100 Series Reason Code Protocols | DSHS

Revised January 21, 2020

Purpose:

100 Series Reason Code Protocols
Go to the Reason Code Link chart to link directly to a specific reason code or scroll through the list below.
For ACES Procedures go to ACES Letters in the ACES User Manual.
Staff must add explanatory text to the notice unless the "Recommended Free Form Text" column specifies "None Required."
The "Recommended Free Form Text" is the suggested wording for a reason code requiring mandatory explanation to the client.

Code	Reason Code Title / Text	WAC References	Recommended Free Form Text
101	ABD Cash/HEN Referral Spouse Ineligible You can't receive Aged, Blind, or Disabled (ABD) cash or a Housing and Essential Needs (HEN) Referral when your spouse receives Supplemental Security Income (SSI) and a State Supplemental Payment (SSP).	182-508-0005 388-400-0060 388-400-0070 388-474-0010 388-474-0001 388-474-0012	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.	388-492-0030	None Required
104	SSA Terminates WASHCAP Food Assistance Social Security asked us to stop your Washington State Combined Application Project (WASHCAP) food benefits. See WAC rule (Washington Administrative Code)	388-492-0110 388-492-0030 388-492-0120	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.	388-492-0030	None Required
106	WASHCAP Terminates - Client Getting $1.00 Or Less SSI Money You stopped receiving SSI cash.	388-492-0030	None Required
107	WASHCAP Terminates - Client Not Eligible For SSI Money Or Medical SSA decided that you cannot get SSI. See WAC rule (Washington Administrative Code):	388-492-0030 388-492-0120	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.	388-474-0012	None Required
110	Not SSP Eligible - Invalid Living Arrangement You can't receive a State Supplemental Payment (SSP) when you live in an institution.	388-474-001 2	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: You live with your SSI ineligible spouse. You are blind. You are age 65 or older.	388-474-0012	None Required
112	Receiving Tribal TANF Benefits We believe you are eligible for cash benefits from the tribe	388-400-0005	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.	388-490-0005 182-503-0535	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.	182-512-0100	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.	388-408-0035 388-489-0005	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.	388-489-0025	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.	388-466-0120 388-466-0150	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.	388-400-0005 388-400-0010	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.	388-418-0011	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.	388-418-0011	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.	182-512-0050	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.	182-511-1050 182-511-1150	None required

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