WSR 99-19-160

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Economic Services Administration)

[ Filed September 22, 1999, 10:35 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 98-22-056.

Title of Rule: WAC 388-450-0200 Medical cost income deductions for food assistance, 388-450-0215 Prospective budgeting, 388-434-0005 Eligibility reviews for cash and medical assistance, 388-450-0060 Lump sum payments, 388-450-0180 Effect of countable income on eligibility and benefit level for cash assistance, 388-450-0205 Budgeting income deductions for food assistance, 388-450-0220 Retrospective budgeting, 388-450-0235 discontinued income, 388-450-0240 Effect of net lump sum payments for cash assistance, 388-456-0001 Monthly reporting, and 388-470-0080 Compensatory award or related settlement lump sum payments.

Purpose: Amend WAC 388-450-0200, 388-450-0215, 388-434-0005 to reflect the change to a single method of budgeting income for all programs. Repeal WAC 388-450-0060, 388-450-0180, 388-450-0205, 388-450-0220, 388-450-0240, 388-470-0080. These rules will be revised to reflect prospective budgeting and be moved to WAC 388-450-0162, 388-455-0005, 388-455-0010, and 388-455-0015. Repeal WAC 388-450-0220 Retrospective budgeting, 388-450-0235 Discontinued income, and 388-456-0001 Monthly reporting. These sections are not relevant with the department using prospective budgeting as the sole method of budgeting income.

Statutory Authority for Adoption: RCW 74.08.090 and 74.04.510.

Statute Being Implemented: RCW 74.08.090 and 74.04.510.

Summary: See Purpose above.

Reasons Supporting Proposal: RCW 74.08.090 gives the department authority to make rules and regulations to ensure uniform administration of programs throughout the state. RCW 74.04.510 requires the department to adopt rules consistent with federal laws, rules and regulations relating to the food stamp program.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: John Camp, Division of Assistance Programs, P.O. Box 45480, Olympia, WA 98504-5480, (360) 413-3232.

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: Changes rules to reflect department's choice of prospective budgeting as the sole method for budgeting income and deductions.

Proposal Changes the Following Existing Rules: WAC 388-450-0200 Medical cost income deductions for food assistance, 388-450-0215 Prospective budgeting, 388-434-0005 Eligibility reviews for cash and medical assistance, 388-450-0060 Lump sum payments, 388-450-0180 Effect of countable income on eligibility and benefit level for cash assistance, 388-450-0205 Budgeting income deductions for food assistance, 388-450-0220 Retrospective budgeting, 388-450-0235 discontinued income, 388-450-0240 Effect of net lump sum payments for cash assistance, 388-456-0001 Monthly reporting, and 388-470-0080 Compensatory award or related settlement lump sum payments.

Amends WAC 388-450-0200, 388-450-0215, and 388-434-0005 to reflect the change to a single method of budgeting income for all programs. Repeals WAC 388-450-0060, 388-450-0180, 388-450-0205, 388-450-0220, 388-450-0240, and 388-470-0080. These rules will be revised to reflect prospective budgeting and be moved to WAC 388-450-0162, 388-455-0005, 388-455-0010, and 388-455-0015. Repeals WAC 388-450-0220 Retrospective budgeting, 388-450-0235 Discontinued income, and 388-456-0001 Monthly reporting. These sections are not relevant with the department using prospective budgeting as the sole method of budgeting income.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The changes as a result of this rule do not affect small businesses.

RCW 34.05.328 does not apply to this rule adoption. These rules do not meet the definition of significant legislative rule.

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on October 26, 1999, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by October 12, 1999, phone (360) 664-6094, TTY (360) 664-6178, e-mail wallpg@dshs.wa.gov.

Submit Written Comments to: Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by October 26, 1999.

Date of Intended Adoption: No earlier than October 27, 1999.

September 20, 1999

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

2652.2
AMENDATORY SECTION(Amending WSR 99-16-024, filed 7/26/99, effective 9/1/99)

WAC 388-450-0200
Medical ((cost)) expenses may be used as an income deduction((s)) for food assistance households containing an elderly or disabled household member.

(1) ((Excess medical and/or shelter deductions incurred by the client are allowed when a client:

(a) Is elderly or disabled;

(b) Received food assistance as a noncash assistance unit until becoming categorically eligible due to the receipt of SSI; or

(c) Becomes categorically eligible due to the receipt of SSI after noncash assistance food stamps were denied as provided under WAC 388-414-0001.

(2) One-time medical expenses are averaged over the certification period or taken as a deduction at one time at the client's option.

(3) Anticipated medical expenses are averaged over the certification period.

(4) A medical expense deduction is not allowed when the expense is:

(a) A reimbursement;

(b) A vendor payment, except for Low Income Home Energy Assistance Act (LIHEAA) payments;

(c) Claimed after the initial billing, even though:

(i) Not reported when first due;

(ii) Included in the most recent billing; and

(iii) Actually paid.

(d) Allowed as a deduction once but not paid, and subsequently included in a repayment agreement;

(e) Included in a timely but defaulted repayment agreement and then included in a subsequent repayment agreement;

(f) Claimed by a client after presumptive SSI is denied;

(g) Considered overdue to the provider; or

(h) Already paid by a prospectively budgeted assistance unit)) Food assistance households can use medical expenses in excess of thirty-five dollars monthly as an income deduction for members that are:

(a) Age sixty or older; or

(b) Disabled as defined in WAC 388-400-0040.

(2) The department allows deductions for expenses to cover services, supplies, or medication prescribed by a state licensed practitioner or other state certified, qualified, health professional, such as:

(a) Medical, psychiatric, naturopathic physician, dental, or chiropractic care;

(b) Prescription drugs;

(c) Over the counter drugs;

(d) Eye glasses;

(e) Medical supplies other than special diets;

(f) Medical equipment.

(g) Hospital and outpatient treatment including:

(i) Nursing care; or

(ii) Nursing home care including payments made for a person who was an assistance unit member at the time of placement.

(h) Health insurance premiums paid by the client including:

(i) Medicare premiums or cost sharing; and

(ii) Insurance deductibles and co-payments.

(i) Spenddown expenses as defined in WAC 388-519-0010. Spenddown expenses are allowed as a deduction as they are estimated to occur or as the expense become due;

(j) Dentures, hearing aids, and prosthetics;

(k) Cost of obtaining and caring for a seeing eye or hearing animal, including food and veterinarian bills. We do not allow the expense of guide dog food as a deduction if you receive Ongoing Additional Requirements under WAC 388-255-1050 to pay for this need;

(l) Reasonable costs of transportation and lodging to obtain medical treatment or services;

(m) Attendant care necessary due to age, infirmity, or illness. If your household provides most of the attendant's meals, we allow an additional deduction equal to a one-person allotment.

(3) There are two types of deductions:

(a) One-time expenses are expenses that cannot be estimated to occur on a regular basis. You can choose to have us:

(i) Allow the one-time expense as a deduction when it is billed or due; or

(ii) Average the expense through your certification period.

(b) Recurring expenses are expenses that happen on a regular basis. We estimate your monthly expenses for the certification period.

(4) We do not allow a medical deduction if:

(a) The expense has already been paid;

(b) The expense is repaid by someone else;

(c) The expense is paid or will be paid by another agency;

(d) The expense is covered by medical insurance;

(e) You claim the expense later than the first billing, even if:

(i) You did not claim the expense the first time it was billed;

(ii) The expense is included in the current billing; and

(iii) You paid the bill.

(f) We previously allowed the expense, and you did not pay it. We do not allow the expense again even if it is part of a repayment agreement;

(g) You included the expense in a repayment agreement after failing to meet a previous agreement for the same expense;

(h) You claim the expense after you have been denied for presumptive SSI; and you are not considered disabled by any other criteria; or

(i) The provider considers the expense overdue.

[Statutory Authority: RCW 74.08.090 and 74.04.510.  99-16-024, 388-450-0200, filed 7/26/99, effective 9/1/99.  Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090.  98-16-044, 388-450-0200, filed 7/31/98, effective 9/1/98.]


AMENDATORY SECTION(Amending WSR 99-16-024, filed 7/26/99, effective 9/1/99)

WAC 388-450-0215
((Prospective budgeting)) How the department estimates income to determine your eligibility and benefits.

((Unless specifically stated, this section applies to TANF/SFA, RCA, GA, medical and food assistance programs.

(1) Prospective budgeting means an assistance unit's benefit amount for the month is computed using the best estimate of income and circumstance for that month.

(2) Best estimate means a reasonable expectation and knowledge of current, past and future circumstances. For TANF/SFA, RCA and GA assistance:

(a) An overpayment is established if the income is underestimated; and

(b) A corrective payment is issued if the income is overestimated.

(3) For medical assistance programs, the assistance unit's income is always prospectively budgeted.

(4) For TANF/SFA, RCA, GA, and food assistance programs, an assistance unit's income and circumstances are prospectively budgeted:

(a) For the first two months of benefit eligibility;

(b) When the benefits have been closed for less than one month and were closed in the first prospectively budgeted month; or

(c) When the assistance unit's benefits are suspended, as defined in WAC 388-450-0245 and the assistance unit experiences a significant change in their income, such as loss of employment, in the budget or process month.

(5) For each month of benefit eligibility certain assistance units will have their income prospectively budgeted. This applies to assistance units in which:

(a) All adult members are elderly or disabled and do not have earned income or recent work history, as defined in WAC 388-404-0015, 388-400-0040 and 388-456-0010;

(b) All members are homeless as defined in WAC 388-408-0050;

(c) The only countable income is received from migrant work; or

(d) For food assistance programs the only countable income is received from seasonal farm work.

(6) Cash assistance income is budgeted prospectively)) The department uses prospective budgeting to determine eligibility and benefits.

(1) The department determines the amount of benefits an assistance unit can receive each month based on an estimate of your income and circumstances for that month. This is known as prospective budgeting.

(2) We base this estimate on what can be reasonably expected based on your current, past and future circumstances.

(3) We determine if our estimate is reasonable by looking at documents, statements, and other verification.

(4) There are two methods of estimating a client's income:

(a) Anticipating monthly income: We estimate the actual amount of income you expect to receive in the month; and

(b) Averaging income: We estimate your income based on adding the total income you expect to receive for a period of time and dividing by the number of months in the time period.

(5) We must use the anticipating monthly method in the following circumstances:

(a) If you are a destitute migrant or seasonal farmworker as defined in WAC 388-406-0020;

(b) If you are receiving SSI, Social Security, or SSI-related medical benefits;

(c) If you have income allocated to someone receiving SSI-related medical benefits under WAC 388-450-0150; or

(d) If you have already received income in the month that you apply for benefits.

(6) In all other circumstances, we allow clients to select the method of estimating their income.

(7) If you choose the anticipating monthly method, we estimate the actual amount of income you expect to receive in the month. Your benefits will vary based on the income that is expected for that month.

(8) If you choose the averaging method, the expected changes in your income are taken into consideration so your benefits do not change as much:

(a) Clients that receive their income weekly or every other week will have their income converted to a monthly amount. If you are paid:

(i) Weekly, we multiply your expected pay by 4.3; or

(ii) Every other week, we multiply your expected pay by 2.15.

(b) Clients that receive their income other than weekly or every other week will have their monthly income estimated by:

(i) Adding the total amount of income expected to be received for the period of time; and

(ii) Dividing by the number of months in the period of time.

[Statutory Authority: RCW 74.08.090 and 74.04.510.  99-16-024, 388-450-0215, filed 7/26/99, effective 9/1/99.  Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090.  98-16-044, 388-450-0215, filed 7/31/98, effective 9/1/98. Formerly WAC 388-505-0590.]

2651.3
AMENDATORY SECTION(Amending WSR 98-16-044, filed 7/31/98, effective 9/1/98)

WAC 388-434-0005
The department reviews each client's eligibility ((reviews for cash and medical assistance)) for benefits on a regular basis.

(1) ((Clients receiving cash assistance are required to have eligibility redetermined at least once every twelve months. The redetermination will be based on information provided on a form designated by the department.  A family needs to complete only one form.

(2) A client's redetermination may be the scheduled review or initiated before the scheduled review when there are a number of eligibility changes to be reviewed.  The redetermination includes:

(a) A review of each eligibility factor; and

(b) An evaluation of any change occurring since eligibility was established or last reviewed.

(3) For clients not receiving cash assistance, an eligibility redetermination date will be established in advance.  For programs which require a fixed beginning and ending date, eligibility redetermination will be initiated prior to the end of coverage.

(4) Clients receiving assistance will be responsible for completing and responding to the eligibility redetermination request and attending an interview if required under WAC 388-452-0005.

(5) Clients who do not respond to a notice of redetermination will be considered to be withdrawing their request for continuing assistance.  Termination of medical assistance will occur if there is insufficient information to redetermine medical program eligibility.

(6) Clients will receive a notice when the cash and food assistance is suspended, terminated, or a benefit error is discovered during the review as specified under chapter 388-458 WAC.

(7) Clients who become ineligible for cash assistance continue to receive the same medical coverage until a redetermination for other medical programs is completed.

(8) Clients not requesting a continuation of cash assistance have a right to be considered for other medical program eligibility.

(9) Clients receiving CN medical only remain eligible until a redetermination of eligibility for other medical programs is completed.

(10) Recipients who are assessed as needing necessary supplemental accommodation (NSA) services will be assisted in complying with the requirements of this section as specified under WAC 388-200-1300)) If you receive cash assistance, the department reviews your eligibility for assistance at least once every six months.

(2) When it is time for your eligibility review, the department requires you to complete a review form. We use the information you provide to determine your eligibility for all assistance programs.

(3) If you complete an interview for assistance with a department representative and sign the printed application for benefits (AFB) form, you do not have to complete a separate review form.

(4) For cash assistance, the eligibility review form or the AFB must be dated and signed by both husband and wife, or both parents of a child in common when the parents live together.

(5) If you receive medical assistance only, the eligibility review form or the AFB must be signed by at least one parent when the parents live together.

(6) We may move the date of your eligibility review if we decide your circumstances need to be reviewed sooner.

(7) At your review, we look at:

(a) All eligibility requirements under WAC 388-400-0005 through 388-400-0035, 388-503-0505 through 388-503-0515, and 388-505-0210 through 388-505-0220;

(b) Changes that happened since we last determined your eligibility; and

(c) Changes that are anticipated to happen during the next review period.

(8) If you receive medical assistance only, we set your eligibility review date in advance under WAC 388-416-0005 through 388-416-0035. We will start the review process before your benefits end.

(9) Clients are responsible for attending an interview if one is required under WAC 388-452-0005.

(10) If you do not complete the eligibility review for cash assistance, you are considered to be withdrawing your request for continuing assistance. Your cash assistance benefits will end. Your medical assistance will end if there is not enough information to redetermine eligibility for medical benefits.

(11) We must send you written notice under WAC 388-458-0005, 388-458-0010, and 388-450-0015 before assistance can be suspended, terminated, or a benefit error is established as a result of your eligibility review.

(12) If you are currently receiving cash or medical assistance, and you are found to no longer be eligible for benefits, we will determine if you are eligible for other medical programs. Until we decide if you are eligible for other programs, your medical assistance will continue under WAC 388-418-0025 even if you request that your benefits end.

(13) When a client is determined to need necessary supplemental accommodation (NSA) under WAC 388-200-1300, we will help the client meet the requirements of this section.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090.  98-16-044, 388-434-0005, filed 7/31/98, effective 9/1/98. Formerly WAC 388-522-2230.]

2645.1
REPEALER

     The following section of the Washington Administrative Code is repealed:
WAC 388-470-0080 Compensatory award or related settlement lump sum payments.
2643.2
REPEALER

     The following sections of the Washington Administrative Code are repealed:
WAC 388-450-0060 Lump sum payments.
WAC 388-450-0180 Effect of countable income on eligibility and benefit level for cash assistance.
WAC 388-450-0205 Budgeting income deductions for food assistance.
WAC 388-450-0220 Retrospective budgeting.
WAC 388-450-0235 Discontinued income.
WAC 388-450-0240 Effect of net lump sum payments for cash assistance.
2644.1
REPEALER

     The following section of the Washington Administrative Code is repealed:
WAC 388-456-0001 Monthly reporting.

Washington State Code Reviser's Office