WSR 02-07-115

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Economic Services Administration)

[ Filed March 20, 2002, 10:29 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 02-03-094.

Title of Rule: WAC 388-474-0001 What is Supplemental Security Income (SSI) and who can get it?, 388-474-0005 What medical coverage does a Supplemental Security Income client, essential person and an ineligible spouse get?, 388-474-0010 How does being a Supplemental Security Income (SSI) affect your cash assistance eligibility?, new WAC 388-474-0012 What is a Supplemental Security Income (SSI) state supplemental payment (SSP) and who can get it?, 388-474-0015 What happens to my categorically needy (CN) medical coverage when my Supplemental Security Income (SSI) cash payment is terminated?, 388-474-0020 What can a general assistance unemployable (GA-U) client expect when Supplemental Security Income (SSI) benefits begin?, and 388-478-0055 How much do I get from my Supplemental Security Income (SSI) and state supplemental payments (SSP)?

Purpose: The purpose of these proposed rules is to assume the administration of the state supplemental payment (SSP) program in order to save on administrative costs, and to more equally distribute SSP payments.

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

Statute Being Implemented: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090, 74.04.630.

Summary: Defines who is eligible for an SSP payment. How SSP payments will be made. What kind of medical coverage is available for SSI/SSP clients. What the payment standards for SSI/SSP clients will be.

Reasons Supporting Proposal: These amendments will result in significant administrative savings for the state and more equitable distribution for the clients.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Carole McRae, 1009 College Street, Lacey, WA 98503, (360) 413-3074.

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: A recent RCW change gives the state the ability to self-administer the SSI state supplemental payment (SSP) program. The effect of these changes will be a substantial administrative cost savings to the state. SSP payments will also be more equally distributed as a result of these changes.

Proposal Changes the Following Existing Rules: Rules are being amended to give the state the ability to administer the state supplement payment plan for clients who receive federal supplemental security income.

No small business economic impact statement has been prepared under chapter 19.85 RCW. These amendments do not have a fiscal impact on small businesses.

RCW 34.05.328 does not apply to this rule adoption. These amendments are exempt under RCW 34.05.328 (5)(b)(vii).

Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on April 23, 2002, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by April 19, 2002, 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, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., April 23, 2002.

Date of Intended Adoption: Not earlier than April 24, 2002.

March 15, 2002

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3050.2
AMENDATORY SECTION(Amending WSR 01-06-042, filed 3/5/01, effective 4/5/01)

WAC 388-474-0001   ((General information--)) What is Supplemental Security Income((.)) (SSI) and who can get it?   (1) ((Persons with limited income and resources who are aged, blind, or disabled may qualify for)) SSI is a federal cash benefit((s under the Supplemental Security Income program (SSI))) program administered by the Social Security Administration (SSA) under Title XVI of the Social Security Act.

(2) You can get SSI if you have limited income and resources and if you are:

(a) Aged (sixty-five and older);

(b) Blind; or

(c) Disabled.

(3) The SSI program replaced state programs for aged, blind and disabled persons beginning in January 1974. ((Persons who)) If you received state assistance in December 1973((, as aged, blind or disabled or were needed in the home to care for an eligible person, automatically)) and you became eligible for SSI in January 1974((. The blind or disabled)), you are called a grandfathered ((clients)) client by the state and a mandatory income level (MIL) client by SSI. You must continue to meet the definition of blind or disabled that was in effect under the state plan in December 1973. These definitions can be found in the SSA program operations manual system (POMS), see http://policy.ssa.gov/poms.nsf. ((A person designated in January 1974 as essential to the care of a grandfathered SSI client will continue to be included in the SSI payment as long as the essential person continuously resides with the SSI client.

(3) The spouse of an SSI recipient who does not qualify for SSI in their own right may be included in the state supplement payment but is not considered an SSI recipient for purposes of medical assistance eligibility))

(4) If you are needed in the home to care for an eligible person, you are called an essential person. You are also called a grandfathered client.

(5) If you are an essential person you must have lived continuously with the eligible person since January 1974.

(6) If you are an SSI recipient and you have a spouse who does not qualify for SSI in their own right, you may be eligible for a state supplemental payment for your spouse (also referred to as an ineligible spouse).

[Statutory Authority: RCW 74.04.050, 74.08.090, and 74.09.055. 01-06-042, 388-474-0001, filed 3/5/01, effective 4/5/01. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-474-0001, filed 7/31/98, effective 9/1/98.]


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

WAC 388-474-0005   What medical coverage((.)) does a Supplemental Security Income client, essential person, and an ineligible spouse get?   (1) If you are an SSI ((recipient qualifies for)) client you automatically get categorically needy (CN) medical coverage ((without a medical determination, except when the SSI recipient)) (WAC 388-505-0110) unless you:

(a) ((Refuses)) Refuse to provide private medical insurance information; or

(b) Refuse to assign the right to recover insurance funds to the department((;

(b) Disposes of resources for less than fair market value and then applies for Medicaid coverage of nursing home care within thirty months of the date of transfer; or

(c) Has a Medicaid qualifying trust)) (WAC 388-505-0540).

(2) ((A person designated as)) If you are an essential person as described in ((January, 1974, qualifies for)) WAC 388-474-0001 you get CN medical coverage as long as ((they)) you continue to ((reside)) live with the SSI ((recipient)) client.

(3) ((The spouse of an SSI recipient designated as an)) If you are an ineligible spouse ((must have medical eligibility separately determined when:

(a) They do not automatically qualify for medical coverage in subsection (2) above; or

(b) They are not eligible for SSI in their own right.

(4) Persons who are not receiving SSI, but are SSI-related and qualify for CN medical assistance are described in WAC 388-505-0110)) you are not considered an SSI recipient. You must have your medical assistance determined separately.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-474-0005, filed 7/31/98, effective 9/1/98.]


AMENDATORY SECTION(Amending WSR 01-19-023, filed 9/12/01, effective 11/1/01)

WAC 388-474-0010   How does being a Supplemental Security Income (SSI) client affect ((eligibility for)) your cash assistance ((programs?)) eligibility?   ((A person who is)) (1) If you are married to an SSI recipient but ((cannot)) do not get SSI in ((their own right is)) your own right, you are called an "ineligible spouse."

(((1))) (2) If you are an ineligible spouse((,)) you cannot get the SSI state supplement (((see WAC 388-478-0055) if)) when you are:

(a) The caretaker relative of a child who receives TANF or SFA; and

(b) Required to be included in the TANF or SFA assistance unit with the child ((under WAC 388-408-0015.

(2))) (see WAC 388-408-0015; or

(c) Receiving refugee assistance.

(3) If you are an ineligible spouse and ((are eligible for the)) get an SSI state supplement (WAC 388-474-0012), you ((are not eligible for)) cannot get general assistance ((benefits)) (GA).

[Statutory Authority: RCW 74.08.090, 74.04.057, 74.04.050. 01-19-023, 388-474-0010, filed 9/12/01, effective 11/1/01. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-474-0010, filed 7/31/98, effective 9/1/98.]


NEW SECTION
WAC 388-474-0012   What is a Supplemental Security Income (SSI) state supplemental payment (SSP) and who can get it?   (1) Effective June 2002, the SSI state supplemental payment (SSP) is state-paid cash assistance for clients who:

(a) Get a federal SSI payment; or

(b) Are in active SSI payment status including grandfathered SSI clients and ineligible spouses.

(2) The SSP begins the first of the month the state is notified of federal SSI approval.

(3) A SSI client will not get SSP payments for any period prior to the first of the month the state is notified of federal SSI approval.

[]


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

WAC 388-474-0015   ((Termination of)) What happens to my categorically needy (CN) medical coverage when my Supplemental Security Income (SSI((.))) cash payment is terminated?   (1) ((A person terminated from SSI cash assistance will have)) Your CN medical coverage ((continued)) (WAC 388-505-0110)( continues after an SSI cash payment ends when:

(a) Countable income exceeds the SSI income standard due solely to the annual cost-of-living adjustment (COLA); or

(b) A timely request for a hearing has been filed. ((Categorically needy)) CN medical coverage is continued until Social Security Administration (SSA) makes a final decision on the hearing request and on any subsequent timely appeals.

(2) ((A person terminated from SSI is eligible for continued CN)) If your SSI ends your CN medical coverage continues for a period of up to one hundred twenty days ((from the date of termination of SSI cash benefits)) while the department reviews your eligibility for other cash or medical programs ((is being determined)).

(3) If you are a terminated SSI or SSI-related client, the department will ((have their)) your disability ((redetermined under certain conditions. These conditions are:

(a) The person presents)) status when:

(a) You present new medical evidence;

(b) ((The person's)) Your medical condition changes significantly; or

(c) ((The)) Your termination from SSI was not based on a review of current medical evidence.

(4) Children terminated from SSI due to loss of disabled status ((as a disabled person)) may be eligible for medical benefits under WAC 388-505-0210.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-474-0015, filed 7/31/98, effective 9/1/98. Formerly WAC 388-524-2405.]

Reviser's note: The typographical 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.
AMENDATORY SECTION(Amending WSR 98-16-044, filed 7/31/98, effective 9/1/98)

WAC 388-474-0020   ((Duplicate)) What can a general assistance ((and overpayments.))-unemployable (GA-U) client expect when Supplemental Security Income (SSI) benefits begin?   (((1) Persons receiving cash benefits under the general assistance program who receive advance, emergency or retroactive SSI cash assistance for the same time period are considered to have received duplicate assistance. The amount of general assistance paid during this time period must be repaid to the department.

(2) Applicants for general assistance-unemployable (GA-U) are required to)) You can only get assistance to meet your basic needs from one government source at a time (WAC 388-448-0210). If you are a GA-U client who begins setting SSI, you should know that:

(1) If you got advance, emergency or retroactive SSI cash assistance for any period where you got GA-U, you must repay the department the amount of GA-U paid to you for the matching time period.

(2) When you apply for GA-U you must sign DSHS 18-235(X), interim assistance reimbursement agreement (IARA) ((as a condition of eligibility for)) to get GA-U assistance.

(3) You cannot use your GA-U ((funds cannot be used)) money to replace money deducted from ((a person's)) your SSI check ((by SSA)) to repay an SSI overpayment ((of SSI benefits)).

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-474-0020, filed 7/31/98, effective 9/1/98.]

3051.2
AMENDATORY SECTION(Amending WSR 01-19-024, filed 9/12/01, effective 11/1/01)

WAC 388-478-0055   ((SSI payment standards for eligible recipients.)) How much do I get from my Supplemental Security Income (SSI) and state supplemental payments (SSP)?   (1) ((Supplemental Security Income ())SSI(())) is a federal cash assistance program for needy individuals and couples who meet federal disability guidelines as aged, blind or disabled. (( Since the SSI program began in January 1974, the state of Washington has added to the federal benefit level with state funds, known as the SSI state supplement. If you are found eligible for SSI, you will receive cash assistance based on the combined federal and state supplement benefit levels, minus countable income. An essential person is someone who lives with you and provides care and personal services that enable you to live in either your own home or the home of the essential person)) SSP is a payment from the state that you get because you get SSI.

If you are eligible for SSI, you will receive a federal cash payment from SSI, as well as a SSP cash payment from the state.

If you were converted from state assistance to the federal SSI program in January 1974 because you were aged, blind, or disabled, the department calls you a grandfathered client. SSI calls you a mandatory income level (MIL) client. To be a grandfathered MIL client, you must have remained continuously eligible for SSI from January 1974.

A change in living situation, cost-of-living adjustment (COLA) or federal benefit level (FPL) can affect a MIL (grandfathered) client. A MIL (grandfathered) client gets a federal SSI benefit and a SSP payment, which totals the higher of the following:

(a) The state assistance standard set in December 1973, unless you lived in a medical institution at the time of conversion, plus the federal cost-of-living adjustments (COLA) since then; or

(b) The current standard.

(2) The federal, state and combined benefit levels for an eligible individual and couple are:

(a) If you are living alone in area 1: King, Pierce, Snohomish, Thurston, and Kitsap Counties.


LIVING ALONE - In own household or alternate care, except nursing homes or medical institutions

Federal Benefit Level

State Supplement Benefit Level

Combined Federal/State Benefit Level

Individual $ ((531.00)) 545.00 $ ((25.90)) 21.00 $ ((556.90)) 556.00
((Individual with:

One essential person))

(($ 797.00)) (($ 19.90)) (($ 816.90))
((Individual with:

Multiple essential persons))

(($531 for the eligible individual plus $266 for each essential person (no state supplement)))
Individual with an ineligible spouse $ ((531.00)) 545.00 $ ((166.10)) 42.00 $ ((697.10)) 587.00
Couple $ ((796.00)) 817.00 $ ((19.90)) 42.00 $ ((815.90)) 859.00
((Couple with one or more essential persons)) (($796 for eligible couple plus $266 for each essential person (no state supplement)))
MIL (individuals with or without an ineligible spouse, essential persons and couples) Subject to change in living situation, FBL, or COLA Frozen at the current payment rate Variable

(b) If you are living alone in area 2: All other counties.


LIVING ALONE - In own household or alternate care, except nursing homes or medical institutions

Federal Benefit Level

State Supplement Benefit Level

Combined Federal/State Benefit Level

Individual $ ((531.00)) 545.00 $ ((5.45)) 21.00 $ ((536.45)) 566.00
((Individual with:

One essential person))

(($ 797.00)) (($ 0.00)) (($ 797.00))
((Individual with:

Multiple essential persons))

(($531 for the eligible individual plus $266 for each essential person (no state supplement)))
Individual with an ineligible spouse $ ((531.00)) 545.00 $ ((136.15)) 42.00 $ ((667.15)) 587.00
Couple $ ((796.00)) 817.00 $ ((0.00)) 42.00 $ ((796.00)) 859.00
((Couple with one or more essential persons)) (($796 for eligible couple plus $266 for each essential person (no state supplement)))
MIL (individuals with or without ineligible spouse, essential persons, and couples Subject to change in living situation, FBL, and COLA Frozen at the current payment rate Variable

(c) If you are in shared living in either Area 1 or 2.


SHARED LIVING - In the home of another person Federal Benefit Level State Supplement Benefit Level Combined Federal/State Benefit Level
Individual $ ((354.00)) 367.05 $ ((3.71)) 21.00 $ ((357.71)) 388.05
((Individual with:

One essential person))

(($ 531.34)) (($ 4.20)) (($ 535.54))
((Individual with:

Multiple essential persons))

(($354.00 for the eligible individual plus $177.00 for each essential person (no state supplement)))
Individual with an ineligible spouse $ ((354.00)) 465.00 $ ((101.66)) 42.00 $ ((455.66)) 507.00
Couple $ ((530.67)) 548.87 $ ((4.20)) 42.00 $ ((534.87)) 590.87
((Couple with one or more essential persons)) (($530.67 for eligible couple plus $177.00 for each essential person (no state supplement)))

(d) If you are residing in a medical institution: Area 1 and 2.


MEDICAL INSTITUTION Federal Benefit Level State Supplement Benefit Level Combined Benefit Level
Individual $ 30.00 $ 11.62 $ 41.62

(((e) Mandatory income level (MIL) for grandfathered claimant. You are "grandfathered" if you qualified for assistance from the state as aged, blind, or disabled, were converted from the state to federal disability assistance under SSI in January 1974, and have remained continuously eligible for SSI since that date.

If you are a MIL client, your combined federal/state SSI benefit level is the higher of the following:

(i) The state assistance standard you received in December 1973, except if you resided in a medical institution at the time of conversion, plus the federal cost-of-living adjustments (COLA) since then; or

(ii) The current standard.))

[Statutory Authority: RCW 74.08.090, 74.04.057. 01-19-024, 388-478-0055, filed 9/12/01, effective 11/1/01; 01-08-015, 388-478-0055, filed 3/23/01, effective 5/1/01. Statutory Authority: RCW 74.08.090. 00-20-054, 388-478-0055, filed 9/29/00, effective 11/1/00. Statutory Authority: RCW 74.08.090 and 74.04.057. 00-11-130, 388-478-0055, filed 5/22/00, effective 7/1/00; 99-18-063, 388-478-0055, filed 8/30/99, effective 10/1/99. Statutory Authority: RCW 74.08.090 and 74.04.630. 99-04-103, 388-478-0055, filed 2/3/99, effective 3/6/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-478-0055, filed 7/31/98, effective 9/1/98. Formerly WAC 388-511-1115.]

Washington State Code Reviser's Office