AH
WSR 97-03-036
PERMANENT RULES
DEPARTMENT OF
SOCIAL AND HEALTH SERVICES
(Public Assistance)
[Filed January 9, 1997, 1:06 p.m.]
Purpose: Minor editorial changes. Provides clarification that rules concerning the ineligibility of an ineligible spouse apply only to noninstitutional medical. Deletes subsections concerning the eligibility of an SSI client based on drug/alcohol addiction.
Citation of Existing Rules Affected by this Order: Amending WAC 388-503-0310 and 388-511-1105.
Statutory Authority for Adoption: RCW 74.08.090 and 74.04.050.
Adopted under notice filed as WSR 96-23-019 on November 12, 1996.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 1, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, amended 2, repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 2, repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 2, repealed 0.
Effective Date of Rule: Thirty-one days after filing.
January 8, 1997
Merry A. Kogut, Manager
Rules and Policies Assistance Unit
AMENDATORY SECTION (Amending Order 3981, filed 5/22/96, effective 6/22/96 WAC 388-503-0310 Categorically needy eligible persons. The department shall determine eligible for categorically needy medical assistance a client who is:
(1) Receiving or eligible to receive a cash assistance payment under:
(a) Aid to families with dependent children (AFDC); or
(b) Supplemental security income (SSI) including a grandfathered person and a person with an essential spouse; or
(c) State supplemental payment (SSP) to a person as assistance based on need in supplementation of SSI benefits. This payment includes mandatory state supplement or optional state supplement as defined under WAC 388-500-0005. The ineligible spouse of an SSI beneficiary receiving a state supplement payment for the ineligible spouse is not eligible for noninstitutional categorically needy medical assistance.
(2) A person twenty years of age or younger who meets the:
(a) One-person AFDC financial requirements and is in:
(i) Foster care; or
(ii) Subsidized adoption; or
(iii) A nursing facility or intermediate care facility for mentally retarded (ICF/MR); or
(iv) An approved inpatient psychiatric facility.
(b) Eligibility requirements under chapter 388-509 WAC.
(3) A current client of Title II, Social Security Administration (SSA) benefits who:
(a) Was a concurrent client of Title II and SSI benefits;
(b) Is ineligible for SSI benefits and/or state supplementary payments; and
(c) Would be eligible for SSI benefits if the department deducts the following from the current Title II benefit amount:
(i) All Title II cost-of-living benefit increases under P.L. 94-566, Section 503 received by the client since termination from SSI/SSP; and
(ii) All Title II cost-of-living benefit increases received during the time period in subsection (3)(c)(i) of this section by the client's spouse and/or other financially responsible family member living in the same household.
(4) An SSI client, after January 1, 1981, who continues to be eligible for medical assistance under P.L. 96-265 and 99-643;
(5) A currently disabled client receiving widow's or widower's benefits under Section 202 (e) or (f) of the Social Security Act if the disabled client:
(a) Was entitled to a monthly insurance benefit under Title II of the Social Security Act for December 1983; and
(b) Was entitled to and received a widow's or widower's benefit based on a disability under Section 202 (e) or (f) of the Social Security Act for January 1984;
(c) Became ineligible for SSI/SSP in the first month in which the increase provided under Section 134 of P.L. 98-21 was paid to the client;
(d) Has been continuously entitled to a widow's or widower's benefit under Section 202 (e) or (f) of the act;
(e) Would be eligible for SSI/SSP benefits if the amount of that increase, and any subsequent cost-of-living increases provided under Section 215(i) of the act, were disregarded;
(f) Is fifty through fifty-nine years of age; and
(g) Filed an application for Medicaid coverage before July 1, 1988.
(6) Effective January 1, 1991, any person receiving Title II disabled widow/widower benefits (DWB) under Section 202 (e) or (f) of the SSA, if the person:
(a) Is not eligible for the hospital insurance benefits under Medicare Part A of Title XVIII;
(b) Received SSI/SSP payments in the month before receiving such Title II benefits;
(c) Became ineligible for SSI/SSP due to receipt of or increase in such Title II benefits; and
(d) Would be eligible for SSI/SSP if the amount of such Title II benefits or increase in such Title II benefits under Section 202 (e) or (f) of the SSA, and any subsequent cost-of-living increases provided under Section 215(i) of the act were disregarded.
(7) A disabled or blind client receiving Title II Disabled Adult Childhood (DAC) benefits under Section 202(d) of the SSA if the client:
(a) Has attained eighteen years of age;
(b) Lost SSI/SSP on or after July 1, 1988, due to receipt of or increase in DAC benefits; and
(c) Would be eligible for SSI/SSP if the amount of the DAC benefits or increase under Section 202(d) of the SSA and any subsequent cost-of-living increases provided under Section 215(i) of the SSA Act were disregarded.
(8) A client who:
(a) In August 1972, received:
(i) Old age assistance (OAA);
(ii) Aid to blind (AB);
(iii) Aid to families with dependent children (AFDC); or
(iv) Aid to the permanently and totally disabled (APTD); and
(b) Was entitled to or received retirement, survivors, and disability insurance (RSDI) benefits; or
(c) Is ineligible for OAA, AB, AFDC, SSI or APTD solely because of the twenty percent increase in Social Security benefits under P.L. 92-336.
(9) A pregnant woman whose family income is at or below one hundred eighty-five percent of the Federal Poverty Level (FPL), or postpartum woman as described under WAC 388-508-0830;
(10) A child, born to a woman eligible for and receiving medical assistance on the date of the child's birth, from the date of birth for a period of one year when the child remains a member of the mother's household;
(11) A child eighteen years of age or younger meeting residence, citizenship, and Social Security number requirements whose countable family income is at or under two hundred percent of the FPL.
(12) In a family unit ineligible for AFDC financial assistance as a result (wholly or in part) of the collection or increased collection of child or spousal support shall be eligible for medical assistance for four months beginning with the month of ineligibility, if the family unit received AFDC financial assistance in at least three of the six months immediately preceding the month of ineligibility;
(13) In a family unit which becomes ineligible for AFDC before April 1, 1990, solely because of increased hours or increased income from employment shall remain categorically eligible for medical assistance for four calendar months beginning with the month of ineligibility, provided:
(a) The family received AFDC in at least three of the six months immediately preceding the month of ineligibility; and
(b) A member of such family continues to be employed; and
(c) The department considers earned income tax credits (EITC) as income for the purposes of this subsection.
(14) Denied AFDC cash payments solely because of a departmental recovery of an overpayment;
(15) In a medical facility and:
(a) Who would be eligible for cash assistance if the person was not institutionalized; or
(b) Is an SSI-related institutionalized person and has gross income above the cash assistance level but below three hundred percent of the Federal Benefit Rate.
(16) Sixty-five years of age or older, a patient in an institution for mental diseases (IMD), and is resource and income eligible as described under subsection (15)(a) or (b) of this section;
(17) A person eligible for and accepting hospice services as described under WAC 388-86-047 and who shall be:
(a) SSI categorically related with gross income less than three hundred percent of the SSI Federal Benefit Rate; or
(b) AFDC categorically related.
(18) Blind or presumptively disabled under SSI criteria, as described under WAC 388-511-1105, and the person receives continuing general assistance (GA-X) cash assistance;
(19) An alien ineligible for AFDC or SSI cash assistance because of deeming of income of the alien's sponsors;
(20) Not an inmate of a public institution;
(21) Not receiving cash assistance because of special situations as defined under WAC 388-507-0740; or
(22) A client who:
(a) Was entitled to RSDI benefits in August 1972; and
(b) Is ineligible for AFDC or SSI solely because of the twenty percent increase in Social Security benefits under PL 92-336.
(((23) Suspended from receipt of SSI benefits for noncompliance with
drug or alcohol treatment requirements; or
(24) Determined eligible for SSI benefits based on a finding that
alcoholism/drug addiction is a contributing factor to the person's
disability and such benefits have been exhausted after receipt for
thirty-six months.))
[Statutory Authority: RCW 74.08.090 and SPA 95-11. 96-12-001 (Order
3981), 388-503-0310, filed 5/22/96, effective 6/22/96. Statutory
Authority: RCW 74.08.090. 94-17-036 (Order 3769), 388-503-0310, filed
8/10/94, effective 9/10/94; 94-10-065 (Order 3732), 388-503-0310, filed
5/3/94, effective 6/3/94. Formerly parts of WAC 388-82-010 and 388-82-115.]
AMENDATORY SECTION (Amending Order 3845, filed 4/5/95, effective 5/6/95)
WAC 388-511-1105 SSI-related eligibility requirements. (1) For the purposes of SSI-related medical assistance, the client shall be:
(a) Sixty-five years of age or over; or
(b) Blind with:
(i) Central visual acuity of 20((.))/200 ((degrees)) or less in the
better eye with the use of a correcting lens; or
(ii) A limitation in the fields of vision so the widest diameter of the visual field subtends an angle no greater than twenty degrees; or
(c) Disabled.
(i) Decisions on SSI-related disability are the responsibility of the medical assistance administration (MAA) and shall be subject to the authority of:
(A) Federal statutes and regulations codified at 42 U.S.C. Sec 1382c and 20 C.F.R. Parts 404 and 416, as amended; or
(B) Controlling federal court decisions which define the OASDI and SSI disability standard and determination process.
(ii) For MAA's purposes, "disabled" means unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which:
(A) Can be expected to result in death; or
(B) Has lasted or can be expected to last for a continuous period of not less than twelve months.
(iii) In the case of a child seventeen years of age or younger, if the child suffers from any medically determinable physical or mental impairment of comparable severity.
(2) When a person has applied for Title II or Title XVI benefits and the SSA has denied the person's application solely because of a failure to meet Title II and Title XVI blindness or disability criteria, the SSA denial shall be binding on the department, unless the applicant's:
(a) SSA denial is under appeals in the reconsideration stage, the SSA's administrative hearing process, or the SSA's appeals council; or
(b) Medical condition has changed since the SSA denial was issued.
(3) The ineligible spouse, of an SSI beneficiary receiving a state supplement payment for the ineligible spouse, shall not be eligible for Medicaid as noninstitutional categorically needy. Such ineligible spouse may be eligible for noninstitutional medically needy.
(4) The client shall be resource eligible under WAC 388-511-1110 on the first day of the month to be eligible for any day or days of that month. The department shall make a resource determination of the first moment of the first day of the month. The department shall determine changes in the amount of a client's countable resources during a month do not affect eligibility or ineligibility for that month. Refer to WAC 388-513-1395 for an institutionalized client.
(5) The department shall consider a client under 1619(b) of the Social Security Act as eligible for SSI.
(6) The department shall provide a resident of Washington requiring
medical assistance outside the United States care according to WAC 388-501-0180.
[Statutory Authority: RCW 74.08.090, P.L. 100-383, AFDC Transmittal Memo, POMS 830.100, 830.115, 830.725 and 1130.605. 95-08-070 (Order 3845), 388-511-1105, filed 4/5/95, effective 5/6/95. Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-511-1105, filed 5/3/94, effective 6/3/94. Formerly parts of WAC 388-85-115 and 388-92-015.]