SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Date of Adoption: October 22, 2003.
Purpose: To continue the emergency rule adopted as WSR 03-14-104 while the permanent rule-making process is completed. The medically indigent program was eliminated effective July 1, 2003. Funding for the medically indigent program was not appropriated in the state's 2003-2005 Omnibus operating budget.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-438-0100; and amending WAC 388-438-0110 and 388-503-0505.
Statutory Authority for Adoption: Section 209, Part II, 2003-2005 Omnibus operating budget (chapter 25, Laws of 2003 1st sp.s.).
Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.
Reasons for this Finding: Operating funds for the medically indigent program were not appropriated under the state's 2003-2005 Omnibus operating budget. The department has filed a notice of intent (WSR 03-12-054) to adopt the permanent rule, and is taking appropriate steps to adopt the permanent rule.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 2, Repealed 1.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making:
Pilot Rule Making:
or Other Alternative Rule Making:
Effective Date of Rule: October 28, 2003.
October 22, 2003
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit3250.1
(2) Except for the social security number, citizenship, or alien status requirements, an alien must meet categorical Medicaid eligibility requirements as described in:
(a) WAC 388-505-0110, for an SSI-related person;
(b) WAC 388-505-0220, for family medical programs;
(c) WAC 388-505-0210, for a child under the age of nineteen; or
(d) WAC 388-523-0100, for medical extensions.
(3) When an alien has monthly income which exceeds the CN medical standards, the department will consider AEM medically needy coverage for children or for adults who are age sixty-five or over or who meet SSI disability criteria. See WAC 388-519-0100.
(4) To qualify for the AEM program, the alien must meet one of the criteria described in subsection (2) of this section and have:
(a) An emergency medical condition as described in WAC 388-500-0005; or
(b) Been approved by the department as requiring nursing facility or COPES level of care.
(5) The alien's date of arrival in the United States is not used when determining eligibility for the AEM program.
(6) The department does not deem a sponsor's income and resources as available to the client when determining eligibility for the AEM program. The department counts only the income and resources a sponsor makes available to the client.
(7) Under the AEM program, a person receives CN scope of care, as described in WAC 388-529-0100. Covered services are limited to those medical services necessary for treatment of the person's emergency medical condition. The following services are not covered:
(a) Organ transplants and related services;
(b) Prenatal care, except labor and delivery; and
(c) School-based services.
(8) A person whose income exceeds the CN income standard has spenddown liability and MN scope of care.
(9) A person determined eligible for the AEM program is certified for three months. The number of three-month certification periods is not limited, but, the person must continue to meet eligibility criteria in subsection (2) and (3) of this section.
[Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-438-0110, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.08.090 and C.F.R. 436.128, 436.406(c) and 440.255. 01-05-041, § 388-438-0110, filed 2/14/01, effective 3/17/01. Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.057, 74.09.530, 42 C.F.R. 435.139 and 42 C.F.R. 440.255. 99-23-082, § 388-438-0110, filed 11/16/99, effective 12/17/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-438-0110, filed 7/31/98, effective 9/1/98.]3256.1
(2) Persons applying for medical coverage are considered first for federally funded or federally matched programs. State-funded programs are considered after federally funded programs are not available to the client except for brief periods when the state-funded programs offer a broad scope of care which meet a specific client need.
(3) Unless otherwise specified in program specific WAC, the eligibility criteria for each medical program is as follows:
(a) Verification of age and identity (chapters 388-404, 388-406, and 388-490 WAC); and
(b) Residence in Washington state (chapter 388-468 WAC); and
(c) Citizenship or immigration status in the United States (chapter 388-424 WAC); and
(d) Possession of a valid Social Security Account Number (chapter 388-476 WAC); and
(e) Assignment of medical support rights to the state of Washington (WAC 388-505-0540); and
(f) Cooperation in securing medical support (chapter 388-422 WAC); and
(g) Countable resources within program limits (chapters 388-470 and 388-478 WAC); and
(h) Countable income within program limits (chapters 388-450 and 388-478 WAC).
(4) In addition to the general eligibility requirements in subsection (3) of this section, each program has specific eligibility requirements as described in applicable WAC.
(5) Persons living in a public institution, including a
correctional facility, are not eligible for the department's
medical coverage programs. ((
A person living in a city or
county jail may be considered only for the medically indigent
(MI) program.)) For a person under age twenty or over age
sixty-five who is a patient in an institution for mental
disease see WAC 388-513-1315(13) for exception.
(6) Persons terminated from SSI or TANF cash grants and those who lose eligibility for categorically needy (CN) medical coverage have their CN coverage continued while their eligibility for other medical programs is redetermined. This continuation of medical coverage is described in chapter 388-434 WAC.
[Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-503-0505, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-503-0505, filed 7/31/98, effective 9/1/98. Formerly WAC 388-501-0110, 388-503-0305 and 388-505-0501.]3255.1
The following section of the Washington Administrative Code is repealed:
|WAC 388-438-0100||Medically indigent (MI) program.|