Original Notice.

Preproposal statement of inquiry was filed as WSR 00-22-014.

Title of Rule: WAC 388-450-0210 Countable income for medical programs.

Purpose: Proposed rules provide for exclusion of an income increase during the second or third month of family medical program eligibility. It also provides for the inclusion of the income of a sponsor when determining medical program eligibility of a sponsored alien. Includes other technical corrections.

Statutory Authority for Adoption: RCW 74.08.090 and 74.08A.100 and Title XIX State Plan amendment 00-008.

Statute Being Implemented: Title XIX State Plan amendment 00-008.

Summary: Proposed rules provide for exclusion of an income increase during the second or third month of family medical program eligibility. It also provides for the inclusion of the income of a sponsor when determining medical program eligibility of a sponsored alien. Includes other technical corrections.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Joanie Scotson, Medical Assistance Administration, Mailstop 45534, Olympia, WA 98504-5534, (360) 725-1330.

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: The proposed rules provide for exclusion of an income increase during the second or third month of family medical program eligibility. It also provides for the inclusion of the income of a sponsor when determining medical program eligibility of a sponsored alien. Includes other technical corrections.

Proposal Changes the Following Existing Rules: The proposed rule provides for exclusion of an increase in earned income during the second or third month of family medical program eligibility. This ensures the family would meet the federal requirements to receive a medical extension. It also provides for the inclusion of the income of a sponsor when determining medical program eligibility of a sponsored alien as required by RCW 74.08A.100. The other changes do not reflect a change in existing rules but are technical corrections.

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

RCW 34.05.328 applies to this rule adoption. Although this rule meets the definition of a significant legislative rule, it is exempt under RCW 34.05.328 (5)(b)(vii).

Hearing Location: Office Building-2 Auditorium, DSHS Headquarters Building, 1115 Washington, 14th and Jefferson, Olympia, WA 98504, on December 26, 2001, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by December 21, 2001, 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 Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by 5:00 p.m., December 26, 2001.

Date of Intended Adoption: Not sooner than December 27, 2001.

November 15, 2001

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

(a) The income cannot be specifically excluded; and

(b) All appropriate deductions and disregards allowed by a specific program, have been applied.

(2) A client's countable income cannot exceed the income standard for the specific medical programs described in WAC 388-478-0065 ((through 388-478-0085)), 388-478-0070, 388-478-0075, 388-478-0080, or 388-513-1305, 388-513-1315, or 388-513-1395 unless((:

(a) The program allows the spenddown of excess income; or

(b) T)) the program ((makes an allowance)) allows for those limits to be exceeded.

(3) Unless modified by subsection (4) of this section, the TANF/SFA income ((methodology)) rules, as described in this chapter, ((is)) are used to determine a client's countable income for the following programs:

(a) ((TANF/SFA-related categorically needy (CN) or medically needy (MN))) Family medical program;

(b) ((TANF/SFA-related CN extended)) Medical extensions as described in chapter 388-523 WAC;

(c) Pregnant women's program((, CN or MN));

(d) Children's medical program((, CN or MN));

(e) Children's health program((;

(f) SFA-related medical)); and

(((g))) (f) Medically Indigent (MI) program.

(4) Exceptions to the TANF/SFA cash assistance methodology apply as follows:

(a) The financial responsibility of relatives ((is more limited)) when a client is applying for medical ((as)) for families, children, pregnant women or for the medically indigent program is specified in ((chapter 388-408)) WAC 388-408-0055;

(b) ((Income is always prospectively budgeted for medical;

(c))) Actual work-related child and dependent care expenses, which are the client's responsibility, are income deductions (the limits on this deduction in WAC 388-450-0170 (3) and (4) do not apply);

(((d))) (c) Court or administratively-ordered current or back support paid to meet the needs of legal dependents, are income deductions;

(((e))) (d) Only income actually contributed to an alien client from the alien's sponsor is countable unless the sponsor signed the affidavit of support I-864 or I-864A. See subsection (5) of this section;

(((f))) (e) TANF/SFA gross earned income limits as described in WAC 388-450-0165 do not apply;

(((g))) (f) The fifty percent ((work incentive)) earned income deduction is not used to calculate countable income for CN programs with income levels based upon the Federal Poverty Level (FPL). These programs are listed in subsection (3)(((b),)) (c), (d) and (e) of this section. The only work related income deductions for these programs are:

(i) Ninety dollars; and

(ii) Actual work-related child and dependent care expenses, as described in ((subsection (4)(c))) (b) of this ((section)) subsection; and

(iii) Child support as described in (c) of this subsection. (g) When determining medically needy (MN) or MN scope of care coverage for children or pregnant women for the programs described in subsection (3)(c) and (d), the exception described in subsection (4)(f) is not used as the MN income standards are not based on the FPL;

(h) A nonrecurring lump sum payment is considered as income in the month the client receives payment, and a resource if the client retains the payment after the month of receipt;

(i) Diversion cash assistance (DCA), is not countable income;

(j) Effective April 1, 2002, the department will disregard an increase in earned income when:

(i) A family is receiving benefits under the family medical program; and

(ii) The increase occurs during the second or third month of eligibility. The disregard stops the last day of the third month of eligibility for a family medical program.

(5) When an alien's sponsor has signed the affidavit of support I-864 or I-864A, the sponsor's income and resources are counted as described in WAC 388-450-0155, 388-450-0156, 388-450-0160, and 388-470-0060.

(6) Except when this state has adopted more liberal rules, SSI income ((methodology is)) rules are used to determine a client's countable income for the following programs:

(a) SSI-related CN or MN; and

(b) Medicare ((cost sharing)) savings programs. Refer to chapter 388-475 WAC.

(((6) Exceptions to the SSI income methodology apply as follows:

(a) Lump sum payments are excluded as income;

(b) The interest portion of a payment a client receives from a sales contract which is a nonexcluded resource is treated as unearned income; and

(c) The principle and interest portions of a payment a client receives from a sales contract, which meets the definition in WAC 388-470-0040(3), are treated as unearned income.))

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-450-0210, filed 7/31/98, effective 9/1/98. Formerly WAC 388-505-0580, 388-505-0590 and 388-519-1910.]

Washington State Code Reviser's Office