Original Notice.

Preproposal statement of inquiry was filed as WSR 99-22-095 [98-22-095].

Title of Rule: WAC 388-424-0005 The effect of citizenship and alien status on eligibility, 388-424-0010 Alien status, and 388-505-0210 Children's medical eligibility.

Purpose: Implement a state-funded CN scope of care medical program for alien children who arrived in the United States after August 22, 1996, and whose family income is less than 200% FPL.

Statutory Authority for Adoption: RCW 74.08.090.

Statute Being Implemented: RCW 74.08A.100.

Summary: See Purpose above.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Joanie Scotson, Medical Assistance Administration, P.O. Box 45535, Olympia, WA 98504, (360) 753-7462.

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

Rule is not necessitated by federal law, federal or state court decision.

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

Proposal Changes the Following Existing Rules: Adds a category of children eligible for a medical program.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This proposed rule does not have an economic impact on small businesses. It concerns eligibility policy and affects only staff and clients.

RCW 34.05.328 applies to this rule adoption. The rules fit the definition of a significant legislative rule but DSHS is exempt from preparing a cost benefit analysis under RCW 34.05.328(5).

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on July 27, 1999, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by July 16, 1999, phone (360) 664-6094, TTY (360) 664-6178, e-mail wallpg@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) 664-6185, by July 27, 1999.

Date of Intended Adoption: July 28, 1999.

June 8, 1999

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

(1) A child under the age of one is eligible for ((newborn)) categorically needy (CN) ((children's)) medical assistance when:

(a) The child's mother((,)) was eligible for and receiving services under a medical ((assistance)) program at the time of the child's birth; and

(b) ((The child is under one year of age; and

(c))) The child remains with the mother and resides in the state.

(2) Children under the age of nineteen are eligible for CN medical assistance when they meet the requirements for:

(a) ((Meet the requirements of:

(i))) Citizenship or immigrant status as described in ((chapter 388-424)) WAC 388-424-0010 (1) or (2); ((and

(ii))) (b) State residence as described in chapter 388-468 WAC; ((and

(iii))) (c) A social security number as described in chapter 388-476 WAC; and

(((b) Meet)) (d) Family income levels as described in WAC 388-478-0075((; or

(c) Meet the requirements of WAC 388-505-0220 or 388-523-0100)) (1)(c).

(3) Children under the age of nineteen who first physically entered the U.S. after August 21, 1996 are eligible for state-funded CN scope of care when they meet the:

(a) Eligibility requirements in subsection (2)(b), (c), and (d) of this section; and

(b) Qualified alien requirements for lawful permanent residents, parolees, or conditional entrants as described in WAC 388-424-0005 (3)(a), (c), or (f).

(4) Children under the age of twenty-one are eligible for CN medical assistance when they:

(a) Meet citizenship or immigrant status, state residence, and social security number requirements as described in subsection (2)(a), (b), and (c) of this section; ((and))

(b) Meet income levels described in WAC 388-478-0075 when income is counted according to WAC 388-408-0055 (1)(c); and

(c) Meet one of the following criteria:

(i) Reside in ((an institution ()) a medical hospital, intermediate care facility for mentally retarded (ICF/MR), or nursing ((home)) facility(() as described in WAC 388-513-1320)) for more than thirty days; ((or

(d))) (ii) Reside in a psychiatric or chemical dependency facility ((as described in WAC 388-513-1320.

(4) Children under the age of twenty-one are eligible for CN if they:

(a)));

(iii) Are in foster care; or

(((b))) (iv) Receive subsidized adoption services.

(5) Children((, regardless of age,)) are eligible for CN medical assistance if they ((are eligible to)):

(a) Receive Supplemental Security Income (SSI) payments based upon their own disability((.

(6) Children are eligible for CN medical if they)); or

(b) Received SSI payments for August 1996, and except for the passage of amendments to federal disability definitions, would be eligible for SSI payments.

(((7))) (6) Children under the age of nineteen are eligible for Medically Needy (MN) medical assistance when they:

(a) Meet citizenship, state residence, and social security number requirements as described in subsection (2)(a), (b), and (c); and

(b) Have income at or above the income levels described in WAC ((388-478-0070)) 388-478-0075 (1)(c).

(((8))) (7) A child is eligible for SSI-related MN when the child:

(a) ((They meet)) Meets the conditions in subsection (((7))) (6)(a) ((and (b))); ((and))

(b) ((They meet)) Meets the blind and/or disability criteria of the federal SSI program; and

(c) Has family income above the level described in WAC 388-478-0070(1).

(((9)))(8) Nonimmigrant children, including visitors or students from another country and undocumented children, under the age of eighteen are eligible for the state-funded children's health program, if ((they)):

(a) ((Are)) The department determines the child ineligible for any CN or MN scope of care medical program; ((and))

(b) ((Meet)) They meet family income levels described in WAC 388-478-0075 (1)(a); and

(c) They meet state residency requirements as described in chapter 388-468 WAC.

(((10))) (9) There are no resource standards for ((either)) the children's CN or the state-funded CN scope of care, or the children's health programs.

(((11) The requirements in WAC 388-503-0505 (3)(c) and (d) do not apply to persons applying for the state funded children's health program.

(12))) (10) Children may also be eligible for:

(a) Temporary assistance for needy families (TANF) or state ((funded)) family assistance (SFA)-related medical as described in WAC 388-505-0220; and

(b) TANF/SFA-related medical extensions as described in WAC 388-523-0100.

(((13))) (11) Except for a client described in subsection (((3))) (4)(c) and (d), an inmate of a public institution, as defined in WAC 388-500-0005, is not eligible for CN or MN medical coverage.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090.  98-16-044, § 388-505-0210, filed 7/31/98, effective 9/1/98. Formerly WAC 388-509-0905, 388-509-0910 and 388-509-0920.]

(1) To receive benefits ((for)) under the temporary assistance for needy families (TANF), Medicaid, ((and)) or federal food stamp((s)) program, a person((s)) must be a:

(a) U.S. citizen((s));

(b) U.S. national((s)); or

(c) Qualified alien((s)) who meets the ((additional conditions)) eligibility requirements described in:

(i) WAC 388-424-0010 ((relative to)) for TANF and Medicaid ((and)); or

(ii) WAC 388-424-0020 ((relative to)) for federal food stamps.

(2) To receive benefits under the general assistance and ADATSA programs, a person must be a:

(a) U.S. citizen;

(b) U.S. national;

(c) Qualified alien; or

(d) A PRUCOL alien as defined in subsection (4) of this section.

(3) Qualified aliens are ((aliens)) any of the following:

(a) ((Who are)) Lawful permanent residents under the Immigration and Nationality Act (INA);

(b) ((Who are)) Those granted asylum under section 208 of the INA;

(c) ((Who are)) Those paroled ((into the U.S.)) under section 212 (d)(5) of the INA for at least one year;

(d) ((Who are)) Those admitted ((to the U.S.)) as refugees under section 207 of the INA;

(e) ((Who are)) Aliens whose deportation (removal) is being withheld under section 241(b)(3) or 243(h) of the INA;

(f) ((Who are)) Those granted conditional entry ((into the U.S.)) under section 203 (a)(7) of the INA as in effect prior to April 1, 1980;

(g) ((Who are)) Cuban and Haitian entrants as defined in section (501)(e) of the Refugee Education Assistance Act of 1980; or

(h) ((Who are)) Amerasians admitted under section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act, 1988 (as amended); or

(i) Aliens who are victims of domestic violence, or whose children are victims of domestic violence, when:

(i) The domestic violence ((is)) was committed in the U.S. by the alien's spouse, parent, or a member of the spouse or parent's family residing in the same household as the alien; ((and))

(ii) ((In situations where the children are the victims of domestic violence,)) The alien did not actively participate in the violence against his or her own children when the children are the victims of domestic violence; ((and))

(iii) The alien no longer resides with the person who committed the domestic violence; ((and))

(iv) There is a substantial connection between the domestic violence and the need for public assistance benefits; and

(v) The alien has an application with the Immigration and Naturalization Service (INS) either approved or pending for:

(A) Legal immigration status under section((s)) 204 (a)(1)(A)(((iii)(I) and)) or section 204 (a)(((1)(A)(iv))) (1)(B) of the INA; or

(B) ((Suspension of deportation or)) Cancellation of removal under section 244 (a)(3) of the INA as in effect prior to April 1, 1997 or section 240A (b)(2) of the INA.

(((3) To receive benefits under the general assistance and ADATSA programs, persons must be:

(a) U.S. citizens;

(b) U.S. nationals;

(c) Qualified aliens; or

(d) Aliens permanently residing in the U.S. under color of law (PRUCOL).))

(4) ((Aliens are considered to be PRUCOL when)) A PRUCOL alien must meet all of the following conditions:

(a) They are permanently residing in the U.S.((, who ));

(b) They do not meet ((the)) a definition of a qualified alien as defined in subsection (((2))) (3) of this section((, and:

(a)));

(c) The INS knows they are residing in the U.S.((,)); and

(((b))) (d) The INS is not likely to enforce their departure.

(5) During the application process, one of the following persons must indicate on the application for benefits whether each household member is a U.S. citizen or qualified alien:

(a) An adult applicant in the household; or

(b) The person applying for benefits when there are no adults in the household.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090.  98-16-044, § 388-424-0005, filed 7/31/98, effective 9/1/98. Formerly WAC 388-505-0520, 388-518-1805 and 388-510-1020.]

(1) Qualified aliens as described in WAC 388-424-0005(3) who were residing in the U.S. before August 22, 1996 ((can)) may receive temporary assistance for needy families (TANF) and Medicaid benefits.

(2) Qualified aliens who first physically ((enter)) entered the U.S. ((on or)) after August ((22)) 21, 1996 cannot receive TANF or Medicaid for five years after their date of entry, unless they are any of the following:

(a) ((Refugees admitted to the U.S. under section 207 of the Immigration and Nationality Act (INA);

(b) Aliens granted asylum under section 208 of the INA;

(c) Aliens whose deportation is being withheld under section 243(h) of the INA;

(d) Cuban and Haitian entrants as defined in section (501)(e) of the Refugee Education Assistance Act of 1980;

(e) Amerasians admitted to the U.S. under section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act, 1988 (as amended); or

(f))) An alien as described under WAC 388-424-0005 (3)(b), (d), (e), (g), or (h); or

(b) A lawful permanent resident((s who are)) who is:

(i) On active duty in the U.S. military, other than active duty for training;

(ii) An honorably discharged U.S. veteran((s));

(iii) A veteran((s)) of the military forces of the Philippines who served prior to July 1, 1946, as described in Title 38, section 107 of the U.S. code;

(iv) A Hmong ((and)) or Highland Lao veteran((s)) who served in the military on behalf of the U.S. Government during the Vietnam conflict; or

(v) The spouse or unmarried dependent ((children)) child(ren) of a person described in subsection((s)) (2)(f)(i) through (iv) of this section.

(3) ((An)) Aliens who ((would)) qualify for Medicaid benefits, but ((is)) are determined ineligible ((solely)) because of ((his or her)) alien status or requirements for a Social Security Number, ((can)) may receive medical coverage as follows:

(a) State-funded categorically needy (CN) scope of care for:

(i) Pregnant women, as specified in WAC 388-462-0015;

(ii) Children((, through the children's health program,)) as specified in WAC 388-505-0210;

(iii) Persons eligible for or receiving cash assistance under the state family assistance program (SFA); ((and)) or

(iv) ((Persons)) Aliens who were lawfully residing in the U.S. ((prior to)) before August 22, 1996, including PRUCOL aliens as defined in WAC 388-424-0005(4).

(b) Alien emergency medical services as specified in WAC 388-438-0110.

(4) ((A person's)) Alien status ((is not used to determine)) does not effect eligibility for the medically indigent program ((as)) described in WAC 388-438-0100.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090.  98-16-044, § 388-424-0010, filed 7/31/98, effective 9/1/98. Formerly WAC 388-505-0520 and 388-518-1805.]

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