WSR 02-13-103

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed June 18, 2002, 4:03 p.m. ]

Original Notice.

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

Title of Rule: WAC 388-503-0505, 388-503-0510, 388-503-0515, 388-408-0055, 388-416-0010, and 388-416-0025.

Purpose: Implementation of RCW 74.08A.100 and 74.09.415 as revised by SB 6833 (chapter 366, 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

3114.1
AMENDATORY SECTION(Amending WSR 98-16-044, filed 7/31/98, effective 9/1/98)

WAC 388-503-0505   General eligibility requirements for medical programs.   (1) Persons applying for benefits under the medical coverage programs established under chapter 74.09 RCW must meet the eligibility criteria established by the department in chapters 388-400 through 388-555 WAC.

(2) Persons applying for medical coverage are considered first for federally funded or federally matched programs. State-funded programs are considered after federally funded programs are not available to the client except for brief periods when the state-funded programs offer a broad scope of care which meet a specific client need.

(3) Unless otherwise specified in program specific WAC, the eligibility criteria for each medical program ((are)) is as follows:

(a) ((Verifiable)) Verification of age and identity (chapters 388-404, 388-406, and 388-490 WAC); and

(b) Residence in Washington state (chapter 388-468 WAC); and

(c) Citizenship or immigration status in the United States (chapter 388-424 WAC); and

(d) Possession of a valid Social Security Account Number (chapter ((388-474)) 388-476 WAC); and

(e) Assignment of medical support rights to the state of Washington (WAC 388-505-0540); and

(f) Cooperation in securing medical support (chapter 388-422 WAC); and

(g) Countable resources ((which are)) within program limits (chapters 388-470 and 388-478 WAC); and

(h) Countable income ((which are)) within program limits (chapters 388-450 and 388-478 WAC).

(4) In addition to the general eligibility requirements in subsection (3) of this section, each program has specific eligibility requirements as described in applicable WAC.

(5) Persons living in ((correctional institutions)) a public institution, including a correctional facility, are not eligible for the department's medical coverage programs. A person living in a city or county jail may be considered only for the medically indigent (MI) program. For a person under age twenty or over age sixty-five who is a patient in an institution for mental disease see WAC 388-513-1315(13) for exception.

(6) Persons terminated from SSI or TANF cash grants and those who lose eligibility for categorically needy (CN) medical coverage have their CN coverage ((extended)) continued while their eligibility for other medical programs is redetermined. This ((extension)) continuation of medical coverage is described in chapter 388-434 WAC.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-503-0505, filed 7/31/98, effective 9/1/98. Formerly WAC 388-501-0110, 388-503-0305 and 388-505-0501.]


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

WAC 388-503-0510   How a client is determined "related to" a categorical program.   (1) A person is related to the Supplemental Security Income (SSI) program if they are:

(a) Aged, blind, or disabled as defined in WAC 388-511-1105(1) or chapter 388-475 WAC; or

(b) Considered as eligible for SSI under WAC 388-511-1105(5) chapter 388-475 WAC; or

(c) Children meeting the requirements of WAC 388-505-0210(6).

(2) A person or family is considered to be related to the temporary assistance for needy families (TANF) program ((or the state-funded assistance (SFA) program)) if they meet:

(a) The program requirements for the TANF ((or the SFA)) cash assistance programs or the requirements of WAC 388-505-0220, 388-505-0210, or 388-505-0210 (3) or (4), or ((388-503-0310 (17)(b))); or

(b) Would meet such requirements except that((:

(i))) the assistance unit's countable income ((exceeds)) or resources exceed the TANF ((or the SFA program standards in chapter 388-478 WAC; or

(ii) The assistance unit's countable resources exceed the cash program standards in chapter 388-470 WAC)).

(3) Persons related to SSI or to TANF are eligible for categorically needy (CN) or medically needy (MN) medical coverage if they meet the other eligibility criteria for these medical programs. See chapters 388-475, 388-505 and 388-519 WAC for these eligibility criteria.

(4) Persons related to SSI or to TANF and who receive the related CN medical coverage have redetermination rights as described in WAC 388-503-0505(6).

(((5) Persons related to SFA are eligible for state-funded medical coverage as long as they meet the other eligibility criteria for the medical program. The state-funded medical coverage has the same scope of coverage as CN or MN coverage described in subsection (3) of this section.))

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-503-0510, filed 7/31/98, effective 9/1/98.]

Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings.
AMENDATORY SECTION(Amending WSR 98-16-044, filed 7/31/98, effective 9/1/98)

WAC 388-503-0515   Medical coverage resulting from a cash grant.   (1) Families or individuals eligible for SSI, SSI state supplement or TANF cash grants are automatically eligible for categorically needy (CN) medical coverage. These clients receive medical coverage benefits without making a separate application. Certification for CN medical coverage parallels that for the cash benefits.

(2) Upon termination of cash benefits as described in subsection (1) of this section, medical coverage continues until the client's eligibility for other medical coverage can be completed. Continuing medical coverage is terminated if the client does not cooperate with the eligibility re-determination process.

(((3) Families or individuals eligible for or related to state financial assistance (SFA) cash grants are eligible for state-funded medical coverage. For this program, the term "related-to" is defined parallel to WAC 388-503-0510(2). The scope of medical coverage parallels that for the federally funded CN program.))

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-503-0515, filed 7/31/98, effective 9/1/98.]

3129.1
AMENDATORY SECTION(Amending WSR 98-16-044, filed 7/31/98, effective 9/1/98)

WAC 388-408-0055   Medical assistance units.   (1) A medical assistance unit (MAU) is determined on the basis of relationship and financial responsibility.

(a) Married persons, living together are financially responsible for each other;

(b) Parents are financially responsible for their unmarried, minor children living in the same household;

(c) A parent's financial responsibility is limited when their minor child is receiving inpatient chemical dependency or mental health treatment. Only the income a parent chooses to contribute to the child is considered available when:

(i) The treatment is expected to last ninety days or more;

(ii) The child is in court-ordered out-of-home care in accordance with chapter 13.34 RCW; or

(iii) The department determines the parents are not exercising responsibility for the care and control of the child.

(d) Minor children are not financially responsible for their parents or for their siblings.

(2) Certain situations require the establishment of separate MAUs for some family members living in the same household. Separate MAUs are established for:

(a) A pregnant minor, regardless of whether she lives with her parent(s);

(b) A child with income;

(c) A child with resources which makes another family member ineligible for medical assistance;

(d) A child of unmarried parents when both parents reside with the child;

(e) Each unmarried parent of a child in common, plus any of their children who are not in separate MAUs;

(f) A ((nonresponsible)) caretaker relative that is not financially responsible for the support of the child;

(g) SSI recipients or SSI-related persons ((related to SSI)) from the non-SSI related family members;

(h) The purpose of applying medical income standards for an:

(i) SSI-related applicant whose spouse is not relatable to SSI or is not applying for SSI-related medical; and

(ii) Ineligible spouse of an SSI-recipient.

(3) Only the parent's income actually contributed to a pregnant minor is considered income to the minor.

(4) A parent's income up to one hundred percent of the Federal Poverty Level (FPL) is allocated to the parent and other members of the parent's MAU. The excess is allocated among their children in separate MAUs.

(5) A parent's resources are allocated equally among the parent and all persons in the parent's household for whom the parent is financially responsible. This includes family members in separate MAUs.

(6) Countable income for medical programs is described in WAC 388-450-0150 and 388-450-0210.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-408-0055, filed 7/31/98, effective 9/1/98. Formerly WAC 388-506-0610, 388-506-0630 and 388-507-0730.]

3116.1
AMENDATORY SECTION(Amending WSR 98-16-044, filed 7/31/98, effective 9/1/98)

WAC 388-416-0010   Medical certification periods for recipients of cash assistance programs.   (1) The certification period for medical services begins on the first day of the month of application when the client is determined eligible for cash assistance for one of the following programs:

(a) Temporary assistance for needy families (TANF) ((or state family assistance (SFA))); ((or))

(b) Supplemental Security Income (SSI); or

(c) ((General assistance for pregnant women (GA-S); or

(d) General assistance for children (GA-H); or

(e))) Refugee assistance.

(2) The certification period for the medical programs associated with the cash programs in subsection (1) of this section continues as long as eligibility for these programs lasts. When a client's cash assistance is terminated, eligibility for medical assistance is continued until eligibility is redetermined as described in WAC ((388-418-WAC)) 388-418-0025.

(3) The certification period for medical can begin up to three months prior to the month of application for clients described in subsection (1) of this section if the conditions in WAC 388-416-0015(6) apply.

(4) The certification period for medical care services begins on the date eligibility begins for the following cash assistance programs:

(a) General assistance for unemployable persons (GA-U); or

(b) Alcohol and drug abuse treatment and support act (ADATSA) programs, when the client is either receiving a grant or waiting for treatment to begin.

(5) The certification period for medical care services for clients in subsection (4) of this section runs concurrently with the period of eligibility for the client's cash assistance program.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-416-0010, filed 7/31/98, effective 9/1/98. Formerly WAC 388-521-2110, 388-521-2120, 388-522-2210 and 388-524-2420.]


REPEALER

     The following section of the Washington Administrative Code is repealed:
WAC 388-416-0025 Certification period for children's health program.

Washington State Code Reviser's Office