WSR 04-19-134

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Economic Services Administration)

[ Filed September 21, 2004, 4:18 p.m. , effective October 1, 2004 ]


Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: SB 6411 (chapter 54, Laws of 2004) requires the department to implement simplified reporting in October 2004. These rule changes are necessary to support the department's simplified reporting initiative.

Purpose: The department is amending WAC 388-416-0005 How long can I get Basic Food?, 388-418-0007 When do I have to report changes in my circumstances?, 388-418-0020 How does the department determine the date a change affects my benefits?, and 388-434-0005 The department reviews each client's eligibility for benefits on a regular basis, which are related to the department's eligibility review process for cash and medical programs, certification periods for Basic Food, effective dates for changes to benefits, and change reporting requirements for Basic Food, cash, and medical programs; and adopting new WAC 388-418-0011 What is a six-month report, and do I have to complete one in order to keep getting benefits? The amended and new rules are necessary to implement the department's simplified reporting initiative for cash, medical, and the Washington Basic Food program. SB 6411 requires the department to implement simplified reporting in October 2004.

Citation of Existing Rules Affected by this Order: Amending WAC 388-416-0005, 388-418-0007, 388-418-0020, and 388-434-0005.

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

Other Authority: SB 6411 (chapter 54, Laws of 2004).

Adopted under notice filed as WSR 04-15-052 on July 13, 2004.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 4, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 4, Repealed 0.

Date Adopted: September 15, 2004.

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3434.1
AMENDATORY SECTION(Amending WSR 03-22-039, filed 10/28/03, effective 12/1/03)

WAC 388-416-0005   How long can I get Basic Food?   (1) The length of time the department determines your assistance unit (AU) is eligible to get Basic Food is called a certification period. The department (((we))) may certify your AU for up to:

(a) Six months if your AU:

(i) Includes an able-bodied adult without dependents (ABAWD) who receives Basic Food in your AU and your AU does not live in an exempt area as described in WAC 388-444-0030;

(ii) Includes a person who receives ADATSA benefits as described in chapter 388-800 WAC;

(iii) Is considered homeless under WAC 388-408-0050; or

(iv) Includes a migrant or seasonal farmworker as described under WAC 388-406-0021.

(b) Twenty-four months if everyone in your AU is elderly and no one in your AU has earned income or cash assistance.

(((b) Twelve months if everyone in your AU is disabled or elderly and no one in your AU has earned income.

(c) Six months if your AU has:

(i) Cash assistance; or

(ii) Earned income; or

(iii) Income, household circumstances, and deductions that are not likely to change.

(d) Three months for all other AUs, including when your AU has:

(i) A migrant or seasonal farmworker;

(ii) An able-bodied adult without dependents (ABAWD);

(iii) No income or cash assistance;

(iv) Expenses that are more than the income the AU gets;

(v) Homeless individuals or AU members staying in an emergency or family violence shelter;

(vi) A member who is staying in a non-ADATSA drug and alcohol treatment center

(2) We may shorten or lengthen your certification period to match your cash or medical assistance end date unless you have already received the maximum certification allowable for your AU))

(c) Twelve months if your AU does not meet any of the conditions for six or twenty-four months.

(2) If your AU is homeless or includes an ABAWD when you live in a nonexempt area, we may shorten your certification period.

(3) We terminate your ((certification period)) Basic Food benefits when:

(a) We get proof of a change that makes your AU ineligible; or

(b) We get information that your AU is ineligible; and

(c) You do not provide needed information to verify your AU's circumstances.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510. 03-22-039, 388-416-0005, filed 10/28/03, effective 12/1/03. Statutory Authority: RCW 74.08.090 and 74.04.510. 01-11-107, 388-416-0005, filed 5/21/01, effective 7/1/01; 99-16-024, 388-416-0005, filed 7/26/99, effective 9/1/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-416-0005, filed 7/31/98, effective 9/1/98.]

3431.2
AMENDATORY SECTION(Amending WSR 03-21-028, filed 10/7/03, effective 11/1/03)

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 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 or Basic Food, you must report changes described in WAC 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)) If your household has a change of circumstances you are not required to report under WAC 388-418-0005, you do not need to contact the department about this change. If you tell us about this change, we take action based on the new information. This includes:

(a) Requesting additional information we need to determine your eligibility and benefits under WAC 388-490-0005;

(b) Increasing your benefits when we have proof of a change that makes you eligible for more benefits; or

(c) Reducing or terminating your benefits based on the change.

(2) If you are applying for benefits 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 changes required under WAC 388-418-0005 by the tenth day of the month following the month the change happened.

(3) If you receive cash assistance, medical, or Basic Food, you must report changes required under WAC 388-418-0005 by the tenth day of the month following the month the change happened.

(4) For a change in income, the date a change happened is the date you receive income based on this change. For example, the date of your first paycheck for a new job, or the date of a paycheck showing a change in your wage or salary.

(5) If we require you to complete a six-month report, you must complete the report to inform us of your circumstances as described under WAC 388-418-0010 in order to keep getting benefits.

(6) If you get TANF/SFA, and you learn that a child in your assistance unit (AU) will be gone from your home longer than ninety days, you must report this information to us within five calendar days from the date you learn this information. If you do not report this within five days, the child's caretaker is not eligible for cash benefits for one month. We continue to budget the ineligible person's countable income as described in WAC 388-450-0162 while determining the benefits for the remaining people in the AU.

(7) 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 74.04.050, 74.04.055, 74.04.057, 74.04.510. 03-21-028, 388-418-0007, filed 10/7/03, effective 11/1/03. Statutory Authority: RCW 74.08.090 and 74.04.510. 01-11-109, 388-418-0007, filed 5/21/01, effective 7/1/01.]

3432.3
NEW SECTION
WAC 388-418-0011   What is a six-month report, and do I have to complete one in order to keep getting benefits?   (1) A six-month report is a form the department sends you to confirm your current circumstances. We use the information you provide us through this report to determine if you are still eligible for benefits and calculate your monthly benefits.

(2) If you receive benefits from any of the following programs, you must complete a six-month report:

(a) Cash Assistance unless you receive only Refugee Cash Assistance as described under WAC 388-400-0030;

(b) Family-related medical;

(c) Children's Medical; or

(d) Basic Food unless you meet one of the following conditions:

(i) Your assistance unit has a certification period of six months or less. If you have a certification period of six months or less, you must complete a recertification under WAC 388-434-0010 in order to keep getting Basic Food benefits; or

(ii) All adults in your assistance unit are elderly or disabled and have no earned income.

(3) If you must complete a six-month report, we send you the report with the most current information we have on your case. You can choose to complete the report in one of the following ways:

(a) Complete and return the form to the department. For us to consider your six-month report complete, you must take all of the steps below:

(i) Complete the report form, telling us about changes in your circumstances we ask about;

(ii) Sign and date the report;

(iii) Provide proof of any changes you report;

(iv) If you receive children's or family medical benefits, provide proof of your income even if it has not changed; and

(v) Mail or turn in the completed form and any required proof to us by the due date on the report. This is the tenth day of the sixth month of your review or certification period.

(b) Complete the six-month report over the phone. For us to consider your six-month report complete, you must take all of the steps below:

(i) Contact us at the phone number we provide on the report form, telling us about changes in your circumstances we ask about;

(ii) Provide proof of any changes you report. We may be able to verify some information over the phone;

(iii) If you receive children's or family medical benefits, provide proof of your income even if it has not changed; and

(iv) Mail or turn in any required proof to us by the due date on the report. This is the tenth day of the sixth month of your review or certification period.

(4) If your benefits change because of the information in your six-month report, we determine the date the change takes effect as described under WAC 388-418-0020.

[]

3435.1
AMENDATORY SECTION(Amending WSR 03-21-028, filed 10/7/03, effective 11/1/03)

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, 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, you must provide proof of the change before we adjust 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 eligible for more benefits and we have already sent you benefits for that month, we provide you the additional benefits within ten days of the day we got the proof.

(5) When a change causes a decrease in benefits, we ((change)) reduce your benefit amount ((before we ask)) without asking 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 388-458-0025.

(b) If you do not report ((the)) a 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 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 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)) you must tell us about under WAC 388-418-0005, or you report a change later than we require under WAC 388-418-0007, we determine your eligibility as if you had reported this on time. If you received more benefits than you should, we set up an overpayment as described under chapter 388-410 WAC.

(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.

(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, we wait to take action on the change.

(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 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.

(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 74.04.050, 74.04.055, 74.04.057, 74.04.510. 03-21-028, 388-418-0020, filed 10/7/03, effective 11/1/03. 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.]

3436.3
AMENDATORY SECTION(Amending WSR 04-03-019, filed 1/12/04, effective 2/12/04)

WAC 388-434-0005   How often does the department ((reviews each client's)) review my 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)) twelve 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)) an 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)) For medical assistance ((only, the eligibility review form or the AFB must be signed by at least one parent when the parents live together)), a signature is not required to complete your review.

(6) We may ((move the date of your eligibility)) review your eligibility at any time 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)) for 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)) certification period according to WAC 388-416-0010, 388-416-0015, 388-416-0020, and 388-416-0035.

(9) Clients You 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)) we consider you to be withdrawing your request for continuing assistance((, therefore)):

(a) Your cash assistance benefits will end; and

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

(i) Application;

(ii) Eligibility review; or

(iii) Food assistance application or recertification.

(11) We must)) month we received your most recent application or eligibility review.

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

(((12) If you are currently receiving cash or))

(12) If you currently receive Categorically Needy (CN) 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 another program, your (CN) medical assistance will continue under WAC 388-418-0025.

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

[Statutory Authority: RCW 74.08.090, 74.09.530, and 2003 c 10. 04-03-019, 388-434-0005, filed 1/12/04, effective 2/12/04. 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.]

Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.

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Washington State Code Reviser's Office