Medical Eligibility Overview

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PSYCHIATRIC INDIGENT INPATIENT (PII)

Income and resource limits for the PII program are the same as for MN. Clients with excess income and/or resources above these limits must spend down the excess before they are eligible for PII.

EMERGENCY MEDICAL EXPENSE REQUIREMENT (EMER): PII requires a yearly (a continuous 12-month period) EMER of $2,000 per household before they are eligible. The EMER is comparable to a deductible on an insurance policy. An applicant can meet this requirement with inpatient community
psychiatric care only.  Involuntary commitment clients are not subject to
the EMER.

IMPORTANT:   The maximum length of certification for PII is three months in any 12-month period.

 PII clients have limited coverage:
The PII program covers usual and customary charges for voluntary inpatient psychiatric hospitalization billed on a hospital billing form (UB-92) with a Regional Support Network (RSN) approval number.

The PII program does not cover ancillary charges for physician, transportation, pharmacy or other costs associated with a voluntary inpatient psychiatric hospitalization.  For more information, contact Christina Winans at (360) 902-0844.  See Provider Memo 03-16 Psychiatric Indigent Inpatient program: http://fortress.wa.gov/dshs/maa/Download/Memos/2003Memos/03-16maa.pdf

Involuntary psychiatric hospitalizations (commitments) are authorized under the Involuntary Treatment Act (ITA), RCW 71.05 and RCW 71.34.  Generally, there is no change in how ITA cases are handled.  For those who are not eligible for medical assistance, hospitals continue to use existing procedures to bill ITA cases.  That process is separate and apart from the Psychiatric Indigent Inpatient (PII) program. 

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