WSR 05-03-081

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed January 17, 2005, 1:01 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 04-14-097.

Title of Rule and Other Identifying Information: Amending WAC 388-462-0015 Medical eligibility for pregnant women.

Hearing Location(s): Blake Office Park East (behind Goodyear Courtesy Tire), Rose Room, 4500 10th Avenue S.E., Lacey, WA, on February 22, 2005, at 10:00 a.m.

Date of Intended Adoption: Not sooner than February 23, 2005.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., February 22, 2005.

Assistance for Persons with Disabilities: Contact Fred Swenson, DSHS Rules Consultant, by February 17, 2005, TTY (360) 664-6178 or (360) 664-6097.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The amendment removes the requirement for a licensed medical practitioner to verify that the client is pregnant. Also the other subsections were rewritten to clarify the rule.

Reasons Supporting Proposal: See above.

Statutory Authority for Adoption: RCW 74.08.090, 74.04.050, and 74.04.057.

Statute Being Implemented: RCW 74.09.415.

Rule is not necessitated by federal law, federal or state court decision.

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

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Wendy Forslin, MAA, P.O. Box 45534, Olympia, WA 98504-5534, (360) 725-1343.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This change does not affect small businesses.

A cost-benefit analysis is not required under RCW 34.05.328. This rule revision, regarding client medical eligibility, is exempt from the provisions of RCW 34.05.328 per RCW 34.05.328 (5)(b)(vii).

January 11, 2005

Andy Fernando, Manager

Rules and Policies Assistance Unit

3507.2
AMENDATORY SECTION(Amending WSR 02-17-030, filed 8/12/02, effective 9/12/02)

WAC 388-462-0015   Medical ((programs)) eligibility for pregnant women.   Eligibility requirements for pregnancy medical are described below.

(1) A pregnant woman is eligible for ((medical services described in this chapter only when her pregnancy is confirmed by a licensed medical practitioner, licensed laboratory, community clinic, family planning clinic, or health department clinic.

(2) A pregnant woman is eligible for CN Medicaid coverage if she meets the following requirements as described in WAC 388-503-0505)) categorically needy (CN) scope of care if she meets the following requirements:

(a) Citizenship or immigration status (chapter 388-424 WAC); and

(b) Social security account number (chapter 388-474 WAC); and

(c) Is a Washington state ((residence)) resident (chapter 388-468 WAC); and

(d) Has countable income ((meets the standard)) as described in WAC 388-478-0075.

(((3))) (2) A pregnant woman is considered for medically needy (MN) ((program coverage)) scope of care if she meets the requirements in subsection (((2))) (1)(a) through (c) of this section and:

(a) ((Her)) Has countable income ((is greater than)) that exceeds the standard in subsection (((2))) (1)(d) of this section; and

(b) ((Her)) Has countable resources that do not exceed the standard in WAC 388-478-0070.

(((4))) (3) A pregnant woman ((is)) may be eligible for ((CN scope of care under the state-funded pregnant woman program)) non-citizen pregnancy medical if she is not eligible for ((programs)) medical described in subsections (1) and (2) of this section due to citizenship, immigrant status, or social security number requirements.

(((5))) (4) A pregnant woman ((is considered for MN scope of care under the state-funded pregnant woman program if)) meeting the eligibility criteria in subsection (3) is eligible for:

(a) ((She is not eligible for the program under subsection (4) of this section because her income exceeds the standard)) CN scope of care when the countable income is at or below the income standard described in subsection (1)(d); ((and)) or

(b) ((Her resources do not exceed the standard in WAC 388-478-0070.)) MN scope of care when:

(i) The countable income exceeds the standard in subsection (1)(d); and

(ii) The resources do not exceed the standard described in WAC 388-478-0070.

(((6) A pregnant woman is considered for the medically indigent (MI) program if her resources exceed the standards in WAC 388-478-0070.

(7) Only the)) (5) Consider as income ((of an unmarried father of an unborn child)) to the pregnant woman the amount that is actually contributed to ((a pregnant woman is considered as income to her.

(8) There are no resource limits for the programs described in subsections (2) and (4) of this section.

(9))) her by the father of her unborn child when the pregnant woman is not married to the father.

(6) The assignment of child support and medical support rights as described in chapter 388-422 WAC do not apply to pregnant women.

(((10) Unless stated otherwise, this section contains the only eligibility requirements for pregnant women to qualify for medical coverage.

(11))) (7) A woman who was eligible for and received medical coverage on the last day of pregnancy is eligible for extended medical benefits for postpartum care ((through the end of the month:

(a) Which includes the sixtieth day from the end of the pregnancy, for a pregnant woman receiving medical in any program except medically indigent (MI); or

(b) The pregnancy ends, for a pregnant woman receiving MI benefits)) for a minimum of sixty days from the end of her pregnancy. This extension continues through the end of the month in which the sixteenth day falls.

(((12))) (8) A woman who was eligible for ((a)) medical ((program)) coverage on the last day of pregnancy is eligible for family planning services for twelve months from the end of the pregnancy even when eligibility for pregnancy was determined after the pregnancy ended.

[Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, 388-462-0015, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-462-0015, filed 7/31/98, effective 9/1/98. Formerly WAC 388-508-0820, 388-508-0830, 388-522-2230 and 388-508-0835.]

Washington State Code Reviser's Office