WSR 06-09-087

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed April 18, 2006, 4:23 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 06-06-074.

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 standards.

Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane behind Goodyear Tire. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6097), on May 23, 2006, at 10:00 a.m.

Date of Intended Adoption: Not earlier than May 24, 2006.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., May 23, 2006.

Assistance for Persons with Disabilities: Contact Stephanie Schiller, DSHS Rules Consultant, by May 19, 2006, 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 WACs to explain what each standard is based on and to remove the actual numbers since these standards are based on the federal poverty level.

Reasons Supporting Proposal: These amendments reduce the administrative burden of updating these rules several times a year when the federal standards increase.

Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 42 U.S.C. 9902(2).

Statute Being Implemented: RCW 74.04.050, 74.04.057, 74.08.090, 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: Mary Beth Ingram, P.O. Box 45534, Olympia, WA 98504-5534, (360) 725-1327.

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 cost-benefit analysis requirement per RCW 34.05.328 (5)(b)(vii) regarding rules related to DSHS financial or medical eligibility.

April 17, 2006

Andy Fernando, Manager

Rules and Policies Assistance Unit

3642.4
AMENDATORY SECTION(Amending WSR 06-03-080, filed 1/12/06, effective 2/12/06)

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) published by the federal government yearly for the following medical programs:

(a) Children's health program is one hundred percent of FPL;

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

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

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

(e) 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, 2005, the monthly FPL standards are:))


((
FAMILY SIZE 100% FPL 133% FPL 150% FPL 185% FPL 200% FPL 220% FPL 250% FPL
1 $798 $1061 $1197 $1476 $1595 $1755 $1994
2 $1070 $1422 $1604 $1978 $2139 $2353 $2673
3 $1341 $1784 $2012 $2481 $2682 $2950 $3353
4 $1613 $2145 $2419 $2984 $3225 $3548 $4032
5 $1885 $2506 $2827 $3486 $3769 $4146 $4711
6 $2156 $2868 $3234 $3989 $4312 $4743 $5390
7 $2428 $3229 $3642 $4491 $4855 $5341 $6069
8 $2700 $3590 $4049 $4994 $5399 $5939 $6748
9 $2971 $3952 $4457 $5497 $5942 $6536 $7428
10 $3243 $4313 $4864 $5999 $6485 $7134 $8107
Add to the ten person standard for each person over ten:
$272 $362 $408 $503 $544 $598 $680
))

[Statutory Authority: RCW 74.08.090, 74.09.415, 74.09.530 and 2005 c 279. 06-03-080, 388-478-0075, filed 1/12/06, effective 2/12/06. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 42 U.S.C. 9902(2). 05-17-157, 388-478-0075, filed 8/22/05, effective 9/22/05. 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 05-17-157, filed 8/22/05, effective 9/22/05)

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, 2005, the QMB program's income standards are:))


((
(a) One person $798
(b) Two persons $1070
))
(2) The ((special)) specified 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, 2005, the SLMB program's income standards are:))


((
Minimum Maximum
(a) One person $798.01 $957
(b) Two persons $1070.01 $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, 2005, the QI-1 program's income standards are:))

((
Minimum Maximum
(a) One person $957.01 $1077
(b) Two persons $1283.01 $1444
))
(4) The qualified disabled working individual (QDWI) program income standard is two hundred percent of FPL. ((Beginning April 1, 2005, the QDWI program's income standards are:))


((
(a) One person $1595
(b) Two persons $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, and 42 U.S.C. 9902(2). 05-17-157, 388-478-0085, filed 8/22/05, effective 9/22/05. 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