WSR 16-07-006 PERMANENT RULES HEALTH CARE AUTHORITY (Washington Apple Health) [Filed March 3, 2016, 3:06 p.m., effective April 3, 2016] Effective Date of Rule: Thirty-one days after filing.
Purpose: To improve clarity and align with 42 C.F.R. 435.603.
Citation of Existing Rules Affected by this Order: Amending WAC 182-506-0010.
Adopted under notice filed as WSR 15-24-110 on December 1, 2015.
Changes Other than Editing from Proposed to Adopted Version: WAC 182-506-0010 Medical assistance units for MAGI-based programs. This section applies to applicants or recipients whose financial eligibility for Washington apple health coverage is based on modified adjusted gross income methodology under WAC 182-503-0510 and 182-509-0300.
(1) General medical assistance unit (MAU) rules.
(a) The rules in this section describe how the medicaid agency must determine who is in an applicant's or recipient's MAU.
(b) In this section and WAC 182-506-0012, "applicant" means a person applying for or receiving coverage.
(cb) Each person will have an individualized MAU and may have different eligibility results than other people on the same application.
(dc) The countable income used to determine a person's eligibility is the sum of the countable income of everyone in the person's MAU.
(2) Rules regardless of tax filing status.
(a) If a married couple resides together, the agency must include both people in each other's MAU regardless of tax filing status.
(b) If a member of the MAU is pregnant, the number of people in the MAU increases by one for each unborn child.
(c) A deceased person does not count in the MAU of other applicants or recipients except in the month the person died.
(3) People residing in an institution under chapter 182-514 WAC. An applicant or recipient is the only person in the MAU if the applicant or recipient:
(a) Has resided in a medical institution, institution for mental diseases (IMD), or inpatient psychiatric facility for thirty consecutive days; or
(b) Based on an assessment by the department of social and health services, is likely to reside in a medical institution, IMD, or inpatient psychiatric facility for thirty consecutive days.
WAC 182-506-0012 Determining a person's medical assistance unit. This section applies to people whose financial eligibility for Washington apple health coverage is based on modified adjusted gross income methodology.
(1) Determining a tax filer's medical assistance unit (MAU).
(a) A tax filer is a person who:
(i) Expects to file a federal income tax return; and
(ii) Does not expect to be claimed as a tax dependent on a federal income tax return.
(b) If the applicant or recipient is a tax filer, the following people constitute the applicant's or recipient's MAU:
(i) The tax filer;
(ii) The tax filer's spouse, if residing with the tax filer; and
(iii) Everyone the tax filer expects to claim as a tax dependent.
(2) Determining a tax dependent's MAU.
(a) A tax dependent is a person who expects to be claimed as a tax dependent on a tax filer's federal income tax return.
(b) If the applicant or recipient is a tax dependent:
(i) The following people constitute the tax dependent's MAU unless the tax dependent meets one of the exceptions in (b)(ii) of this subsection:
(A) The tax dependent;
(B) The tax dependent's spouse, if living with the tax dependent;
(C) The tax filer who claims the tax dependent;
(D) The spouse of the tax filer who claims the tax dependent, if living with the tax filer; and
(E) All tax dependents claimed by the tax filer.
(ii) A tax dependent who meets one of the exceptions below is treated as a nonfiler under subsection (3) of this section:
(A) A tax dependent who is neither the spouse nor the child of the tax filer;
(B) A child under age nineteen who resides with both parents and those parents do not file a joint tax return; or
(C) The tax dependent expects to be claimed by a noncustodial parent.
(3) Determining a nonfiler's MAU.
(a) A nonfiler is a person who does not expect to file a federal income tax return and either:
(i) Does not expect to be claimed as a dependent; or
(ii) Meets one of the exceptions listed in subsection (2)(b)(ii) of this section.
(b) If the applicant or recipient is a nonfiler, the nonfiler and the following people constitute the applicant or recipient's MAU, but only if residing with the nonfiler:
(i) The nonfiler's spouse;
(ii) The nonfiler's children under age nineteen; and
(iii) If the nonfiler is under age nineteen, the nonfiler's parents and the nonfiler's siblings under age nineteen.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, 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 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 1, 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 1, Amended 1, Repealed 0.
Date Adopted: March 3, 2016.
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 14-01-021, filed 12/9/13, effective 1/9/14)
WAC 182-506-0010 Medical assistance units (((MAU))) for MAGI-based ((Washington apple health)) programs.
(((1) A person's financial eligibility for programs that use modified adjusted gross income (MAGI) methodology, as described in WAC 182-509-0300, is based on multiple factors including relationship to other household members, age, tax status and pregnancy. The rules in this section describe which household members' income is counted in determining a person's eligibility. These household members comprise the person's "medical assistance unit" (MAU). Members of a single household may have different MAUs.
(2) The determination of countable income for MAGI-based programs is described in chapter 182-509 WAC.
(3) A person's MAGI-based countable income equals the total countable income of the members of the person's MAU (see WAC 182-509-0001). This income is compared to the income standard for the MAU size when determining eligibility for programs based on a federal poverty limit standard.
(4) The number of persons in the MAU is increased by one for each unborn child for each pregnant woman already included in the MAU under this section.
(5) For any given tax year in which an initial eligibility determination, renewal of eligibility, post-eligibility review or change of circumstance is made, MAUs are determined as follows:
(a) The MAU for a person who expects to file a federal tax return and does not expect to be claimed as a tax dependent by another tax filer includes the following:
(i) The person (tax filer) and all persons the tax filer expects to claim as a tax dependent; and
(ii) The following additional persons, but only if they live in the same residence:
(A) The person's spouse;
(B) The person's natural, adopted and step-children less than nineteen years of age;
(C) If the person is less than nineteen years of age, the person's natural, adopted and step-parents; and
(D) If the person is less than nineteen years of age, the natural, adoptive and step-siblings who are less than nineteen years of age.
(b) The MAU for a person who expects to be claimed as a tax dependent by a tax filer includes:
(i) The person (tax dependent), the tax filer, and any other persons in the tax filer's MAU (as determined according to (a) of this subsection), except if:
(A) The person is not the spouse or biological, adopted, or natural child of the tax filer;
(B) The person is under age nineteen and living in the same residence as both parents, but is expected to be claimed as a tax dependent by only one parent, either because the parents are unmarried or do not expect to file taxes jointly; or
(C) The person is under age nineteen and expects to be claimed by a noncustodial parent.
(ii) If (b)(i)(A), (B) or (C) of this section applies, the person's MAU is determined according to the nonfiler rules described in (c) of this subsection.
(c) The MAU for a person who does not expect to file a federal tax return and who either does not expect to be claimed as a tax dependent or meets one of the tax dependent exceptions in (b) of this subsection includes the following persons, but only if they live in the same residence:
(i) The person (self);
(ii) The person's spouse;
(iii) The person's natural, adopted and step-children less than nineteen years of age;
(iv) If the person is less than nineteen years of age, the person's natural, adopted and step-parents; and
(v) If the person is less than nineteen years of age, the natural, adoptive and step-siblings who are less than nineteen years of age.)) This section applies to applicants or recipients whose financial eligibility for Washington apple health coverage is based on modified adjusted gross income methodology under WAC 182-503-0510 and 182-509-0300.
(1) General medical assistance unit (MAU) rules.
(a) The rules in this section describe how the medicaid agency must determine who is in an applicant's or recipient's MAU.
(b) Each person will have an individualized MAU and may have different eligibility results than other people on the same application.
(c) The countable income used to determine a person's eligibility is the sum of the countable income of everyone in the person's MAU.
(2) Rules regardless of tax filing status.
(a) If a married couple resides together, the agency must include both people in each other's MAU regardless of tax filing status.
(b) If a member of the MAU is pregnant, the number of people in the MAU increases by one for each unborn child.
(c) A deceased person does not count in the MAU of other applicants or recipients except in the month the person died.
(3) People residing in an institution under chapter 182-514 WAC. An applicant or recipient is the only person in the MAU if the applicant or recipient:
(a) Has resided in a medical institution, institution for mental diseases (IMD), or inpatient psychiatric facility for thirty consecutive days; or
(b) Based on an assessment by the department of social and health services, is likely to reside in a medical institution, IMD, or inpatient psychiatric facility for thirty consecutive days.
NEW SECTION
WAC 182-506-0012 Determining a person's medical assistance unit.
This section applies to people whose financial eligibility for Washington apple health coverage is based on modified adjusted gross income methodology.
(1) Determining a tax filer's medical assistance unit (MAU).
(a) A tax filer is a person who:
(i) Expects to file a federal income tax return; and
(ii) Does not expect to be claimed as a tax dependent on a federal income tax return.
(b) If the applicant or recipient is a tax filer, the following people constitute the applicant's or recipient's MAU:
(i) The tax filer;
(ii) The tax filer's spouse, if residing with the tax filer; and
(iii) Everyone the tax filer expects to claim as a tax dependent.
(2) Determining a tax dependent's MAU.
(a) A tax dependent is a person who expects to be claimed as a tax dependent on a tax filer's federal income tax return.
(b) If the applicant or recipient is a tax dependent:
(i) The following people constitute the tax dependent's MAU unless the tax dependent meets one of the exceptions in (b)(ii) of this subsection:
(A) The tax dependent;
(B) The tax dependent's spouse, if living with the tax dependent;
(C) The tax filer who claims the tax dependent;
(D) The spouse of the tax filer who claims the tax dependent, if living with the tax filer; and
(E) All tax dependents claimed by the tax filer.
(ii) A tax dependent who meets one of the exceptions below is treated as a nonfiler under subsection (3) of this section:
(A) A tax dependent who is neither the spouse nor the child of the tax filer;
(B) A child under age nineteen who resides with both parents and those parents do not file a joint tax return; or
(C) The tax dependent expects to be claimed by a noncustodial parent.
(3) Determining a nonfiler's MAU.
(a) A nonfiler is a person who does not expect to file a federal income tax return and either:
(i) Does not expect to be claimed as a dependent; or
(ii) Meets one of the exceptions listed in subsection (2)(b)(ii) of this section.
(b) If the applicant or recipient is a nonfiler, the nonfiler and the following people constitute the applicant's or recipient's MAU, but only if residing with the nonfiler:
(i) The nonfiler's spouse;
(ii) The nonfiler's children under age nineteen; and
(iii) If the nonfiler is under age nineteen, the nonfiler's parents and the nonfiler's siblings under age nineteen.
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