WSR 99-15-044

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed July 15, 1999, 10:24 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 99-07-103.

Title of Rule: WAC 388-478-0075 Medical programs--Monthly income standards and 388-478-0085 Medicare cost-sharing programs.

Purpose: Implements the increased standards for the federal poverty level, which was effective April 1, 1999.

Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.530.

Statute Being Implemented: Poverty guidelines updated annually in the federal register under authority of Section 673(2) of the Omnibus Budget Reconciliation Act of 1981 (42 U.S.C. 9902(2)).

Summary: These amendments increase the monthly income standards for children, pregnant women and for people participating in the Medicare cost-sharing programs.

Reasons Supporting Proposal: To amend state rules to implement the increased standards for the federal poverty level.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Joanie Scotson, Medical Assistance Administration, Mailstop 45530, Olympia, WA 98504-5530, (360) 753-7462.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is necessary because of federal law, Section 673(2) of the Omnibus Budget Reconciliation Act of 1981 (42 U.S.C. 9902(2)).

Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose above.

Proposal Changes the Following Existing Rules: See Purpose above.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This proposed rule has no impact on small businesses. It affects eligibility for medical assistance programs.

RCW 34.05.328 does not apply to this rule adoption. These proposed rules implement federal standards. RCW 34.05.328 (5)(b)(vii) exempts DSHS rules that apply to eligibility.

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on August 24, 1999, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by August 10, 1999, phone (360) 664-6094, TTY (360) 664-6178, e-mail wallpg@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by August 24, 1999.

Date of Intended Adoption: August 26, 1999.

July 14, 1999

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

2542.6
AMENDATORY SECTION(Amending WSR 98-16-044, filed 7/31/98, effective 9/1/98)

WAC 388-478-0075
Medical programs--Monthly income standards ((for)) based on the federal poverty level ((income based programs)) (FPL).

(1) The department bases the income ((eligibility)) standard upon the Federal Poverty Level (FPL) for the following medical programs ((is based upon the Federal Poverty Level (FPL) as established by the U.S. Department of Labor and updated annually)):

(a) Children's health program is one hundred percent of FPL((,));

(b) Pregnant women's program is one hundred eighty-five percent of FPL((, and));

(c) Children's categorically needy program is two hundred percent of FPL; and

(d) The children’s health insurance program (CHIP), effective January 1, 2000, is over two hundred percent of FPL but under two hundred fifty percent of FPL.

(2) ((The FPL is effective as of)) Beginning April 1, ((1998.)) 1999, the monthly FPL standards are:


FAMILY

SIZE

100%

FPL

185% FPL 200% FPL 250%

FPL

1 $ ((671)) 687 $((1242)) 1271 $((1342)) 1374 $1717
2 $ ((905)) 922 $((1673)) 1706 $((1809)) 1844 $2305
3 $((1138)) 1157 $((2105)) 2140 $((2275)) 2314 $2892
4 $((1371)) 1392 $((2537)) 2575 $((2742)) 2784 $3480
5 $((1605)) 1627 $((2968)) 3010 $((3209)) 3254 $4067
6 $((1838)) 1862 $((3400)) 3445 $((3675)) 3724 $4655
7 $((2071)) 2097 $((3832)) 3879 $((4142)) 4194 $5242
8 $((2305)) 2332 $((4263)) 4314 $((4609)) 4664 $5830
9 $((2538)) 2567 $((4695)) 4749 $((5075)) 5134 $6417
10 $((2771)) 2802 $((5127)) 5184 $((5542)) 5604 $7005
Add to the ten person standard for each person over ten:
$ ((234)) 235 $ ((432)) 435 $((467)) 470 $588

(3) There are no resource limits for the programs under this section.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090.  98-16-044, 388-478-0075, filed 7/31/98, effective 9/1/98. Formerly WAC 388-507-0805, 388-508-0810, 388-509-0910, 388-509-0920, 388-509-0940 and 388-509-0960.]


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

WAC 388-478-0085
Medicare cost sharing programs--Monthly income and countable resources standards.

(1) The qualified Medicare beneficiary (QMB) program income standard is ((based upon)) one hundred percent of the Federal Poverty Level (FPL). Beginning April 1, ((1998, this)) 1999, the QMB program's income standards are:


(a) One person $ ((671)) 687
(b) Two persons $ ((905)) 922

(2) The special low-income Medicare beneficiary (SLMB) program income standard is over one hundred percent of ((the)) FPL, but under one hundred twenty percent of ((the)) FPL. Beginning April 1, ((1998, this)) 1999, the SLMB program's income standards are:


Minimum Maximum
(a) One person $ ((671.01)) 687.01 $ ((805)) 824
(b) Two persons $ ((905.01)) 922.01 $((1085)) 1106

(3) The expanded special low-income Medicare beneficiary (ESLMB) program income standard is over one hundred twenty percent of ((the)) FPL, but under one hundred thirty-five percent of ((the)) FPL. Beginning April 1, ((1998, this)) 1999, the ESLMB program's income standards are:

Minimum Maximum
(a) One person $ ((805.01)) 824.01 $ ((906)) 927
(b) Two persons $((1085.01)) 1106.01 $((1221)) 1245

(4) The qualified disabled working individual (QDWI) program income standard is standard is based upon two hundred percent of ((the)) FPL. Beginning April 1, ((1998, this)) 1999, the QDWI program's income standards are:


(a) One person $((1342)) 1374
(b) Two persons $((1809)) 1844

(5) The qualified individual (QI) program income standard is over one hundred thirty-five percent of ((the)) FPL, but under one hundred seventy-five percent of ((the)) FPL. Beginning April 1, ((1998 this)) 1999, the QI program's income standards are:


Minimum Maximum
(a) One person $ ((906.01)) 927.01 $((1174)) 1202
(b) Two persons $((1221.01)) 1245.01 $((1583)) 1613

(6) The ((countable)) resource standard((s)) for ((all of)) the Medicare cost sharing programs in this section((s are the same. These resource standards are)) is:


(a) One person $4000
(b) Two persons $6000

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090.  98-16-044, 388-478-0085, filed 7/31/98, effective 9/1/98. Formerly WAC 388-517-1715, 388-517-1730, 388-517-1750 and 388-517-1770.]

Washington State Code Reviser's Office