WSR 03-17-087

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Economic Services Administration)

[ Filed August 19, 2003, 4:20 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 03-13-035 on June 10, 2003.

Title of Rule: Part 1 of 2 chapter 388-418 WAC. WAC 388-418-0005 What type of changes must I report for cash, food, and medical assistance?, 388-418-0007 When do I have to report changes in my circumstances?, and 388-418-0020 How does the department determine the date a change affects my benefits?

See Part 2 of 2 for related rules in chapters 388-450 and 388-490 WAC.

Purpose: Amend the rules to comply with federal requirements for the food stamp program and rewrite the text of the rules to be more easily understood.

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

Statute Being Implemented: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510.

Summary: These rules explain what changes department clients must report, when changes impact a client's benefits, and how the department budgets income to determine if clients are eligible for benefits and calculate monthly benefits.

Reasons Supporting Proposal: These changes are necessary to implement mandatory changes to the basic food program required by the FNS final rule on anticipating income and reporting changes. The changes also amend the text of the rules to be more easily understood.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: John Camp, 1009 College S.E., Lacey, WA 98504, (360) 413-3232.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is necessary because of federal law, Title 7 of the Code of Federal Regulations, Part 273 - 273.2, 273.10, and 273.12.

Explanation of Rule, its Purpose, and Anticipated Effects: Rule: WAC 388-418-0005 What type of changes must I report for cash, food, and medical assistance?, 388-418-0007 When do I have to report changes in my circumstances?, and 388-418-0020 How does the department determine the date a change affects my benefits?

Purpose and Effect: See Title of Rule and Summary above.

Proposal Changes the Following Existing Rules: See Title of Rule and Summary above.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This proposed rule does not have an economic impact on small businesses; it only affects DSHS clients by modifying reporting requirements and budgeting rules for food assistance benefits.

RCW 34.05.328 does not apply to this rule adoption. These amendments are exempt as allowed under RCW 34.05.328 (5)(b)(vii) which states in part, "(t)his section does not apply to...rules of the department of social and health services relating only to client medical or financial eligibility and rules concerning liability for care of dependents." This rule adopts federal requirements mandated by Title 7 of the Code of Federal Regulations, Part 273, 273.2 regarding office operations, 273.10 regarding determining financial eligibility and benefit level, and 273.12 regarding requirements for change reporting households for federal food stamp benefits. The department also applies the same requirements for cash assistance.

Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on September 23, 2003, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by September 19, 2003, phone (360) 664-6094, TTY (360) 664-6178, e-mail FernAX@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, mail to P.O. Box 45850, Olympia, WA 98504-5850, deliver to 4500 10th Avenue S.E., Lacey, WA, fax (360) 664-6185, e-mail fernaax@dshs.wa.go [fernaax@dshs.wa.gov], by 5:00 p.m., September 23, 2003.

Date of Intended Adoption: No earlier than September 24, 2003.

August 18, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3294.1
AMENDATORY SECTION(Amending WSR 01-11-109, filed 5/21/01, effective 7/1/01)

WAC 388-418-0005   What type of changes must I report for cash, Basic Food, and medical assistance?   For purposes of this section, an "assistance unit" or "AU" is a group of people who live together and whose income or resources we count to decide what benefits the AU gets. Even if someone in your AU is not eligible to get a benefit, we still count that person's income or resources if they are financially responsible for you or someone in your AU, such as a common child. If you are a parent of a child who gets long-term care benefits, you need only report changes in income or resources that are actually contributed to the child. Tables one, two and three below show the types of changes you must report based on the type of assistance you get. Use table one to see if you must report a change for cash or Basic Food ((assistance)). Use table two to see if you must report a change for children's, pregnant women's, or family medical assistance. Use table three to see if you must report a change for SSI-related medical or long-term care medical assistance.


Table 1 - Cash Assistance and Basic Food ((Assistance))
Type of change to report when you or anyone in your assistance unit AU): Do I have to report this change for cash assistance? Do I have to report this change for Basic Food ((assistance))?
(1) Starts to get money from a new source; Yes Yes
(2) Has unearned income that changed by more than ((twenty-five)) fifty dollars from amount we budgeted; Yes Yes
(3) Moves into or out of your home, including newborns or if an AU member dies. This also includes when someone temporarily moves in or out; Yes Yes
(4) Moves to a new residence; Yes Yes
(5) Has a change in shelter costs; Yes, but only if you went from having no shelter costs to having a shelter cost, or from having shelter costs to not having to pay anything. You don't have to report a change in the amount you pay. Yes, report the change at your recertification. If your shelter costs go up, you could get more ((food assistance)) benefits. Report the change sooner to see if you will get more benefits.
(6) Gets married, divorced, or separated; Yes Yes
(7) Gets a vehicle; Yes Yes
(8) Has a disability that ends; Yes Yes
(9) Has countable resources that are more than the resource limits under WAC 388-470-0005; Yes Yes
(10) Gets a job or changes employers; Yes Yes, but only if it causes a change in the person's income.
(11) Changes from part-time to full-time or full-time to part-time work. We use your employer's definition of part-time and full-time work; Yes Yes
(12) Has a change in hourly wage rate or salary; Yes Yes
(13) Stops working; Yes Yes
(14) Has a pregnancy that begins or ends; Yes No
(15) Has a change in uncovered medical expenses; No Yes, report this change only at your next eligibility review. If you are elderly or disabled and you have an increase in uncovered medical expenses, report this change sooner as you may be eligible to get more benefits.


Table 2 - Medical Assistance
Type of change to report when you or anyone in your assistance unit (AU): Do I have to report this change for family medical assistance (i.e., TANF/SFA-related) or Children's Medical? Do I have to report this change for ((children's medical and/or)) Pregnancy Medical?
(16) A change in work hours to below 20 hours per week averaged monthly. No Yes, but only if there are no children in your AU and the person is a nonexempt ABAWD under WAC 388-444-0030 and 388-444-0035.
(17) A change in legal obligation to pay child support. No Yes
(18) Starts to get money from a new source; Yes No
(((17))) (19) Has unearned income that changed; Yes No
(((18))) (20) Moves into or out of your home, including newborns or if an AU member dies. This also includes when someone temporarily moves in or out; Yes Yes
(((19))) (21) Moves to a new residence; Yes Yes
(((20))) (22) Has a change in shelter costs; No No
(((21))) (23) Gets married, divorced, or separated; Yes No
(((22))) (24) Gets a vehicle; No No
(((23))) (25) Has a disability that ends; No No
(((24))) (26) Has countable resources that are more than the resource limits under WAC 388-470-0005; No No
(((25))) (27) Gets a job or changes employers; Yes No
(((26))) (28) Changes from part-time to full-time or full-time to part-time work. We use your employer's definition of part-time and full-time work; Yes No
(((27))) (29) Has a change in hourly wage rate or salary; Yes No
(((28))) (30) Stops working; Yes No
(((29))) (31) Has a pregnancy that begins or ends; Yes Yes
(((30))) (32) Has a change in uncovered medical expenses. No Yes, but only if an AU member has a spenddown.


Table 3 - SSI-Related Medical Assistance and Long-Term Care
Type of change to report when you or anyone in your assistance unit (AU): Do I have to report this change for SSI-related medical assistance? Do I have to report this change for long-term care (i.e., COPES, CAP, or nursing home)
(((31))) (33) Starts to get money from a new source; Yes Yes
(((32))) (34) Has unearned income that changed; Yes Yes
(((33))) (35) Has a change in earnings or stops working Yes Yes
(((34))) (36) Moves into or out of your home, including newborns or if an AU member dies. This also includes when someone temporarily moves in or out; Yes Yes
(((35))) (37) Moves to a new residence; Yes Yes
(((36))) (38) Has a change in shelter costs; No, unless you went from paying rent to not paying any rent. You do not need to report if your rent amount changes. Yes, if client or community spouse live in their own home
(((37))) (39) Gets married, divorced, or separated; Yes Yes
(((38))) (40) Gets a vehicle; Yes, but only if that person or their spouse gets SSI-related medical Yes, but only if that person gets long-term care
(((39))) (41) Has a disability that ends; Yes Yes
(((40))) (42) Has countable resources that are more than the resource limits, under WAC 388-470-0005 or 388-513-1350; Yes, but only if that person or their spouse get SSI-related medical Yes, but only if that person gets long-term care
(((41))) (43) Has a change in uncovered medical expenses. Yes, but only if an AU member has a spenddown. Yes.

[Statutory Authority: RCW 74.08.090 and 74.04.510. 01-11-109, 388-418-0005, filed 5/21/01, effective 7/1/01; 99-23-034, 388-418-0005, filed 11/10/99, effective 1/1/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-418-0005, filed 7/31/98, effective 9/1/98.]


AMENDATORY SECTION(Amending WSR 01-11-109, filed 5/21/01, effective 7/1/01)

WAC 388-418-0007   When do I have to report changes in my circumstances?   (1) If you are applying for cash and/or Basic Food ((assistance)) and have had a change:

(a) After the date you applied but before your interview, you must report the change at the time of your interview; or

(b) After you have been interviewed, you must report the change within ten days of the date of your approval notice.

(2) If you get TANF/SFA, you must report within five calendar days from the day you learn that a child in the AU will be gone from your home longer than ninety days. If you do not report this within five days:

(a) You are not eligible for cash benefits for one month; and

(b) All of your countable income as described in WAC 388-450-0162 is budgeted against the cash benefits for the remaining AU members.

(3) If you receive cash ((and/))or Basic Food ((assistance, all other)), you must report changes described in WAC ((388-417-0005 must be reported)) 388-418-0005 within ten days from the day you become aware of the change.

(4) If you receive medical assistance you must report the changes described in WAC 388-418-0005 within twenty days from the day you become aware of the change.

(5) If you report changes late, you may get the wrong amount or wrong type of benefits. If you get more benefits than you are eligible for, you may have to pay them back as described in chapter 388-410 WAC.

[Statutory Authority: RCW 74.08.090 and 74.04.510. 01-11-109, 388-418-0007, filed 5/21/01, effective 7/1/01.]


AMENDATORY SECTION(Amending WSR 02-14-086, filed 6/28/02, effective 7/1/02)

WAC 388-418-0020   How does the department determine the date a change affects my benefits?   (1) Unless otherwise specified, the rules in this chapter refer to cash, ((food and)) medical assistance, and Basic Food benefits.

(2) If you report a change that happened between the date you applied for benefits and the date we interview you under WAC 388-452-0005, we take this change into consideration when we process your application for benefits.

(3) If you report a change in your income that we expect to continue at least a month beyond the month when you reported the change, we recalculate the income we estimated under WAC 388-450-0215 based on this change.

(4) When a change causes an increase in benefits, ((the client)) you must provide proof of the change before we adjust ((the benefit amount)) your benefits.

(a) If you give us the proof within ten days from the date we requested it, we increase your benefits starting the month after the month you reported the change.

(b) If you give us the proof more than ten days after the date we requested it, we increase your benefits starting the month after the month we got the proof.

(c) If you are ((entitled to get)) eligible for more benefits and we have already sent you benefits for that month, we ((must send them to you)) provide you the additional benefits within ten days of the day we got the proof.

(((3))) (5) When a change causes a decrease in benefits, we change your benefit amount before we ask for proof:

(a) If you report the change within the time limits in WAC 388-418-0007, we decrease your benefits starting the first month following the advance notice period. The advance notice period:

(i) Begins on the day we send you a letter about the change, and

(ii) Is determined according to the rules in WAC ((388-458-0010)) 388-458-0025.

(b) If you do not report the change within the time limits in WAC 388-418-0007:

(i) We figure out the effective date as if you had reported it on time. This includes:

(A) Ten days for you to report the change, and

(B) Ten days for the advance notice period to begin, if required under ((chapter 388-458)) WAC 388-458-0030.

(ii) If the effective date should have been a past month:

(A) We establish an overpayment claim according to the rules in chapter 388-410 WAC for all the appropriate months; and

(B) Decrease your benefits starting the following month.

(iii) We establish an overpayment claim and decrease your benefits starting the month after next when:

(A) The effective date should have been next month; and

(B) It is less than ten days away; and

(C) We ((were supposed to)) must give you ten days notice under WAC 388-458-0030.

(iv) If the effective date should have been next month or the following month and we have time to give you ten-days notice, we decrease your benefits starting that month.

(c) We have until your next recertification/eligibility review to ask for proof.

(((4))) (6) If we are not sure how the change will affect your benefits, we send you a letter as described in WAC 388-458-0020 requesting information from you.

(a) We give you ten days to provide the information. If you need more time, you can ask for it.

(b) If you do not give us the information in time, we will stop your benefits after giving you advance notice, if required, as described in WAC 388-458-0030.

(((5))) (7) Within ten days of the day we learn about a change, we:

(a) Send advance notice according to the rules in chapter 388-458 WAC; and

(b) Take necessary action to correct the benefit. We wait to take action on a change if you request a hearing about a proposed decrease in benefits before the effective date or within the advance notice period as described in WAC 388-458-0040.

(((6))) (8) If you disagree with a decision we made to change your benefits, you may request a fair hearing under chapter 388-02 WAC. The fair hearing rules in chapter 388-02 WAC do not apply for a "mass change." A mass change is when we change the rules that impact all recipients and applicants.

(9) When you request a hearing and get continued benefits:

(a) We keep giving you the same benefits you got before the advance notice of reduction until the earliest of the following events occur:

(i) For Basic Food ((assistance)) only, your certification period expires;

(ii) The end of the month the fair hearing decision is mailed;

(iii) You state in writing that you do not want continued benefits;

(iv) You withdraw your fair hearing request in writing; or

(v) You abandon your fair hearing request; or

(vi) An administrative law judge issues a written order that ends continued benefits prior to the fair hearing.

(b) We establish an overpayment claim according to the rules in chapter 388-410 WAC when the hearing decision agrees with the action we took.

(((7))) (10) Some changes have a specific effective date as follows:

(a) When cash assistance benefits increase because a person is added to your assistance unit, we use the effective date rules for applications in WAC 388-406-0055.

(b) When cash assistance benefits increase because you start paying shelter costs, we use the date the change occurred.

(c) When a change in law or regulation changes the benefit amount, we use the date specified by the law or regulation.

(d) When institutional medical assistance participation changes, we calculate the new participation amount beginning with the month your income or allowable expense changes.

[Statutory Authority: RCW 74.08.090, 74.04.057, and 74.04.510. 02-14-086, 388-418-0020, filed 6/28/02, effective 7/1/02. Statutory Authority: RCW 74.08.090 and 74.04.510. 99-23-034, 388-418-0020, filed 11/10/99, effective 1/1/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-418-0020, filed 7/31/98, effective 9/1/98.]

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