PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Effective Date of Rule: Thirty-one days after filing.
Purpose: To make state rules consistent with federal regulations by requiring medicaid recipients eligible for medicare benefits to apply for and enroll in Medicare Part A, Part B and Part D when the state can pay medicare cost sharing as described in chapter 388-517 WAC.
Citation of Existing Rules Affected by this Order: Amending WAC 388-503-0505.
Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.530; 42 U.S.C., Section 1396a.
Adopted under notice filed as WSR 07-17-084 on August 15, 2007.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 1, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: October 1, 2007.
Stephanie E. Schiller
Rules Coordinator
3904.1(2) Persons applying for medical coverage are considered first for federally funded or federally matched programs. State-funded programs are considered after federally funded programs are not available to the client except for brief periods when the state-funded programs offer a broad scope of care which meet a specific client need.
(3) Unless otherwise specified in program specific WAC, the eligibility criteria for each medical program is as follows:
(a) Verification of age and identity (chapters 388-404, 388-406, and 388-490 WAC); and
(b) Residence in Washington state (chapter 388-468 WAC); and
(c) Citizenship or immigration status in the United States (chapter 388-424 WAC); and
(d) Possession of a valid Social Security Account Number (chapter 388-476 WAC); and
(e) Assignment of medical support rights to the state of Washington (WAC 388-505-0540); and
(f) Cooperation in securing medical support (chapter 388-422 WAC); and
(g) Application for Medicare and enrollment into Medicare's prescription drug program if:
(i) It is likely that the individual is entitled to Medicare; and
(ii) The state has authority to pay Medicare cost sharing as described in chapter 388-517 WAC.
(h) Countable resources within program limits (chapters 388-470 and 388-478 WAC); and
(((h))) (i) Countable income within program limits
(chapters 388-450 and 388-478 WAC).
(4) In addition to the general eligibility requirements in subsection (3) of this section, each program has specific eligibility requirements as described in applicable WAC.
(5) Persons living in a public institution, including a correctional facility, are not eligible for the department's medical coverage programs. For a person under age twenty or over age sixty-five who is a patient in an institution for mental disease see WAC 388-513-1315(13) for exception.
(6) Persons terminated from SSI or TANF cash grants and those who lose eligibility for categorically needy (CN) medical coverage have their CN coverage continued while their eligibility for other medical programs is redetermined. This continuation of medical coverage is described in chapter 388-434 WAC.
[Statutory Authority: RCW 74.08.090, 74.09.530, and 2003 1st sp.s. c 25. 04-07-141, § 388-503-0505, filed 3/22/04, effective 4/22/04. Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-503-0505, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-503-0505, filed 7/31/98, effective 9/1/98. Formerly WAC 388-501-0110, 388-503-0305 and 388-505-0501.]