Purpose: To reinstate twelve-month continuous eligibility for children's medical. The governor has directed the Department of Social and Health Services to reinstate twelve-month continuous eligibility for the children's medical programs. When effective, this rule supersedes and replaces emergency rules filed as WSR 05-19-032.

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

     Statutory Authority for Adoption: RCW 74.08.090, 74.09.530, and 74.09.415.

      Adopted under notice filed as WSR 05-16-126 on August 3, 2005.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

     Date Adopted: September 8, 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. Eligibility is continuous without regard to changes in circumstances other than aging out of the program, moving out of state or death. 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 SCHIP 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 SCHIP 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.]

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