WSR 98-08-082

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Medical Assistance Administration)

[Filed April 1, 1998, 9:21 a.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 98-01-068

Title of Rule: WAC 388-507-0710 TANF-related medical program income standards and 388-513-1350 Institutional--Available resources

Purpose: To adopt federal standards regarding medical assistance eligibility and benefits (the one-person medically needy income level and community spouse resource maximum), and the resource standard for an institutionalized person's spouse (who is not institutionalized)

Statutory Authority for Adoption: RCW 74.08.090, 74.04.050, 74.04.057, 74.09.575

Statute Being Implemented: Section 1924 (42 U.S.C. 1396r-5)

Summary: These amendments implement an annual increase for the one-person medically needy income level and community spouse resource maximum and the resource standard for an institutionalized person's spouse (who is not institutionalized), as required by federal legislation

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Joanie Scotson, P.O. Box 45530, Olympia, WA, (360) 753-7462

Name of Proponent: Department of Social and Health Services, governmental.

Rule is necessary because of federal law, Section 1924 (42 U.S.C. 1396r-5)

Explanation of Rule, its Purpose, and Anticipated Effects: See Summary above

Proposal Changes the Following Existing Rules: These sections, WAC 388-507-0710 and 388-513-1350, are rewritten for clarity. The amendments reflect the annual increase of the one-person income standard for the medically needy program, and the resource standard for an institutionalized person's spouse (who is not institutionalized), as required by federal legislation

No small business economic impact statement has been prepared under chapter 19.85 RCW. Does not economically impact small businesses.

RCW 34.05.328 does not apply to this rule adoption. RCW 34.05.328 (5)(b)(vii) exempts the Department of Social and Health Services rules that only [apply] to client medical or financial eligibility.

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on May 5, 1998, at 10:00 a.m

Assistance for Persons with Disabilities: Contact Paige Wall by April 21, 1998, phone (360) 902-7540, TTY (360) 902-8324, e-mail pwall@dshs.wa.gov

Submit Written Comments to: Identify WAC Numbers, Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, FAX (360) 902-8292, by May 5, 1998

Date of Intended Adoption: No sooner than May 6, 1998

March 31, 1998

Edith M. Rice, Chief

Office of Legal Affairs

SHS-2347:3

AMENDATORY SECTION (Amending WSR 97-09-112, filed 4/23/97, effective 5/24/97)

WAC 388-507-0710  ((AFDC)) TANF-related medical program income standards. (1) ((The department shall determine income standards for AFDC-related clients as described under)) A TANF-related client's countable income is determined according to the provisions in WAC 388-505-0590 (((2) and (4))).

(2) Effective January 1, ((1997, the department shall set)) 1998, the medically needy income level (MNIL) ((at)) is:

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090 and 74.09.575. 97-09-112, § 388-507-0710, filed 4/23/97, effective 5/24/97. Statutory Authority: RCW 74.08.090 and Title XIX State Agency Letter 95-44. 96-09-033 (Order 3963), § 388-507-0710, filed 4/10/96, effective 5/11/96. Statutory Authority: RCW 74.08.090 and Title XIX State Agency Letter 94-49, notice of increase in SSI level. 95-05-022 (Order 3832), § 388-507-0710, filed 2/8/95, effective 3/11/95. Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), § 388-507-0710, filed 5/3/94, effective 6/3/94.]

SHS-2346:6

AMENDATORY SECTION (Amending WSR 97-09-112, filed 4/23/97, effective 5/24/97)

WAC 388-513-1350  Institutional--Available resources. This section describes those resources which are considered available to an institutionalized client. (1) Resources are defined under chapter 388-511 WAC for an SSI-related client and under chapter 388-216 WAC ((388-22-030)) for ((an AFDC)) a TANF-related client.

(2) The methodology and standards for determining and evaluating resources are under WAC 388-513-1310, ((388-513-1330, 388-513-1340)) 388-513-1350, and 388-513-1360. Transfers of resources are evaluated under WAC 388-513-1365. Trusts are described under WAC 388-505-0595.

(3) ((The department shall determine ownership of resources following Washington state community property principles)) "Continuously institutionalized" means that for thirty consecutive days, a person:

(a) Is not absent from an institution; or

(b) Does not receive home-based or community-based waivered services.

(4) For a person((:

(a))) whose most recent period of continuous institutionalization began on or before September 30, 1989((; and

(b) Who remains continuously institutionalized.

(4) For purposes of Medicaid eligibility, the department shall consider resources are)):

(a) ((Community)) Available resources ((when jointly)) are one-half of the total value of nonexempt resources held in the:

(i) Names of both the institutionalized spouse and the community spouse; or

(ii) Name of the institutionalized spouse only.

(b) ((The separate property of the community spouse when)) Unavailable resources are:

(i) The other half of the total value of nonexempt resources determined under subsection (3)(a) of this section;

(ii) Held solely in the ((separate)) name of the community spouse; or

(((ii))) (iii) Transferred between spouses as described under ((WAC 388-513-1350(7))) subsection (4)(b) of this section.

(((5) The department shall:

(a) Divide by two, the total value of the community resources the spouses own; and

(b) Assign one-half of the total value of the community resources to each spouse.

(6) The department shall not consider a person continuously institutionalized if, for thirty consecutive days, the person:

(a) Is absent from an institution; or

(b) Does not receive home-based or community-based waivered services.

(7))) (5) For ((the purpose of determining Medicaid eligibility of)) a person, whose most recent ((continuous)) period of continuous institutionalization starts on or after October 1, 1989, ((the department shall:

(a) Exclude resources as described under WAC 388-511-1160; except, the department shall exempt one vehicle without regard to use or value when the institutionalized person has a community spouse;

(b) Consider available to the community spouse,)) available resources include all nonexempt resources in the name of either the community spouse or the institutionalized ((spouse, except resources exceeding the greater of)) spouse except;

(a) The following resources are exempt when the institutionalized person has a community spouse:

(i) ((Seventy-nine)) One vehicle without regard to use or value; and

(ii) Effective January 1, 1998, eighty thousand ((twenty)) seven hundred sixty dollars ((effective January 1, 1997;

(ii) An amount)); or

(b) An amount greater than the amount in subsection (4)(a)(ii) of this section if:

(i) Established by a fair hearing under chapter 388-08 WAC when the community spouse's resource allowance is inadequate to provide a minimum monthly maintenance needs allowance; or

(((iii) An amount ordered)) (ii) Transferred to the community spouse by ((the)) court order.

(((c) Ensure))

(6) Resources ((available to the community spouse are in the name of the community spouse or)) of the institutional spouse must be transferred to the community spouse or to another person for the sole benefit of the community spouse:

(i) Before the first regularly scheduled eligibility review; or

(ii) As soon as ((practicable thereafter)) possible, taking into account ((such)) the time ((as may be)) necessary to obtain a court order for the support of the community spouse.

(((d) Consider resources greater than such resources described under subsection (7)(b) of this section available to the institutional spouse.

(8) The department shall consider))

(7) The resources of the community spouse are:

(a) Unavailable to the institutionalized spouse:

(i) The month after the institutionalized spouse is determined eligible for institutional benefits; and

(ii) While the institutionalized spouse ((remains in a continuous period of institutionalization)) is continuously institutionalized.

(b) Available to the institutionalized spouse when the institutionalized spouse:

(i) Acquires resources which, when added to resources held by the institutionalized spouse, exceed the one-person resource maximum, if the most recent period of institutionalization began on or after October 1, 1989; or

(ii) ((Has a break of thirty days or more in a period of institutionalization)) Is not continuously institutionalized.

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090 and 74.09.575. 97-09-112, § 388-513-1350, filed 4/23/97, effective 5/24/97. Statutory Authority: RCW 74.08.090 and Title XIX State Agency Letter 95-44. 96-09-033 (Order 3963), § 388-513-1350, filed 4/10/96, effective 5/11/96. Statutory Authority: RCW 74.08.090 and Title XIX State Agency Letter 94-49, notice of increase in SSI level. 95-05-022 (Order 3832), § 388-513-1350, filed 2/8/95, effective 3/11/95. Statutory Authority: RCW 74.08.090. 94-23-129 (Order 3808), § 388-513-1350, filed 11/23/94, effective 12/24/94; 94-10-065 (Order 3732), § 388-513-1350, filed 5/3/94, effective 6/3/94. Formerly parts of WAC 388-95-337 and 388-95-340.]

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