WSR 03-14-108

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed June 30, 2003, 3:52 p.m. , effective June 30, 2003 ]

Date of Adoption: June 27, 2003.

Purpose: This rule is amended to delete references to unearned income. Upon adoption, the department will use only earned income to establish premium amounts in the second six months of the medical extension certification period.

Citation of Existing Rules Affected by this Order: Amending WAC 388-523-0120.

Statutory Authority for Adoption: RCW 74.08.090.

Other Authority: Section 209, chapter 7, Laws of 2001.

Adopted under notice filed as WSR 03-10-089 on May 6, 2003.

Changes Other than Editing from Proposed to Adopted Version: Subsection (5)(e) second sentence, added wording about good cause rights; subsection (5)(e), added the word "of" for grammatical accuracy; and subsection (8), cross-reference corrected to "(6)(b)."

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: This rule must become effective immediately to prevent imminent harm to the department's low-income clients in need of extensions to their medical coverage. The amended rule removes the requirement to count unearned income. This reduces the amount of premiums charged to clients for receipt of medical coverage. This amendment will improve the client's ability to pay monthly premiums for medical coverage.
Effective Date of Rule: Upon filing [June 30, 2003].

June 27, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3228.4
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 of advance and adequate notice about the premium payment requirements. ((Refer to)) WAC 388-422-0020 (4) and (5) provisions regarding good cause rights and periodic review apply to good cause for non-payment of premiums.

(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)(b), 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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