How to Read Washington DSHS Notice Codes for Medicare Savings Programs

The Codes on Your Notice Letter Matter

When DSHS approves or denies your Medicare Savings Program application, the notice uses ACES coverage group codes — internal system identifiers that tell you exactly which program tier you've been assigned to (or denied for). These codes are not explained anywhere on the notice itself, which is why families stare at the letter and have no idea what just happened.

Here's what each code means:

If your notice shows S03, your parent has the fullest coverage available — providers cannot bill them for any Medicare cost-sharing. If it shows S05 or S08, the benefit is limited to the Part B premium.

Reading a Denial Notice

A denial notice includes three critical pieces of information:

1. The WAC citation — usually WAC 182-517-0100, which governs MSP eligibility
2. The income calculation — DSHS shows the gross income figure they used, the disregards they applied, and the resulting countable income
3. Your hearing rights — the deadline to request a fair hearing with the Office of Administrative Hearings (generally 90 calendar days from the date the notice was mailed)

The income calculation is where errors appear most often. Check whether DSHS applied the $20 unearned income disregard. Verify that they used the correct household size (single vs. couple limits). Confirm that earned income deductions ($65 + 50% of remainder) were applied if your parent works.

If the math on the notice doesn't match your own calculation, you have grounds for a hearing.

Common Notice Scenarios

Approval with tier change. If your parent was previously QMB (S03) and the renewal notice reassigns them to SLMB (S05), it means their income rose above 110% FPL but stays below 120%. They keep the Part B premium benefit but lose coverage for deductibles and cost-sharing. This is a reportable action — you can request a hearing if you believe the income assessment is wrong.

Denial after renewal. A notice terminating benefits cites the new income figure that pushed your parent over the limit. Check whether the COLA timing gap applies — Washington disregards the Social Security COLA increase from January through March, so a January denial based on post-COLA income during that window may be procedurally incorrect.

Request for Information (RFI). This isn't a denial — it's DSHS asking for documents they couldn't verify electronically. Respond by the deadline on the letter. If the deadline passes without a response, the application is denied for failure to verify, and you'll need to reapply.

What to Do With a Confusing Notice

If a notice doesn't make sense — unfamiliar codes, contradictory information, or missing pages — call DSHS at 1-877-501-2233 with the notice in front of you. Ask the representative to read back the ACES coverage code and explain what the action means in plain language. Note the representative's name and call date.

If the notice is wrong or you disagree with the decision, request a fair hearing within 90 calendar days from the date the notice was mailed. For guidance on decoding notices and preparing a hearing response, see the Washington Medicare Savings Programs & Extra Help Guide.

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