
|
Code |
Reason Code Title / Text |
WAC References |
Free Form Text |
|---|---|---|---|
|
260 |
Food Assistance Voluntary Quit - 2nd Offense |
You quit your job at on 00/00/00. You cannot get benefits until 00/00/00 unless you reapply and (specify what client has to do to get benefits before that). |
|
|
261 |
Food Assistance Voluntary Quit - 3rd Or Subsequent Offense |
You quit your job at on 00/00/00. You cannot get benefits until 00/00/00 unless you reapply and (specify what client has to do to get benefits before that).. |
|
|
262 |
Convicted of Receiving PA In 2 Or More States |
Specify which other state the benefits were received in and when they were received. |
|
|
263 |
Convicted Of Unlawful Practices |
|
You were convicted on 00/00/00. The court says you cannot get benefits until 00/00/00. |
|
264 |
Minor Parent Inappropriate Living Situation |
None Required |
|
|
265 |
Minor Parent Failed School Requirement |
None Required |
|
|
266 |
Non-Cooperation With TPL |
None Required |
|
|
268 |
40% WorkFirst Sanction |
(Name) did not (specify IRPrequirement not met) on 00/00/00. We told you about this on 00/00/00. (Name) can regain eligibility by . |
|
|
269 |
10-Year Penalty For Fraudulent Statement |
You were convicted on 00/00/00. |
|
Code |
Reason Code Title / Text |
WAC References |
Free Form Text |
|---|---|---|---|
|
271 |
Trafficking Less Than $500 Or For Controlled Substance |
You cannot get benefits from 00/00/00 to 00/00/00 because you . |
|
|
272 |
Permanent Disqualification - Illegal Trafficking More Than $500 Or For Controlled Substance
See WAC rule (Washington Administrative Code): |
You cannot get benefits from 00/00/00 to 00/00/00 because you . |
|
|
275 |
No Longer Receiving SSI |
None Required |
|
|
276 |
Your medical condition doesn’t meet the emergency medical requirements for Washington Apple Health Alien Emergency Medical Coverage. |
None Required |
|
| 277 |
Not Receiving Medical when Child is Born The mother of the child listed above was not receiving medical assistance when the child was born. |
182-505-0115 | None Required |
|
279 |
QMB Start Date - Administrative Use Only |
None |
None Required |
|
Code |
Reason Code Title / Text |
WAC References |
Free Form Text |
|---|---|---|---|
|
280 |
Not Entitled To Medicare Part A |
None Required |
|
|
281 |
Waiver Not Approved |
We do not have a plan of care for your (type of home or community based (HCB) program). |
|
|
282 |
Indian Food Distribution Program |
None Required |
|
|
284 |
Failed To Meet Spenddown Requirement |
None Required |
|
|
285 |
Income Exceeds 250% Of FPL (CHIP) |
The income limit for your family size is $_____ |
|
|
286 |
Cash Diversion - Not Eligible ForTANF |
If no other reason code or letter: You are not eligible for TANF/SFA because . |
|
|
288 |
Ineligible ESLMB Already Receiving MA |
None Required |
|
|
289 |
Failed To Appear For Application Appointment CA/MA/FA |
None Required |
|
Code |
Reason Code Title / Text |
WACReferences |
Free Form Text |
|---|---|---|---|
|
290 |
Overdue Incapacity Review |
None Required |
|
|
292 |
Group Home Decertified |
You live at (Name of Facility). |
|
|
294 |
Changed To Family Planning |
None Required |
|
|
295 |
Dependent Has Creditable Medical Coverage (CHIP) |
None Required |
Revised January 21, 2020
|
Code |
Reason Code Title / Text |
WAC References |
Recommended Free Form Text |
|---|---|---|---|
|
300 |
Non-Payment of Premium According to our records, you have not paid all required premiums. See WAC rule (Washington Administrative Code): |
None Required |
|
|
301 |
Exceeds Income Standard |
182-513-1205 182-513-1245 |
None Required |
|
302 |
Change In Child Support |
The amount of child support you must pay changed from $_______ to $_____. |
|
|
304 |
Additional Requirements Change |
The amount of money you get for (type of additional requirement) has changed from $__ to $__ because . |
|
|
305 |
Food Assistance Change Due To Change In Grant Amount |
None Required |
|
|
306 |
Change In Unearned Income |
Your income from (source) has changed from $___ to $__. |
|
|
307 |
Change In Gross Earned Income |
Your gross earned income has changed from $___ to $___. |
|
Code |
Reason Code Title / Text |
WAC References |
Free Form Text |
|---|---|---|---|
|
320 |
Exceeds Gross Income Limit |
The limit for your household size is $___. |
|
|
321 |
Change In Net Deemed Income |
We are counting $__ of (Name)'s income. |
|
|
323 |
Change In Home Maintenance Exemption
See WAC rule (Washington Administrative Code): |
Your home maintenance amount has changed because ________. (add specific details, e.g. “Your rent has changed from $____ to $_____.” Or “On __(date)___, Dr. _____ told us you can’t return home before _____.”) |
|
|
324 |
Child Support More Than Grant |
None Required |
|
|
327 |
Change In Recoupment |
None Required |
|
|
328 |
Excess Net Income - Food Assistance |
The limit for your household size is $ . |
|
|
329 |
Change In Dependent Care Costs |
The amount you pay has changed from $____ to $____. |
|
Code |
Reason Code Title / Text |
WAC References |
Free Form Text |
|---|---|---|---|
|
330 |
Lump Sum |
You got $__ from __ on 00/00/00. Your countable resources are now $__. Your resources cannot be more than $_____ (specify resource limit for household size). If the grant is suspended: If the grant is terminated: |
|
|
331 |
Excess Net Income - Cash Assistance |
The limit for your household size is $ ____. |
|
|
332 |
Change In CPI Allowance |
182-513-1385 182-513-1205 182-513-1215 182-513-1225 |
None Required |
|
334 |
Exceeds Earned Income Limit Your earned income is over the limit for this program |
The limit for your household size is $____. |
|
|
335 |
Change In Uncovered Medical Expense Allocation |
The amount you can use to pay for the following medical expenses has changed: (Type of expense) from $__to $ . |
|
|
336 |
Change In CSMA / FMMA Allocation |
182-513-1385 |
Your allocation changed from $___ to $___because __________. |
|
338 |
Not Eligible Until Month After Application Month |
None Required |
|
|
339 |
Medical Extension Ends |
None Required. |
| Code | Reason Code Title / Text | WAC References | Free Form Text |
|---|---|---|---|
|
340 |
QMB Ineligible - Client Is Not Institutional Related |
None Required |
|
|
341 |
SSP Rate Change The state supplemental payment rate for all SSI recipients has changed. See WAC rule (Washington Administrative Code): |
None Required |
|
|
342 |
Termination/Denial Due to Non-Payment of Premium You didn't pay required premiums. |
None Required |
|
| 343 |
Third Party Resource Amount Changed The amount of Third Party Resources you get has changed. See WAC rule (Washington Administrative Code): |
The amount of your third party resource has changed from $___ to $__. | |
| 345 |
Home Maintenance Exemption Changed We changed the housing deduction due to one or more of the following: The amount of your housing costs changed. Your income changed. The amount we allow for your housing costs changed. |
182-513-1380 | None Required. |
| 346 |
Home Maintenance Exemption Exceeds Time Limit We ended your housing deduction because you received it for the maximum of 6 months. |
182-513-1380 | None Required. |
| 347 |
Home Maintenance Exemption Discontinued We ended your housing deduction due to one or more of the following: Your living situation changed. You no longer have a housing cost. Your doctor doesn't expect you to go home within 6 months. Your income or expenses changed. Your marital status changed. |
182-513-1380 | None Required. |
| 348 | Exceeds Ineligible Parent TANF Time Limits A parent in your home received 60 months of TANF/SFA cash assistance for themselves or on behalf of their child(ren) and doesn’t qualify for a time limit hardship extension. |
Specify the name of the parent that is referenced. | |
| 349 |
NCS Permanently Disqualified A person is permanently disqualified from receiving TANF/SFA when their case is closed 3 or more times for WorkFirst non-compliance sanction. |
None Required |
| Code | Reason Code Title / Text | WAC References | Free Form Text |
|---|---|---|---|
|
350 |
Household Exceeds Allowable Income Household Exceeds Allowable Income |
388-450-0162 | Your household income of $______is over the limit for this program. The income limit for a household of__ is $_____ (300% of the Federal Poverty Level) |
| 351 |
Not Aged, Blind, or Disabled -Cash You aren't eligible for benefits under this program because you aren't age 65, blind, or likely to be disabled. 42 CFR 435.541 |
388-449-0001 | None Required |
| Code | Reason Code Title / Text | WAC References | Free Form Text |
|---|---|---|---|
|
386 |
Diversion Cash Assistance - No Bona Fide Need |
You asked for help with the following expenses:
(List expenses) We cannot cover these expenses because (specify why need is not “bona fide” or is not covered. For example, “You did not give us a written estimate of how much it would cost to fix your car.” Or “You told us you have income of $____ and expenses of $ ____. Based on that, you should have enough money to pay for move-in expenses without our help.”). |
|
|
388 |
WA Fund CAP For QI-1 Already Reached |
None Required |
Revised on October 1, 2021
|
Code |
Reason Code Title / Text |
WAC References |
Recommended Free Form Text |
|---|---|---|---|
|
401 |
Over Resources |
Your resources cannot be more than $_____ (specify resource limit for household size). See the attachment for more information on how we figured out your resources. |
|
| 402 |
Lottery/Gambling Disqualification The amount of your lottery or gambling winnings is over the limit allowed for this program. |
388-483-0005 | Someone in your household won $3,750 or more from gambling or the lottery, received on 00/00/0000. You can't get food benefits until you reapply and meet income and resources for Basic Food. |
|
Excess Home Equity - LTC You don't qualify for Long Term Care (LTC) services because the equity in your home is over the $500,000 limit. You may receive LTC services if we approve an undue hardship waiver. We approve hardship waivers when you can show that without LTC services:
Your request must:
|
Explain the equity value we are counting and how we arrived at that number. |
||
|
411 |
Transfer Of Resource Disqualification 1 - 12 Months |
(Name) transferred his/her (type of property) on 00/00/00. That (type of property) is worth$ . Since s/he only got $ for it, you cannot get benefits from 00/00/00 to 00/00/00. |
|
|
416 |
Transfer of Resources - CA/MA You have a penalty period because you gave something away or sold it for less than fair market value. You can only get benefits now if you prove you cannot pay for your housing, food, clothing, or health needs. |
Explain the equity value we are counting and how we arrived at that number |
|
|
417 |
Transfer of Resources - LTC You transferred, gave away, or sold resources for less than fair market value. This is called uncompensated value. |
None required. |
|
| 418 |
Non-Cooperation with Asset Verification You, or those financially responsible for you, didn’t give the agency permission to contact financial institutions to verify resources through the Asset Verification System. We are unable to determine your eligibility. The agency must verify resources to determine eligibility for Aged, Blind or Disabled related medical coverage. If you, or those financially responsible for you, decide to provide authorization for Asset Verification, please contact us. See WAC rule (Washington Administrative Code): |
N/A | |
|
460 |
Payment Standard Reduction Payment standards are changing. You do not have administrative hearing rights based on a change in payment standards. |
None required. |
|
| 465 |
State or Federal Law Change – Standards Update State or federal law changed the payment standard for your cash assistance amount. |
None Required. | |
| 471 |
No Related Food Stamp AU You don’t receive Basic Food, Food Assistance Program for Legal Immigrants (FAP) or Transitional Food Assistance (TFA). |
388-493-0010 | None Required. |
| 472 |
Related TANF AU Exists Someone in your food assistance unit receives Temporary Assistance for Needy Families (TANF) or State Family Assistance (SFA). |
388-493-0010 | None Required. |
| 473 |
No Qualifying Child You don’t have a qualifying child under the age of 18 in your home. |
388-493-0010 | None Required. |
| 474 |
Not Working the Minimum Hours Required We don’t have current proof that you, your spouse, or co-parent works at least 35 hours per week. |
388-493-0010 | None Required. |
| 475 |
Food Stamp is the Priority Program We count Working Family Support as income. Approving this program would close your food assistance. |
388-493-0010 | None Required. |
| 476 |
Working Family Support Program Terminated The Working Family Support program is ending. |
388-493-0010 | None Required. |
Revised on: June 4, 2020
|
Code |
Reason Code Title / Text Requirement |
WAC References |
Recommended Free Form Text |
|---|---|---|---|
|
SSA Denial You aren't eligible for ABD cash assistance because the Social Security Administration denied your application for Supplemental Security Income (SSI). |
388-449-0001 |
(Social Service Specialist provides mandatory free form text via 14-118) |
|
|
Gainful Employment You aren't eligible for ABD cash assistance. We have determined you aren't disabled because you are currently working. |
388-449-0005 |
(Social Service Specialist provides mandatory free form text via 14-118) |
|
|
Acceptable Medical Source (and no medical) You aren't eligible for ABD cash assistance because you didn't provide medical evidence from an acceptable medical source. |
388-449-0060 |
(Social Service Specialist provides mandatory free form text via 14-118) |
|
|
Insufficient Information You aren't eligible for ABD cash assistance because the medical evidence we received doesn't contain enough information to determine if you are disabled. |
(Social Service Specialist provides mandatory free form text via 14-118) |
||
|
Chemical Dependency You aren't eligible for ABD cash assistance. We can't determine if you are disabled because the medical evidence we received shows drug or alcohol use is material to your impairment . |
388-449-0060 |
(Social Service Specialist provides mandatory free form text via 14-118) |
|
|
Duration You aren't eligible for ABD cash assistance because your impairment does not meet the minimum duration requirement. |
(Social Service Specialist provides mandatory free form text via 14-118) |
||
|
Severity You aren't eligible for ABD cash assistance because your impairment is mild and not expected to keep you from working. |
(Social Service Specialist provides mandatory free form text via 14-118) |
||
|
Past Work You aren't eligible for ABD cash assistance because your impairment doesn't keep you from returning to your past work. |
(Social Service Specialist provides mandatory free form text via 14-118) |
||
|
Other Work You aren't eligible for ABD cash assistance because you have the residual functional capacity to be employed. |
(Social Service Specialist provides mandatory free form text via 14-118)
|
||
|
Termination - No Current Medical See INCAP denial form for text |
(Social Service Specialist provides mandatory free form text via 14-118) | ||
|
Medical Evidence Inconclusive |
|
(Social Service Specialist provides mandatory free form text via 14-118) |
|
|
Medical Information Shows Improvement / Decreased Severity The current medical evidence we have leads us to believe that you shouldn’t have received benefits because you were able to work. |
|
(Social Service Specialist provides mandatory free form text via 14-118) |
|
|
Change In Federal Law |
None |
None Required |
|
|
Medical Evidence Shows Clear Improvement – Due to Treatment Medical evidence shows clear improvement due to treatment. |
On 00/00/00, I got a report form from Dr. (Name of doctor) that said your (specify condition) has improved so much that you can work now. (The Social Worker should provide the FSS with some free-form text via the 14-118). |
||
|
Currently Employed Currently employed. |
(Social Service Specialist provides mandatory free form text via 14-118) |
||
|
Error In Previous Determination Of Incapacity Error in previous determination. |
|
(Social Service Specialist provides mandatory free form text via 14-118) |
|
|
No Eligibility Review Form |
None Required |
||
|
Eligibility Review Form Incomplete
|
You must return the completed form to us by 00/00/00 in order for your benefits to continue. |
||
| 530 |
Termination/Cancer Treatment Ends Prior to Cert Period The Department of Health has determined that your treatment has ended or you no longer meet the requirements of the program. |
Text should be supplied by unit that works these. | |
|
Voluntary Withdrawal for Excess Resources |
None required |
||
| 532 |
State-Funded LTC - Program Full The state-funded long term care services program is subject to caseload limits. The program is currently full. We aren't enrolling new members at this time. |
182-507-0125 | NA |
| 533 |
Employment requirement not met - HWD You don't meet the employment requirements for the HWD program. |
182-511-1200 | NA |
|
Error in Initial Eligibility - Removed Continuous Tracking for Child |
None |
Specify the reason for termination and a WAC related to that reason. |
|
| 536 |
Error Initial Eligibility - Removed Locked-in Premium Tier. - For Administrative Use Only |
182-505-0210 | NA |
| 537 |
TANF/SFA Background Check Failure You can't receive TANF or SFA benefits for the unrelated child living with you because you didn't pass the background check. |
None Required | |
| 538 |
TSOA Closure You can’t receive services under this program when you are eligible for certain Medicaid programs. |
182-513-1615 |
No Mandatory Freeform Text |
|
CEAP Financial Worker Closure- For Administrative Use Only |
None |
None Required |
|
| 541 | CEAP Program Funds Exhausted - For Administrative Use Only | None | NA |
|
Incomplete six-month report We received your change report form. Some information is still missing. We sent you a letter telling you what you need to give to us. We did not get it. |
Specify what is missing. |
||
| 545 |
Invalid Working Family Support Composition You can’t be in a separate assistance unit from your spouse or co-parent. If you are eligible for WFS you may be added to your spouse or co-parent’s assistance unit. |
388-493-0010 | None Required |
| 546 |
Non-Cooperation with Asset Verification You, or those financially responsible for you, didn’t give the agency permission to contact financial institutions to verify resources through the Asset Verification System. We are unable to determine your eligibility. The agency must verify resources to determine eligibility for Aged, Blind or Disabled related medical coverage. If you, or those financially responsible for you, decide to provide authorization for Asset Verification, please contact us. See WAC rule (Washington Administrative Code): |
N/A | |
|
You asked us to stop TFA; or you are now receiving Basic Food. You asked us to stop your Transitional Food benefits; or We approved your request for Basic Food. See WAC rule (Washington Administrative Code): |
None Required |
||
|
Voluntary Withdrawal |
None Required |
||
|
Whereabouts Unknown |
None Required |
||
|
Failed To Provide Verification |
On MM/DD/YYYY we asked you to provide the following items by MM/DD/YYYY. We haven't received them. The items we asked for are: List of items |
||
| 554 |
RCL Error in Initial Eligibility Not Medicaid Eligible on Day of Discharge |
182-513-1235 | Describe the reason the client was not initially eligible for Medicaid. |
|
Application Opened In Error - For Administrative Use Only |
None |
None Required |
|
|
Non-Cooperation With Quality Control - Food Assistance |
You cannot get benefits for # months because___ . You can regain your eligibility by ___ . If you have any questions about this, call the Quality Assurance worker at 000-000-0000. |
||
|
AU Requests Closure |
None Required |
||
|
Failed To Cooperate In Securing Other Income And Resources |
You told us that you have (type of income/resource). To become eligible, you must try to make it available by _______(specify what they must do to make income or resource available). |
||
|
Client Already Received Assistance In Another AU For This Benefit Month |
You are already getting cash assistance. |
||
|
AU Screened In Error - System Generated Only |
None |
None Required |
|
|
Non-Cooperation With TPL Process |
You told us that you could get help with medical from (specifyTPL source). |
||
|
Refused to Cooperate With Application Process |
You did not ____ . If you need help, let me know and I will try to assist you. |
||
|
Drug / Alcohol Center Loses Certification |
None Required |
||
|
Child Accepted To Foster Care |
None Required |
||
| 570 |
Child's Temporary Placement Has Ended Your child's absence is no longer temporary. |
388-454-0015 | None Required |
|
User Voided Application - For Administrative Use Only |
None |
None Required |
|
|
Not Receiving Cash Assistance - For Administrative Use Only |
None |
None Required |
|
|
Missed Application Deadline - For Administrative Use Only |
None |
None Required |
|
|
Non-Cooperation with Chemical Dependency Assessment or Treatment You aren’t eligible for assistance because you didn’t cooperate with a chemical dependency assessment or treatment. You aren’t eligible for assistance again until you reapply and cooperate with assessment or treatment. |
(Social Service Specialist provides mandatory free form text via 14-118) |
||
|
DCA Adult Eligible For TANF, Established Loan Repayment - For Administrative Use Only |
None |
None Required |
|
|
DCA Ineligible To get Diversion Cash Assistance (DCA) everyone in your family must be able to receive Temporary Assistance for Needy Families/State Family Assistance (TANF/SFA). See WAC rule (Washington Administrative Code): |
Specify which DCA requirement was not met. |
||
|
Already Eligible For Program In Different AU - For Administrative Use Only |
|
The following persons aren't eligible for [cash/food] assistance for [MM/YYYY] because they already received [cash/food] assistance in another household: [list name of ineligible persons] NOTE: You may need to manually create a denial or termination letter or add text to the ACES system-generated letter and WAC references. |
|
|
Ineligible QI-1 Already Receiving MA You are eligible for the State-funded Buy-In Program. We will pay for your Medicare Part A premiums, if you have any, as well as your Part B premiums, coinsurance, and deductibles. |
None Required |
||
|
Failed MA Incapacity Requirements Based on your current medical information, you are no longer disabled under Social Security rules. See WAC rule (Washington Administrative Code): |
None Required |
||
|
590 |
Transfer of Resources - Long Term Care You transferred, gave away, or sold resources for less than fair market value. This is called uncompensated value. |
Explain the amount of the transfer used to determine the penalty or penalties periods. Indicate the dates the penalty period starts and ends. |
|
|
596 |
Failure to Pursue Medicaid You aren't eligible for ABD cash or Housing and Essential Needs (HEN) Referral because you failed to pursue Medicaid.
|
(Social Service Specialist provides mandatory free form text via 14-118) |
|
| 597 |
Manual WASHCAP Earned Income Termination You can't receive Washington State Combined Application Project (WASHCAP) food assistance because you've been working more than 3 months. |
None Required | |
| 598 |
WASHCAP Invalid Living Arrangement You can't receive Washington Combined Application Project food benefits because your living arrangement changed. |
388-492-0030 | State what the invalid living arrangement is. |
|
Other - For User Generation Only |
None |
(If used for ABD or HEN Referral denial or termination, Social Service Specialist provides mandatory free form text via 14-118) |
Revised July 16, 2020
Letters are sent to clients in their primary language. ACES supports eight languages besides English:
When sending letters to the client, use the client’s current mailing address. If the client did not provide a current mailing address on the application, send the letter to the last known address.
This internal DSHS website can only be accessed by DSHS staff or persons who have been authorized by the department.
Revised March 25, 2011
For ACES Procedures go to ACES Letters in the ACES User Manual.
|
Letter |
Letter Title |
Freeform Text Requirement |
|---|---|---|
|
0002-24 |
Approval for Expedited Food Assistance |
List verification needed. Provide examples of what client can provide. |
|
0004-05 |
General Denial - No Information |
List items that you asked for that were not provided. |
|
0006-03 |
GA Termination on Reconsideration |
State what new information was received and why it did not change the determination. |
|
0006-04 |
GA Termination for Clear Improvement |
On 00/00/00, I got a report form from Dr. (Name of doctor) that said your (specify condition) has improved so much that you can work now. Or You work # hours per week for (employer) as a (position). |
|
0006-05 |
GA Termination for No Medical Information |
On 00/00/00, I asked you to provide some information by 00/00/00. I still need: List of items |
|
0006-06 |
GA Termination for Medical Evidence Inconclusive |
On 00/00/00, I asked you to provide some information by 00/00/00. I still need: List of items |
|
0006-07 |
GA Termination for No Incapacity - Prior Error |
We made a mistake when we put you on GAU on (date). You did not meet our requirements because _________ (enter case specific information regarding the medical information received and why it doesn’t meet severity and/or duration requirements - e.g. “The information we got from Dr. Sun showed your back injury was not severe enough to keep you from doing light work that you have done in the past.”). |
|
0017-01 |
Supplemental Payment for Cash/Food |
We are giving you additional benefits for (Month) because ___________. |
|
0020-01 |
MN Spenddown |
List all bills used to meet spenddown |
|
0020-03 |
Bills Received-Spenddown Not Met |
In the first mandatory freeform text section:
In the second mandatory freeform text section:
|
|
0021-01 |
General Reinstatement for Cash/Food |
We are reopening your case because ______________. |
|
0023-01 |
Missing Verification for Interview |
List:
|
|
0023-02 |
General Request for Information or Action |
List:
|
|
0045-02 |
Cash Assistance Overpayment - Intentional |
State why client has an overpayment. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers. |
|
0045-03 |
Cash Assistance Overpayment - Unintentional |
Describe why client has an overpayment. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers. |
|
0045-05 |
Food Assistance Overpayment - Inadvertent Error |
Describe why client has an overpayment. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers. |
|
0045-06 |
Food Assistance Overpayment - Administrative Error |
State why client has an overpayment. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers. |
|
0045-07 |
Food Assistance Overpayment - IPV |
State why client has an overpayment. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers. |
|
0045-08 |
Medical Assistance Overpayment |
State why client has an overpayment. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers. |
|
0045-09 |
Overpayment Modification |
State why the overpayment is being modified. After this, state: See WAC rule (Washington Administrative Code): List appropriate WAC numbers. |
|
0055-01 |
ADH for 1st or 2nd Offense Before 1-1-97 |
In the first mandatory freeform text section:
In the second mandatory freeform text section:
|
|
0055-02 |
1st or 2nd Food Assistance Disqualification After 12-31-96 |
In the first mandatory freeform text section:
In the second mandatory freeform text section:
|
|
0055-03 |
ADH for 1st or 2nd Offense/Duplicate Participation |
List the evidence we have about the program violation. |
|
0055-04 |
ADH for Permanent Disqualification |
In the first mandatory freeform text section:
In the second mandatory freeform text section:
|
|
0070-03 |
ETR Not Requested |
State why you are not forwarding the request for a decision. |
|
0070-05 |
ETR Denial |
State why the ETR was denied. |
|
0085-01 |
WorkFirst Non-Participation Appointment |
According to your IRP, you are supposed to (State what requirement of the IRP the client is not meeting). State what information you have that leads you to believe this. (If this appointment will also be a case staffing, then enter the following text):At this appointment, we will also be reviewing your participation in the WorkFirst program with other involved agency staff. I have invited (List agency staff) to this appointment. |
|
0085-02 |
Food Assistance E&T Good Cause |
As part of your E&T (Employment and Training) requirements, you are supposed to (state what E&T requirement the client is not meeting). State what information you have that leads you to believe this. |
|
0085-03 |
Missed Appointment or Activity for IRP |
According to your IRP, you are supposed to (State what requirement of the IRP the client is not meeting). State what information you have that leads you to believe this. |
Revised July 31, 2015
Series Reason Code Protocols
Click on the Reason Code Series number to go to the list of codes in that series in the chart below
In the chart, click on a specific reason code to go directly to the Reason Code Series page and the code you have selected.
| 100's | 200's | 300's | 400's | 500's | 600's |
|---|
The Reason Codes Series pages will show the following elements for each reason code:
For ACES Procedures go to ACES Letters in the ACES User Manual.
| 101 | 102 | 103 | 104 | 105 | 106 | 107 | 109 |
|---|---|---|---|---|---|---|---|
| 110 | 111 | 112 | 120 | ||||
| 130 | 131 | 132 | 134 | ||||
| 141 | 142 | 160 | 161 | 162 | 163 | 164 | |
| 187 | 188 | 195 | |||||
|
|
|||||||
| 200 | 201 | 202 | 203 | 204 | 205 | 206 | 207 |
| 208 | 209 | ||||||
| 210 | 212 | 213 | 214 | 215 | 218 | 219 | |
| 220 | 221 | 222 | 223 | 224 | 225 | 226 | 227 |
| 228 | 229 | ||||||
| 230 | 232 | 233 | 235 | 237 | 238 | 239 | |
| 240 | 241 | 242 | 243 | 244 | 245 | 246 | 247 |
| 248 | 249 | ||||||
| 250 | 251 | 252 | 254 | 255 | 256 | 257 | 258 |
| 259 | |||||||
| 260 | 261 | 262 | 263 | 264 | 265 | 266 | 268 |
| 269 | |||||||
| 271 | 272 | 275 | 276 | 279 | |||
| 280 | 281 | 282 | 283 | 284 | 285 | 286 | 287 |
| 288 | 289 | ||||||
| 290 | 292 | 293 | 294 | 295 | 296 | 297 | 298 |
| 299 | |||||||
|
|
|||||||
| 300 | 301 | 302 | 304 | 305 | 306 | 307 | |
| 320 | 321 | 323 | 324 | 327 | 328 | 329 | |
| 330 | 331 | 332 | 334 | 335 | 336 | 338 | |
| 339 | |||||||
| 340 | 341 | 342 | 343 | 345 | 346 | 347 | 348 |
| 349 | 350 | 351 | |||||
| 386 | 388 | ||||||
|
|
|||||||
| 401 | 410 | 417 | |||||
| 411 | 416 | 460 | |||||
|
|
|||||||
| 501 | 502 | 503 | 504 | 505 | 506 | 509 | |
| 510 | 511 | 517 | 518 | 519 | |||
| 520 | 521 | 522 | 523 | 525 | 528 | 530 | |
| 531 | 532 | 533 | 535 | 536 | 537 | ||
| 540 | 541 | 542 | 546 | 549 | |||
| 550 | 551 | 552 | 555 | 556 | 557 | 558 | 559 |
| 561 | 564 | 566 | 567 | 569 | |||
| 570 | 572 | 578 | |||||
| 589 | |||||||
| 590 | 596 | 597 | 598 | 599 | |||
| 600 | 601 | 602 | 603 | 604 | 605 | 606 | 607 |
|---|---|---|---|---|---|---|---|
| 608 | 609 |