WSR 04-15-002

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed July 7, 2004, 1:27 p.m. , effective August 7, 2004 ]


Purpose: To correct Washington Administrative Code (WAC) cross references that are outdated due to the adoption of new rules for the SSI-related Medicaid programs per WSR 03-20-076, 03-20-077, 03-20-078, and 03-20-079.

Citation of Existing Rules Affected by this Order: Amending WAC 388-475-1050 and 388-475-1250.

Statutory Authority for Adoption: RCW 74.08.090, 34.05.353.

Other Authority: Section 1902 (a)(10)(A)(ii) of the Social Security Act.

Adopted under notice filed as WSR 04-09-091 on April 20, 2004.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 2, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.

Date Adopted: July 1, 2004.

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3347.1
AMENDATORY SECTION(Amending WSR 02-01-073, filed 12/14/01, effective 1/14/02)

WAC 388-475-1050   Healthcare for workers with disabilities (HWD) -- Program requirements.   This section describes requirements a person must meet to be eligible for the healthcare for workers with disabilities (HWD) program.

(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 388-475-0860; 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 of income;

(ii) WAC ((388-450-0085, Self-employment 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((; and

(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.]


AMENDATORY SECTION(Amending WSR 02-01-073, filed 12/14/01, effective 1/14/02)

WAC 388-475-1250   Healthcare for workers with disabilities (HWD) -- Premium payments.   This section describes how the department calculates the premium amount a person must pay for healthcare for workers with disabilities (HWD) coverage. This section also describes program requirements regarding the billing and payment of HWD premiums.

(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 388-475-0700(1).

(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.]

Legislature Code Reviser 

Register

Washington State Code Reviser's Office