Purpose: The amendment removes the requirement for a licensed medical practitioner to verify that the client is pregnant. Also other subsections were rewritten to clarify the rule.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-462-0015 Medical eligibility for pregnant women.

     Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, and 74.08.090.

     Other Authority: RCW 74.09.500, 42 U.S.C. 9902(2).

      Adopted under notice filed as WSR 05-03-081 on January 17, 2005.

     Changes Other than Editing from Proposed to Adopted Version: Editing changes only.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

     Date Adopted: March 4, 2005.

Andy Fernando, Manager

Rules and Policies Assistance Unit

     (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 Medicaid coverage if she meets the following requirements as described in WAC 388-503-0505)) categorically needy (CN) scope of care if she meets the following requirements:

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

     (b) Social security account number (chapter 388-474 WAC); and

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

     (d) Has countable income ((meets the standard)) as described in WAC 388-478-0075.

     (((3))) (2) A pregnant woman is considered for medically needy (MN) ((program coverage)) scope of care if she meets the requirements in subsection (((2))) (1)(a) through (c) of this section and:

     (a) ((Her)) Has countable income ((is greater than)) that exceeds the standard in subsection (((2))) (1)(d) of this section; and

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

     (((4))) (3) A pregnant woman ((is)) may be eligible for ((CN scope of care under the state-funded pregnant woman program)) non-citizen pregnancy medical if she is not eligible for ((programs)) medical described in subsections (1) and (2) of this section due to citizenship, immigrant status, or social security number requirements.

     (((5))) (4) A pregnant woman ((is considered for MN scope of care under the state-funded pregnant woman program if)) meeting the eligibility criteria in subsection (3) is eligible for:

     (a) ((She is not eligible for the program under subsection (4) of this section because her income exceeds the standard)) CN scope of care when the countable income is at or below the income standard described in subsection (1)(d); ((and)) or

     (b) ((Her resources do not exceed the standard in WAC 388-478-0070.)) MN scope of care when:

     (i) The countable income exceeds the standard in subsection (1)(d); and

     (ii) The resources do not exceed the standard described 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)) (5) Consider as income ((of an unmarried father of an unborn child)) to the pregnant woman the amount 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))) her by the father of her unborn child when the pregnant woman is not married to the father.

     (6) 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))) (7) 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)) for a minimum of sixty days from the end of her pregnancy. This extension continues through the end of the month in which the sixtieth day falls.

     (((12))) (8) A woman who was eligible for ((a)) medical ((program)) coverage on the last day of pregnancy is eligible for family planning services for twelve months from the end of the pregnancy even when eligibility for pregnancy was determined after the pregnancy ended.

[Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-462-0015, filed 8/12/02, effective 9/12/02. 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.]

© Washington State Code Reviser's Office