Original Notice.

     Preproposal statement of inquiry was filed as WSR 03-19-033 on September 9, 2003.

     Title of Rule: WAC 388-450-0200 Medical expenses may be used as an income deduction for food assistance households containing an elderly or disabled household member.

     Purpose: The department is amending the rule to update program language, clarify when the department allows a medical expense as an income deduction, and correct references in the rule.

     Statutory Authority for Adoption: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510.

     Statute Being Implemented: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510.

     Summary: This rule explains who can use medical expenses as an income deduction for the Washington basic food program and which types of medical expenses may be used for this deduction.

     Reasons Supporting Proposal: The proposed amendments are necessary to be consistent with federal regulations for food stamps. This revision is intended to update program language, clarify when the department allows a medical expense as an income deduction, and correct references in the rule.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: John Camp, 1009 College S.E., Lacey, WA 98504, (360) 413-3232.

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

     Rule is necessary because of federal law, Title 7 of the Code of Federal Regulations, Part 273-273.9 (d)(3).

     Explanation of Rule, its Purpose, and Anticipated Effects: Rule: WAC 388-450-0200 Medical expenses may be used as an income deduction for food assistance households containing an elderly or disabled household member.

     Purpose and Effect: See Purpose, Summary, and Reasons Supporting Proposal above.

     Proposal Changes the Following Existing Rules: See Purpose, Summary, and Reasons Supporting Proposal above.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. This proposed rule does not have an economic impact on small businesses; it only affects DSHS clients by clarifying who can receive an income deduction based on medical expenses for basic food.

     RCW 34.05.328 does not apply to this rule adoption. These amendments are exempt as allowed under RCW 34.05.328 (5)(b)(vii) which states in-part, "[t]his section does not apply to...rules of the department of social and health services relating only to client medical or financial eligibility and rules concerning liability for care of dependents." This rule adopts federal requirements mandated by Title 7 of the Code of Federal Regulations, Part 273, 273.9 (d)(3) regarding how the excess medical expense deduction affects financial eligibility for food stamps.

     Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on December 23, 2003, at 10:00 a.m.

     Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, phone (360) 664-6094, TTY (360) 664-6178, e-mail FernAX@dshs.wa.gov.

     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 fernaax@dshs.wa.gov, by 5:00 p.m., December 23, 2003.

     Date of Intended Adoption: Not earlier than December 24, 2003.

November 12, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     (b))) (AU) includes an elderly or disabled person as defined in WAC 388-400-0040, your AU may be eligible for an income deduction for the elderly or disabled person's out-of-pocket medical expenses. We allow the deduction for medical expenses over thirty-five dollars each month.

     (2) ((The department allows deductions for expenses to cover)) You can use a medical expense toward this deduction if the expense covers services, supplies, ((or)) medication, or other medically needed items prescribed by a state-licensed practitioner or other state-certified, qualified, health professional((, such as)). Examples of expenses you can use for this deduction include those for:

     (a) Medical, psychiatric, naturopathic physician, dental, or chiropractic care;

     (b) Prescribed alternative therapy such as massage or acupuncture;

     (c) Prescription drugs;

     (((c))) (d) Over the counter drugs;

     (((d))) (e) Eye glasses;

     (((e))) (f) Medical supplies other than special diets;

     (((f))) (g) Medical equipment((.

     (g))) or medically needed changes to your home;

     (h) Shipping and handling charges for an allowable medical item. This includes shipping and handling charges for items purchased through mail order or the Internet;

     (i) Long distance calls to a medical provider;

     (j) Hospital and outpatient treatment including:

     (i) Nursing care; or

     (ii) Nursing home care including payments made for a person who was an assistance unit member at the time of placement.

     (((h))) (k) Health insurance premiums paid by the client including:

     (i) Medicare premiums ((or cost sharing)); and

     (ii) Insurance deductibles and co-payments.

     (((i))) (l) Out-of-pocket expenses used to meet a spenddown ((expenses)) as defined in WAC 388-519-0010. We do not allow your entire spenddown ((expenses are allowed)) obligation as a deduction. We allow the expense as a deduction as ((they are)) it is estimated to occur or as the expense ((become)) becomes due;

     (((j))) (m) Dentures, hearing aids, and prosthetics;

     (((k))) (n) Cost ((of obtaining and caring)) to obtain and care for a seeing eye ((or)), hearing, or other specially trained service animal((, including)). This includes the cost of food and veterinarian bills. We do not allow the expense of ((guide dog)) food for a service animal as a deduction if you receive ongoing additional requirements under WAC 388-255-1050 to pay for this need;

     (((l))) (o) Reasonable costs of transportation and lodging to obtain medical treatment or services;

     (((m))) (p) Attendant care necessary due to age, infirmity, or illness. If your ((household)) AU provides most of the attendant's meals, we allow an additional deduction equal to a one-person allotment.

     (3) There are two types of deductions:

     (a) One-time expenses are expenses that cannot be estimated to occur on a regular basis. You can choose to have us:

     (i) Allow the one-time expense as a deduction when it is billed or due; ((or))

     (ii) Average the expense through the remainder of your certification period; or

     (iii) If your AU has a twenty-four-month certification period, you can choose to use the expense as a one-time deduction, average the expense for the first twelve months of your certification period, or average it for the remainder of our certification period.

     (b) Recurring expenses are expenses that happen on a regular basis. We estimate your monthly expenses for the certification period.

     (4) We do not allow a medical expense as an income deduction if:

     (a) The expense ((has already been)) was paid before you applied for benefits or in a previous certification period;

     (b) The expense ((is repaid)) was paid or will be paid by someone else;

     (c) The expense ((is)) was paid or will be paid by the department or another agency;

     (d) The expense is covered by medical insurance;

     (e) ((You claim the expense later than the first billing, even if:

     (i) You did not claim the expense the first time it was billed;

     (ii) The expense is included in the current billing; and

     (iii) You paid the bill.

     (f))) We previously allowed the expense, and you did not pay it. We do not allow the expense again even if it is part of a repayment agreement;

     (((g))) (f) You included the expense in a repayment agreement after failing to meet a previous agreement for the same expense;

     (((h))) (g) You claim the expense after you have been denied for presumptive SSI; and you are not considered disabled by any other criteria; or

     (((i))) (h) The provider considers the expense overdue.

[Statutory Authority: RCW 74.08.090 and 74.04.510. 99-23-083, § 388-450-0200, filed 11/16/99, effective 1/1/00; 99-16-024, § 388-450-0200, filed 7/26/99, effective 9/1/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-450-0200, filed 7/31/98, effective 9/1/98.]

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