PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Date of Adoption: November 25, 2003.
Purpose: This rule revision is necessary to ensure the state's compliance with federal Medicaid limitations on categorically needy (CN) and medically needy (MN) medical services covered under emergency services for alien residents. It also provides for three-month certification periods and imposes limitations on persons entering the state solely to receive medical care.
Citation of Existing Rules Affected by this Order: Amending WAC 388-438-0110.
Statutory Authority for Adoption: RCW 74.08.090, 74.04.050, 74.04.057, and 74.09.530.
Other Authority: Section 1903 (v)(2)(c) of the Social Security Act.
Adopted under notice filed as WSR 03-20-074 on September 29, 2003.
Changes Other than Editing from Proposed to Adopted Version: Subsection (8) has been changed. The proposed rule text read: "(8) A person whose income exceeds the CN income standard has spend down liability and MN scope of care."
The subsection has been changed to read: "(8) When a person's income exceeds the CN income standard as described in subsection (3) of this section, the person has spend down liability and MN scope of care. MN scope of care is described in WAC 388-529-0100. The medical service limitations and exclusions described in subsection (7) are also excluded under the MN program."
The changes were made because the additional language better meets the department's intent in describing MN emergency services for alien residents.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.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Repealed 0;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Repealed 0;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Repealed 0.
Effective Date of Rule:
Thirty-one days after filing.
November 25, 2003
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit
3250.3(2) Except for the social security number, citizenship, or alien status requirements, an alien must meet categorical Medicaid eligibility requirements as described in:
(a) WAC 388-505-0110, for an SSI-related person;
(b) WAC 388-505-0220, for family medical programs;
(c) WAC 388-505-0210, for a child under the age of nineteen; or
(d) WAC 388-523-0100, for medical extensions.
(3) When an alien has monthly income ((which)) that
exceeds the CN medical standards, the department will consider
AEM medically needy coverage for children or for adults who
are age sixty-five or over or who meet SSI disability
criteria. See WAC 388-519-0100.
(4) To qualify for the AEM program, the alien must meet one of the criteria described in subsection (2) of this section and have:
(a) ((An)) A qualifying emergency medical condition as
described in WAC 388-500-0005; or
(b) Been approved by the department ((as requiring)) for,
and receiving, nursing facility or COPES level of care.
(5) The alien's date of arrival in the United States is not used when determining eligibility for the AEM program.
(6) The department does not deem a sponsor's income and resources as available to the client when determining eligibility for the AEM program. The department counts only the income and resources a sponsor makes available to the client.
(7) Under the AEM program, a person receives CN scope of care, as described in WAC 388-529-0100. Covered services are limited to those medical services necessary for treatment of the person's emergency medical condition. The following services are not covered:
(a) Organ transplants and related services;
(b) Prenatal care, except labor and delivery; and
(c) School-based services.
(8) When a person's income exceeds the CN income standard as described in subsection (3) of this section, the person has spend down liability and MN scope of care. MN scope of care is described in WAC 388-529-0100. The medical service limitations and exclusions described in subsection (7) are also excluded under the MN program.
(9) A person determined eligible for the AEM program is certified for three months. The number of three-month certification periods is not limited, but, the person must continue to meet eligibility criteria in subsection (2) and (4) of this section.
(10) A person is not eligible for the AEM program if they entered the state specifically to obtain medical care.
[Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-438-0110, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.08.090 and C.F.R. 436.128, 436.406(c) and 440.255. 01-05-041, § 388-438-0110, filed 2/14/01, effective 3/17/01. Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.057, 74.09.530, 42 C.F.R. 435.139 and 42 C.F.R. 440.255. 99-23-082, § 388-438-0110, filed 11/16/99, effective 12/17/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-438-0110, filed 7/31/98, effective 9/1/98.]