WSR 04-03-019

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed January 12, 2004, 3:59 p.m. ]


Date Adopted: January 8, 2004.

Purpose: The purpose of the rule amendment is to initiate six-month reviews for family and children's medical programs and to eliminate continuous eligibility for children which was mandated by the legislature in the 2003 state supplemental budget.

Citation of Existing Rules Affected by this Order: Amending WAC 388-416-0015, 388-434-0005, and 388-418-0025.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.530, and State Supplemental Budget for FY 2003 (chapter 10, Laws of 2003).

Adopted under notice filed as WSR 03-19-068 on September 12, 2003.

Changes Other than Editing from Proposed to Adopted Version: Proposed WAC 388-418-0005 was withdrawn and has been reproposed as WSR 04-02-072.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 3, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 3, Repealed 0.

Effective Date of Rule: Thirty-one days after filing.

January 8, 2004

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3251.1
AMENDATORY SECTION(Amending WSR 00-08-002, filed 3/22/00, effective 5/1/00)

WAC 388-416-0015   Certification periods for categorically needy (CN) medical and children's health insurance program (CHIP).   (1) A certification period is the period of time a person is determined eligible for a categorically needy (CN) medical program. Unless otherwise stated in this section, the certification period begins on the first day of the month of application and continues to the last day of the last month of the certification period.

(2) For a child eligible for the newborn medical program, the certification period begins on the child's date of birth and continues through the end of the month of the child's first birthday.

(3) For a woman eligible for a medical program based on pregnancy, the certification period ends the last day of the month that includes the sixtieth day from the day the pregnancy ends.

(4) For families((,)) and children((, and SSI-related persons,)) the certification period is ((twelve)) six months. When the medical assistance unit is also receiving benefits under a cash or food assistance program, the medical certification period is updated to begin anew at each:

(a) Approved application for cash or food assistance; or

(b) Completed eligibility review.

(5) For an SSI-related person the certification period is twelve months.

(6) When the child turns nineteen the certification period ends even if the ((twelve)) six-month period is not over. The certification period may be extended past the end of the month the child turns nineteen when:

(a) The child is receiving inpatient services on the last day of the month the child turns nineteen;

(b) The inpatient stay continues into the following month or months; and

(c) The child remains eligible except for exceeding age nineteen.

(((6))) (7) A retroactive certification period can begin up to three months immediately before the month of application when:

(a) The client would have been eligible for medical assistance if the client had applied; and

(b) The client received covered medical services as described in WAC 388-529-0100.

(((7))) (8) If the client is eligible only during the three-month retroactive period, that period is the only period of certification.

(((8))) (9) Any months of a retroactive certification period are added to the designated certification periods described in this section.

(((9))) (10) For a child determined eligible for CHIP medical benefits as described in chapter 388-542 WAC:

(a) The certification periods are described in subsections (1), (4), and (((5))) (6) of this section;

(b) There is not a retroactive eligibility period as described in subsections (((6), (7), and (8))) (7), (8), and (9); and

(c) For a child who has creditable coverage at the time of application, the certification period begins on the first of the month after the child's creditable coverage is no longer in effect, if:

(i) All other CHIP eligibility factors are met; and

(ii) An eligibility decision is made per WAC 388-406-0035.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090 and 74.09.450. 00-08-002, 388-416-0015, filed 3/22/00, effective 5/1/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-416-0015, filed 7/31/98, effective 9/1/98. Formerly 388-509-0970, 388-521-2105, 388-522-2210 and 388-522-2230.]

3253.3
AMENDATORY SECTION(Amending WSR 99-23-083, filed 11/16/99, effective 1/1/00)

WAC 388-434-0005   The department reviews each client's eligibility for benefits on a regular basis.   (1) If you receive cash assistance, the department reviews your eligibility for assistance at least once every six months.

(2) When it is time for your eligibility review, the department requires you to complete a review form. We use the information you provide to determine your eligibility for all assistance programs.

(3) If you complete an interview for assistance with a department representative and sign the printed application for benefits (AFB) form, you do not have to complete a separate review form.

(4) For cash assistance, the eligibility review form or the AFB must be dated and signed by both husband and wife, or both parents of a child in common when the parents live together.

(5) If you receive medical assistance only, the eligibility review form or the AFB must be signed by at least one parent when the parents live together.

(6) We may move the date of your eligibility review if we decide your circumstances need to be reviewed sooner.

(7) At your review, we look at:

(a) All eligibility requirements under WAC 388-400-0005 through 388-400-0035, 388-503-0505 through 388-503-0515, and 388-505-0210 through 388-505-0220;

(b) Changes that happened since we last determined your eligibility; and

(c) Changes that are anticipated to happen during the next review period.

(8) If you receive medical assistance only, we set your eligibility review date in advance under WAC 388-416-0005 through 388-416-0035. We will start the review process before your benefits end.

(9) Clients are responsible for attending an interview if one is required under WAC 388-452-0005.

(10) If you do not complete the eligibility review for cash assistance, you are considered to be withdrawing your request for continuing assistance((.)), therefore:

(a) Your cash assistance benefits will end((.)); and

(b) Your medical assistance will continue for ((twelve)) six consecutive months from the last:

(i) Application;

(ii) Eligibility review; or

(iii) Food assistance application or recertification.

(11) We must send you written notice under WAC 388-458-0005, 388-458-0010, and 388-450-0015 before assistance can be suspended, terminated, or a benefit error is established as a result of your eligibility review.

(12) If you are currently receiving cash or medical assistance, and you are found to no longer be eligible for benefits, we will determine if you are eligible for other medical programs. Until we decide if you are eligible for ((other programs)) another program, your medical assistance will continue under WAC 388-418-0025 ((even if you request that your benefits end)).

(13) When a client is determined to need necessary supplemental accommodation (NSA) under WAC ((388-200-1300)) 388-472-0010, we will help the client meet the requirements of this section.

[Statutory Authority: RCW 74.08.090 and 74.04.510. 99-23-083, 388-434-0005, filed 11/16/99, effective 1/1/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-434-0005, filed 7/31/98, effective 9/1/98. Formerly WAC 388-522-2230.]

3259.4
AMENDATORY SECTION(Amending WSR 02-17-030, filed 8/12/02, effective 9/12/02)

WAC 388-418-0025   Effect of changes on medical program eligibility.   (1) ((A client continues)) You continue to be eligible for Medicaid until the department determines ((the client's)) your ineligibility or eligibility for another medical program. This applies to ((a client who)) you if, during a certification period, ((becomes)) you become ineligible for, ((is)) or are terminated from, or ((requests)) request termination from:

(a) A CN Medicaid program; or

(b) Any of the following cash grants:

(i) TANF;

(ii) SSI; or

(iii) GA-X. See WAC 388-434-0005 for changes reported during eligibility review.

(2) ((A child remains continuously eligible for CN Medicaid for a period of twelve months from the date of certification for medical benefits or last review, whichever is later. This applies unless the child:

(a) Moves out of state;

(b) Loses contact with the department or the department does not know the child's whereabouts;

(c) Becomes an inmate of a public institution, including a correctional facility (refer to WAC 388-505-0210(5) for exceptions);

(d) Turns nineteen years of age;

(e) Dies; or

(f) Receives benefits under the state children's health insurance program (SCHIP) and:

(i) Does not pay health insurance premiums for four consecutive months; or

(ii) Is determined to have had creditable coverage at the time of application. Refer to chapter 388-542 WAC.

(3) When a client becomes)) If you become ineligible for refugee cash assistance, refugee medical assistance can be continued ((only)) through the eight-month limit, as described in WAC 388-400-0035(4).

(((4) A client receiving medical benefits with))

(3) If you receive a TANF cash grant or family medical ((program is)), you are eligible for a medical extension, as described under WAC 388-523-0100, when ((the client's)) your cash grant or family medical program is terminated as a result of:

(a) Earned income; or

(b) Collection of child or spousal support.

(((5))) (4) A change in income during a certification period does ((not)) affect eligibility for all medical programs except:

(a) Pregnant women's medical programs; ((or))

(b) Children's medical for newborns (F05); or

(c) The first six months of the medical extension benefits.

(((6))) (5) For a child receiving benefits under SCHIP as described in chapter 388-542 WAC, the department must redetermine eligibility for a Medicaid program when the family reports:

(a) Family income has decreased to less than two hundred percent Federal Poverty Level (FPL);

(b) The child becomes pregnant;

(c) A change in family size; or

(d) The child receives SSI.

[Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, 388-418-0025, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090 and 74.09.450. 00-08-002, 388-418-0025, filed 3/22/00, effective 5/1/00. Statutory Authority: RCW 74.04.050, 74.04.057 and Section 4731 of the BBA (Public Law 105-33). 99-10-064, 388-418-0025, filed 5/3/99, effective 6/3/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-418-0025, filed 7/31/98, effective 9/1/98. Formerly WAC 388-508-0840, 388-509-0920, 388-509-0960, 388-522-2205 and 388-522-2210.]