Date of Adoption: March 22, 2000.

Purpose: Adds language concerning the implementation of the children's health insurance program and has been rewritten to comply with the principles of Executive Order 97-02.

Citation of Existing Rules Affected by this Order: Amending WAC 388-416-0015 and 388-418-0025.

Statutory Authority for Adoption: RCW 74.04.050, 74.04.055, 74.04.057, and 74.08.090.

Other Authority: RCW 74.09.450.

Adopted under notice filed as WSR 00-04-045 on January 27, 2000.

Changes Other than Editing from Proposed to Adopted Version: WAC 388-416-0015, added subsection (9)(c) concerning certification start date for a child with creditable coverage in the month of application. WAC 388-418-0025(1), added language to ensure a client remains eligible for Medicaid during the redetermination process.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 2, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0. Effective Date of Rule: May 1, 2000.

March 22, 2000

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

(1) ((Eligibility for)) A certification period is the period of time a person is determined eligible for a categorically needy (CN) medical ((assistance)) program. Unless otherwise stated in this section, the certification period begins on the first day of the month of application((.      Eligibility ends on)) and continues to the last day of the last month of the certification period.

(2) ((TANF/SFA-related, and SSI-related CN medical are each certified for twelve months.

(3) The pregnant women's program is certified through the end of the month which includes the sixtieth day from the day the pregnancy ends.

(4) The children's medical program is certified for twelve months or through the end of the month the child turns nineteen, whichever is earlier.      This period can be extended when:

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

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

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

(5))) For a child eligible for the newborn medical program ((is certified)), the certification period begins on the child's date of birth and continues through the end of the month ((that the newborn turns one year old)) 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, children, and SSI-related persons, the certification period is twelve 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) When the child turns nineteen the certification period ends even if the twelve-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) ((The)) A retroactive certification period can begin up to three months immediately ((prior to)) before the month of application when:

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

(b) The client received covered medical services ((which are covered by DSHS,)) as described in WAC 388-529-0100((; and

(c))).

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

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

(((8) Medical assistance is continued until eligibility is redetermined as described in chapter 388-418 WAC))

(9) 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) of this section;

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

(1) A client continues to ((receive)) be eligible for Medicaid until the department determines the client's ineligibility or eligibility ((or ineligibility)) for another medical program. This applies to a client who, during a certification period, becomes ineligible for, is terminated from, or requests termination from:

(a) A CN Medicaid program or SFA-related medical program; or

(b) Any of the following cash grants:

(i) TANF or SFA;

(ii) SSI;

(iii) GA-H; or

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

(2) A child remains continuously eligible for medical benefits 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) Turns eighteen years of age if receiving children's health program benefits;

(d) Turns nineteen years of age if receiving children's CN or CN scope of care program benefits; ((or))

(e) Dies; or

(f) Receives benefits under the children's health insurance program (CHIP) 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 ineligible for refugee cash assistance, refugee medical assistance can be continued only through the eight-month limit, as described in WAC 388-400-0035(6).

(4) A client receiving benefits under a TANF or SFA cash grant or related medical program is eligible for a medical extension, as described under WAC 388-523-0100, when the client's cash grant or related medical program is terminated as a result of:

(a) Earned income; or

(b) Collection of child or spousal support.

(5) A change in income during a certification period does not affect eligibility for:

(a) Pregnant women's medical programs; or

(b) The first six months of the TANF/SFA-related medical extension.

(6) For a child receiving benefits under CHIP 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 FPL;

(b) The child becomes pregnant;

(c) A change in family size; or

(d) The child receives SSI.

[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.]

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