Date of Adoption: May 21, 2001.

Purpose: This amendment provides technical clarification including language to exclude from a family medical program those individuals receiving SFA cash assistance whose only child is over the age of nineteen.

Citation of Existing Rules Affected by this Order: Amending WAC 388-505-0210 and 388-505-0220.

Statutory Authority for Adoption: RCW 74.08.090, 74.04.050, [74.04.]055, and [74.04.]057.

Adopted under notice filed as WSR 01-07-012 on March 12, 2001.

Changes Other than Editing from Proposed to Adopted Version: The language in WAC 388-505-0220 (4), (5) and (6) has been revised based upon comments received to ensure accurate interpretation. The intent of the department has not changed.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 2, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 2, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0. Effective Date of Rule: Thirty-one days after filing.

May 17, 2001

Brian Lindgren, Manager

Rules and Policies Assistance Unit

(a) The child's mother was eligible for and receiving coverage under a medical program at the time of the child's birth; and

(b) The child remains with the mother and resides in the state.

(2) Children under the age of nineteen are eligible for CN medical assistance when they meet the requirements for:

(a) Citizenship or U.S. national status as described in WAC 388-424-0005(1) or immigrant status as described in WAC 388-424-0010 (1) or (2);

(b) State residence as described in chapter 388-468 WAC;

(c) A social security number as described in chapter 388-476 WAC; and

(d) Family income levels as described in WAC 388-478-0075 (1)(c).

(3) ((Upon implementation of the children's health insurance program (CHIP) as described in chapter 388-542, WAC,)) Children under the age of nineteen are eligible for ((CHIP)) the children's health insurance program (CHIP), as described in chapter 388-542 WAC, when:

(a) They meet the requirements of subsection (2)(a) and (b) of this section;

(b) They do not have other creditable health insurance coverage; and

(c) Family income exceeds two hundred percent of the federal poverty level (FPL), but does not exceed two hundred fifty percent of the FPL as described in WAC 388-478-0075 (1)(c) and (d).

(4) Children under the age of nineteen who first physically entered the U.S. after August 21, 1996 are eligible for state-funded CN scope of care when they meet the:

(a) Eligibility requirements in subsection (2)(b), (c), and (d) of this section; and

(b) Qualified alien requirements for lawful permanent residents, parolees, conditional entrants, or domestic violence victims as described in WAC 388-424-0005 (3)(a), (c), (f), or (i).

(5) Children under the age of twenty-one are eligible for CN medical assistance when they meet:

(a) ((Meet)) Citizenship or immigrant status, state residence, and social security number requirements as described in subsection (2)(a), (b), and (c) of this section;

(b) ((Meet)) Income levels described in WAC 388-478-0075 when income is counted according to WAC 388-408-0055 (1)(c); and

(c) ((Meet)) One of the following criteria:

(i) Reside in a medical hospital, intermediate care facility for mentally retarded (ICF/MR), or nursing facility for more than thirty days;

(ii) Reside in a psychiatric or chemical dependency facility;

(iii) Are in foster care; or

(iv) Receive subsidized adoption services.

(6) Children are eligible for CN medical assistance if they:

(a) Receive Supplemental Security Income (SSI) payments based upon their own disability; or

(b) Received SSI ((payments)) cash assistance for August 1996, and except for the August 1996 passage of amendments to federal disability definitions, would be eligible for SSI ((payments)) cash assistance.

(7) Children under the age of nineteen are eligible for Medically Needy (MN) medical assistance as defined in chapter 388-500 WAC when they:

(a) Meet citizenship or immigrant status, state residence, and social security number requirements as described in subsection (2)(a), (b), and (c); and

(b) Have income ((at or)) above the income levels described in WAC 388-478-0075 (1)(c).

(8) Children described in subsection (4)(a) and (b) whose countable income exceeds the standard in WAC 388-478-0075(1)(c) are eligible for state-funded MN scope of care.

(9) A child is eligible for SSI-related MN when the child:

(a) ((Meets the conditions in subsection (6)(a);

(b))) Meets the blind and/or disability criteria of the federal SSI program or the condition in subsection (6)(b); and

(((c) Has family))

(b) Has countable income above the level described in WAC 388-478-0070(1).

(((9) Nonimmigrant))

(10) Noncitizen children, including visitors or students from another country and undocumented children, under the age of eighteen are eligible for the state-funded children's health program, if:

(a) The department determines the child ineligible for any CN or MN scope of care medical program;

(b) They meet family income levels described in WAC 388-478-0075 (1)(a); and

(c) They meet state residency requirements as described in chapter 388-468 WAC.

(((10))) (11) There are no resource ((standards for the)) limits for children(('s)) under:

(a) CN or ((the)) MN coverage;

(b) State-funded CN or MN scope of care((,)); or

(c) The children's health programs.

(((11))) (12) Children may also be eligible for:

(a) ((Temporary assistance for needy families (TANF) or state)) Family ((assistance (SFA)-related)) medical as described in WAC 388-505-0220; ((and)) or

(b) ((TANF/SFA-related)) Medical extensions as described in WAC 388-523-0100.

(((12))) (13) Except for a client described in subsection (((4)(c))) (5)(c)(i) and (((d))) (ii), an inmate of a public institution, as defined in WAC 388-500-0005, is not eligible for CN or MN medical coverage.

[Statutory Authority: RCW 74.08.090 and 74.08A.100. 99-17-023, 388-505-0210, filed 8/10/99, effective 9/10/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-505-0210, filed 7/31/98, effective 9/1/98. Formerly WAC 388-509-0905, 388-509-0910 and 388-509-0920.]

(a) Receiving temporary assistance for needy families (TANF) cash benefits; ((or))

(b) Receiving cash diversion assistance described in chapter 388-222 WAC; ((or))

(c) Eligible for TANF cash benefits but choose((s)) not to receive ((cash benefits)); or

(d) Not eligible for or receiving TANF cash assistance, but meet((s)) the eligibility criteria for aid to families with dependent children (AFDC) ((that were)) in effect on July 16, 1996 except that:

(i) Earned income is treated as described in WAC 388-450-0210; and

(ii) Resources are treated as described in WAC 388-470-0005 for applicants and 388-470-0050 and 388-470-0026 for recipients.

(2) A person is eligible for CN family medical coverage when ((they are)) the person is not eligible for or receiving cash benefits solely ((for one of the following reasons)) because the person:

(a) Received sixty months of TANF cash benefits or is a member of an assistance unit which has received sixty months of TANF cash benefits; ((or))

(b) Failed to meet the school attendance requirement in chapter 388-400 WAC; ((or))

(c) Is an unmarried minor parent who is not in a department-approved living situation; ((or))

(d) Is a parent or caretaker relative who fails to notify the department within five days of the date the child leaves the home and the child's absence will exceed ninety days; ((or))

(e) Is a fleeing felon or fleeing to avoid prosecution for a felony charge, or a probation and parole violator; ((or))

(f) Was convicted of a drug related felony; ((or))

(g) Was convicted of receiving benefits unlawfully; ((or))

(h) Was convicted of misrepresenting residence to obtain assistance in two or more states; ((or))

(i) Has gross earnings exceeding the TANF gross income level; or

(j) ((Does not meet work quarter requirements; or

(k) Does not meet the unemployment requirement; or

(l))) Is not cooperating with WorkFirst requirements.

(3) A person is eligible for ((SFA)) state-funded CN scope of care family medical when the person:

(a) Is eligible for or receiving SFA cash benefits; ((or))

(b) Is receiving SFA cash diversion assistance described in chapter 388-222 WAC; ((or))

(c) Is not eligible for or receiving SFA solely due to factors described in subsection (2)(a) through (j) of this section; or

(d) Meets the criteria of (1)(d) of this section.

(4) An adult must cooperate with the division of child support in the identification, use, and collection of medical support from responsible third parties, unless the person meets the medical exemption criteria described in WAC 388-505-0540 or the medical good cause criteria described in chapter 388-422 WAC.

(5) When the only eligible child in an SFA cash assistance unit is over nineteen years of age the assistance unit is not eligible for a family medical program, but individual members shall be redetermined for eligibility for other medical programs.

(6) Except for a client described in WAC 388-505-0210 (5)(c)(i) and (ii), a person who is an inmate of a public institution, as defined in WAC 388-500-0005, is not eligible for CN or MN medical coverage.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-505-0220, filed 7/31/98, effective 9/1/98. Formerly WAC 388-507-0740 and 388-522-2210.]

Washington State Code Reviser's Office