WSR 02-13-102

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed June 18, 2002, 4:02 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 02-10-040.

Title of Rule: WAC 388-418-0025, 388-462-0015, 388-470-0026, 388-470-0070, and 388-478-0075.

Purpose: Implementation of RCW 74.08A.100 and 74.09.415 as revised by SB 6833 (chapter 666, Laws of 2002). These amendments are necessary to eliminate DSHS state-funded medical coverage for undocumented children and for legal immigrant children and adults that are ineligible for Medicaid due to their INS status or the requirement of a five-year ban.

Statutory Authority for Adoption: RCW 74.08A.100, 74.09.080, 74.09.415, 74.08.090.

Statute Being Implemented: RCW 74.08A.100 and 74.09.415 (chapter 366, Laws of 2002).

Summary: See Purpose above.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Joanie Scotson, MAA, P.O. Box 45534, Olympia, WA 98504-5534, (360) 725-1330.

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: These amendments are necessary to eliminate DSHS state-funded medical coverage for children with no INS status and for legal immigrant children and adults that are ineligible for Medicaid due to their INS status or the requirement of a five-year ban.

Proposal Changes the Following Existing Rules: See Purpose above.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rules only affect client eligibility. There is no impact on small businesses.

RCW 34.05.328 applies to this rule adoption. These rules meet the definition of a significant legislative rule under RCW 34.05.328. However, RCW 34.05.328 (5)(b)(vii) exempts DSHS eligibility rules.

Hearing Location: Office Building 2 - Auditorium (DSHS Headquarters) (parking at 12th and Washington), 1115 Washington, Olympia, WA 98502, on July 23, 2002, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by July 19, 2002, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., July 23, 2002.

Date of Intended Adoption: Not sooner than July 24, 2002.

June 13, 2002

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3130.1
AMENDATORY SECTION(Amending WSR 00-08-002, filed 3/22/00, effective 5/1/00)

WAC 388-418-0025   Effect of changes on medical program eligibility.   (1) A client continues to be eligible for Medicaid until the department determines the client's ineligibility or eligibility for another medical program. This applies to a client who, during a certification period, becomes ineligible for, is terminated from, or requests termination from:

(a) A CN Medicaid program ((or SFA-related medical program)); or

(b) Any of the following cash grants:

(i) TANF ((or SFA));

(ii) SSI; or

(iii) ((GA-H; or

(iv))) GA-X. See WAC 388-434-0005 for changes reported during eligibility review.

(2) A child remains continuously eligible for ((medical benefits)) CN Medicaid for a period of twelve months from the date of certification for medical benefits or last review, whichever is later. This applies unless the child:

(a) Moves out of state;

(b) Loses contact with the department or the department does not know the child's whereabouts;

(c) ((Turns eighteen years of age if receiving children's health program benefits)) Becomes an inmate of a public institution, including a correctional facility (Refer to WAC 388-505-0210(5) for exceptions);

(d) Turns nineteen years of age ((if receiving children's CN or CN scope of care program benefits));

(e) Dies; or

(f) Receives benefits under the children's health insurance program (CHIP) and:

(i) Does not pay health insurance premiums for four consecutive months; or

(ii) Is determined to have had creditable coverage at the time of application. Refer to chapter 388-542 WAC.

(3) When a client becomes ineligible for refugee cash assistance, refugee medical assistance can be continued only through the eight-month limit, as described in WAC 388-400-0035(((6))) (4).

(4) A client receiving medical benefits ((under)) with a TANF ((or SFA)) cash grant or ((related)) family medical program is eligible for a medical extension, as described under WAC 388-523-0100, when the client's cash grant or ((related)) family medical program is terminated as a result of:

(a) Earned income; or

(b) Collection of child or spousal support.

(5) A change in income during a certification period does not affect eligibility for:

(a) Pregnant women's medical programs; or

(b) The first six months of the ((TANF/SFA-related)) medical extension benefits.

(6) For a child receiving benefits under CHIP as described in chapter 388-542 WAC, the department must redetermine eligibility for a Medicaid program when the family reports:

(a) Family income has decreased to less than two hundred percent FPL;

(b) The child becomes pregnant;

(c) A change in family size; or

(d) The child receives SSI.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090 and 74.09.450. 00-08-002, 388-418-0025, filed 3/22/00, effective 5/1/00. Statutory Authority: RCW 74.04.050, 74.04.057 and Section 4731 of the BBA (Public Law 105-33). 99-10-064, 388-418-0025, filed 5/3/99, effective 6/3/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-418-0025, filed 7/31/98, effective 9/1/98. Formerly WAC 388-508-0840, 388-509-0920, 388-509-0960, 388-522-2205 and 388-522-2210.]

3120.1
AMENDATORY SECTION(Amending WSR 98-16-044, filed 7/31/98, effective 9/1/98)

WAC 388-462-0015   Medical programs for pregnant women.   (1) A pregnant woman is eligible for medical services described in this chapter only when her pregnancy is confirmed by a licensed medical practitioner, licensed laboratory, community clinic, family planning clinic, or health department clinic.

(2) A pregnant woman is eligible for CN ((medical)) Medicaid coverage if she meets the following requirements as described in WAC 388-503-0505:

(a) Citizenship or immigration status (chapter 388-424 WAC); and

(b) Social Security Account Number (chapter 388-474 WAC); and

(c) Washington state residence (chapter 388-468 WAC); and

(d) Countable income meets the standard described in WAC 388-478-0075.

(3) A pregnant woman is considered for medically needy (MN) program coverage if she meets the requirements in subsection (2)(a) through (c) of this section and:

(a) Her countable income is greater than the standard in subsection (2)(d) of this section; and

(b) Her countable resources do not exceed the standard in WAC 388-478-0070.

(4) A pregnant woman is eligible for CN scope of care under the state-funded pregnant woman program if she is not eligible for programs in subsection (2) of this section due to citizenship, immigrant or Social Security Number requirements.

(5) A pregnant woman is considered for MN scope of care under the state-funded pregnant woman program if:

(a) She is not eligible for the program under subsection (4) of this section because her income exceeds the standard; and

(b) Her resources do not exceed the standard in WAC 388-478-0070.

(6) A pregnant woman is considered for the medically indigent (MI) program if her resources exceed the standards in WAC 388-478-0070.

(7) Only the income of an unmarried father of an unborn child that is actually contributed to a pregnant woman is considered as income to her.

(8) There are no resource limits for the programs described in subsections (2) and (4) of this section.

(9) The assignment of child support and medical support rights as described in chapter 388-422 WAC do not apply to pregnant women.

(10) Unless stated otherwise, this section contains the only eligibility requirements for pregnant women to qualify for medical coverage.

(11) A woman who was eligible for and received medical coverage on the last day of pregnancy is eligible for extended medical benefits for postpartum care through the end of the month:

(a) Which includes the sixtieth day from the end of the pregnancy, for a pregnant woman receiving Medical in any program except Medically Indigent (MI); or

(b) The pregnancy ends, for a pregnant woman receiving MI benefits.

(12) A woman who was eligible for a medical program on the last day of pregnancy is eligible for family planning services for twelve months from the end of the pregnancy.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-462-0015, filed 7/31/98, effective 9/1/98. Formerly WAC 388-508-0820, 388-508-0830, 388-522-2230 and 388-508-0835.]

3121.1
AMENDATORY SECTION(Amending WSR 01-18-006, filed 8/22/01, effective 9/22/01)

WAC 388-470-0026   Excluded resources for family medical programs.   "Continuously eligible" means, for the purposes of this chapter, there has not been a break of a calendar month or more in a client's eligibility since the date the client received resources in an amount that would cause the client to exceed the resource limit of a family medical program.

(1) The department does not count any increase in a client's resources received while a client:

(a) Is eligible for and receiving coverage under a family medical program; and

(b) Remains continuously eligible for a family medical program.

(2) The department does not count the resource increase for a client:

(a) Who meets the requirement of subsection (1)(a) of this section;

(b) Whose family medical program is terminated; and

(c) Who is later found eligible for all months since the termination, which may include a retroactive period of up to three months.

(3) The department counts the resource increase when the client is ineligible for a family medical program for a full calendar month or more except as described in subsection (2) of this section.

(4) When determining the eligibility of a Holocaust survivor for a family medical program, the department does not count the recoveries of:

(a) Insurance proceeds; and

(b) Other assets.

(5) For the purposes of this section, a family medical ((programs include)) program includes the medical extension benefits as described in WAC 388-523-0100.

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530 and 2000 2nd sp.s. c 1 210(12). 01-18-006, 388-470-0026, filed 8/22/01, effective 9/22/01.]


AMENDATORY SECTION(Amending WSR 98-16-044, filed 7/31/98, effective 9/1/98)

WAC 388-470-0070   How vehicles are counted toward the resource limit for cash assistance and ((TANF/SFA-related)) family medical programs.   (1) A vehicle is any device for carrying persons and objects by land, water, or air.

(2) The entire value of a licensed vehicle needed to transport a physically disabled assistance unit member is excluded.

(3) The equity value of one vehicle up to five thousand dollars is excluded when the vehicle is used by the assistance unit or household as a means of transportation. Each separate medical assistance unit is allowed this exclusion.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-470-0070, filed 7/31/98, effective 9/1/98. Formerly WAC 388-506-0610.]

3122.1
AMENDATORY SECTION(Amending WSR 02-07-090, filed 3/19/02, effective 4/1/02)

WAC 388-478-0075   Medical programs--Monthly income standards based on the federal poverty level (FPL).   (1) The department bases the income standard upon the Federal Poverty Level (FPL) for the following medical programs:

(a) ((Children's health program up to one hundred percent of FPL;

(b))) Pregnant women's program up to one hundred eighty-five percent of FPL;

(((c))) (b) Children's categorically needy program up to two hundred percent of FPL;

(((d))) (c) Healthcare for workers with disabilities (HWD) up to two hundred twenty percent of FPL; and

(((e))) (d) The children's health insurance program (CHIP) is over two hundred percent of FPL but under two hundred fifty percent of FPL.

(2) Beginning April 1, 2002, the monthly FPL standards are:


FAMILY

SIZE

100%

FPL

185%

FPL

200%

FPL

220%

FPL

250%

FPL

1 $739 $1366 $1477 $1625 $1846
2 $995 $1841 $1990 $2189 $2488
3 $1252 $2316 $2504 $2754 $3130
4 $1509 $2791 $3017 $3319 $3771
5 $1765 $3266 $3530 $3883 $4413
6 $2022 $3741 $4044 $4448 $5055
7 $2279 $4215 $4557 $5013 $5696
8 $2535 $4690 $5070 $5577 $6338
9 $2792 $5165 $5584 $6142 $6980
10 $3049 $5640 $6097 $6707 $7621
Add to the ten person standard for each person over ten:
$257 $475 $514 $565 $642

(3) There are no resource limits for the programs under this section.

[Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.500, 74.09.510, and Section 1902 (a)(10)(A)(ii)(XV) and (XVI) of the Social Security Act. 02-07-090, 388-478-0075, filed 3/19/02, effective 4/1/02. Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.057, 74.09.530, and Section 673(2) (42 U.S.C. 9902(2)). 01-18-056, 388-478-0075, filed 8/30/01, effective 9/30/01; 00-17-085, 388-478-0075, filed 8/14/00, effective 9/14/00; 99-19-005, 388-478-0075, filed 9/3/99, effective 10/4/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-478-0075, filed 7/31/98, effective 9/1/98. Formerly WAC 388-507-0805, 388-508-0810, 388-509-0910, 388-509-0920, 388-509-0940 and 388-509-0960.]

Washington State Code Reviser's Office