SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Preproposal statement of inquiry was filed as WSR 03-14-077.
Title of Rule: WAC 388-418-0005 Reporting requirements, 388-418-0025 Effect of changes on medical programs, 388-416-0015 Certification periods, and 388-434-0005 Eligibility reviews.
Purpose: The proposed rules implement six-month certification periods for family and children medical programs and eliminate a year of continuous eligibility for children. This change was directed by the Legislature and is intended as a budget-savings measure.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.530.
Statute Being Implemented: RCW 74.08.090 and 74.09.530, chapter 10, Laws of 2003.
Summary: The department must amend these rules to implement six-month certification periods and eliminate continuous eligibility for children's medical.
Reasons Supporting Proposal: The 2001-2003 state supplemental budget (chapter 10, Laws of 2003) included these provisions.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Mary Wood, P.O. Box 45534, Olympia, WA 98504-5534, (360) 725-1329.
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: See Purpose and Summary above.
Proposal Changes the Following Existing Rules: Family and children's medical cases will have six-month rather than twelve-month certification periods. All reported changes during certification periods will be used to recalculate medical eligibility for children.
No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule amendment does not impact small businesses. It only affects DSHS clients.
RCW 34.05.328 does not apply to this rule adoption. Per RCW 34.05.328 (5)(b)(vii), this rule amendment is exempt from the requirements of RCW 34.05.328. The rule amends eligibility requirements for medical, financial and food assistance.
Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on October 21, 2003, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by October 17, 2003, phone (360) 664-6094, TTY (360) 664-6178, e-mail firstname.lastname@example.org.
Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, mail to P.O. Box 45850, Olympia, WA 98504-5850, deliver to 4500 10th Avenue S.E., Lacey, WA, fax (360) 664-6185, e-mail email@example.com, by 5:00 p.m., October 21, 2003.
Date of Intended Adoption: Not sooner than October 22, 2003.
September 10, 2003
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit3259.2
|Table 1 - Cash Assistance and Food Assistance|
|Type of change to report when you or anyone in your assistance unit AU):||Do I have to report this change for cash assistance?||Do I have to report this change for food assistance?|
|(1) Starts to get money from a new source;||Yes||Yes|
|(2) Has unearned income that changed by more than twenty-five dollars from amount we budgeted;||Yes||Yes|
|(3) Moves into or out of your home, including newborns or if an AU member dies. This also includes when someone temporarily moves in or out;||Yes||Yes|
|(4) Moves to a new residence;||Yes||Yes|
|(5) Has a change in shelter costs;||Yes, but only if you went from having no shelter costs to having a shelter cost, or from having shelter costs to not having to pay anything. You don't have to report a change in the amount you pay.||Yes, report the change at your recertification. If your shelter costs go up, you could get more food assistance benefits. Report the change sooner to see if you will get more benefits.|
|(6) Gets married, divorced, or separated;||Yes||Yes|
|(7) Gets a vehicle;||Yes||Yes|
|(8) Has a disability that ends;||Yes||Yes|
|(9) Has countable resources that are more than the resource limits under WAC 388-470-0005;||Yes||Yes|
|(10) Gets a job or changes employers;||Yes||Yes|
|(11) Changes from part-time to full-time or full-time to part-time work. We use your employer's definition of part-time and full-time work;||Yes||Yes|
|(12) Has a change in hourly wage rate or salary;||Yes||Yes|
|(13) Stops working;||Yes||Yes|
|(14) Has a pregnancy that begins or ends;||Yes||No|
|(15) Has a change in uncovered medical expenses;||No||Yes, report this change only at your next eligibility review. If you are elderly or disabled and you have an increase in uncovered medical expenses, report this change sooner as you may be eligible to get more benefits.|
|Table 2 - Medical Assistance|
|Type of change to report when you or anyone in your assistance unit (AU):||Do I have to
||Do I have to
|(16) Starts to get money from a new source;||Yes||No|
|(17) Has unearned income that changed;||Yes||No|
|(18) Moves into or out of your home, including newborns or if an AU member dies. This also includes when someone temporarily moves in or out;||Yes||Yes|
|(19) Moves to a new residence;||Yes||Yes|
|(20) Has a change in shelter costs;||No||No|
|(21) Gets married, divorced, or separated;||Yes||No|
|(22) Gets a vehicle;||No||No|
|(23) Has a disability that ends;||No||No|
|(24) Has countable resources that are more than the resource limits under WAC 388-470-0005;||No||No|
|(25) Gets a job or changes employers;||Yes||No|
|(26) Changes from part-time to full-time or full-time to part-time work. We use your employer's definition of part-time and full-time work;||Yes||No|
|(27) Has a change in hourly wage rate or salary;||Yes||No|
|(28) Stops working;||Yes||No|
|(29) Has a pregnancy that begins or ends;||Yes||Yes|
|(30) Has a change in uncovered medical expenses.||((
||Yes, but only if an AU member has a spenddown.|
|Table 3 - SSI-Related Medical Assistance and Long-Term Care|
|Type of change to report when you or anyone in your assistance unit (AU):||Do I have to report this change for SSI-related medical assistance?||Do I have to report this change for long-term care (i.e., COPES, CAP, or nursing home)|
|(31) Starts to get money from a new source;||Yes||Yes|
|(32) Has unearned income that changed;||Yes||Yes|
|(33) Has a change in earnings or stops working||Yes||Yes|
|(34) Moves into or out of your home, including newborns or if an AU member dies. This also includes when someone temporarily moves in or out;||Yes||Yes|
|(35) Moves to a new residence;||Yes||Yes|
|(36) Has a change in shelter costs;||No, unless you went from paying rent to not paying any rent. You do not need to report if your rent amount changes.||Yes, if client or community spouse live in their own home|
|(37) Gets married, divorced, or separated;||Yes||Yes|
|(38) Gets a vehicle;||Yes, but only if that person or their spouse gets SSI-related medical||Yes, but only if that person gets long-term care|
|(39) Has a disability that ends;||Yes||Yes|
|(40) Has countable resources that are more than the resource limits, under WAC 388-470-0005 or 388-513-1350;||Yes, but only if that person or their spouse get SSI-related medical||Yes, but only if that person gets long-term care|
|(41) Has a change in uncovered medical expenses.||Yes, but only if an AU member has a spenddown.||Yes.|
[Statutory Authority: RCW 74.08.090 and 74.04.510. 01-11-109, § 388-418-0005, filed 5/21/01, effective 7/1/01; 99-23-034, § 388-418-0005, filed 11/10/99, effective 1/1/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-418-0005, filed 7/31/98, effective 9/1/98.]
(a) A CN Medicaid program; or
(b) Any of the following cash grants:
(ii) SSI; or
(iii) GA-X. See WAC 388-434-0005 for changes reported during eligibility review.
A child remains continuously eligible for CN
Medicaid 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) Becomes an inmate of a public institution, including a correctional facility (refer to WAC 388-505-0210(5) for exceptions);
(d) Turns nineteen years of age;
(e) Dies; or
(f) Receives benefits under the state children's health insurance program (SCHIP) 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)) If you become ineligible for
refugee cash assistance, refugee medical assistance can be
only)) through the eight-month limit, as described
in WAC 388-400-0035(4).
(4) A client receiving medical benefits with))
(3) If you receive a TANF cash grant or family medical
program is)), you are eligible for a medical extension, as
described under WAC 388-523-0100, when (( the client's)) your
cash grant or family medical program is terminated as a result
(a) Earned income; or
(b) Collection of child or spousal support.
(5))) (4) A change in income during a certification
period does (( not)) affect eligibility for all medical
(a) Pregnant women's medical programs; ((
(b) Children's medical for newborns F05); or
(c) The first six months of the medical extension benefits.
(6))) (5) For a child receiving benefits under SCHIP as
described in chapter 388-542 WAC, the department must
redetermine eligibility for a Medicaid program when the family
(a) Family income has decreased to less than two hundred percent Federal Poverty Level (FPL);
(b) The child becomes pregnant;
(c) A change in family size; or
(d) The child receives SSI.
[Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-418-0025, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090 and 74.09.450. 00-08-002, § 388-418-0025, filed 3/22/00, effective 5/1/00. 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.]3251.1
(2) For a child eligible for the newborn medical program, the certification period begins on the child's date of birth and continues through the end of the month 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((
,)) and children(( , and SSI-related
persons,)) the certification period is (( twelve)) six 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) For an SSI-related person the certification period is twelve months.
(6) When the child turns nineteen the certification
period ends even if the ((
twelve)) six-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))) (7) A retroactive certification period can begin
up to three months immediately before the month of application
(a) The client would have been eligible for medical assistance if the client had applied; and
(b) The client received covered medical services as described in WAC 388-529-0100.
(7))) (8) If the client is eligible only during the
three-month retroactive period, that period is the only period
(8))) (9) Any months of a retroactive certification
period are added to the designated certification periods
described in this section.
(9))) (10) 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))) (6) of this section;
(b) There is not a retroactive eligibility period as
described in subsections ((
(6), (7), and (8))) (7), (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, 74.08.090 and 74.09.450. 00-08-002, § 388-416-0015, filed 3/22/00, effective 5/1/00. 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.]3253.2
(2) When it is time for your eligibility review, the department requires you to complete a review form. We use the information you provide to determine your eligibility for all assistance programs.
(3) If you complete an interview for assistance with a department representative and sign the printed application for benefits (AFB) form, you do not have to complete a separate review form.
(4) For cash assistance, the eligibility review form or the AFB must be dated and signed by both husband and wife, or both parents of a child in common when the parents live together.
(5) If you receive medical assistance only, the eligibility review form or the AFB must be signed by at least one parent when the parents live together.
(6) We may move the date of your eligibility review if we decide your circumstances need to be reviewed sooner.
(7) At your review, we look at:
(a) All eligibility requirements under WAC 388-400-0005 through 388-400-0035, 388-503-0505 through 388-503-0515, and 388-505-0210 through 388-505-0220;
(b) Changes that happened since we last determined your eligibility; and
(c) Changes that are anticipated to happen during the next review period.
(8) If you receive medical assistance only, we set your eligibility review date in advance under WAC 388-416-0005 through 388-416-0035. We will start the review process before your benefits end.
(9) Clients are responsible for attending an interview if one is required under WAC 388-452-0005.
(10) If you do not complete the eligibility review for
cash assistance, you are considered to be withdrawing your
request for continuing assistance((
(a) Your cash assistance benefits will end((
(b) Your medical assistance will continue for ((
six consecutive months from the last:
(ii) Eligibility review; or
(iii) Food assistance application or rec2ertification.
(11) We must send you written notice under WAC 388-458-0005, 388-458-0010, and 388-450-0015 before assistance can be suspended, terminated, or a benefit error is established as a result of your eligibility review.
(12) If you are currently receiving cash or medical
assistance, and you are found to no longer be eligible for
benefits, we will determine if you are eligible for other
medical programs. Until we decide if you are eligible for
other programs)) another program, your medical assistance
will continue under WAC 388-418-0025 (( even if you request
that your benefits end)).
(13) When a client is determined to need necessary
supplemental accommodation (NSA) under WAC ((
388-472-0010, we will help the client meet the requirements of
[Statutory Authority: RCW 74.08.090 and 74.04.510. 99-23-083, § 388-434-0005, filed 11/16/99, effective 1/1/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-434-0005, filed 7/31/98, effective 9/1/98. Formerly WAC 388-522-2230.]
Reviser's note: The spelling 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.