Purpose: To eliminate six-month report for children's and state children's health insurance program (SCHIP) medical programs. The governor has directed DSHS to eliminate the six-month report requirement for children's and SCHIP medical programs.

     When effective on June 1, 2005, permanent WAC 388-418-0011 filed as WSR 05-09-020 will replace only emergency WAC 388-418-0011 in this filing.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-416-0015 and 388-418-0011.

     Statutory Authority for Adoption: RCW 74.08.090 and 74.09.530.

     Other Authority: H.B. 1441 (2005 session).

     Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest.

     Reasons for this Finding: Since July 2003, approximately 40,000 Washington state children have lost their Medicaid coverage. The governor has directed the Department of Social and Health Services to reduce the eligibility barriers imposed by the 2003 supplemental bill and immediately reinstate the twelve-month certification period for children's and SCHIP medical programs. HB 1441 currently includes language to reinstate twelve-month certifications for children's medical.

     Observing the time requirements of regular rule-making procedures would prevent the department from implementing the governor's directive timely and thereby continue to prevent potentially eligible children from receiving Medicaid. Therefore, immediate adoption of the proposed amendments is necessary to implement the governor's directive in a timely manner.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 2, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.

     Date Adopted: April 25, 2005.

Andy Fernando, Manager

Rules and Policies Assistance Unit

     (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)) the certification period is twelve months with a six-month report required as a condition of eligibility as described in WAC 388-418-0011.

     (5) For children, the certification period is twelve 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))) (6) For an SSI-related person the certification period is twelve months.

     (((6))) (7) When the child turns nineteen the certification period ends even if the twelve-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.

     (((7))) (8) 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.

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

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

     (((10))) (11) 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))) (5), and (((6))) (7) of this section;

     (b) There is not a retroactive eligibility period as described in subsections (((7), (8), and (9))) (8), (9), and (10); 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, 74.04.510, and 2004 c 54. 04-21-064, § 388-416-0015, filed 10/18/04, effective 11/18/04. Statutory Authority: RCW 74.08.090, 74.09.530, and 2003 c 10. 04-03-019, § 388-416-0015, filed 1/12/04, effective 2/12/04. 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.]

     (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; or

     (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.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, and 2004 c 54. 04-19-134, § 388-418-0011, filed 9/21/04, effective 10/1/04.]

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