WSR 05-14-122

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed July 1, 2005, 4:26 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 05-07-095.

Title of Rule and Other Identifying Information: WAC 388-478-0075 Medical programs -- Monthly income standards based on the federal poverty level (FPL) and 388-478-0085 Medicare savings programs -- Monthly income and countable resources standards.

Hearing Location(s): Blake Office Park East (behind Goodyear Courtesy Tire), Rose Room, 4500 10th Avenue S.E., Lacey, WA, on August 9, 2005, at 10:00 a.m.

Date of Intended Adoption: Not sooner than August 10, 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., August 9, 2005.

Assistance for Persons with Disabilities: Contact Stephanie Schiller, DSHS Rules Consultant, by August 5, 2005, TTY (360) 664-6178 or (360) 664-6097 or by e-mail at schilse@dshs.wa.gov.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The department is amending these rules to update the federal poverty level standards used for the medical program standards and the Medicare savings programs. Each year the federal government updates these standards for April and these standards are effective April 1, 2005.

Reasons Supporting Proposal: Amending these rules will enable the department to continue receiving federal funding for Washington state's Medicaid programs.

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

Statute Being Implemented: RCW 74.09.500 and 42 U.S.C. 9902(2).

Rule is necessary because of federal law, 42 U.S.C. 9902(2).

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

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Wendy Forslin, 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 revision is exempt from the provisions of RCW 34.05.328 per RCW 34.05.328 (5)(b)(vii) regarding rules related to DSHS financial or medical eligibility.

June 29, 2005

Andy Fernando, Manager

Rules and Policies Assistance Unit

3529.1
AMENDATORY SECTION(Amending WSR 04-15-092, filed 7/16/04, effective 8/16/04)

WAC 388-478-0075   Medical programs--Monthly income standards based on the federal poverty level (FPL).   (1) The department bases the income standard upon the Federal Poverty Level (FPL) for the following medical programs:

(a) Pregnant women's program up to one hundred eighty-five percent of FPL;

(b) Children's categorically needy program up to two hundred percent of FPL;

(c) Healthcare for workers with disabilities (HWD) up to two hundred twenty percent of FPL; and

(d) The state children's health insurance program (SCHIP) is over two hundred percent of FPL but not over two hundred fifty percent of FPL.

(2) The department uses the FPL income standards to determine:

(a) The mandatory or optional Medicaid status of an individual; and

(b) Premium amount, if any, for a Medicaid child.

(3) There are no resource limits for the programs under this section.

(4) Beginning April 1, ((2004)) 2005, the monthly FPL standards are:


FAMILY SIZE 100% FPL Benchmark 133% FPL 150% FPL 185% FPL 200% FPL 220% FPL 250% FPL
1 $ ((776))

798

$((1032))

1061

$((1164))

1197

$((1436))

1476

$((1552))

1595

$((1707))

1755

$((1940))

1994

2 $((1041))

1070

$((1385))

1422

$((1562))

1604

$((1926))

1978

$((2082))

2139

$((2290))

2353

$((2603))

2673

3 $((1306))

1341

$((1737))

1784

$((1953))

2012

$((2416))

2481

$((2612))

2682

$((2873))

2950

$((3265))

3353

4 $((1571))

1613

$((2090))

2145

$((2357))

2419

$((2907))

2984

$((3142))

3225

$((3456))

3548

$((3928))

4032

5 $((1836))

1885

$((2442))

2506

$((2754))

2827

$((3397))

3486

$((3672))

3769

$((4039))

4146

$((4590))

4711

6 $((2101))

2156

$((2795))

2868

$((3152))

3234

$((3887))

3989

$((4202))

4312

$((4622))

4743

$((5253))

5390

7 $((2366))

2428

$((3147))

3229

$((3549))

3642

$((4377))

4491

$((4732))

4855

$((5205))

5341

$((5915))

6069

8 $((2631))

2700

$((3499))

3590

$((3947))

4049

$((4868))

4994

$((5262))

5399

$((5788))

5939

$((6578))

6748

9 $((2896))

2971

$((3852))

3952

$((4344))

4457

$((5358))

5497

$((5792))

5942

$((6371))

6536

$((7240))

7428

10 $((3161))

3243

$((4204))

4313

$((4742))

4864

$((5848))

5999

$((6322))

6485

$((6954))

7134

$((7903))

8107

Add to the ten person standard for each person over ten:
$ ((265))

272

$((353))

362

$((398))

408

$((491))

503

$((530))

544

$((583))

598

$((663))

680

[Statutory Authority: RCW 74.08.090, 74.04.057, 74.04.050, and 74.09.530. 04-15-092, 388-478-0075, filed 7/16/04, effective 8/16/04. Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.057, 74.09.530, and 42 U.S.C. 9902(2). 03-15-088, 388-478-0075, filed 7/17/03, effective 7/17/03. Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, 388-478-0075, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.500, 74.09.510, and Section 1902 (a)(10)(A)(ii)(XV) and (XVI) of the Social Security Act. 02-07-090, 388-478-0075, filed 3/19/02, effective 4/1/02. Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.057, 74.09.530, and Section 673(2) (42 U.S.C. 9902(2)). 01-18-056, 388-478-0075, filed 8/30/01, effective 9/30/01; 00-17-085, 388-478-0075, filed 8/14/00, effective 9/14/00; 99-19-005, 388-478-0075, filed 9/3/99, effective 10/4/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-478-0075, filed 7/31/98, effective 9/1/98. Formerly WAC 388-507-0805, 388-508-0810, 388-509-0910, 388-509-0920, 388-509-0940 and 388-509-0960.]


AMENDATORY SECTION(Amending WSR 04-17-076, filed 8/13/04, effective 9/13/04)

WAC 388-478-0085   Medicare savings programs--Monthly income and countable resources standards.   (1) The qualified Medicare beneficiary (QMB) program income standard is up to one hundred percent of the Federal Poverty Level (FPL). Beginning April 1, ((2004)) 2005, the QMB program's income standards are:


(a) One person $((776))

798

(b) Two persons $((1041))

1070


(2) The special low-income Medicare beneficiary (SLMB) program income standard is over one hundred percent of FPL, but not more than one hundred twenty percent of FPL. Beginning April 1, ((2004)) 2005, the SLMB program's income standards are:


Minimum Maximum
(a) One person $((776.01))

798.01

$((931))

957

(b) Two persons $((1041.01))

1070.01

$((1249))

1283


(3) The qualified individual (QI-1) program income standard is over one hundred twenty percent of FPL, but not more than one hundred thirty-five percent of FPL. Beginning April 1, ((2004)) 2005, the QI-1 program's income standards are:

Minimum Maximum
(a) One person $((931.01))

957.01

$((1048))

1077

(b) Two persons $((1249.01))

1283.01

$((1406))

1444


(4) The qualified disabled working individual (QDWI) program income standard is two hundred percent of FPL. Beginning April 1, ((2004)) 2005, the QDWI program's income standards are:


(a) One person $((1552))

1595

(b) Two persons $((2082))

2139

(5) The resource standard for the Medicare savings programs in this section is:


(a) One person $4000
(b) Two persons $6000

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, 42 U.S.C. 9902(2). 04-17-076, 388-478-0085, filed 8/13/04, effective 9/13/04. Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.057, 74.09.530, and Section 673(2) (42 U.S.C. 9902(2)). 01-18-056, 388-478-0085, filed 8/30/01, effective 9/30/01; 00-17-085, 388-478-0085, filed 8/14/00, effective 9/14/00; 99-19-005, 388-478-0085, filed 9/3/99, effective 10/4/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-478-0085, filed 7/31/98, effective 9/1/98. Formerly WAC 388-517-1715, 388-517-1730, 388-517-1750 and 388-517-1770.]

Washington State Code Reviser's Office