WSR 05-17-157

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed August 22, 2005, 4:23 p.m. , effective September 22, 2005 ]


Purpose: The department is amending WAC 388-478-0075 and 388-478-0085 to update the federal poverty standards used for medical standards and the Medicare savings programs. Each year the federal government issues the updates effective for April 1, 2005.

Citation of Existing Rules Affected by this Order: Amending WAC 388-478-0075 and 388-478-0085.

Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.500.

Other Authority: 42 U.S.C. 9902(2).

Adopted under notice filed as WSR 05-14-122 on July 1, 2005.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 2, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.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: August 18, 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