Medical Eligibility Overview

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MEDICAID is the state and federally funded aid program that covers the Categorically Needy (CN) and Medically Needy (MN) programs.

Categorically Needy (CN) programs are the federally matched Medicaid programs that provide the broadest scope of medical coverage. Persons may be eligible for CN only, or may also be eligible for cash benefits under the SSI  (Supplemental Security Income) or TANF (Temporary Assistance for Needy Families) programs. CN Includes full scope coverage for pregnant women and children.

FEE-FOR-SERVICE (FFS) is the term used when a client is able to get care 
from doctors and other medical providers who will accept the HRSA medical identification card.

HEALTHY OPTIONS (HO) is the name of the Washington State Health and Recovery Services Administration's managed care program.

MANAGED CARE is a prepaid comprehensive system of medical and health care delivery provided through a designated health care plan which is contracted with HRSA.

MEDICALLY NEEDY (MN) is a federal and state-funded Medicaid program for aged, blind or disabled persons, as well as pregnant women, children and refugees with income and/or resources above CN limits.  It provides slightly less medical coverage than CN.

TANF is the Temporary Assistance for Needy Families program offering cash and other benefits to families in need.

WorkFirst  is Washington State’s Program for federal TANF legislation replacing the former AFDC program.

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