BILL REQ. #:  H-4582.1 

Read first time 01/21/08.   Referred to Committee on Human Services.

     AN ACT Relating to facilitating continuity of medical assistance for persons confined in correctional institutions and institutions for mental diseases; amending RCW 74.08.025, 74.08.060, 74.09.010, and 74.09.555; adding a new section to chapter 74.09 RCW; and providing an effective date.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 74.08.025 and 2005 c 174 s 2 are each amended to read as follows:
     (1) Public assistance may be awarded to any applicant:
     (a) Who is in need and otherwise meets the eligibility requirements of department assistance programs; and
     (b) Who has not made a voluntary assignment of property or cash for the purpose of qualifying for an assistance grant((; and)).
     (((c) Who is not)) (2) A person who is an inmate of a public institution except as a patient in a medical institution or except as an inmate in a public institution who could qualify for federal aid assistance((: PROVIDED, That)) shall not receive public assistance benefits while he or she is an inmate of a public institution, except as otherwise provided by state law. A person who is placed on electronic home monitoring is not an inmate of a public institution under this subsection, and is not prohibited from receiving public assistance benefits on that basis.
     (3) The assistance paid by the department to recipients in nursing homes, or receiving nursing home care, may cover the cost of clothing and incidentals and general maintenance exclusive of medical care and health services. The department may pay a grant to cover the cost of clothing and personal incidentals in public or private medical institutions and institutions for tuberculosis. The department shall allow recipients in nursing homes to retain, in addition to the grant to cover the cost of clothing and incidentals, wages received for work as a part of a training or rehabilitative program designed to prepare the recipient for less restrictive placement to the extent permitted under Title XIX of the federal social security act.
     (((2))) (4) Any person otherwise qualified for temporary assistance for needy families under this title who has resided in the state of Washington for fewer than twelve consecutive months immediately preceding application for assistance is limited to the benefit level in the state in which the person resided immediately before Washington, using the eligibility rules and other definitions established under this chapter, that was obtainable on the date of application in Washington state, if the benefit level of the prior state is lower than the level provided to similarly situated applicants in Washington state. The benefit level under this subsection shall be in effect for the first twelve months a recipient is on temporary assistance for needy families in Washington state.
     (((3))) (5) Any person otherwise qualified for temporary assistance for needy families who is assessed through the state alcohol and substance abuse program as drug or alcohol-dependent and requiring treatment to become employable shall be required by the department to participate in a drug or alcohol treatment program as a condition of benefit receipt.
     (((4))) (6) Pursuant to 21 U.S.C. 862a(d)(1), the department shall exempt individuals from the eligibility restrictions of 21 U.S.C. 862a(a)(1) and (2) to ensure eligibility for temporary assistance for needy families benefits and federal food assistance.

Sec. 2   RCW 74.08.060 and 1985 c 335 s 4 are each amended to read as follows:
     The department shall ((be required to)) approve or deny the application within forty-five days after ((the)) filing ((thereof)) and shall immediately notify the applicant in writing of its decision((: PROVIDED, That)). If the department is not able within forty-five days, despite due diligence, to secure all information necessary to establish ((his)) eligibility, the department ((is charged to)) shall continue to secure such information and if such information, when established, makes the applicant eligible, the department shall pay ((his)) the grant from date of authorization or forty-five days after date of application whichever is sooner.
     This rule shall not prevent an inmate of a Washington state correctional institution or Washington state institution for mental diseases as those terms are defined in RCW 74.09.010 from applying for medical assistance as described in section 4(2) of this act.
     Any person currently ineligible, who will become eligible after the occurrence of a specific event, may apply for assistance within forty-five days of that event.
     The department is authorized, in respect to work requirements, to provide employment and training services, including job search, job placement, work orientation, and necessary support services to verify eligibility.

Sec. 3   RCW 74.09.010 and 2007 c 3 s 2 are each amended to read as follows:
     As used in this chapter:
     (1) "Children's health program" means the health care services program provided to children under eighteen years of age and in households with incomes at or below the federal poverty level as annually defined by the federal department of health and human services as adjusted for family size, and who are not otherwise eligible for medical assistance or the limited casualty program for the medically needy.
     (2) (("Committee" means the children's health services committee created in section 3 of this act.)) "Correctional institution" means any place designated by law for the keeping of persons held in custody under process of law, or under lawful arrest, including state prisons, county and local jails, and other facilities operated by the department of corrections or local governmental units primarily for the purposes of punishment, correction, or rehabilitation following conviction of a criminal offense.
     (3) "County" means the board of county commissioners, county council, county executive, or tribal jurisdiction, or its designee. A combination of two or more county authorities or tribal jurisdictions may enter into joint agreements to fulfill the requirements of RCW 74.09.415 through 74.09.435.
     (4) "Department" means the department of social and health services.
     (5) "Department of health" means the Washington state department of health created pursuant to RCW 43.70.020.
     (6) "Institution for mental diseases" means a hospital, nursing facility, or other institution of more than sixteen beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services, which would be excluded from federal financial participation in expenditure for services under federal law.
     (7) "Internal management" means the administration of medical assistance, medical care services, the children's health program, and the limited casualty program.
     (((7))) (8) "Limited casualty program" means the medical care program provided to medically needy persons as defined under Title XIX of the federal social security act, and to medically indigent persons who are without income or resources sufficient to secure necessary medical services.
     (((8))) (9) "Medical assistance" means the federal aid medical care program provided to categorically needy persons as defined under Title XIX of the federal social security act.
     (((9))) (10) "Medical care services" means the limited scope of care financed by state funds and provided to general assistance recipients, and recipients of alcohol and drug addiction services provided under chapter 74.50 RCW.
     (((10))) (11) "Nursing home" means nursing home as defined in RCW 18.51.010.
     (((11))) (12) "Poverty" means the federal poverty level determined annually by the United States department of health and human services, or successor agency.
     (((12))) (13) "Secretary" means the secretary of social and health services.
     (((13))) (14) "Full benefit dual eligible beneficiary" means an individual who, for any month: Has coverage for the month under a medicare prescription drug plan or medicare advantage plan with part D coverage; and is determined eligible by the state for full medicaid benefits for the month under any eligibility category in the state's medicaid plan or a section 1115 demonstration waiver that provides pharmacy benefits.

NEW SECTION.  Sec. 4   A new section is added to chapter 74.09 RCW to read as follows:
     (1) An individual who is receiving medical assistance benefits at the time he or she becomes confined in a Washington state correctional institution or Washington state institution for mental diseases shall not be terminated from medical assistance on the basis of confinement. Medical assistance to that individual shall be suspended during the period of confinement in the following manner:
     (a) No medical assistance benefits shall be paid to the individual while he or she is in confinement, except as explicitly authorized by state law.
     (b) Upon the individual's release from confinement, medical assistance benefits for the individual shall be immediately resumed. No new application is required to effectuate resumption of medical assistance.
     (c) The individual is not required to recertify eligibility for medical assistance during the period in which he or she is confined.
     (i) If the individual is confined at the time at which he or she would otherwise be required to recertify eligibility for medical assistance, the department may allow the individual to recertify eligibility prior to release from confinement, or may require the individual to recertify eligibility immediately following release, or at any later time established by rule.
     (ii) The department shall explore the feasibility of obtaining a medicaid state plan amendment to allow the state to receive medicaid matching funds for medical assistance provided to an individual during the period in which recertification of eligibility is pending under (c)(i) of this subsection.
     (d) The department may terminate medical assistance to a person who is released from confinement to an address outside of the state of Washington, or to an individual who receives medical assistance based on the children's health program who ages out of the program during the period of confinement.
     (e) The department shall collaborate with the Washington association of sheriffs and police chiefs, the department of corrections, the regional support networks, department field offices, institutions for mental diseases, and correctional institutions to establish policies and procedures that will facilitate speedy notification of the department when an individual enrolled in medical assistance is confined in a Washington state correctional institution or Washington state institution for mental diseases, or is released from confinement. The department shall adopt policies which promote continuity of medical assistance for such individuals, and make efforts to inform individuals in confinement about suspension of medical assistance and any applicable recertification requirement upon release.
     (f) To the extent funding is provided for this purpose, the department shall expedite processing of applications for federal supplemental security income or social security disability benefits for individuals whose medical assistance benefits are suspended under this section.
     (2)(a) The department shall consider an application for medical assistance from an individual who is confined in a Washington state correctional institution or Washington state institution for mental diseases if:
     (i) The individual does not have an established final release date because the individual has not yet been tried or sentenced in a criminal case; or
     (ii) The individual is scheduled to be released from confinement within the next four months.
     (b) The department shall approve or deny an application for medical assistance from a confined individual within forty-five days after filing thereof and shall immediately notify the applicant in writing of its decision. If the department is unable despite due diligence to secure necessary information to establish eligibility within forty-five days, the department shall continue to secure such information for a reasonable period. If the department determines that the applicant would be eligible for medical assistance except for the fact of confinement, the department shall approve the application, and medical assistance for the individual shall be suspended as described in subsection (1) of this section. No benefits shall be paid to the individual prior to release from confinement, except as explicitly authorized by law.
     (c) In reviewing an application for medical assistance under this subsection, the department shall include in its consideration evidence of any medical evaluation performed within one year of the date of application. If insufficient evidence is available upon which to make a determination, the department shall arrange for an evaluation to be performed consistent with RCW 74.09.075.
     (3) The department is authorized to make rules necessary to implement this section.

Sec. 5   RCW 74.09.555 and 2005 c 503 s 12 are each amended to read as follows:
     (1) The department shall adopt rules and policies providing that when persons with a mental disorder, who were enrolled in medical assistance immediately prior to confinement, are released from confinement, their medical assistance coverage will be fully reinstated on the day of their release((, subject to any expedited review of their continued eligibility for medical assistance coverage that is required under federal or state law)).
     (2) The department, in collaboration with the Washington association of sheriffs and police chiefs, the department of corrections, and the regional support networks, shall establish procedures for coordination between department field offices, institutions for mental diseases, and correctional institutions, ((as defined in RCW 9.94.049,)) that result in ((prompt reinstatement of eligibility and)) speedy eligibility determinations for persons who are likely to be eligible for medical assistance services ((upon release from confinement)). Procedures developed under this subsection must address:
     (a) Mechanisms for receiving applications for medical assistance ((services applications)) on behalf of confined persons in anticipation of their release from confinement;
     (b) Expeditious review of applications filed by or on behalf of confined persons and, to the extent practicable, completion of the review before the person is released;
     (c) Mechanisms for providing medical assistance ((services)) identity cards to persons eligible for medical assistance services immediately upon or prior to their release from confinement; and
     (d) Coordination with the federal social security administration, through interagency agreements or otherwise, to expedite processing of applications for federal supplemental security income or social security disability benefits, including federal acceptance of applications on behalf of confined persons.
     (3) Where medical or psychiatric examinations during a person's confinement indicate that the person is disabled, the correctional institution or institution for mental diseases shall provide the department with that information for purposes of making medical assistance eligibility and enrollment determinations prior to the person's release from confinement. The department shall, to the maximum extent permitted by federal law, use the examination in making its determination whether the person is disabled and eligible for medical assistance.
     (4) For purposes of this section, "confined" or "confinement" means incarcerated in a correctional institution((, as defined in RCW 9.94.049,)) or admitted to an ((institute)) institution for mental diseases((, as defined in 42 C.F.R. part 435, Sec. 1009 on July 24, 2005.
     (5) For purposes of this section, "likely to be eligible" means that a person:
     (a) Was enrolled in medicaid or supplemental security income or general assistance immediately before he or she was confined and his or her enrollment was terminated during his or her confinement; or
     (b) Was enrolled in medicaid or supplemental security income or general assistance at any time during the five years before his or her confinement, and medical or psychiatric examinations during the person's confinement indicate that the person continues to be disabled and the disability is likely to last at least twelve months following release)).
     (((6))) (5) The economic services administration shall adopt standardized statewide screening and application practices and forms designed to facilitate ((the)) applications ((of a)) for medical assistance by persons confined ((person who is likely to be eligible for medicaid)) in a correctional institution or institution for mental diseases.

NEW SECTION.  Sec. 6   Section 4 of this act takes effect January 1, 2009.