SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Title of Rule: WAC 388-475-1050 Healthcare for workers with disabilities (HWD)--Program requirements and 388-475-1250 Healthcare for workers with disabilities (HWD)--Premium payments.
Purpose: To correct obsolete Washington Administrative Code (WAC) cross references that are outdated due to the new rules for supplemental security income (SSI)-related Medicaid programs adopted on April 7, 2004, as WSR 04-09-002, 04-09-003, 04-09-004, and 04-09-005.
Statutory Authority for Adoption: RCW 74.08.090, 34.05.353 (1)(c).
Statute Being Implemented: RCW 74.04.050, section 1902 (a)(10)(A)(ii) of the Social Security Act of 1924.
Summary: This housekeeping action corrects the outdated WAC cross-references without changing the effect of the rules.
Reasons Supporting Proposal: The amended rules will ensure that people are referred to the correct WAC sections.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Stephen Kozak, MAA, P.O. Box 45534, Olympia, WA 98507-5534, (360) 725-1321.
Name of Proponent: Department of Social and Health Services, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose, Summary, and Reasons Supporting Proposal above.
Proposal Changes the Following Existing Rules: See
Purpose, Summary, and Reasons Supporting Proposal above.
THIS RULE IS BEING PROPOSED UNDER AN EXPEDITED RULE-MAKING PROCESS THAT WILL ELIMINATE THE NEED FOR THE AGENCY TO HOLD PUBLIC HEARINGS, PREPARE A SMALL BUSINESS ECONOMIC IMPACT STATEMENT, OR PROVIDE RESPONSES TO THE CRITERIA FOR A SIGNIFICANT LEGISLATIVE RULE. IF YOU OBJECT TO THE USE OF THE EXPEDITED RULE-MAKING PROCESS, YOU MUST EXPRESS YOUR OBJECTIONS IN WRITING AND THEY MUST BE SENT TO Rules Coordinator, Rules and Policies Assistance Unit, Department of Social and Health Services, P.O. Box 45850, Olympia, WA 98504-5850 , AND RECEIVED BY 5:00 p.m., June 21, 2004.
April 15, 2004
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit3347.1
(1) To qualify for the HWD program, a person must:
(a) Meet the general requirements for a medical program described in WAC 388-503-0505 (3)(a) through (f);
(b) Be age sixteen through sixty-four;
(c) Meet the federal disability requirements described in WAC 388-475-1150;
(d) Have net income at or below two hundred twenty percent of the federal poverty level (FPL) (see WAC 388-478-0075 for FPL amounts for medical programs); and
(e) Be employed full or part time (including self-employment) as described in WAC 388-475-1200.
(2) To determine net income, the department applies the following rules to total gross household income in this order:
(a) Deduct income exclusions described in WAC
388-450-0020)) 388-475-0800, 388-475-0820, 388-475-0840, and
(b) Follow the CN income rules described in:
(i) WAC ((
388-450-0005 (3) and (4), Income -- Ownership and
availability)) 388-475-0600, SSI-related medical -- Definition
(ii) WAC ((
income -- Allowable
expenses)) 388-475-0650, SSI-related medical -- Available income;
(iii) WAC ((
388-450-0150 (1), (2), (3), and (5),
SSI-related income allocation)) 388-475-0700(1) through (5),
SSI-related medical -- Income eligibility;
(iv) WAC ((
388-450-0210 (4)(b), (e), and (h), Countable
income for medical programs;)) 388-475-0750, SSI-related
medical -- Countable unearned income; and
(v) WAC 388-506-0620, SSI-related medical clients((
(vi) WAC 388-511-1130, SSI-related income availability)).
(3) The HWD program does not require an asset test.
(4) Once approved for HWD coverage, a person must pay his/her monthly premium in the following manner to continue to qualify for the program:
(a) The department calculates the premium for HWD coverage according to WAC 388-475-1250;
(b) If a person does not pay four consecutive monthly premiums, the person is not eligible for HWD coverage for the next four months and must pay all premium amounts owed before HWD coverage can be approved again; and
(c) Once approved for HWD coverage, a person who experiences a job loss can choose to continue HWD coverage through the original twelve months of eligibility, if the following requirements are met:
(i) The job loss results from an involuntary dismissal or health crisis; and
(ii) The person continues to pay the monthly premium.
[Statutory Authority: RCW 74.08.090, Section 1902 (a)(10)(A)(ii) of the Social Security Act, and 2001 c 7 § 209(5), Part II. 02-01-073, § 388-475-1050, filed 12/14/01, effective 1/14/02.]
(1) When determining the HWD premium amount, the department counts only the income of the person approved for the program. It does not count the income of another household member.
(2) When determining countable income used to calculate the HWD premium, the department applies the following rules:
(a) Income is considered available and owned when it is:
(i) Received; and
(ii) Can be used to meet the person's needs for food,
clothing, and shelter, except as described in WAC
388-511-1130)) 388-475-0600(5), 388-475-0650, and
(b) Loans and certain other receipts are not considered to be income as described in 20 C.F.R. Sec. 416.1103, e.g., direct payment by anyone of a person's medical insurance premium or a tax refund on income taxes already paid.
(3) The HWD premium amount equals a total of the following (rounded down to the nearest whole dollar):
(a) Fifty percent of unearned income above the medically needy income level (MNIL) described in WAC 388-478-0070; plus
(b) Five percent of total unearned income; plus
(c) Two point five percent of earned income after first deducting sixty-five dollars.
(4) When determining the premium amount, the department will use the current income amount until a change in income is reported and processed.
(5) A change in the premium amount is effective the month after the change in income is reported and processed.
(6) For current and ongoing coverage, the department will bill for HWD premiums during the month following the month in which coverage is approved.
(7) For retroactive coverage, the department will bill the HWD premiums during the month following the month in which coverage is requested and necessary information is received.
(8) If initial coverage for the HWD program is approved in a month that follows the month of application, the first monthly premium includes the costs for both the month of application and any following month(s).
(9) As described in WAC 388-475-1050 (4)(b), the department will close HWD coverage after four consecutive months for which premiums are not paid in full.
(10) If a person makes only a partial payment toward the cost of HWD coverage for any one month, the person remains one full month behind in the payment schedule.
(11) The department first applies payment for current and ongoing coverage to any amount owed for such coverage in an earlier month. Then it applies payment to the current month and then to any unpaid amount for retroactive coverage.
[Statutory Authority: RCW 74.08.090, Section 1902 (a)(10)(A)(ii) of the Social Security Act, and 2001 c 7 § 209(5), Part II. 02-01-073, § 388-475-1250, filed 12/14/01, effective 1/14/02.]