WSR 03-19-068

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed September 12, 2003, 3:55 p.m. ]

     Original Notice.

     Preproposal statement of inquiry was filed as WSR 03-14-077.

     Title of Rule: WAC 388-418-0005 Reporting requirements, 388-418-0025 Effect of changes on medical programs, 388-416-0015 Certification periods, and 388-434-0005 Eligibility reviews.

     Purpose: The proposed rules implement six-month certification periods for family and children medical programs and eliminate a year of continuous eligibility for children. This change was directed by the Legislature and is intended as a budget-savings measure.

     Statutory Authority for Adoption: RCW 74.08.090, 74.09.530.

     Statute Being Implemented: RCW 74.08.090 and 74.09.530, chapter 10, Laws of 2003.

     Summary: The department must amend these rules to implement six-month certification periods and eliminate continuous eligibility for children's medical.

     Reasons Supporting Proposal: The 2001-2003 state supplemental budget (chapter 10, Laws of 2003) included these provisions.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Mary Wood, P.O. Box 45534, Olympia, WA 98504-5534, (360) 725-1329.

     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 and Summary above.

     Proposal Changes the Following Existing Rules: Family and children's medical cases will have six-month rather than twelve-month certification periods. All reported changes during certification periods will be used to recalculate medical eligibility for children.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule amendment does not impact small businesses. It only affects DSHS clients.

     RCW 34.05.328 does not apply to this rule adoption. Per RCW 34.05.328 (5)(b)(vii), this rule amendment is exempt from the requirements of RCW 34.05.328. The rule amends eligibility requirements for medical, financial and food assistance.

     Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on October 21, 2003, at 10:00 a.m.

     Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by October 17, 2003, 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, mail to P.O. Box 45850, Olympia, WA 98504-5850, deliver to 4500 10th Avenue S.E., Lacey, WA, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., October 21, 2003.

     Date of Intended Adoption: Not sooner than October 22, 2003.

September 10, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3259.2
AMENDATORY SECTION(Amending WSR 01-11-109, filed 5/21/01, effective 7/1/01)

WAC 388-418-0005   What type of changes must I report for cash, food, and medical assistance?   For purposes of this section, an "assistance unit" or "AU" is a group of people who live together and whose income or resources we count to decide what benefits the AU gets. Even if someone in your AU is not eligible to get a benefit, we still count that person's income or resources if they are financially responsible for you or someone in your AU, such as a common child. If you are a parent of a child who gets long-term care benefits, you need only report changes in income or resources that are actually contributed to the child. Tables one, two and three below show the types of changes you must report based on the type of assistance you get. Use table one to see if you must report a change for cash or food assistance. Use table two to see if you must report a change for children's, pregnant women's, or family medical assistance. Use table three to see if you must report a change for SSI-related medical or long-term care medical assistance.


Table 1 - Cash Assistance and Food Assistance
Type of change to report when you or anyone in your assistance unit AU): Do I have to report this change for cash assistance? Do I have to report this change for food assistance?
(1) Starts to get money from a new source; Yes Yes
(2) Has unearned income that changed by more than twenty-five dollars from amount we budgeted; Yes Yes
(3) Moves into or out of your home, including newborns or if an AU member dies. This also includes when someone temporarily moves in or out; Yes Yes
(4) Moves to a new residence; Yes Yes
(5) Has a change in shelter costs; Yes, but only if you went from having no shelter costs to having a shelter cost, or from having shelter costs to not having to pay anything. You don't have to report a change in the amount you pay. Yes, report the change at your recertification. If your shelter costs go up, you could get more food assistance benefits. Report the change sooner to see if you will get more benefits.
(6) Gets married, divorced, or separated; Yes Yes
(7) Gets a vehicle; Yes Yes
(8) Has a disability that ends; Yes Yes
(9) Has countable resources that are more than the resource limits under WAC 388-470-0005; Yes Yes
(10) Gets a job or changes employers; Yes Yes
(11) Changes from part-time to full-time or full-time to part-time work. We use your employer's definition of part-time and full-time work; Yes Yes
(12) Has a change in hourly wage rate or salary; Yes Yes
(13) Stops working; Yes Yes
(14) Has a pregnancy that begins or ends; Yes No
(15) Has a change in uncovered medical expenses; No Yes, report this change only at your next eligibility review. If you are elderly or disabled and you have an increase in uncovered medical expenses, report this change sooner as you may be eligible to get more benefits.


Table 2 - Medical Assistance
Type of change to report when you or anyone in your assistance unit (AU): Do I have to report this change for family medical assistance (i.e., TANF((/SFA))-related) and children's medical? Do I have to report this change for ((children's medical and/or)) pregnancy medical?
(16) Starts to get money from a new source; Yes No
(17) Has unearned income that changed; Yes No
(18) Moves into or out of your home, including newborns or if an AU member dies. This also includes when someone temporarily moves in or out; Yes Yes
(19) Moves to a new residence; Yes Yes
(20) Has a change in shelter costs; No No
(21) Gets married, divorced, or separated; Yes No
(22) Gets a vehicle; No No
(23) Has a disability that ends; No No
(24) Has countable resources that are more than the resource limits under WAC 388-470-0005; No No
(25) Gets a job or changes employers; Yes No
(26) Changes from part-time to full-time or full-time to part-time work. We use your employer's definition of part-time and full-time work; Yes No
(27) Has a change in hourly wage rate or salary; Yes No
(28) Stops working; Yes No
(29) Has a pregnancy that begins or ends; Yes Yes
(30) Has a change in uncovered medical expenses. ((No)) Yes, but only if an AU member has spenddown. Yes, but only if an AU member has a spenddown.


Table 3 - SSI-Related Medical Assistance and Long-Term Care
Type of change to report when you or anyone in your assistance unit (AU): Do I have to report this change for SSI-related medical assistance? Do I have to report this change for long-term care (i.e., COPES, CAP, or nursing home)
(31) Starts to get money from a new source; Yes Yes
(32) Has unearned income that changed; Yes Yes
(33) Has a change in earnings or stops working Yes Yes
(34) Moves into or out of your home, including newborns or if an AU member dies. This also includes when someone temporarily moves in or out; Yes Yes
(35) Moves to a new residence; Yes Yes
(36) Has a change in shelter costs; No, unless you went from paying rent to not paying any rent. You do not need to report if your rent amount changes. Yes, if client or community spouse live in their own home
(37) Gets married, divorced, or separated; Yes Yes
(38) Gets a vehicle; Yes, but only if that person or their spouse gets SSI-related medical Yes, but only if that person gets long-term care
(39) Has a disability that ends; Yes Yes
(40) Has countable resources that are more than the resource limits, under WAC 388-470-0005 or 388-513-1350; Yes, but only if that person or their spouse get SSI-related medical Yes, but only if that person gets long-term care
(41) Has a change in uncovered medical expenses. Yes, but only if an AU member has a spenddown. Yes.

[Statutory Authority: RCW 74.08.090 and 74.04.510. 01-11-109, § 388-418-0005, filed 5/21/01, effective 7/1/01; 99-23-034, § 388-418-0005, filed 11/10/99, effective 1/1/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-418-0005, filed 7/31/98, effective 9/1/98.]


AMENDATORY SECTION(Amending WSR 02-17-030, filed 8/12/02, effective 9/12/02)

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

     (a) A CN Medicaid program; or

     (b) Any of the following cash grants:

     (i) TANF;

     (ii) SSI; or

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

     (2) ((A child remains continuously eligible for 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) 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;

     (e) Dies; or

     (f) Receives benefits under the state children's health insurance program (SCHIP) 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)) If you become ineligible for refugee cash assistance, refugee medical assistance can be continued ((only)) through the eight-month limit, as described in WAC 388-400-0035(4).

     (((4) A client receiving medical benefits with))

     (3) If you receive a TANF cash grant or family medical ((program is)), you are eligible for a medical extension, as described under WAC 388-523-0100, when ((the client's)) your cash grant or family medical program is terminated as a result of:

     (a) Earned income; or

     (b) Collection of child or spousal support.

     (((5))) (4) A change in income during a certification period does ((not)) affect eligibility for all medical programs except:

     (a) Pregnant women's medical programs; ((or))

     (b) Children's medical for newborns F05); or

     (c) The first six months of the medical extension benefits.

     (((6))) (5) For a child receiving benefits under SCHIP 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 Federal Poverty Level (FPL);

     (b) The child becomes pregnant;

     (c) A change in family size; or

     (d) The child receives SSI.

[Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-418-0025, filed 8/12/02, effective 9/12/02. 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.]

3251.1
AMENDATORY SECTION(Amending WSR 00-08-002, filed 3/22/00, effective 5/1/00)

WAC 388-416-0015   Certification periods for categorically needy (CN) medical and children's health insurance program (CHIP).   (1) A certification period is the period of time a person is determined eligible for a categorically needy (CN) medical program. Unless otherwise stated in this section, the certification period begins on the first day of the month of application and continues to the last day of the last month of the certification period.

     (2) For a child eligible for the newborn medical program, the certification period begins on the child's date of birth and continues through the end of the month of the child's first birthday.

     (3) For a woman eligible for a medical program based on pregnancy, the certification period ends the last day of the month that includes the sixtieth day from the day the pregnancy ends.

     (4) For families((,)) and children((, and SSI-related persons,)) the certification period is ((twelve)) six months. When the medical assistance unit is also receiving benefits under a cash or food assistance program, the medical certification period is updated to begin anew at each:

     (a) Approved application for cash or food assistance; or

     (b) Completed eligibility review.

     (5) For an SSI-related person the certification period is twelve months.

     (6) When the child turns nineteen the certification period ends even if the ((twelve)) six-month period is not over. The certification period may be extended past the end of the month the child turns nineteen when:

     (a) The child is receiving inpatient services on the last day of the month the child turns nineteen;

     (b) The inpatient stay continues into the following month or months; and

     (c) The child remains eligible except for exceeding age nineteen.

     (((6))) (7) A retroactive certification period can begin up to three months immediately before the month of application when:

     (a) The client would have been eligible for medical assistance if the client had applied; and

     (b) The client received covered medical services as described in WAC 388-529-0100.

     (((7))) (8) If the client is eligible only during the three-month retroactive period, that period is the only period of certification.

     (((8))) (9) Any months of a retroactive certification period are added to the designated certification periods described in this section.

     (((9))) (10) For a child determined eligible for CHIP medical benefits as described in chapter 388-542 WAC:

     (a) The certification periods are described in subsections (1), (4), and (((5))) (6) of this section;

     (b) There is not a retroactive eligibility period as described in subsections (((6), (7), and (8))) (7), (8), and (9); and

     (c) For a child who has creditable coverage at the time of application, the certification period begins on the first of the month after the child's creditable coverage is no longer in effect, if:

     (i) All other CHIP eligibility factors are met; and

     (ii) An eligibility decision is made per WAC 388-406-0035.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090 and 74.09.450. 00-08-002, § 388-416-0015, filed 3/22/00, effective 5/1/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-416-0015, filed 7/31/98, effective 9/1/98. Formerly 388-509-0970, 388-521-2105, 388-522-2210 and 388-522-2230.]

3253.2
AMENDATORY SECTION(Amending WSR 99-23-083, filed 11/16/99, effective 1/1/00)

WAC 388-434-0005   The department reviews each client's eligibility for benefits on a regular basis.   (1) If you receive cash assistance, the department reviews your eligibility for assistance at least once every six months.

     (2) When it is time for your eligibility review, the department requires you to complete a review form. We use the information you provide to determine your eligibility for all assistance programs.

     (3) If you complete an interview for assistance with a department representative and sign the printed application for benefits (AFB) form, you do not have to complete a separate review form.

     (4) For cash assistance, the eligibility review form or the AFB must be dated and signed by both husband and wife, or both parents of a child in common when the parents live together.

     (5) If you receive medical assistance only, the eligibility review form or the AFB must be signed by at least one parent when the parents live together.

     (6) We may move the date of your eligibility review if we decide your circumstances need to be reviewed sooner.

     (7) At your review, we look at:

     (a) All eligibility requirements under WAC 388-400-0005 through 388-400-0035, 388-503-0505 through 388-503-0515, and 388-505-0210 through 388-505-0220;

     (b) Changes that happened since we last determined your eligibility; and

     (c) Changes that are anticipated to happen during the next review period.

     (8) If you receive medical assistance only, we set your eligibility review date in advance under WAC 388-416-0005 through 388-416-0035. We will start the review process before your benefits end.

     (9) Clients are responsible for attending an interview if one is required under WAC 388-452-0005.

     (10) If you do not complete the eligibility review for cash assistance, you are considered to be withdrawing your request for continuing assistance((.)), therefore:

     (a) Your cash assistance benefits will end((.)); and

     (b) Your medical assistance will continue for ((twelve)) six consecutive months from the last:

     (i) Application;

     (ii) Eligibility review; or

     (iii) Food assistance application or rec2ertification.

     (11) We must send you written notice under WAC 388-458-0005, 388-458-0010, and 388-450-0015 before assistance can be suspended, terminated, or a benefit error is established as a result of your eligibility review.

     (12) If you are currently receiving cash or medical assistance, and you are found to no longer be eligible for benefits, we will determine if you are eligible for other medical programs. Until we decide if you are eligible for ((other programs)) another program, your medical assistance will continue under WAC 388-418-0025 ((even if you request that your benefits end)).

     (13) When a client is determined to need necessary supplemental accommodation (NSA) under WAC ((388-200-1300)) 388-472-0010, we will help the client meet the requirements of this section.

[Statutory Authority: RCW 74.08.090 and 74.04.510. 99-23-083, § 388-434-0005, filed 11/16/99, effective 1/1/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-434-0005, filed 7/31/98, effective 9/1/98. Formerly WAC 388-522-2230.]

     Reviser's note: The spelling error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.

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