WSR 09-17-104

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed August 18, 2009, 9:04 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 09-12-090.

Title of Rule and Other Identifying Information: The department is amending WAC 388-517-0310 Eligibility for federal medicare savings and state-funded medicare buy-in programs.

Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at http://www.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6094), on September 22, 2009, at 10:00 a.m.

Date of Intended Adoption: Not sooner than September 23, 2009.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on September 22, 2009.

Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by September 8, 2009, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at johnsjl4@dshs.wa.gov.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Per federal statute, effective January 1, 2010 the resource standards for medicare savings programs change to match the resource standards for the medicare Part D low-income subsidy. The resource standards will be adjusted yearly after that.

Reasons Supporting Proposal: Federal funding depends on the state's compliance with federal regulations.

Statutory Authority for Adoption: Public Law 110-275, Section 113 (Medicare Improvements for Patients and Providers Act); RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.500.

Statute Being Implemented: Public Law 110-275, Section 113 (Medicare Improvements for Patients and Providers Act); RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.500.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Department of social and health services, governmental.

Name of Agency Personnel Responsible for Drafting: Kevin Sullivan, P.O. Box 45504, (360) 725-1344; Implementation and Enforcement: Carole McRae, P.O. Box 45534, (360) 725-1250.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule does not impact small businesses.

A cost-benefit analysis is not required under RCW 34.05.328. Per RCW 34.05.328 (5)(b)(vii), client eligibility rules for medical assistance are exempt from this provision.

August 12, 2009

Don Goldsby, Manager

Rules and Policies Assistance Unit

-4140.1
AMENDATORY SECTION(Amending WSR 07-15-032, filed 7/12/07, effective 8/12/07)

WAC 388-517-0310   Eligibility for federal medicare savings and state-funded medicare buy-in programs.   (1) Persons eligible for any medicare savings programs (MSP) must:

(a) Be entitled to or receiving medicare Part A. Qualified disabled working individuals (QDWI) clients must be under age sixty-five;

(b) Meet program income standards, see WAC 388-478-0085; and

(c) Have resources ((at or below twice the resource standards for SSI and SSI related programs, see WAC 388-478-0080(4))) equal to or less than the medicare Part D low-income subsidy resource standard found at: http://hrsa.dshs.wa.gov/Eligibility/images/Standards%20Chart%20July%202008%20Final.pdf.

(2) MSP follow categorically needy program rules for SSI related persons in chapter 388-475 WAC.

(3) MSP clients are entitled to a fair hearing when the department takes an adverse action such as denying or terminating MSP benefits.

(4) The department subtracts the allocations and deductions described under WAC 388-513-1380 from a long-term care client's countable income and resources when determining MSP eligibility:

(a) Allocations to a spouse and/or dependent family member; and

(b) Client participation in cost of care.

(5) Medicaid eligibility may affect MSP eligibility, as follows:

(a) Qualified medicare beneficiaries (QMB) and specified low income beneficiaries (SLMB) clients can receive medicaid and still be eligible to receive QMB or SLMB benefits.

(b) Qualified individuals (QI-1) and qualified disabled working individuals (QDWI) clients who begin to receive medicaid are no longer eligible for QI-1 or QDWI benefits.

(6) Every year, when the federal poverty level changes:

(a) The department adjusts income standards for MSP and state funded medicare buy-in programs, see WAC 388-478-0085.

(b) The department begins to count the annual Social Security cost-of-living (COLA) increase on April 1st each year when determining eligibility for MSP and state funded medicaid buy-in programs.

(7) There is no income limit for the state-funded medicare buy-in program. The state-funded medicare buy-in program is for clients who receive medicaid but do not qualify for the federal MSP.

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530 and 42 U.S.C. Section 1396a. 07-15-032, 388-517-0310, filed 7/12/07, effective 8/12/07. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530, and 42 U.S.C. 1396a(a) (Section 1902 (n)(2) of the Social Security Act of 1924). 05-14-125, 388-517-0310, filed 7/1/05, effective 8/1/05.]

Washington State Code Reviser's Office