WSR 03-10-089

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed May 6, 2003, 4:50 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 03-04-085.

Title of Rule: WAC 388-523-0120 Medical extensions -- Premiums.

Purpose: Amend to delete references to unearned income. Upon adoption, the department will use only earned income to establish the premium amounts in the second six months of the medical extension certification period. Provides additional clarifying information.

Statutory Authority for Adoption: RCW 74.08.090.

Statute Being Implemented: Section 209, chapter 7, Laws of 2001.

Summary: See Purpose above.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Joanie Scotson, MAA, P.O. Box 45534, Olympia, WA 98504-5534, (360) 725-1330.

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: These amendments are necessary to eliminate references to unearned income. Upon adoption, the department will use earned income (less employment-related child-care to establish premiums).

Proposal Changes the Following Existing Rules: See Purpose above.

No small business economic impact statement has been prepared under chapter 19.85 RCW. There is no impact on small businesses. The rule only affects client financial and medical eligibility.

RCW 34.05.328 does not apply to this rule adoption. These rules meet the definition of a significant legislative rule under RCW 34.05.328. However, RCW 34.05.328 (5)(b)(vii) exempts rules relating to DSHS client financial and medical eligibility.

Hearing Location: Office Building 2, Auditorium, 14th and Jefferson, Olympia, Washington 98504, on June 10, 2003, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact DSHS Rules Coordinator by June 3, 2003, phone (360) 664-6097, 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 June 10, 2003.

Date of Intended Adoption: Not sooner than June 11, 2003.

April 28, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3228.2
AMENDATORY SECTION(Amending WSR 02-10-018, filed 4/22/02, effective 5/23/02)

WAC 388-523-0120   Medical extensions -- Premiums.   (1) "Countable income" means, for the purposes of determining the premium amount described in this chapter, all earned ((and unearned)) income of the adult family members ((except SSI cash assistance)), minus the amount of employment-related child care paid for by the family. The earned ((and unearned)) income of an adult, living in the household, who is financially responsible for other members of the assistance unit is included, whether or not the person is an eligible member of the assistance unit.

(2) ((For a family whose first month of medical extension benefits occurs on or after February 2002,)) The department requires the family to pay premiums for medical coverage provided during the second six-month medical extension period. The premium amount is one percent of the family's average countable income ((per person/per month. This amount is)) rounded down to the nearest whole dollar. This whole dollar amount is billed per adult per month. See subsection (3).

(3) The premiums for:

(a) Months seven, eight, and nine are based solely on the average countable income received in months one, two and three of the medical extension period; and

(b) Months ten, eleven, and twelve are based solely on the average countable income received in months four, five, and six of the medical extension period.

(4) A subsequent change in income does not effect the premium amount described in subsection (2) and (3) of this section.

(5) When a family's premium is one month in arrears, the family is ineligible for the balance of the medical extension period unless good cause exists. Reasons for good cause include, but are not limited to:

(a) Illness, mental impairment, injury, trauma, or stress;

(b) Lack of understanding the premium payment requirement due to a language barrier;

(c) Transportation problems;

(d) ((The client did not pay)) Nonpayment of the premium because ((they)) the client expected to be able to meet the family medical needs, but could not; or

(e) ((The client was given)) Receipt of incorrect information or ((did not receive)) nonreceipt advance and adequate notice about the premium payment requirements. Refer to WAC 388-422-0020 (4) and (5).

(6) The department exempts individual family members from ((the)) premium payment requirements, as follows:

(a) Children;

(b) Pregnant women;

(c) American Indians and Alaska Natives; and

(d) Caretaker adults in a family whose countable income is equal to or less than one hundred percent of the Federal Poverty Level based on family size as described in WAC 388-478-0075(2).

(7) When determining the exemption described in subsection (6)(d), the premium exemption is effective the first of the month following the client's report of the pregnancy to the department.

(8) When determining the exemption described in subsection (6)(d), the department shall include in the household size an unborn child and a person who is financially responsible for other members of the assistance unit, whether or not the person is an eligible member of the assistance unit. A person receiving SSI cash assistance is not included when determining the household size.

(((8))) (9) The department determines a family's exemption from the premium requirement as described in subsection (6)(d) for:

(a) Months seven, eight and nine based solely on information available to the department at the time the premium for these months is calculated; and

(b) Months ten, eleven, and twelve based solely on information available to the department at the time the premium for these months is calculated.

(((9))) (10) Any ((income)) change resulting in an individual meeting the exemption criteria in subsection (6)(d) after the establishment of the premium amount for months seven, eight and nine is used to calculate the premium amount for months ten, eleven, and twelve. Any change resulting in an individual meeting the exemption criteria in subsection (6)(d) after the establishment of the premium amount for months ten, eleven, and twelve is not used to recalculate the premium amount for months ten, eleven, and twelve.

[Statutory Authority: RCW 74.08.090 and 2001 c 7 209. 02-10-018, 388-523-0120, filed 4/22/02, effective 5/23/02.]

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