Original Notice.

     Preproposal statement of inquiry was filed as WSR 02-03-091.

     Title of Rule: WAC 388-406-0040 What happens if the processing of my application is delayed?, 388-406-0045 Is there a good reasons my application for cash or medical assistance has not been processed?, 388-406-0050 How do I know when my application is processed?, 388-406-0055 When do my benefits start?, 388-406-0060 What happens when my application is denied?, 388-406-0065 Can I still get benefits even after my application is denied?, 388-452-0005 Do I have to be interviewed in order to get benefits?, and 388-472-0005 What are my rights and responsibilities?

     Purpose: Amending rules in chapter 388-406 WAC and WAC 388-452-0005 and 388-472-0005 to clarify and streamline policy.

     Statutory Authority for Adoption: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.08.090, and 74.09.530.

     Statute Being Implemented: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.08.090, and 74.09.530.

     Summary: Amending rules in chapter 388-406 WAC and WAC 388-452-0005 and 388-472-0005.

     Reasons Supporting Proposal: To clarify and streamline existing policy.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Vicky T. Robinson, 1009 College Street S.E., Lacey, WA, (360) 413-3031.

     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: Amending rules in chapter 388-406 WAC to clarify and streamline existing policy. Also amending WAC 388-452-0005 and 388-472-0005 for clarity.

     Proposal Changes the Following Existing Rules: The proposed rules clarify what happens when the processing of an application is delayed, good cause reasons for the delay, when an application is processed, when benefits start, what happens when an application is denied, and reconsideration of denied applications. Also describes client's rights and responsibilities.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. Small businesses are not affected by these rule changes.

     RCW 34.05.328 does not apply to this rule adoption. These amendments do not meet the definition of significant legislative rule changes and are exempt under RCW 34.05.325 [34.05.328] (5)(b)(vii).

     Hearing Location: Office Building 2 Auditorium (DSHS Headquarters) (parking on 12th off Jefferson), 14th and Jefferson, Olympia, WA 98504, on June 4, 2002, at 10:00 a.m.

     Assistance for Persons with Disabilities: Contact DSHS Rules Coordinator by May 31, 2002, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

     Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., June 4, 2002.

     Date of Intended Adoption: No sooner than June 5, 2002.

April 11, 2002

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     (3) For medical and cash assistance, application processing may be delayed only when good cause exists as specified in WAC 388-406-0045)) We process your application for benefits as soon as possible. We do not intentionally delay processing your application for benefits for any reason. If we have enough information to decide eligibility for:

     (a) Food assistance, then we promptly process your request for food assistance even if we need more information to determine eligibility for cash or medical;

     (b) Medical assistance, then we promptly process your request for medical even if we need more information to determine eligibility for cash or food assistance.

     (2) If we discover that your application for food assistance has not been processed within the first thirty days and we have enough information to determine eligibility, then we promptly process your application. If additional information is needed to determine eligibility, we give you:

     (a) A written request for the additional information; and

     (b) An additional thirty days to provide the information.

     (3) If your application for food assistance has not been processed by the sixtieth day and you are responsible for the delay, then we deny your request for benefits. If we are responsible for the delay, then we:

     (a) Promptly process your request if we have the information needed to determine eligibility; or

     (b) Deny your request if we don't have enough information to determine eligibility. If we deny your request we notify you of your right to file a new application and that you may be entitled to benefits lost. If you reapply by the sixtieth day of your first application and are eligible, we give you benefits lost from:

     (i) The date of your first application if we caused the delay in the first thirty days; or

     (ii) The month following the month of your first application if you caused the delay in the first thirty days.

[Statutory Authority: RCW 74.08.090 and 74.04.510. 99-16-024, § 388-406-0040, 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, § 388-406-0040, filed 7/31/98, effective 9/1/98. Formerly WAC 388-504-0480.]

     (1) ((Good cause reasons for delay in processing a medical or cash assistance application include:

     (a) The applicant does not provide requested information or take another required action;

     (b) The eligibility decision depends on medical reports and there is a delay in obtaining the reports or in securing medical information;

     (c) An eligibility determination depends on correspondence with out-of-state or intercity contacts and no other verification is available for the eligibility factor;

     (d) An administrative or other emergency occurs which is beyond the department's control; or

     (e) For cash assistance, an eligibility determination depends on extensive property appraisals)) We do not have a good reason for not processing your application for TANF or SFA within thirty days if:

     (a) We did not give or send you a notice of what information we needed to determine your eligibility within twenty days from the date of your application;

     (b) We did not give or send you a notice that we needed additional information or action within five calendar days of the date we learned that more information was needed to determine eligibility;

     (c) We did not process your application within five calendar days from getting the information needed to decide eligibility; and

     (d) We decide good cause exists but do not document our decision in the case record on or before the time limit for processing the application ends.

     (2) We do have a good reason for not processing your application timely if:

     (a) You do not give us the information or take an action needed for us to determine eligibility;

     (b) We have an emergency beyond our control; or

     (c) There is no other available verification for us to determine eligibility and the eligibility decision depends on information that has been delayed such as:

     (i) Medical documentation;

     (ii) Proof of your resources; or

     (iii) Out-of-state documents or correspondence.

     (3) For medical assistance, good cause exists only when the department otherwise acted promptly at all stages of the application process .

     (((3) For TANF and SFA, good cause exists only when the department:

     (a) Notifies the applicant in writing of specific information needed to determine eligibility within twenty days of the date of application;

     (b) Notifies the applicant in writing of the need for additional information or action within five calendar days;

     (c) Determines eligibility and disposes of the application within five working days of receiving all information necessary to determine eligibility; and

     (d) Determines good cause exists and documents the decision in the case record on or before the time limit for processing the application expires.))

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-406-0045, filed 7/31/98, effective 9/1/98. Formerly WAC 388-504-0480.]

     (6) A decision to deny an application must be made according to the requirements of WAC 388-406-0060)) is processed when:

     (a) We approve or deny benefits; and

     (b) We give or send you a letter telling you if you are eligible to get benefits.

     (2) Any letters we send you must meet the requirements under chapter 388-458 WAC.

     (3) We send you a letter of withdrawal under WAC 388-458-0006 if you voluntarily withdraw an application verbally, in sign language, or in writing.

     (4) We send you a letter of denial according to the requirements of WAC 388-406-0060.

[Statutory Authority: RCW 74.08.090 and 74.04.510. 99-16-024, § 388-406-0050, 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, § 388-406-0050, filed 7/31/98, effective 9/1/98. Formerly WAC 388-525-2505.]

     (1) ((For)) Cash assistance, ((the earlier of)) your benefits start:

     (a) The date ((the department has sufficient)) we have enough information to make an eligibility decision; or

     (b) ((The last day of the time limit period specified in WAC 388-406-0035.

     (2) For medical programs, as specified in chapter 388-416 WAC.

     (3) For food assistance, except as described in subsections (4) and (5) of this section:

     (a) The first day of the month following the end of the previous certification period for:

     (i) All households that reapply before their previous certification period ends; and

     (ii) Migrant and seasonal farmworker households that reapply within one month after their previous certification period ends; or

     (b) The date of application for all other households.

     (4) For food assistance applications approved after reconsideration as required by WAC 388-406-0065:

     (a) The date the household provides required verification when:

     (i) The application is denied because the applicant fails to respond to a written request for the verification, and

     (ii) The household provides the requested verification after the end of the initial thirty-day time limit; or

     (b) The date the household becomes eligible for TANF or SFA when:

     (i) The household is denied nonassistance food assistance; and

     (ii) Is later found to be categorically eligible for food assistance because TANF or SFA is approved.

     (5) For food assistance applications not processed within the thirty-day time limit, the first day of the month following the month of application when:

     (a) Required verification is not provided by the household by the end of the initial thirty-day time limit;

     (b) The household provides the required verification by the end of the second thirty-day period; and

     (c) The delay in providing the required verification is the fault of the household)) No later than the thirtieth day for TANF, SFA, or RCA; or

     (c) No later than the forty-fifth day for general assistance (GAU).

     (2) Food assistance, your benefits start from the date you applied unless:

     (a) You are recertified for food assistance, then the date we start your benefits is under WAC 388-434-0020;

     (b) We were unable to process your application within thirty days because of a delay on your part. If you caused the delay, then we approve your benefits starting the first day of the month following the month of application if you submit required verification by the end of the second thirty-day period, even if we denied your application; or

     (c) We denied your application for food assistance and your assistance unit becomes categorically eligible (CE) within sixty days from the date you applied, then the date we approve food assistance is the date you become CE. You are CE if you meet the criteria specified in WAC 388-414-0001.

     (3) Medical assistance, the date your benefits start is stated in chapter 388-416 WAC.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-406-0055, filed 7/31/98, effective 9/1/98.]

     (ii) You did not provide the requested information that was necessary to decide eligibility)) for cash, medical, or food assistance benefits if:

     (a) You do not show for your appointment for cash or food assistance and have not rescheduled and your application is over thirty days old;

     (b) We do not have the information we need to determine your eligibility within ten days of request and you did not ask for additional time to give us the information;

     (c) Your entire assistance unit does not meet certain eligibility criteria to get benefits;

     (d) For food assistance, your application has not been processed by the sixtieth day because of a delay on your part.

     (2) If we deny your application, you are not eligible to get benefits.

     (3) We can reconsider if you are eligible for benefits under the requirements of WAC 388-406-0065 even after your application is denied.

     (4) We give or send a letter to you explaining why your application was denied as required under WAC 388-458-0011.

     (5) If you disagree with our decision about your application, you can ask for a fair hearing. If we deny your application because we do not have enough information to decide that you are eligible, the hearing issue is whether you can provide the needed information or if we already have sufficient information to decide eligibility

[Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.055, 74.04.057 and C.F.R. 273.2(h1d), waiver October 10, 1984. 00-13-076, § 388-406-0060, filed 6/19/00, effective 7/20/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-406-0060, filed 7/31/98, effective 9/1/98. Formerly WAC 388-504-0485.]

     Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings.
AMENDATORY SECTION(Amending WSR 98-16-044, filed 7/31/98, effective 9/1/98)

WAC 388-406-0065   ((Reconsideration of denied applications.)) Can I still get benefits even after my application is denied?   (1) ((For medical and cash assistance, an applicant is allowed thirty days from the date of a denial notice to provide information needed to determine eligibility as specified in the notice.

     (a) A redetermination of eligibility will be made and eligibility will be determined based on the information provided unless the applicant's circumstances have changed to the extent that additional information is needed to determine eligibility.

     (b) If eligibility is approved based on the information provided, the eligibility date is based on the application date of the denied application.

     (2) A denial of an application for medical benefits will be rescinded if the applicant, following the thirty-day period specified in subsection (1) of this section:

     (a) Timely requests a fair hearing to appeal the denial; and

     (b) Provides additional information needed to establish eligibility, including medical expenses sufficient to meet spenddown if the applicant shows reasonable cause for the delay in verifying the medical expenses.

     (3) For food assistance, an applicant is allowed thirty days from the end of the initial thirty-day period to provide information needed to determine eligibility as specified in a denial notice. If the information is provided, the eligibility date is determined as specified under WAC 388-406-0055.

     (4) A denied food assistance application will be re-evaluated within sixty days of the application date when the household was:

     (a) Applying for both food assistance and TANF, SFA or SSI; and

     (b) Denied food assistance before TANF, SFA or SSI was approved)) If we (the department) deny your application for benefits, we can redetermine your eligibility for benefits without a new application if:

     (a) For cash or medical assistance, you give us the information we need within thirty days from the date we denied your application;

     (b) For food assistance:

     (i) You give us the information we need by the end of the month following the month you applied; or

     (ii) You become categorically eligible for food assistance under WAC 388-414-0001 within sixty days of the date you applied for benefits.

     (2) If you are eligible for cash or food assistance, we decide the date your benefits start according to WAC 388-406-0055. If you are eligible for medical assistance, we decide the date your benefits start according to chapter 388-416 WAC.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-406-0065, filed 7/31/98, effective 9/1/98. Formerly WAC 388-504-0485.]

     (a) At initial certification; and

     (b) At least once every twelve months if your assistance unit (AU) is certified for twelve months or less.

     (2) You are not required to attend an interview when your application or review is just for medical benefits. If we (((the department))) deny your application for cash or food assistance because you did not appear for an interview, we ((will)) continue to process your request for medical benefits:

     (a) If you are pregnant;

     (b) If you are a child under the age of nineteen;

     (c) If you have a family with children under the age of nineteen; or

     (d) If we have enough information to determine if you are eligible or can get the information by mail.

     (3) You will have ((only a single)) just one interview even when you apply for or have a review for more than one assistance program.

     (4) If you are not interviewed on the same day that we get your application, we schedule an interview appointment for you. We schedule your appointment the day we get your application or on the next business day if we get your application on a holiday or a weekend.

     (5) We schedule an interview so your AU has at least ten days after the interview to provide needed verification:

     (a) Before the end of the thirty-day processing period for applications; or

     (b) Before your certification period ends for eligibility reviews.

     (6) If you miss your first interview and request another interview within thirty days of the date of your application for benefits, we schedule a second interview for you.

     (7) You or another person who can give information about your AU must attend the interview. You may bring another person to the interview. You may choose another person to go to the interview for you when:

     (a) You cannot come to the local office for us to decide if you are eligible for cash assistance; or

     (b) You have an authorized representative as described in WAC 388-460-0005 for food assistance.

     (8) We usually have interviews at the local office. You can have a scheduled telephone interview or an interview in your home if attending an interview at the local office causes a hardship for you or your representative. Examples of hardships include:

     (a) If your entire assistance unit is elderly or mentally or physically disabled;

     (b) If you live in a remote area or have transportation problems;

     (c) Severe weather;

     (d) If someone in your AU is ill, or you have to stay home to care for an AU member;

     (e) Your work or training hours make it difficult to come into the office during regular business hours;

     (f) Someone in your AU is affected by family violence such as physical or mental abuse, harassment, or stalking by the abuser; or

     (g) Any other problem which would make it difficult for you to come into the office for an interview.

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.530. 01-14-060, § 388-452-0005, filed 6/29/01, effective 8/1/01; 00-22-087, § 388-452-0005, filed 10/31/00, effective 12/1/00. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530 and 42 C.F.R. 435.907. 99-11-075, § 388-452-0005, filed 5/18/99, effective 6/18/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-452-0005, filed 7/31/98, effective 9/1/98. Formerly WAC 388-504-0420.]

     ((The following rules apply to cash, food and medical assistance programs unless stated otherwise.))

     (1) If you apply for or ((receive)) get cash, food or medical assistance benefits you have the right to:

     (a) ((Be fully informed, in writing, of all legal rights and responsibilities in connection with benefits;

     (b) Be treated politely and fairly without regard to race, color, political beliefs, national origin, religion, age, gender, disability or birthplace;

     (c) Give us a written request for benefits using a form or alternative method designated by us. You have the right to get a receipt when leaving an application or other materials with us;

     (d) Ask that the application be processed without delay if you are pregnant, in need of immediate medical care, experiencing an emergency such as having no money for food, or facing an eviction. If you are pregnant and request an interview, you have the right to have one within five working days;

     (e) Get a written decision in most cases within thirty days.

     (i) Medical and some disability decisions may take forty-five to sixty days. Pregnancy medical will be authorized within fifteen working days.

     (ii) Food assistance will be authorized within thirty days if you are eligible. If you are eligible and have little or no money, food assistance will be authorized within five days.

     (f) Have information you give us kept private. We share some facts with other agencies for efficient management of federal and state programs;

     (g) For cash and medical assistance programs, ask us not to collect child support if the absent parent may harm you or your child;

     (h) For some cash assistance programs, ask for extra money to help in an emergency, such as an eviction or a utility shutoff;

     (i) Get a written notice, in most cases, at least ten days before we make changes to reduce or end your benefits;

     (j) Ask for a fair hearing if you do not agree with us about a decision. You can also ask a supervisor or administrator to review our decision or action without affecting your right to a fair hearing;

     (k) Have interpreter or translator services provided at no cost to you and without delay;

     (l) Refuse to speak to a fraud investigator. You do not have to let an investigator into your home. You may ask the investigator to come back at another time. Such a request will not affect your eligibility for benefits;

     (m) If you are applying for or receiving medical assistance, limited casualty programs, medical care services, or children's health services you have the same rights as cash assistance clients; and

     (n) Receive help from us to register to vote.

     (2) You are responsible to:

     (a) Report any changes to us within:

     (i) Ten days for all cash and food assistance programs; and

     (ii) Twenty days for all medical assistance programs.

     (b) Give all the facts needed to determine eligibility;

     (c) Give us proof of any facts for which proof is needed;

     (d) For most cash or medical assistance programs related to children, cooperate with us to get child support or medical care support unless you show that cooperation may harm you or your child;

     (e) Apply for and get any benefits from other agencies or programs prior to getting cash or medical assistance from us;

     (f) Complete reports and reviews when asked to do so;

     (g) Get a job or training if required;

     (h) Show your medical identification card or other notification of eligibility from us to your medical care provider; and

     (i) Cooperate with the quality assurance review process.

     (3) You will be screened for and provided necessary supplemental accommodation services as described in this chapter)) Have your rights and responsibilities explained to you and given to you in writing;

     (b) Be treated politely and fairly no matter what your race, color, political beliefs, national origin, religion, age, gender, disability or birthplace;

     (c) Request benefits by giving us an application form using any method listed under WAC 388-406-0010. You can ask for and get a receipt when you give us an application or other documents;

     (d) Have your application processed as soon as possible. Unless your application is delayed under WAC 388-406-0040, we process your application for benefits within thirty days, except:

     (i) If you are eligible for expedited services under WAC 388-406-0015, you get food assistance within five days. If we deny you expedited services, you have a right to ask that the decision be reviewed by the department within two working days from the date we denied your application;

     (ii) If you are pregnant and otherwise eligible, you get medical within fifteen working days.

     (iii) General assistance (GAU), alcohol or drug addiction treatment (ADATSA), or medical assistance may take up to forty-five days; and

     (iv) Medical assistance requiring a disability decision may take up to sixty days.

     (e) Be given at least ten days to give us information needed to determine your eligibility. If we do not have the information needed to decide your eligibility, then we may deny your request for benefits;

     (f) Have the information you give us kept private. We may share some facts with other agencies for efficient management of federal and state programs;

     (g) Ask us not to collect child support or medical support if you fear the noncustodial parent may harm you, your children, or the children in your care;

     (h) Ask for extra money to help pay for temporary emergency shelter costs, such as an eviction or a utility shutoff, if you get TANF;

     (i) Get a written notice, in most cases, at least ten days before we make changes to lower or stop your benefits;

     (j) Ask for a fair hearing if you disagree with a decision we make. You can also ask a supervisor or administrator to review our decision or action without affecting your right to a fair hearing;

     (k) Have interpreter or translator services given to you at no cost and without delay;

     (l) Refuse to speak to a fraud investigator. You do not have to let an investigator into your home. You may ask the investigator to come back at another time. Such a request will not affect your eligibility for benefits; and

     (m) Get help from us to register to vote.

     (2) If you get cash, food, or medical assistance, you are responsible to:

     (a) Tell us if you are pregnant, in need of immediate medical care, experiencing an emergency such as having no money for food, or facing an eviction so we can process your request for benefits as soon as possible;

     (b) Report the following expenses so we can decide if you can get more food assistance:

     (i) Shelter costs;

     (ii) Child or dependent care costs;

     (iii) Child support that is legally obligated;

     (iv) Medical expenses; and

     (v) Self-employment expenses.

     (c) Report changes as required under WAC 388-418-0005 and 388-418-0007. If you get:

     (i) Cash or food assistance, changes must be reported within ten days from the date you learn of the change; or

     (ii) Medical assistance, changes must be reported within twenty days from the date you learn of the change.

     (d) Give us the information needed to determine eligibility;

     (e) Give us proof of information when needed. If you have trouble getting proof, we help you get the proof or contact other persons or agencies for it;

     (f) Cooperate in the collection of child support or medical support unless you fear the noncustodial parent may harm you, your children, or the children in your care;

     (g) Apply for and get any benefits from other agencies or programs prior to getting cash assistance from us;

     (h) Complete reports and reviews when asked;

     (i) Look for, get, and keep a job or participate in other activities if required for cash or food assistance;

     (j) Give your medical identification card or letter of eligibility from us to your medical care provider; and

     (k) Cooperate with the quality control review process.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, and 74.08.090. 01-10-104, § 388-472-0005, filed 5/1/01, effective 6/1/01. Statutory Authority: RCW 74.08.090 and 74.04.510. 99-17-025, § 388-472-0005, filed 8/10/99, effective 10/1/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-472-0005, filed 7/31/98, effective 9/1/98. Formerly WAC 388-504-0430, 388-504-0440, 388-504-0450 and 388-505-0560.]

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