HEALTH CARE AUTHORITY

[Filed October 9, 2020, 3:14 p.m., effective November 9, 2020]

Effective Date of Rule: Thirty-one days after filing.

Purpose: Health care authority (HCA) is establishing rules to comply with ESHB 1109, section 211(47), which provides funding for services identical to those services covered by the Washington state family planning waiver program to individuals who: (1) Are age twenty and older; (2) who are at or below two hundred sixty percent of the federal poverty level; (3) who are not covered by public or private insurance; and (4) who need family planning services and are not currently covered by or eligible for another medical assistance program for family planning.

Citation of Rules Affected by this Order: Amending WAC 180-532-510.

Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.

Other Authority: ESHB 1109, section 211(47), chapter 415, Laws of 2019, operating budget.

Adopted under notice filed as WSR 20-10-110 on May 6, 2020.

Changes Other than Editing from Proposed to Adopted Version:

Proposed/Adopted	WAC Subsection	Reason
WAC 182-532-510
Proposed	To be eligible for one of the family planning only programs listed in this section, a client must meet the qualifications for that program.	To define the term "full-scope coverage" HCA added to subsection (2)(a)(v).
Adopted	To be eligible for one of the family planning only programs listed in this section, a client must meet the qualifications for that program. For the purposes of this section, "full-scope coverage" means coverage under either the categorically needy (CN) program, the broadest, most comprehensive scope of health care services covered or the alternative benefits plan (ABP), the same scope of care as CN, applicable to the apple health for adults program.
WAC 182-532-510 (2)(a)(v)
Proposed	(v) Have been denied apple health coverage within the last thirty days, unless the applicant: (A) Is age eighteen or younger and seeking services in confidence; (B) Is a domestic violence victim who is seeking services in confidence; or (C) Has an income of one hundred fifty percent to two hundred sixty percent of the federal poverty level, as described in WAC 182-505-0100.	To clarify that clients making an informed choice to not apply for full-scope coverage, including family planning, are eligible for family planning only services.
Adopted	(v) Have been denied apple health coverage within the last thirty days, unless the applicant: (A) Has made an informed choice to not apply for full-scope coverage, including family planning; (B) Is age eighteen or younger and seeking services in confidence; (B)(C) Is a domestic violence victim who is seeking services in confidence; or (C)(D) Has an income of one hundred fifty percent to two hundred sixty percent of the federal poverty level, as described in WAC 182-505-0100.

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 1, Repealed 0.

Number of Sections Adopted at the 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 9, 2020.

AMENDATORY SECTION(Amending WSR 19-18-024, filed 8/28/19, effective 10/1/19)

WAC 182-532-510Family planning only programs—Eligibility.

To be eligible for one of the family planning only programs listed in this section, a client must meet the qualifications for that program. For the purposes of this section, "full-scope coverage" means coverage under either the categorically needy (CN) program, the broadest, most comprehensive scope of health care services covered or the alternative benefits plan (ABP), the same scope of care as CN, applicable to the apple health for adults program.

(1) Family planning only - Pregnancy related program.

(a) To be eligible for family planning only - Pregnancy related services, as defined in WAC 182-532-001, a client must be determined eligible for the Washington apple health for pregnant ((clients))women program during the pregnancy, or determined eligible for a retroactive period covering the end of a pregnancy. See WAC 182-505-0115.

(b) A client is automatically eligible for the family planning only - Pregnancy related program when the client's pregnancy ends.

(c) A client may apply for the family planning only program in subsection (2) of this section up to sixty days before the expiration of the family planning only - Pregnancy related program.

(2) Family planning only program.

(a) To be eligible for family planning only services, as defined in WAC 182-532-001, a client must:

(i) ((Be a United States citizen, U.S. National, or "qualified alien" as described under WAC 182-503-0535;

(ii))) Provide a valid Social Security number (SSN) or proof of application to receive an SSN, be exempt from the requirement to provide an SSN as provided in WAC 182-503-0515, or meet good cause criteria listed in WAC 182-503-0515(2);

(((iii)))(ii) Be a Washington state resident, as described under WAC 182-503-0520;

(((iv)))(iii) Have an income at or below two hundred sixty percent of the federal poverty level, as described under WAC 182-505-0100;

(((v)))(iv) Need family planning services; and

(((vi)))(v) Have been denied apple health coverage within the last thirty days, unless the applicant:

(A) Has made an informed choice to not apply for full-scope coverage, including family planning;

(B) Is age eighteen ((and))or younger and seeking services in confidence;

(((B)))(C) Is a domestic violence victim who is seeking services in confidence; or

(((C)))(D) Has an income of one hundred fifty percent to two hundred sixty percent of the federal poverty level, as described in WAC 182-505-0100.

(b) A client is not eligible for family planning only medical if the client is:

(i) Pregnant;

(ii) Sterilized;

(iii) Covered under another apple health program that includes family planning services; or

(iv) Covered by concurrent creditable coverage, as defined in RCW 48.66.020, unless they meet criteria in (a)(((vi)))(v) of this subsection.

(c) A client may reapply for coverage under the family planning only program up to sixty days before the expiration of the twelve-month coverage period. The agency does not limit the number of times a client may reapply for coverage.