WSR 98-16-044

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Economic Services Administration)

[Filed July 31, 1998, 1:11 p.m., effective September 1, 1998]



Date of Adoption: July 31, 1998.

Purpose: To consolidate and simplify program and eligibility requirements for cash, food, and medical assistance to comply with criteria in the Governor's Executive Order 97.02. The rules being adopted have been consolidated, shortened and simplified by a special task team with members from Economic Services and Medical Assistance Administration in collaboration with clients, advocates, and the public. No program policy was changed in this process.

CHAPTER 388-400 WAC, PROGRAM SUMMARY Summarizes assistance eligibility requirements by program.
CHAPTER 388-404 WAC, AGE REQUIREMENTS Describes age requirements that apply to DSHS assistance programs.
CHAPTER 388-406 WAC, APPLICATIONS Explains how the department accepts and processes an application for assistance.
CHAPTER 388-408 WAC, ASSISTANCE UNITS Explains how different public assistance programs determine who makes up a single household.
CHAPTER 388-410 WAC, BENEFIT ERROR Explain how program overpayments are determined and the methods used for collection.
CHAPTER 388-412 WAC, BENEFIT ISSUANCES Explains how the department issues benefits for public assistance.
CHAPTER 388-414 WAC, CATEGORICAL ELIGIBILITY FOR FOOD Explains that when a client is already eligible for certain programs, they are automatically eligible for food assistance.
CHAPTER 388-416 WAC, CERTIFICATION PERIOD Explains how long an eligible client can receive assistance before the department rechecks eligibility.
CHAPTER 388-418 WAC, CHANGE OF CIRCUMSTANCES Explains which changes in circumstance clients must report to the department.
CHAPTER 388-420 WAC, CHEMICAL DEPENDENCY FOOD ASSISTANCE Describe when clients are eligible for food assistance while receiving alcohol or drug treatment.
CHAPTER 388-422 WAC, CHILD SUPPORT Explains child support requirements that clients must meet in order to be eligible for assistance.
CHAPTER 388-424 WAC, CITIZENSHIP/ALIEN STATUS Describes citizenship and alien status requirements for eligibility for cash, food and medical assistance.
CHAPTER 388-426 WAC, CLIENT COMPLAINTS Provides for a complaint procedure for clients of assistance programs.
CHAPTER 388-428 WAC, CONFIDENTIALITY Explain which client information the department can disclose for assistance programs and which is confidential.
CHAPTER 388-430 WAC, DEPRIVATION Describes the factors which are considered when determining if a child is deprived of parental support.
CHAPTER 388-434 WAC, ELIGIBILITY REVIEWS AND RECERTIFICATIONS Describes how the department reviews eligibility for cash and medical assistance benefits and how they recertify food assistance eligibility periodically.
CHAPTER 388-436 WAC, EMERGENCY CASH ASSISTANCE Define criteria for programs to provide cash assistance to clients under special or emergency circumstances.
CHAPTER 388-437 WAC, EMERGENCY ASSISTANCE FOR FOOD STAMPS Explains the conditions under which food stamps are available in a disaster.
CHAPTER 388-438 WAC, EMERGENCY ASSISTANCE FOR MEDICAL NEEDS Explains who can receive services under special emergency medical assistance programs.
CHAPTER 388-440 WAC, EXCEPTION TO RULE Explains circumstances under which the secretary of DSHS may grant an exception to policy requirements for an individual client.
CHAPTER 388-442 WAC, FELONS Explains under what circumstances a felon is eligible for public assistance.
CHAPTER 388-444 WAC, FOOD STAMP EMPLOYMENT AND TRAINING Tells which clients have to participate in employment or training in order to receive assistance. Explains how these mandates relate to food assistance.
CHAPTER 388-446 WAC, FRAUD Describes what happens to clients suspected or convicted of committing fraud to receive assistance.
CHAPTER 388-448 WAC, INCAPACITY Describes which clients meet definitions for general assistance-unemployable benefits and which children are considered deprived of parental support.
CHAPTER 388-450 WAC, INCOME Describes what is considered as income and how income affects a client's eligibility for cash, medical and food assistance.
CHAPTER 388-452 WAC, INTERVIEWING CLIENTS Sets minimum criteria for client interviews for assistance programs.
CHAPTER 388-454 WAC, LIVING WITH A RELATIVE Explain which relatives a child can live with to be eligible for assistance.
CHAPTER 388-456 WAC, MONTHLY REPORTING Explains when clients have to file monthly reports to remain eligible for assistance.
CHAPTER 388-458 WAC, NOTICES TO CLIENTS Sets criteria for when and how DSHS has to provide formal notice to a client before taking action.
CHAPTER 388-460 WAC, PAYEES ON BENEFIT ISSUANCES Explains how the department decides whose name to issue an assistance payment to in a household.
CHAPTER 388-462 WAC, PREGNANCY Explains the assistance programs available to women when they are pregnant.
CHAPTER 388-464 WAC, QUALITY ASSURANCE Require certain clients to cooperate with the quality assurance review process in ESA.
CHAPTER 388-466 WAC, REFUGEE PROGRAM Explain eligibility requirements for refugee assistance.
CHAPTER 388-468 WAC, RESIDENCY Sets residency rules for public assistance eligibility.
CHAPTER 388-470 WAC, RESOURCES Explains how many assets a person may have and still be eligible for assistance benefits.
CHAPTER 388-472 WAC, RIGHTS AND RESPONSIBILITIES Sets out mandated rights and responsibilities for clients.
CHAPTER 388-474 WAC, SUPPLEMENTAL SECURITY INCOME Describes who may qualify for SSI benefits, what coverage is available, under what conditions they can be terminated and what overpayments or duplicate payments.
CHAPTER 388-476 WAC,

SOCIAL SECURITY NUMBER

Tells when a social security number is a requirement and describes requirements when a social security number is not available for assistance programs.
CHAPTER 388-478 WAC, STANDARDS FOR PAYMENTS Defines maximum and minimum payment standards for assistance programs.
CHAPTER 388-480 WAC,

STRIKERS

Describe assistance eligibility provisions that apply when a person is on strike.
CHAPTER 388-482 WAC,

STUDENT STATUS

Explain which students are eligible for food assistance.
CHAPTER 388-484 WAC,

TANF/SFA FIVE YEAR TIME LIMIT

Provides for a limit to the length of time a person may receive assistance under Temporary Assistance for Needy Families or State Family Assistance programs.
CHAPTER 388-486 WAC, TEEN PARENTS Explains eligibility criteria for unmarried pregnant or parenting teens to receive assistance.
CHAPTER 388-488 WAC, TRANSFER OF PROPERTY Describes what happens to assistance eligibility when a client transfers property to another person.
CHAPTER 388-490 WAC, VERIFICATION Lists mandatory verification requirements and criteria for additional verification requests.
WAC 388-503-0505 Defines eligibility for medical assistance programs.
WAC 388-503-0510 Defines eligibility for medical assistance programs
WAC 388-503-0515 Defines eligibility for medical assistance programs
WAC 388-505-0110 Describes medical assistance coverage for adults who can't be covered under Family Medical
WAC 388-505-0210 Describes children's Medicaid eligibility
WAC 388-505-0220 Explains when families are eligible for medical benefits.
WAC 388-517-0300 Explains the programs that help clients pay Medicare coverage out-of-pocket costs.
WAC 388-519-0100 Explains how a person may be eligible for medical assistance if their income exceeds specific limits.
WAC 388-519-0110 Explains how a person may be eligible for medical assistance if their income exceeds specific limits.
WAC 388-519-0120 Explains how a person may be eligible for medical assistance if their income exceeds specific limits.
WAC 388-523-0100 Explains when medical assistance benefits may be extended.
WAC 388-529-0100 Describes the medical coverage available to clients in medical programs.
WAC 388-529-0200 Describes the medical services available to eligible clients.



Citation of Existing Rules Affected by this Order:

Repealed



Chapter 388-49 WAC FOOD ASSISTANCE PROGRAMS
WAC 388-055-0006 Summary of eligibility conditions
WAC 388-055-0008 Eligibility conditions-Refugee status
WAC 388-055-0010 Common eligibility conditions
WAC 388-055-0020 Work and training eligibility conditions
WAC 388-055-0030 Treatment of income and resources
WAC 388-055-0040 Refugee medical assistance
WAC 388-055-0060 Refugee notification and referral
WAC 388-200-1100 Grievance procedures
WAC 388-200-1150 Exception to rule
Chapter 388-210 WAC APPLICATIONS FOR ASSISTANCE
Chapter 388-212 WAC VERIFICATION OF ELIGIBILITY
Chapter 388-215 WAC AFDC-CATEGORICAL ELIGIBILITY
Chapter 388-216 WAC RESOURCE ELIGIBILITY
Chapter 388-217 WAC TRANSFER OF PROPERTY
Chapter 388-218 WAC AFDC-INCOME POLICIES
Chapter 388-219 WAC GENERAL ASSISTANCE-INCOME POLICIES
Chapter 388-220 WAC STATE FAMILY ASSISTANCE
Chapter 388-225 WAC CONSOLIDATED EMERGENCY ASSISTANCE PROGRAM-CEAP
Chapter 388-230 WAC GENERAL ASSISTANCE FOR PREGNANT WOMEN
Chapter 388-233 WAC GENERAL ASSISTANCE FOR CHILDREN
WAC 388-235-0010 Purpose of program
WAC 388-235-0020 Definitions
WAC 388-235-0030 Summary of eligibility conditions
WAC 388-235-0040 Assistance unit
WAC 388-235-0050 Age requirements
WAC 388-235-0060 Residence-Establishing
WAC 388-235-0070 Residence-Temporary absences
WAC 388-235-0080 Residence-Applicant living in another state
WAC 388-235-0090 Residence-Applicant receiving assistance from another state
WAC 388-235-0100 Citizenship and alien status
WAC 388-235-0110 Social Security number
WAC 388-235-2000 Resources
WAC 388-235-3000 Income
WAC 388-235-4000 GAU payment and need standards
Chapter 388-245 WAC MAINTENANCE OF GRANT PROGRAMS
Chapter 388-250 WAC GRANT STANDARDS
WAC 388-255-1350 Additional requirements for emergent situations
WAC 388-255-1400 One-time grant-Authorization-Disbursement
WAC 388-265-1010 Grant payment-General provisions
WAC 388-265-1050 Grant authorization
WAC 388-265-1100 Grant payee
WAC 388-265-1550 Client notification of protective payee or vendor payee
WAC 388-265-1700 Confidential information-Protective payee or vendor payee
WAC 388-265-1800 Warrant endorsement
WAC 388-265-1850 Warrant delivery
WAC 388-265-1900 Warrant cancellation
WAC 388-265-1950 Loss, theft, or destruction of a client's warrant
WAC 388-265-2000 Loss, theft, or destruction of a vendor warrant
Chapter 388-270 WAC INCORRECT PAYMENTS
WAC 388-275-0020 SSI: Definitions
WAC 388-275-0030 SSI: Administrative Responsibilities
WAC 388-275-0050 SSI: Waiver of state supplement
WAC 388-275-0060 SSI: Payments
WAC 388-275-0070 SSI: Termination of state supplement
WAC 388-275-0090 SSI: Representative Payee


Amended



WAC 388-86-027 Describes requirements for the Healthy Kids program.
WAC 388-501-0135 Explains the program for clients needing help in the appropriate use of medical services.
WAC 388-505-0540 Assigns rights for medical programs.
WAC 388-538-060 Explains who is eligible for healthy options programs.
WAC 388-538-080 Explains who is exempt from healthy options programs.
WAC 388-538-095 Explains healthy options scope of care.
WAC 388-538-130 Explains who is removed from healthy options programs.


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

Adopted under notice filed as WSR 98-11-084 on May 19, 1998, and WSR 98-13-080 on June 16, 1998.

Changes Other than Editing from Proposed to Adopted Version:
RULE NUMBER NATURE OF CHANGE REASON FOR CHANGE
388-406-0045 To clarify what is accepted as good cause for a delay Each of these changes was requested by a

reviewer to

make the rules easier to read, understand and

use. After discussion with

the program and, if needed,

meeting with the reviewer, the

change was

made to respond to reviewer comments.

388-408-0055 To clarify the responsibility of the parent
388-412-0005 To clarify the amount of cash payment
388-412-0015 To clarify how allotments are determined
388-416-0015 To clarify how long medical assistance determination lasts
388-416-0020 To clarify the 12 month certification period
388-418-0020 To clarify what how a change of circumstance is treated in the Temporary Assistance for Needy Families program
388-438-0100 To clarify acceptable exemptions for charity care expenses
388-444-0005 To clarify the number of hours a client may be required to participate in Food Stamp Employment & Training
388-444-0060 To clarify that payment standards for workfare expenses are set by DSHS
388-458-0005 To clarify when DSHS is required to notify the client before taking action
388-458-0010 To clarify when DSHS is required to notify the client before taking action
388-462-0015 To clarify when a pregnant woman is eligible for medical assistance
388-468-0005 To clarify a household's eligibility for medical assistance
388-470-0005 To clarify when household resources will be used to determine eligibility
388-470-0015 To clarify when a client's resource is considered unavailable
388-472-0005 To clarify two client rights: the client's right to receive a receipt for an application and a pregnant woman's right to be seen within 5 days
388-478-0065 To clarify when an unborn child is counted as part of the household
388-478-0070 To clarify requirements for monthly reporting for the Medically Indigent program
388-86-027 To clarify requirements for the Healthy Kids Program



Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 288, amended 7, repealed 391.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 0, repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 288, amended 7, repealed 391.

Effective Date of Rule: September 1, 1998.

July 31, 1998

Edith M. Rice

for Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit



REPEALER



The following chapters and sections of the Washington Administrative Code are repealed:



Chapter 388-49 WAC Food assistance programs.

Chapter 388-210 WAC Applications for assistance.

Chapter 388-212 WAC Verification of eligibility.

Chapter 388-215 WAC Aid to families with dependent children--Categorical eligibility.

Chapter 388-216 WAC Resource eligibility.

Chapter 388-217 WAC Transfer of property.

Chapter 388-218 WAC Aid to families with dependent children--Income policies.

Chapter 388-219 WAC General assistance--Income policies.

Chapter 388-220 WAC State family assistance.

Chapter 388-225 WAC Consolidated emergency assistance program--CEAP.

Chapter 388-230 WAC General assistance for pregnant women.

Chapter 388-233 WAC General assistance for children.

Chapter 388-245 WAC Maintenance of grant programs.

Chapter 388-250 WAC Grant standards.

Chapter 388-270 WAC Incorrect payments.

WAC 388-55-006 Summary of eligibility conditions.

WAC 388-55-008 Eligibility conditions--Refugee status.

WAC 388-55-010 Common eligibility conditions.

WAC 388-55-020 Work and training eligibility conditions.

WAC 388-55-030 Treatment of income and resources.

WAC 388-55-040 Refugee medical assistance.

WAC 388-55-060 Refugee notification and referral.

WAC 388-200-1100 Grievance procedure.

WAC 388-200-1150 Exception to rule.

WAC 388-235-0010 Purpose of program.

WAC 388-235-0020 Definitions.

WAC 388-235-0030 Summary of eligibility conditions.

WAC 388-235-0040 Assistance unit.

WAC 388-235-0050 Age requirements.

WAC 388-235-0060 Residence-Establishing.

WAC 388-235-0070 Residence-Temporary absences.

WAC 388-235-0080 Residence-Applicant living in another state.

WAC 388-235-0090 Residence-Applicant receiving assistance from another state.

WAC 388-235-0100 Citizenship and alien status.

WAC 388-235-0110 Social security number.

WAC 388-235-2000 Resources.

WAC 388-235-3000 Income.

WAC 388-235-4000 GAU payment and need standards.

WAC 388-255-1350 Additional requirements for emergent situations.

WAC 388-255-1400 One-time grant--Authorization--Disbursement.

WAC 388-265-1010 Grant payment--General provisions.

WAC 388-265-1050 Grant authorization.

WAC 388-265-1100 Grant payee.

WAC 388-265-1550 Client notification of protective payee or vendor payee.

WAC 388-265-1700 Confidential information--Protective payee or vendor payee.

WAC 388-265-1800 Warrant endorsement.

WAC 388-265-1850 Warrant delivery.

WAC 388-265-1900 Warrant cancellation.

WAC 388-265-1950 Loss, theft, or destruction of a client's warrant.

WAC 388-265-2000 Loss, theft, or destruction of a vendor warrant.

WAC 388-275-0020 Definitions.

WAC 388-275-0030 Administrative responsibility.

WAC 388-275-0050 Waiver of state supplement.

WAC 388-275-0060 Payments.

WAC 388-275-0070 Termination of state supplement.

WAC 388-275-0090 Representative payee.

Chapter 388-400 WAC



PROGRAM SUMMARY



NEW SECTION



WAC 388-400-0005  Temporary assistance for needy families--General eligibility requirements. (1) To be eligible for temporary assistance for needy families (TANF), a child must:

(a) Meet the age requirements under WAC 388-404-0005;

(b) Live in the home of a relative as required under chapter 388-454 WAC;

(c) Be deprived of parental support and care as required under chapter 388-430 WAC; and

(d) Live with a parent who is not ineligible for TANF due to the time limit requirements of WAC 388-484-0005.

(2) To be eligible for TANF, a person must:

(a) Meet the citizenship/alien status requirements of WAC 388-424-0005;

(b) Reside in the state of Washington, or, if a child, live with a parent or other relative who meets the state residency requirements of WAC 388-468-0005;

(c) Be in financial need as specified under chapters 388-450, 388-470 and 388-488 WAC;

(d) Assign any rights to child support and cooperate in establishing paternity and collecting child support as required under chapter 388-422 WAC;

(e) Provide a Social Security number as required under WAC 388-476-0005;

(f) Cooperate in a review of eligibility as required under WAC 388-434-0005;

(g) Cooperate in a quality assurance review as required under WAC 388-464-0005;

(h) Participate in the WorkFirst program as required under chapter 388-310 WAC;

(i) Not be participating in a strike as defined under WAC 388-480-0005;

(j) Report circumstances monthly as required under chapter 388-456 WAC;

(k) Report changes of circumstances as required under chapter 388-418 WAC; and

(l) If a pregnant woman who is not otherwise eligible for TANF; meet the requirements of WAC 388-462-0010.

(3) TANF assistance units for children and caretaker relatives are established according to chapter 388-408 WAC.

(4) The following persons are not eligible for TANF:

(a) Persons convicted of certain felonies and other crimes as specified in chapter 388-442 WAC; and

(b) Persons convicted of unlawful practices in obtaining public assistance as specified in chapter 388-446 WAC.

(5) Unmarried pregnant and parenting teens must meet the living arrangement and school attendance requirements of chapter 388-486 WAC.



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NEW SECTION



WAC 388-400-0010  State family assistance--Summary of eligibility requirements. (1) To be eligible for state family assistance (SFA), a person must:

(a) Meet all temporary assistance for needy families (TANF) eligibility requirements except those for citizenship and alien status; and

(b) Meet the citizenship/residence requirements as specified in WAC 388-424-0015.

(2) An assistance unit is not eligible for SFA if it includes an adult who has received SFA, TANF, or a combination of SFA and TANF for a total of sixty months since August 1, 1997. Months are disregarded as specified under WAC 388-484-0005 when calculating the number of months an adult family member has received SFA or TANF.

(3) Assistance units for families with members who meet SFA and TANF citizenship/alien status requirements will be established under the TANF assistance unit rules in chapter 388-408 WAC.



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NEW SECTION



WAC 388-400-0015  General assistance for children--Summary of eligibility requirements. (1) To be eligible for general assistance for children (GA-H), a child must:

(a) Live with a court-appointed legal guardian or court appointed permanent custodian as required under chapter 388-454 WAC;

(b) Meet the general assistance citizenship/alien status requirements under WAC 388-424-0005(3);

(c) Be in financial need according to temporary assistance for needy families (TANF) income and resource rules in chapters 388-450, 388-470 and 388-488 WAC, except that child support received is considered the child's unearned income; and

(d) Meet all other requirements of a child eligible for TANF except citizenship/alien status and requirements to:

(i) Live with a relative of specified degree; and

(ii) Participate in WorkFirst activities if not in school.

(2) A child is not eligible for GA-H if:

(a) The child is eligible for or receives TANF or Supplemental Security Income (SSI); or

(b) The child or the child's caretaker has refused or failed to cooperate in obtaining TANF or SSI on behalf of the child.

(3) A GA-H assistance unit is established as specified in WAC 388-408-0010.

(4) The child's custodian or payee is the GA-H grant payee.



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NEW SECTION



WAC 388-400-0020  General assistance for pregnant women--General eligibility requirements. (1) To be eligible for general assistance for pregnant women (GA-S), a woman must:

(a) Meet the requirements of WAC 388-462-0005; and

(b) Meet the general assistance citizenship/alien status requirements under WAC 388-424-0005(3);

(c) Be in financial need according to temporary assistance for needy families (TANF) income and resource rules in chapters 388-450, 388-470 and 388-488 WAC;

(d) Provide a Social Security number as required under WAC 388-476-0005; and

(e) Reside in the state of Washington as required under WAC 388-468-0005.

(2) A woman is not eligible for GA-S if she:

(a) Is eligible for or her needs are being met by the Supplemental Security Income (SSI) program TANF or state family assistance (SFA);

(b) Is under sanction for failing to comply with SSI requirements;

(c) Fails or refuses to cooperate without good cause in obtaining SSI; or

(d) Fails or refuses to cooperate in obtaining TANF or SFA. This includes disqualifications for:

(i) Convictions for misrepresenting residence to obtain assistance in two or more state as specified under chapter 388-446 WAC;

(ii) Convictions for drug-related felonies and failing to complete drug treatment as specified under chapter 388-442 WAC;

(iii) Failing to report a child's absence within five days of becoming reasonably certain the absence will exceed ninety days as specified in chapter 388-418 WAC; or

(iv) Failing to meet school attendance requirements for unmarried teen parents as specified under chapter 388-486 WAC.

(3) The assistance unit for a woman applying for or receiving GA-S will be established according to WAC 388-408-0010.

(4) Unmarried pregnant or parenting minors who are not emancipated under a court decree must meet the living arrangement requirements of WAC 388-486-0005.

(5) A pregnant woman in an institution may be eligible for GA-S as specified under WAC 388-230-0080.



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NEW SECTION



WAC 388-400-0025  General assistance unemployable--General eligibility requirements. (1) To be eligible for general assistance - unemployable (GA-U), a person must:

(a) Be incapacitated as required under WAC 388-235-5000 through 388-235-6000;

(b) Meet the age requirement of WAC 388-404-0010;

(c) Be in financial need according to GA-U income and temporary assistance for needy families (TANF) resource rules in chapters 388-450, 388-470 and 388-488 WAC;

(d) Meet the general assistance citizenship/alien status requirements under WAC 388-424-0005(3);

(e) Provide a Social Security number as required under WAC 388-476-0005;

(f) Reside in the state of Washington as required under WAC 388-468-0005;

(g) Undergo a treatment and referral assessment as provided under WAC 388-235-7000 through 388-235-7600;

(h) Assign interim assistance as provided under WAC 388-235-9200 and 388-235-9300;

(i) Not be eligible for or receiving benefits from other programs as specified under WAC 388-235-9000.

(2) The assistance unit for a person applying for or receiving GA-U will be established according to WAC 388-408-0010.

(3) A person in an institution may be eligible for GA-U as specified under WAC 388-235-1500.



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NEW SECTION



WAC 388-400-0030  Refugee cash assistance--Summary of eligibility requirements. (1) To be eligible for refugee cash assistance (RCA), persons must:

(a) Provide the name of the voluntary agency (VOLAG) which resettled them; and

(b) Meet the:

(i) Immigration status requirements of WAC 388-466-0005;

(ii) Work and training requirements of WAC 388-466-0015;

(iii) Income and resource requirements under chapters 388-450 and 388-470 WAC with exceptions as provided under WAC 388-466-0010; and

(iv) Monthly reporting requirements of chapter 388-456 WAC.

(2) Persons are not eligible to receive RCA if they:

(a) Are eligible for temporary assistance for needy families (TANF) or Supplemental Security Income;

(b) Have been denied TANF or have been terminated from TANF due to intentional noncompliance with TANF eligibility requirements; or

(c) Are full-time students in institutions of higher education unless the educational activity is part of a department-approved employability plan.

(3) Refugee families, including families with children who are United States citizens, will be treated as single assistance units according to chapter 388-408 WAC.

(4) Eligibility and benefit levels for RCA assistance units are determined using the TANF payment standards in WAC 388-478-0020.

(5) Persons eligible for RCA are eligible for additional requirements for emergent situations as provided in chapter 388-436 WAC.

(6) A person meeting the requirements of this section is eligible for refugee cash assistance only during the eight-month period beginning in the first month the person entered the United States.



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NEW SECTION



WAC 388-400-0035  Refugee medical assistance--Summary of eligibility requirements. (1) To be eligible for refugee medical assistance (RMA), persons must:

(a) Provide the name of the voluntary agency (VOLAG) which resettled them; and

(b) Meet the immigration status requirements of WAC 388-466-0005.

(2) Except for a person who is not eligible under subsection (3) of this section, a person is eligible for RMA if the person:

(a) Receives refugee cash assistance (RCA); or

(b) Is eligible for but chooses not to apply for or receive RCA.

(3) Persons are not eligible to receive RMA if they are:

(a) Eligible for Medicaid;

(b) Are not eligible for RCA because they have not met the employment and training requirements of WAC 388-466-0015; or

(c) Are full-time students in institutions of higher education unless the educational activity is part of a department-approved employability plan.

(4) Refugee families, including families with children who are United States citizens, will be treated as single assistance units according to chapter 388-408 WAC.

(5) A person meeting the requirements of this section is eligible for RMA only during the eight-month period beginning in the first month the person entered the United States.

(6) A recipient of RCA and RMA who becomes ineligible for RCA due to an increase in income remains eligible for extended RMA benefits until the end of the eighth month period following entry into the United States.

(7) A person will have his or her eligibility for RMA determined based on the rules for the medically needy program if the person is:

(a) Not eligible for Medicaid; or

(b) Not eligible for RCA because of excess income, unless the person is eligible for extended RMA under subsection (6) of this section.



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NEW SECTION



WAC 388-400-0040  General eligibility requirements for the federal food assistance program. (1) Persons applying for benefits for the federal food assistance program must meet certain eligibility criteria established under the Food Stamp Act of 1977 as amended.

(2) When a person applies for benefits, a decision is made about who must be included in the assistance unit as specified under WAC 388-408-0035.

(3) After the assistance unit is determined, all members must:

(a) Be U.S. citizens or nationals as specified under WAC 388-424-0005(1); or

(b) Be qualified aliens as specified under WAC 388-424-0020;

(c) Be residents of the state of Washington as specified under chapter 388-468 WAC; and

(d) Provide Social Security numbers as specified under chapter 388-476 WAC.

(4) To be eligible, an assistance unit must:

(a) Have income at or below gross and net income standards unless excluded from these standards as specified under WAC 388-478-0060;

(b) Own resources at or below the applicable resource limits as specified in WAC 388-470-0005;

(c) Provide identity as specified under WAC 388-406-0015;

(d) Participate in the food stamp employment and training program (FSE&T) as specified under chapter 388-444 WAC;

(e) Meet the eligibility criteria for strikers as specified in chapter 388-480 WAC;

(f) Return a completed monthly report as required under chapter 388-456 WAC.

(5) Assistance units are allowed deductions from their income as specified under WAC 388-450-0200.

(6) Persons with disabilities may be allowed special consideration as explained in subsection (7) of this section, when the person:

(a) Receives SSI;

(b) Receives disability payments:

(i) Under Titles I, II, XIV, or XVI of the Social Security Act;

(ii) From a local, state or federal government agency that considers the disability as permanent under section 221(i) of the Social Security Act;

(iii) From the Railroad Retirement Act under sections 2 (a)(1)(iv) and (v) and meets Title XIX disability elements or is eligible for Medicare.

(c) Receives disability-related medical assistance under Title XIX of the Social Security Act;

(d) Is a veteran and receives disability payments rated at one hundred percent;

(e) Is a spouse of a veteran and:

(i) Is in need of an attendant or permanently housebound; or

(ii) Has a disability as described under section 221(i) of the Social Security Act and entitled to death or pension payments under Title 38 of the USC.

(7) A person with disabilities described in subsection (6) of this section:

(a) Does not have to have income at or below the gross income standard, only the net income standard;

(b) May be entitled to a medical deduction as described under chapter 388-450 WAC; or

(c) Is not required to count the value of a vehicle when the vehicle is needed to transport them as specified under WAC 388-470-0070 and 388-470-0075.

(8) The following persons applying for food assistance are denied benefits:

(a) Students attending an institution of higher education when the student does not meet the eligibility factors as specified under WAC 388-482-0005;

(b) Able-bodied adults without dependents who are no longer eligible under WAC 388-444-0030; and

(c) Assistance units who participate in the food distribution program. This program is available to assistance units living on or near an Indian reservation. The program is administered by tribal organizations approved by the federal Food and Nutrition Service (FNS).

(9) The following persons applying for food assistance are denied benefits but some of their income and all of their resources are considered available to the eligible assistance unit members:

(a) Fugitive felons including probation and parole violators and felons convicted of drug-related felonies as specified under chapter 388-442 WAC;

(b) Persons failing to attest to citizenship or alien status under WAC 388-408-0035(9);

(c) Persons disqualified for:

(i) An intentional program violation as specified under WAC 388-446-0015;

(ii) Failure to provide a Social Security number under chapter 388-476 WAC; or

(iii) Not participating with work requirements as specified under chapter 388-444 WAC; or

(d) Persons who are ineligible aliens under WAC 388-424-0020.



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SHS-2449.1

NEW SECTION



WAC 388-400-0045  Food assistance program for legal immigrants (FAP)--General eligibility requirements. (1) A legal immigrant meets alien status eligibility for the state-funded food assistance program if the immigrant:

(a) Meets those alien status requirements of the Food Stamp Act of 1977 in effect prior to August 22, 1996;

(b) Is not eligible for federal food stamps solely due to the immigrant provisions of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, P.L. 104-193, as amended. The immigrant must meet alien status rules under WAC 388-424-0025.

(2) FAP provides the same amount of benefits as the federal food stamp program. Some assistance units may receive a combined benefit of both state and federal food stamps. Food assistance benefit levels are found in WAC 388-478-0060.

(3) FAP follows the same eligibility rules, except for alien status, as the federal food stamp program. The federal food stamp program summary is found in WAC 388-400-0040.



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SHS-2396:4

Chapter 388-404 WAC



AGE REQUIREMENTS



NEW SECTION



WAC 388-404-0005  Age of child eligible for TANF, SFA and GA-H. To be eligible for temporary assistance for needy families (TANF), state family assistance (SFA) or general assistance for children (GA-H), a child must be:

(1) Under age eighteen; or

(2) Under age nineteen; and:

(a) Participating full-time in a secondary school program or the equivalent level of vocational or technical training; and

(b) Reasonably expected to complete the program by the end of the month in which the child reaches age nineteen.



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NEW SECTION



WAC 388-404-0010  Age requirement for GA-U and ADATSA. To be eligible for general assistance - unemployable (GA-U) or the ADATSA program a person must be:

(1) At least eighteen years of age or older; or

(2) For GA-U only, if under eighteen years of age, a member of a married couple:

(a) Residing together, or

(b) Residing apart solely because a spouse is:

(i) On a visit of ninety days or less;

(ii) In a public or private institution;

(iii) Receiving care in a hospital, long-term care facility, or chemical dependency treatment facility; or

(iv) On active duty in the uniformed military services of the United States.



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NEW SECTION



WAC 388-404-0015  Definition of elderly person for food and cash assistance programs. For food and cash assistance, "elderly person" means a person sixty years of age or older.



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SHS-2397:5

Chapter 388-406 WAC



APPLICATIONS



NEW SECTION



WAC 388-406-0005  Who may apply. Any person may file an application for cash, medical or food assistance.

(1) For food assistance, applications may be made by a responsible household member or an authorized representative.

(2) For medical and cash assistance, an application may be made by:

(a) Persons applying on their own behalf or on behalf of their dependents;

(b) A legal guardian or caretaker applying on behalf of a minor or incompetent person; or

(c) Any other person acting on behalf of the applicant when application cannot be made under one of the preceding methods. For cash assistance the person must indicate the reason the applicant is not able to apply on his or her own behalf.

(3) For GA-U and medical programs, a Washington state resident who is temporarily living out of the state may apply through a person or agency acting on the client's behalf.



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NEW SECTION



WAC 388-406-0010  Filing an application. (1) A person may file an application by submitting a written request for benefits using a form designated by the department, to the applicant's local community service office (CSO) in person or by mail.

(a) A person may file an application on the same day that benefits are requested when the request is made in the applicant's local CSO during regular business hours.

(b) A household applying for food, medical and/or cash assistance may do so by submitting a single request for benefits.

(c) For food assistance, a household consisting only of clients applying for or receiving Supplemental Security Income (SSI) may file an application at the local Social Security Administration District Office (SSADO).

(d) Clients who receive SSI or who are otherwise determined eligible for Medicaid by the Social Security Administration will be authorized medical assistance without being required to file a separate application with the department.

(2) The request for benefits form must be as brief as administratively possible and seek information ordinarily known to the applicant, including:

(a) The name and address of the applicant;

(b) The type of assistance requested (i.e., food, medical and/or cash assistance);

(c) For medical and cash assistance:

(i) The applicant's telephone number, if known; and

(ii) The names, birthdates and social security numbers, if known, of all persons for whom assistance is requested; and

(d) For TANF and SFA, the names, birthdates and social security numbers, if known, of:

(i) All children under the age of nineteen who are living in the home and who are siblings of any child for whom assistance is being requested; and

(ii) All parents, if living in the home, of any child for whom assistance is requested.

(e) An application is required for a medically needy program client who requests eligibility beyond the certification period.

(3) To initiate an application, the filed request for benefits form must include:

(a) The name and address of the applicant; and

(b) The signature of the applicant or the applicant's representative.



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NEW SECTION



WAC 388-406-0015  Expedited service for food assistance. (1) Households eligible for expedited service will receive food assistance benefits by the end of the fifth calendar day from the date of application. For SSI recipients, this time frame begins on the date the:

(a) Applicant's local CSO receives the application of a noninstitutionalized SSI household; or

(b) Applicant is released from a public institution.

(2) Applicants are eligible for expedited service when the household:

(a) Has liquid resources of one hundred dollars or less and has gross monthly income under one hundred fifty dollars; or

(b) Has combined gross monthly income and liquid resources which are less than the household's current monthly rent and applicable utility allowance; or

(c) When all members are homeless; or

(d) Includes a destitute migrant or seasonal farmworker, as defined in WAC 388-406-0020, whose liquid resources do not exceed one hundred dollars.

(3) A household must provide verification of:

(a) The identity of the applicant; or

(b) The identity of the authorized representative who is applying for the household; and

(c) Other eligibility factors that can be verified within the five day time period specified in subsection (1) of this section.

(4) A household is not limited to the number of times it can receive expedited service if, following the last expedited certification, the household:

(a) Completes the postponed verification requirements; or

(b) Was certified by the regular nonexpedited processing methods.

(5) When a household is eligible for expedited service and an office interview is not required, the household will have:

(a) A telephone interview or home visit; and

(b) Still receive their benefits within the five-day expedited time period.

(6) A household is entitled to an agency conference within two working days from the date of denial for expedited service.



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NEW SECTION



WAC 388-406-0020  Destitute household definition. (1) A migrant or seasonal farmworker is considered destitute for the purposes of eligibility for food assistance when:

(a) The household's income for the month of application was received before the date of application and was from a source no longer providing income; or

(b) The household's income for the month of application is from a new source and the household will receive no more than twenty-five dollars during the ten calendar days from the date of application.

(2) A household member changing jobs but continuing to work for the same employer is considered to be receiving income from the same source.



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NEW SECTION



WAC 388-406-0025  Applicant to provide information needed to determine eligibility. The applicant or applicant's representative must cooperate with the department by providing information needed to determine eligibility. Cooperation includes:

(1) Completing an application form and any supplemental forms required by the department to determine eligibility.

(a) The applicant will be assisted by department staff in the completion of all required application forms when needed. All applicants will be screened to determine the need for necessary supplemental accommodation (NSA) services and provided with such services as required under WAC 388-200-1300.

(b) Completed application forms must be signed:

(i) For food assistance, by an adult household member or minor applicant when there is no adult member;

(ii) For TANF, SFA and RCA, by all adult applicants and minor parents, if living in the home, of children for whom assistance is requested;

(iii) For GA-S and GA-U, by the applicant and spouse, if living in the home, whether or not assistance is being requested on behalf of the spouse;

(iv) For medical programs, by the applicant's relative or representative when the applicant dies or is otherwise unable to complete the application;

(v) An applicant's signature by mark requires two witnesses. The signatures of witnesses must appear on the form and be identified by the department as witnesses.

(2) Completing an interview if required under chapter 388-452 WAC;

(3) Providing additional information needed to determine eligibility as required under WAC 388-406-0030.



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NEW SECTION



WAC 388-406-0030  Requests for additional information. An applicant is allowed at least ten calendar days to provide additional information required by the department to determine eligibility. This information will be requested in writing and may include supplemental forms and documents or statements verifying the applicant's circumstances as specified in chapter 388-490 WAC. The applicant is allowed additional time to provide requested information when:

(1) The applicant has requested, orally or in writing, additional time to provide the information; or

(2) The department determines the need for different or additional information following the initial interview or after having requested specific information. In these situations, the applicant will be:

(a) Provided with a written request for the additional information; and

(b) Allowed at least ten calendar days to provide the information.

(3) When the applicant for medical and cash assistance has not provided all of the requested information, the applicant will be:

(a) Provided with a written request for information still needed to determine eligibility; and

(b) Allowed at least ten calendar days to provide the information.

(4) All applicants who are assessed as needing NSA services will be assisted in complying with the requirements of this section as required under WAC 388-200-1300.



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NEW SECTION



WAC 388-406-0035  Time limits for processing applications. (1) The application process as defined in WAC 388-406-0050(1) must be completed as quickly as possible. The time limits specified in this section cannot be used as a waiting period for determining eligibility.

(2) When applying the time limits specified in this section, day one is the date following the date:

(a) A request for benefits form is received by the department as specified under WAC 388-406-0010;

(b) A household consisting solely of persons eligible for SSI files a food assistance application at the SSADO; or

(c) An SSI recipient applying for food assistance is released from a public institution when the person filed an application with the SSADO before release.

(3) Time limits are in calendar days unless otherwise specified. Time limits for application process completion are no more than:

(a) Thirty days for TANF, SFA, RCA, consolidated emergency assistance program (CEAP), and diversion cash assistance;

(b) Forty-five days for general assistance and alcohol and drug abuse treatment and shelter assistance (ADATSA); and

(c) Medical program benefits must be processed no more than:

(i) Sixty days when a disability decision is required;

(ii) Fifteen working days for pregnant women; and

(iii) Forty-five days for all other categories.



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NEW SECTION



WAC 388-406-0040  Delays in application processing. (1) When the department discovers that a food assistance application has not been processed within the initial thirty day time limit, and:

(a) The department has sufficient information to determine eligibility, the application will be processed without further delay; or

(b) If additional information is needed to determine eligibility, the household will be:

(i) Mailed or given a written request for the additional information needed to determine eligibility; and

(ii) Allowed an additional thirty day period to provide the information.

(2) When a household files a joint application requesting food assistance and medical or cash assistance:

(a) Approval of the food assistance application cannot be delayed pending the processing of the application for medical or cash assistance; and

(b) A new application for food assistance cannot be required if the application for medical or cash assistance is denied.

(3) For medical and cash assistance, application processing may be delayed only when good cause exists as specified in WAC 388-406-0045.



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NEW SECTION



WAC 388-406-0045  Good cause for delay in processing medical and cash assistance applications. (1) Good cause reasons for delay in processing a medical or cash assistance application include:

(a) The applicant does not provide requested information or take another required action;

(b) The eligibility decision depends on medical reports and there is a delay in obtaining the reports or in securing medical information;

(c) An eligibility determination depends on correspondence with out-of-state or intercity contacts and no other verification is available for the eligibility factor;

(d) An administrative or other emergency occurs which is beyond the department's control; or

(e) For cash assistance, an eligibility determination depends on extensive property appraisals.

(2) For medical assistance, good cause exists only when the department otherwise acted promptly at all stages of the application process.

(3) For TANF and SFA, good cause exists only when the department:

(a) Notifies the applicant in writing of specific information needed to determine eligibility within twenty days of the date of application;

(b) Notifies the applicant in writing of the need for additional information or action within five calendar days;

(c) Determines eligibility and disposes of the application within five working days of receiving all information necessary to determine eligibility; and

(d) Determines good cause exists and documents the decision in the case record on or before the time limit for processing the application expires.



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NEW SECTION



WAC 388-406-0050  Completing the application process. (1) Application processing is completed when the department makes an eligibility decision and:

(a) Authorizes benefits and, for food assistance, mails or gives a written approval notice to the applicant; or

(b) Mails or gives a written withdrawal or denial notice to the applicant.

(2) The applicant will be notified of the department's eligibility decision in writing. A notice of denial or withdrawal must meet the adequate notice requirements in WAC 388-458-0005.

(3) For cash, medical, and food assistance, an applicant may voluntarily withdraw an application orally or in writing.

(4) For medical and cash assistance, an application is considered withdrawn when the applicant:

(a) Fails to appear for a scheduled interview required for eligibility determination; and

(b) Does not contact the department to reschedule the interview within thirty days from the date of application.

(5) For approved applications, the date the applicant becomes eligible for assistance is established according to WAC 388-406-0055.

(6) A decision to deny an application must be made according to the requirements of WAC 388-406-0060.



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NEW SECTION



WAC 388-406-0055  Date of eligibility for approved applications. The effective date of eligibility for approved applications is:

(1) For cash assistance, the earlier of:

(a) The date the department has sufficient information to make an eligibility decision; or

(b) The last day of the time limit period specified in WAC 388-406-0035.

(2) For medical programs, as specified in chapter 388-416 WAC.

(3) For food assistance, except as described in subsections (4) and (5) of this section:

(a) The first day of the month following the end of the previous certification period for:

(i) All households that reapply before their previous certification period ends; and

(ii) Migrant and seasonal farmworker households that reapply within one month after their previous certification period ends; or

(b) The date of application for all other households.

(4) For food assistance applications approved after reconsideration as required by WAC 388-406-0065:

(a) The date the household provides required verification when:

(i) The application is denied because the applicant fails to respond to a written request for the verification, and

(ii) The household provides the requested verification after the end of the initial thirty-day time limit; or

(b) The date the household becomes eligible for TANF or SFA when:

(i) The household is denied nonassistance food assistance; and

(ii) Is later found to be categorically eligible for food assistance because TANF or SFA is approved.

(5) For food assistance applications not processed within the thirty-day time limit, the first day of the month following the month of application when:

(a) Required verification is not provided by the household by the end of the initial thirty-day time limit;

(b) The household provides the required verification by the end of the second thirty-day period; and

(c) The delay in providing the required verification is the fault of the household.



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NEW SECTION



WAC 388-406-0060  Denial of applications. (1) An application will be denied only when the department has not been able to establish the applicant's eligibility.

(2) An application cannot be denied solely because the applicant failed to provide requested information within a reasonably allowed period.

(3) For medical and cash assistance:

(a) An application cannot be denied based on a delay in obtaining medical information if the delay in obtaining the information is beyond the control of the applicant and the department;

(b) A decision to deny an application will be delayed for good cause as specified in WAC 388-406-0045; and

(c) An application for medical benefits will not be denied based on a failure to meet a spenddown obligation until at least thirty days after the end of the base period.

(4) If an applicant requests a fair hearing to contest the department's decision to deny an application because eligibility cannot be established based on information provided by the applicant, the issue in the hearing is whether the applicant can provide evidence to establish eligibility.

(5) Assistance will be denied to an entire assistance unit only when:

(a) Information required to establish eligibility for the entire assistance unit is not available to the department; or

(b) Circumstances which cause ineligibility affect all assistance unit members.

(6) An applicant will be notified of the department's decision to deny an application following notice requirements in WAC 388-458-0005.

(7) When an applicant for food assistance has not provided requested information within ten days:

(a) The application will be denied immediately if an application for TANF, SFA or SSI is not pending; or

(b) The denial decision may be delayed for up to thirty days from the date of application if an application for TANF, SFA or SSI is pending.

(8) A food assistance application which is not denied within the initial thirty-day period will be denied at the end of the second thirty-day period when:

(a) An eligibility decision could not be made based on information available to the department; and

(b) The applicant fails to provide requested information necessary to determine eligibility.



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NEW SECTION



WAC 388-406-0065  Reconsideration of denied applications. (1) For medical and cash assistance, an applicant is allowed thirty days from the date of a denial notice to provide information needed to determine eligibility as specified in the notice.

(a) A redetermination of eligibility will be made and eligibility will be determined based on the information provided unless the applicant's circumstances have changed to the extent that additional information is needed to determine eligibility.

(b) If eligibility is approved based on the information provided, the eligibility date is based on the application date of the denied application.

(2) A denial of an application for medical benefits will be rescinded if the applicant, following the thirty-day period specified in subsection (1) of this section:

(a) Timely requests a fair hearing to appeal the denial; and

(b) Provides additional information needed to establish eligibility, including medical expenses sufficient to meet spenddown if the applicant shows reasonable cause for the delay in verifying the medical expenses.

(3) For food assistance, an applicant is allowed thirty days from the end of the initial thirty-day period to provide information needed to determine eligibility as specified in a denial notice. If the information is provided, the eligibility date is determined as specified under WAC 388-406-0055.

(4) A denied food assistance application will be re-evaluated within sixty days of the application date when the household was:

(a) Applying for both food assistance and TANF, SFA or SSI; and

(b) Denied food assistance before TANF, SFA or SSI was approved.



[]

SHS-2371:7

Chapter 388-408 WAC



ASSISTANCE UNITS



NEW SECTION



WAC 388-408-0005  Definition of assistance unit for cash assistance programs. A cash assistance unit is a person or group of persons who live together and whose income, resources, and needs are considered as a unit for the purpose of determining eligibility and the amount of the cash assistance payment.



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NEW SECTION



WAC 388-408-0010  Assistance units for general assistance programs. (1) A GA-S assistance unit includes only the pregnant woman.

(2) A GA-U assistance unit includes:

(a) An incapacitated adult; or

(b) A married couple if both persons are incapacitated and living together.

(3) A married couple living together must be included in a single assistance unit when:

(a) The husband is incapacitated; and

(b) The wife is pregnant and not eligible for TANF.

(4) A GA-H assistance unit includes only the child or children eligible for GA-H.



[]



NEW SECTION



WAC 388-408-0015  Mandatory TANF and SFA assistance unit members. (1) A TANF assistance unit includes only a woman in her third trimester of pregnancy if there is no other eligible child in the home.

(2) A TANF, SFA or combined TANF/SFA assistance unit must include the following persons, if living together, unless the person must be excluded under WAC 388-408-0020 or is excluded at the option of the family under WAC 388-408-0025:

(a) The child for whom assistance is requested and that child's full, half or adoptive siblings;

(b) Any natural or adoptive parent or stepparent of any child who is included in the assistance unit;

(c) Any parent of a pregnant minor or minor parent who claims to be the needy caretaker relative of:

(i) The pregnant minor or minor parent;

(ii) The minor parent's child; or

(iii) The pregnant minor or minor parent's full, half or adoptive sibling.



[]



NEW SECTION



WAC 388-408-0020  Persons excluded from TANF and SFA assistance units. The following persons may not be included in a TANF or SFA assistance unit:

(1) Persons who are ineligible for reasons other than income and resources, except for adult family members who would make the family ineligible due to the TANF/SFA time limit as specified in chapter 388-484 WAC. Examples of persons who are ineligible for reasons other than income and resources are:

(a) Children who are not deprived of parental support and care as specified in chapter 388-430 WAC;

(b) Aliens who do not meet citizenship or alien status requirements for TANF or SFA as specified in chapter 388-424 WAC; and

(c) Children who do not live with relatives as specified in chapter 388-454 WAC.

(2) An adopted child if:

(a) The child receives federal, state or local adoption assistance; and

(b) Including the child would reduce the assistance unit's grant due to budgeting the adoption assistance income.

(3) Minor parents or children who have been placed in Title IV-E, state, or locally funded foster care except for temporary absences allowed for under WAC 388-454-0015;

(4) An adult parent in a two-parent household when:

(a) The other parent is unmarried and under the age of eighteen; and

(b) The department determines the living arrangement is not appropriate under WAC 388-486-0005.

(5) A recipient of SSI benefits.



[]



NEW SECTION



WAC 388-408-0025  Optional TANF and SFA assistance unit members. Unless excluded under WAC 388-408-0020, the following persons, if otherwise eligible, may be included in a TANF or SFA assistance unit at the option of the caretaker relative:

(1) One nonparental caretaker relative as defined in WAC 388-454-0010 if a parent of a child in the assistance unit does not reside in the home;

(2) The step siblings of a child included in the assistance unit;

(3) Children who are not siblings of a child included in the assistance unit;

(4) The siblings of a child receiving SSI;

(5) Any parent of a child receiving SSI;

(6) One nonparental relative of specified degree of a child receiving SSI if the child's parent or parents are not living in the home;

(7) One nonparental relative of specified degree of a child in the home receiving foster care; and

(8) For recipient assistance units, the child of unmarried parents when the child is living with both parents.



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NEW SECTION



WAC 388-408-0030  Consolidation of TANF and SFA assistance units. (1) All children included as mandatory or optional members and who live with the same caretaker relative or relative married couple must be included in a single assistance unit.

(2) Children do not have to be full, half, or adopted brothers or sisters to be included in the same assistance unit.

(3) When a change of circumstances occurs which makes one or more assistance unit members ineligible for cash assistance, assistance is continued for all assistance unit members who remain eligible.



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NEW SECTION



WAC 388-408-0035  Assistance units for food assistance. (1) For food assistance, a household is:

(a) A person living alone;

(b) A group of people living together who purchase or prepare meals together;

(c) A group of people living together who are required to be one household because of the relationship to each other as described in subsection (2) of this section; or

(d) An elderly person with permanent disabilities who is unable to prepare meals. The combined income of all others living in the residence (excluding the spouse) cannot exceed the one hundred sixty-five percent standard under WAC 388-478-0060. The person's spouse must be included in the food assistance household.

(2) The following people living together must be one household even if they purchase and prepare meals separately:

(a) Spouses which means persons who are legally married or who present themselves as husband and wife to the community, friends and relatives;

(b) Parents and their children under twenty-two years of age regardless of the child's marital status; and

(c) Children under eighteen years of age and the adult who the child is living with when the adult is not the child's parent. When a minor child lives with an adult who is not the child's parent, the child is considered to be under parental control unless the child receives in their own name:

(i) A TANF grant; or

(ii) Gross income equal to or exceeding the TANF grant standard in WAC 388-478-0020(2).

(3) A household member who is absent from the household a full issuance month, is not eligible for benefits with that household.

(4) The following persons living in the residence are not household members and if eligible may be a separate food assistance household:

(a) Roomers who are persons that pay for lodging but not meals;

(b) Others who purchase and prepare meals separately from the household; or

(c) Live-in attendants regardless of purchase and prepare arrangements.

(5) The following persons living in the residence are not household members and are not eligible for food assistance as a separate household:

(a) Ineligible students; and

(b) Persons eighteen to fifty years old without dependents who are no longer eligible for benefits as specified in chapter 388-444 WAC.

(6) A person who is living in the residence and is not a household member as described in subsection (4) and (5), is not included when household size, income eligibility, and benefit level are determined for the food assistance unit.

(7) A boarder is a person who:

(a) Is paying a reasonable amount for lodging and meals as determined by the department; or

(b) Is in foster care.

(8) A client can exclude a boarder at the client's request. If excluded, the boarder cannot be a separate food assistance household. Residents of licensed for-profit boarding homes are not eligible for benefits.

(9) The following household members are ineligible for food assistance and are considered ineligible members:

(a) Those disqualified for:

(i) Intentional program violation (IPV) as specified in WAC 388-446-0015;

(ii) Noncompliance with work requirements as specified in WAC 388-444-0055; or

(iii) Failure to provide SSN as specified in WAC 388-476-0005;

(b) Those who fail to sign the application attesting to citizenship or alien status or immigrants not eligible because of alien status;

(c) Fleeing felons as specified in WAC 388-442-0010(1); or

(d) Those convicted of drug felonies as described under WAC 388-442-0010(2).

(10) A person who is living in the residence and is an ineligible household member is not included when household size and benefit level is determined.



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NEW SECTION



WAC 388-408-0040  Residents of institutions. (1) Most residents of institutions are not eligible for food assistance benefits. Residents of the following institutions may be eligible:

(a) Federally subsidized housing for the elderly;

(b) Qualified drug and alcohol treatment centers when an employee of the treatment center is the authorized representative;

(c) Qualified group homes for persons with disabilities;

(d) A shelter for battered women and children when the resident left the home that included the abuser; or

(e) Nonprofit shelters for the homeless. Homeless clients may use food stamps to purchase prepared meals from meal providers for the homeless.

(2) A qualified group home is a nonprofit residential facility that:

(a) Houses sixteen or fewer persons with disabilities as defined under WAC 388-400-0040(6); and

(b) Is certified by the division of developmental disabilities (DDD).

(3) Elderly or disabled household members and spouses may use food stamps to purchase meals from the following when approved by FNS:

(a) Communal dining facility; or

(b) Nonprofit meal delivery service.



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NEW SECTION



WAC 388-408-0045  Shelters for battered women and children. (1) Persons living in a shelter for battered women and children may receive food assistance.

(2) A shelter resident who left a food assistance household that included the abuser:

(a) Is certified as a separate household;

(b) May receive an additional allotment even when the resident already received benefits with the abuser; and

(c) Are certified on the basis of:

(i) Income and resources to which they have access; and

(ii) Expenses for which they are responsible.



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NEW SECTION



WAC 388-408-0050  Homeless status for food assistance. A client is considered homeless when they do not have a regular nighttime residence or when they stay primarily in a:

(1) Supervised shelter that provides temporary living or sleeping quarters;

(2) Halfway house providing temporary residence for persons going into or coming out of an institution;

(3) Residence of another person that is temporary and the client has lived there for ninety days or less; or

(4) A place not usually used as sleeping quarters for humans.



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NEW SECTION



WAC 388-408-0055  Medical assistance units. (1) A medical assistance unit (MAU) is determined on the basis of relationship and financial responsibility.

(a) Married persons, living together are financially responsible for each other;

(b) Parents are financially responsible for their unmarried, minor children living in the same household;

(c) A parent's financial responsibility is limited when their minor child is receiving inpatient chemical dependency or mental health treatment. Only the income a parent chooses to contribute to the child is considered available when:

(i) The treatment is expected to last ninety days or more;

(ii) The child is in court-ordered out-of-home care in accordance with chapter 13.34 RCW; or

(iii) The department determines the parents are not exercising responsibility for the care and control of the child.

(d) Minor children are not financially responsible for their parents or for their siblings.

(2) Certain situations require the establishment of separate MAUs for some family members living in the same household. Separate MAUs are established for:

(a) A pregnant minor, regardless of whether she lives with her parent(s);

(b) A child with income;

(c) A child with resources which makes another family member ineligible for medical assistance;

(d) A child of unmarried parents when both parents reside with the child;

(e) Each unmarried parent of a child in common, plus any of their children who are not in separate MAUs;

(f) A nonresponsible caretaker relative;

(g) SSI recipients or persons related to SSI from the non-SSI related family members;

(h) The purpose of applying medical income standards for an:

(i) SSI-related applicant whose spouse is not relatable to SSI or is not applying for SSI-related medical; and

(ii) Ineligible spouse of an SSI-recipient.

(3) Only the parent's income actually contributed to a pregnant minor is considered income to the minor.

(4) A parent's income up to one hundred percent of the Federal Poverty Level (FPL) is allocated to the parent and other members of the parent's MAU. The excess is allocated among their children in separate MAUs.

(5) A parent's resources are allocated equally among the parent and all persons in the parent's household for whom the parent is financially responsible. This includes family members in separate MAUs.

(6) Countable income for medical programs is described in WAC 388-450-0150 and 388-450-0210.



[]

SHS-2427:5

Chapter 388-410 WAC



BENEFIT ERROR



NEW SECTION



WAC 388-410-0001  Cash/medical assistance overpayments. (1) An overpayment means any assistance paid to an assistance unit where:

(a) Eligibility for the payment did not exist; or

(b) Assistance paid was in excess of need.

(2) There are two different types of overpayments for cash and medical assistance:

(a) Intentional overpayments; and

(b) Unintentional overpayments.

(3) The client is presumed to have committed an intentional overpayment when the client willfully or knowingly:

(a) Fails to report within twenty days a change in circumstances that affects the client's eligibility or need; or

(b) Misstates or fails to reveal a material fact that affects eligibility or need as specified in WAC 388-446-0001.

(4) All overpayments that are not due to the willful or knowing failure of the client to provide information necessary to determine eligibility are considered unintentional overpayments.

(5) Child support payments received directly from the absent parent are not treated as a grant overpayment if kept by the caretaker relative. Such payments are considered a debt to the division of child support.



[]



NEW SECTION



WAC 388-410-0005  Cash and medical assistance overpayment amount and liability. (1) The amount of overpayment for cash and medical assistance households is determined by the amount of assistance received to which the assistance unit was not entitled.

(2) Cash and medical assistance overpayments are recovered from:

(a) Any individual member of an overpaid assistance unit, whether or not the member is currently a recipient; or

(b) Any assistance unit of which a member of the overpaid assistance unit has subsequently become a member.

(3) A cash or medical assistance overpayment is not recovered from:

(a) A nonneedy caretaker relative or guardian who received no financial benefit from the payment of assistance; or

(b) A person not receiving assistance when an unintentional overpayment of less than thirty-five dollars is discovered and/or computed.

(4) Overpayments resulting from incorrectly received cash assistance are reduced by:

(a) Cash assistance a household would have been eligible to receive from any other category of cash assistance during the period of ineligibility; and

(b) Child support the department collected for the month of overpayment in excess of the amount specified in (a) of this subsection; or

(c) Any existing grant underpayments.

(5) A cash assistance overpayment cannot be reduced by a medical or food assistance underpayment.

(6) A medical assistance overpayment cannot be reduced by a cash or food assistance underpayment.

(7) An underpayment from one assistance unit cannot be credited to another assistance unit to offset an overpayment.

(8) All overpayments occurring after January 1, 1982 are required to be repaid by mandatory grant deduction except where recovery is inequitable as specified in WAC 388-410-0010.



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NEW SECTION



WAC 388-410-0010  Repayment of grant overpayment occurring prior to April 3, 1982, and resulting department error. (1) An assistance unit will not be held liable for an overpayment occurring prior to April 3, 1982, which was caused by departmental error, until the department determines recovery would not be inequitable. Recovery is considered inequitable if:

(a) The department informed the recipient or the recipient's authorized representative that the recipient was entitled to part or all of the financial assistance or services overpaid; or

(b) The department acted in a manner which would reasonably lead the recipient to believe he/she was eligible to receive the assistance or services overpaid; and

(c) The recipient retained or accepted the assistance with the understanding that he/she had the right to rely upon the information received from the department; and

(d) The recipient would suffer an injury if the department were allowed to refuse to recognize the department's admission, statement, act or omission; and

(e) Injury as used in this section includes liability for repayment of a debt due the state.

(2) If the department determines recovery would be inequitable:

(a) The recipient is not liable for repayment;

(b) The overpayment is not a debt due the state; and

(c) The recipient is so informed.

(3) If recovery would not be inequitable, the recipient will be notified:

(a) Of the specific reason why recovery is not inequitable;

(b) That the recipient is liable for repayment of the debt;

(c) Whether the overpayment is subject to a mandatory deduction from the current grant; and

(d) Of the right to contest the decision.



[]



NEW SECTION



WAC 388-410-0015  Recovery of cash assistance overpayments by mandatory grant deduction. (1) All overpayments of cash assistance are recovered by means of a mandatory deduction from future continuing assistance grants except as specified by WAC 388-410-0010.

(2) All members of an overpaid assistance unit are responsible for repayment of an overpayment. Repayment may be from:

(a) Resources and/or income; or

(b) Deductions from subsequent grants; and

(c) An assistance unit member's estate.

(3) The mandatory grant deduction of an intentional overpayment is ten percent of the monthly grant payment standard.

(4) A monthly grant deduction of up to one hundred percent of the grant can be established when:

(a) The overpayment is intentional;

(b) The client has liquid resources available but refuses to use these resources in full or partial satisfaction of the overpayment; and

(c) The amount of income and resources remaining available to the assistance unit is not less than ninety percent of the grant payment standard.

(5) An unintentional overpayment is recovered by grant deduction of five percent of the monthly grant payment standard unless the client voluntarily requests a larger deduction in writing.

(6) A monthly deduction for overpayment recovery can be established against the clothing and incidental grant of a recipient in a nursing facility, intermediate care facility, or hospital. A monthly deduction cannot be established against the vendor payment to the nursing facility, intermediate care facility or hospital.

(7) When the monthly grant deduction is equal to or more than the current grant for which the client is eligible had no overpayment occurred, the grant is suspended.

(8) No more than the total amount of an overpayment may be collected by mandatory deduction from a client's public assistance grant. The client will receive compensation for an underpayment resulting from any erroneous monthly deduction.



[]



NEW SECTION



WAC 388-410-0020  Food assistance overpayments. There are three different types of overpayments in the food assistance program. These types are:

(1) An administrative error overpayment defined as an overpayment caused solely by:

(a) The department's action or failure to act causing an incorrect determination of categorical eligibility (CE); and

(b) A resulting claim which can be computed based on a change in net income or assistance unit size.

(2) An inadvertent household error overpayment defined as any overpayment caused by either misunderstanding or unintended error by a household that is:

(a) The result of Social Security Administration (SSA) action or failure to act causing an incorrect determination of CE; and

(b) A resulting claim which can be computed based on a change in net income or assistance unit size.

(3) An intentional program violation overpayment defined as any overpayment resulting from an intentional program violation as specified under chapter 388-446 WAC.



[]



NEW SECTION



WAC 388-410-0025  Food assistance overpayment liability. (1) Food assistance overpayment claims are established against any assistance unit:

(a) Receiving more food assistance benefits than it was entitled to receive; or

(b) Containing an adult member who was an adult member of another assistance unit receiving more benefits than it was entitled to receive.

(2) All persons who were adult members of a food stamp assistance unit at the time of a food stamp overpayment are jointly and separately liable and are subject to collection action.

(3) A food assistance administrative error claim or inadvertent household error claim cannot be established unless the assistance unit:

(a) Signed the application form; and

(b) Was certified by the community service office (CSO) in the correct catchment area; or

(c) Cashed an expired food coupon authorization card that was altered by the assistance unit.

(4) An administrative error overpayment is established when:

(a) Discovered within twelve months of its occurrence; and

(b) The household is mailed a recovery demand letter and the overpayment is calculated within twenty-four months of discovery.

(5) An inadvertent household error overpayment is established when:

(a) Discovered within twenty-four months of its occurrence; and

(b) The household is mailed a recovery demand letter and the overpayment is calculated within twenty-four months of discovery.

(6) An intentional program violation overpayment is established when:

(a) Discovered within seventy-two months of its occurrence; and

(b) The household is mailed a recovery demand letter and the overpayment is calculated within twenty-four months of discovery.



[]



NEW SECTION



WAC 388-410-0030  Food assistance overpayment amount and recovery. (1) The amount of a food assistance overpayment is determined by counting the difference between:

(a) The allotment actually authorized; and

(b) The allotment that should have been authorized.

(2) The monthly allotment the assistance unit should have been authorized is determined counting the actual income received by the assistance unit.

(3) A food assistance overpayment can be reduced by a food assistance underpayment if the underpayment was:

(a) Not previously restored; or

(b) Already used to reduce an overpayment.

(4) All inadvertent household or administrative error claims are subject to collection unless:

(a) The entire overpayment claim is cancelled by an underpayment;

(b) The administrative error claim is less than one hundred dollars;

(c) The inadvertent household error claim is less than thirty-five dollars;

(d) The department cannot locate the liable household; or

(e) An attempt to collect will prejudice an inadvertent household error case referred for possible prosecution or administrative disqualification.

(5) An intentional program violation is subject to collection action against the liable assistance unit unless:

(a) The assistance unit has repaid the overpayment;

(b) The assistance unit cannot be located; or

(c) The department determines collection action will prejudice the case against an assistance unit member referred for prosecution.

(6) An assistance unit or assistance unit member may repay an overpayment by:

(a) A lump sum;

(b) Regular installments under a payment schedule as specified in subsection (7) of this section; or

(c) Allotment reduction.

(7) Currently participating food assistance units liable for an inadvertent household error or intentional program violation overpayment may repay by a negotiated monthly installment amount. The repayment amount must not be less than the amount that could be recovered through allotment reduction. The payment schedule may be renegotiated by either the department or the assistance unit member.

(8) Food assistance units repaying overpayments by allotment reduction will repay:

(a) An administrative error overpayment by an amount agreed to by the assistance unit;

(b) An inadvertent household error overpayment by the greater of:

(i) Ten percent of the assistance unit's monthly allotment; or

(ii) Ten dollars per month.

(c) An intentional program violation overpayment by the greater of:

(i) Twenty percent of the household's monthly allotment; or

(ii) Ten dollars per month.

(9) Involuntary reduction of the allotment an assistance unit is currently receiving is authorized when the household is liable for an inadvertent household error; and

(a) Fails to notify the department of their chosen repayment agreement; or

(b) Fails to request a fair hearing and continued benefits within twenty days of receipt of notice from the department of collection action.

(10) An assistance unit that is liable for an intentional program violation claim must chose a repayment agreement within ten days of receipt of notice of collection action. Failing to do so will subject the assistance unit to involuntary reduction of their current food assistance allotment.

(11) A household that fails to meet the terms of an agreed repayment schedule is subject to involuntary reduction of their current food assistance allotment unless:

(a) Overdue payments are caught up; or

(b) The household requests renegotiation of the payment schedule.

(12) Collection action is suspended when:

(a) A liable household member cannot be located; or

(b) Cost of further collection action is likely to exceed the amount that can be recovered.

(13) The amount of an overpayment can be negotiated if the amount offered approximates the net amount expected to be collected prior to the expiration of the collection period by statute.

(14) Prior to the expiration of the collection period, unpaid overpayments are written off and any applicable liens are released when:

(a) There is no further possibility of collection;

(b) There was an accepted offer of compromise leaving an unpaid balance after payment; or

(c) There is an unpaid balance remaining after a case has been in suspense for three consecutive years.

(15) Food assistance overpayments occurring in another state may be collected in this state if the originating state does not intend to pursue collection and provides the following:

(a) Documentation of the overpayment computation and overpayment notice prepared for the client; and

(b) Proof of service showing the client received the overpayment notice.



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NEW SECTION



WAC 388-410-0035  Alien and alien sponsor cash, and food assistance overpayments. (1) An alien and their sponsor are jointly and individually liable for any overpayment of cash or food assistance made to the alien during the three years after the alien's entry into the United States.

(2) When an overpayment to a sponsored alien results from incorrect information provided by the alien's sponsor, both the alien and the sponsor are liable for repayment.

(3) When the alien's sponsor had good cause for reporting the incorrect information, the sponsored alien is solely liable for an inadvertent household error overpayment.

(4) When good cause does not exist, collection action is initiated against:

(a) The alien's sponsor; or

(b) The sponsored alien's assistance unit; or

(c) Of the two, the one considered most likely to repay first.

(5) Collection action is initiated against an alien's sponsor for an inadvertent household error when:

(a) A department representative contacts the sponsor in person or by phone; and

(b) The sponsor is informed in writing there will be no responsibility for repayment if good cause for reporting incorrect information causing the overpayment can be demonstrated.

(6) Collection action is initiated against the sponsored alien's assistance unit for an inadvertent household error when:

(a) Collection action is taken first against the alien's sponsor; and

(b) The alien's sponsor does not respond within thirty days; or

(c) The sponsored alien provides incorrect information concerning the sponsor or sponsor's spouse through misunderstanding or unintended error.



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NEW SECTION



WAC 388-410-0040  Cash and food assistance underpayments. (1) All cash assistance underpayments not credited against an overpayment are repaid upon discovery to any current or former recipient.

(2) All food assistance benefits underpaid are restored when:

(a) An underpayment was caused by department error;

(b) An administrative disqualification for intentional program violation was reversed;

(c) A rule or instruction specifies restoration of unpaid benefits; or

(d) A court action finds benefits were wrongfully withheld.

(3) A client is eligible for restoration of underpaid benefits for any of the twelve months prior to:

(a) The month the client requests restoration;

(b) The month the department discovers an underpayment;

(c) The date the household makes a fair hearing request when a request for restoration of benefits was not received; or

(d) The date court action was started when the client has taken no other action to obtain restoration of benefits.

(4) The client may request a fair hearing if they disagree with the amount of benefits the department determines were underpaid.

(5) If household composition changes prior to the department's restoration of an underpayment, the underpayment is paid to:

(a) First, the household containing a majority of the persons who were household members at the time of the underpayment; or

(b) Second, the household containing the head of the household at the time of the underpayment.



[]



Chapter 388-412 WAC



BENEFIT ISSUANCES



NEW SECTION



WAC 388-412-0005  Cash assistance payments. For cash assistance payments, the state issues a warrant which looks similar to a check.

(1) Each separate assistance receives a separate cash benefit grant, even if there are multiple assistance units in the same residence.

(2) A married couple who both receive any general assistance benefit must be considered one assistance unit. However, cash payments are made individually and will not exceed one half of the two-person GA-U standard.

(3) Grants are rounded down to the next whole dollar amount with the following exceptions:

(a) Clothing and personal incidental (CPI) allowance; and

(b) Grants with a deduction for repayment of an overpayment.

(4) Grant payments are not issued for under ten dollars except:

(a) Grants with a deduction for repayment of an overpayment;

(b) CPI allowances with income deducted; or

(c) Supplemental Social Security (SSI) interim assistance payments.



[]



NEW SECTION



WAC 388-412-0010  Endorsing the warrant. (1) Clients must endorse their warrants unless they have executed a power of attorney. If a client has given someone else a power of attorney, the client must give the department a copy.

(2) If a client is unable to sign the warrant, it must be endorsed by the client's mark or thumb print witnessed by two people. The witnesses must give their names and addresses to the person that cashes the warrant.



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NEW SECTION



WAC 388-412-0015  Food assistance allotments. (1) A client's food assistance benefit amount is called an allotment. An allotment is the total dollar value of coupons an eligible assistance unit receives for a calendar month.

(2) Assistance units with no income receive the maximum allotment as described under the thrifty food plan (TFP) in WAC 388-478-0060. Assistance units with net income receive smaller amounts.

(3) When an assistance unit has income, the allotment is determined by:

(a) Multiplying the assistance unit's net monthly income by thirty percent and rounding down that amount to the next whole dollar; and

(b) Subtracting the results from the thrifty food plan for the appropriate assistance unit size as specified in WAC 388-478-0060.

(4) Except for those described in WAC 388-406-0055 eligible assistance units receive benefits from the effective date of eligibility to the end of the first month. This is called proration and is based on a thirty-day month.

(5) In the first month of eligibility, assistance units do not receive an allotment when the amount is less than ten dollars.

(6) Eligible one and two person assistance units receive a minimum ten dollar allotment:

(a) After the first month of eligibility; or

(b) In the first month of eligibility when the CSO receives the assistance unit's application on the first day of the month.



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NEW SECTION



WAC 388-412-0020  Mail delivery of benefit issuances. Benefits are mailed to the address where clients live except when:

(1) The department redirects the benefit issuance to the local office;

(2) The department has established there are problems with receiving mail at the client's address;

(3) A client requests in writing that the benefit issuance be mailed to the local office, such as a homeless client without an address; or

(4) A client requests that the benefit issuance be sent to a temporary address for less than ninety days.



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NEW SECTION



WAC 388-412-0025  Issuing food assistance benefits. (1) An eligible assistance unit is issued benefits by means of:

(a) A food coupon authorization (FCA) card that must be redeemed for food coupons;

(b) Food coupons mailed directly to the client; or

(c) Electronic benefit transfers (EBT).

(2) Clients are issued food assistance benefits during the first ten days of the month.

(3) A client must redeem an FCA for coupons during the period that is specified on the FCA card.

(4) Eligible clients applying on or after the 16th of the month are issued one allotment called a combined issuance that includes benefits for:

(a) The month of application; and

(b) The following month.



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NEW SECTION



WAC 388-412-0030  Returning a warrant. (1) A person who has possession of a warrant payable to a deceased payee must return the warrant to the department for cancellation.

(2) A person who has possession of a warrant payable to an assistance unit payee who has left the home and is not likely to return during the month to endorse the warrant, must return the warrant to the CSO.

(3) The warrant will be reissued to another eligible payee for the assistance unit.



[]



NEW SECTION



WAC 388-412-0035  Loss, theft, destruction or nonreceipt of a warrant issued to clients and vendors. The following applies to replacements of warrants issued to clients and to vendors on behalf of clients.

(1) The department does not replace a warrant or the cash proceeds from a warrant which was endorsed by a client.

(2) Clients asking for a replacement of a warrant which was not endorsed by them must:

(a) Complete a notarized statement called an affidavit;

(b) Provide all facts surrounding the loss, theft, destruction or nonreceipt of the warrant; and

(c) File a report with the police or the post office, as appropriate.

(3) If a client is eligible to receive a replacement, the warrant is issued:

(a) On or before the tenth of the month in which the warrant was due; or

(b) Within five working days of the date the decision is made to replace the warrant, whichever is later.

(4) A client is issued the full amount of the original warrant if the warrant is replaced.



[]



NEW SECTION



WAC 388-412-0040  Replacing lost, stolen, or destroyed food assistance allotments. (1) A client may receive a replacement for a one month food assistance allotment when:

(a) An FCA or food coupons are lost or stolen from the mail;

(b) An FCA is stolen after receipt; or

(c) An FCA card, coupons or food purchased with coupons are destroyed in a disaster.

(2) To get a replacement, a client must:

(a) Report the theft or destruction within ten days of the incident; or

(b) Report nonreceipt of the benefits within the period that benefits are intended to be used; and

(c) Sign a department affidavit within ten days of the report attesting to the loss.

(3) A client's request for a replacement is denied when:

(a) Certified mail coupons are signed for by any person residing or visiting at the address provided by the client;

(b) Coupons or an FCA card are lost or misplaced after receipt;

(c) Coupons are stolen after receipt;

(d) A client already received two replacements described in subsection (1) above within the previous five months; or

(e) The request is determined to be fraudulent.

(4) A client cannot receive a disaster food stamp program allotment and a replacement allotment for the same period.

(5) A replacement as specified in subsection (1) will not count against an assistance unit when:

(a) An allotment is returned to the department;

(b) The original or replacement FCA is not cashed;

(c) The replacement is issued because of a department error;

(d) A partial coupon delivery is caused by a department error; or

(e) The coupons delivered are improperly made or are mutilated. There must be at least three-fifths of the each coupon to turn in for an exchange.



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SHS-2426:4

Chapter 388-414 WAC



CATEGORICAL ELIGIBILITY FOR FOOD ASSISTANCE



NEW SECTION



WAC 388-414-0001  Food assistance categorical eligibility. (1) A food assistance unit is categorically eligible (CE) to receive food benefits when all members are authorized to receive a cash benefit under any of the following cash programs:

(a) Temporary assistance for needy families (TANF);

(b) State family assistance (SFA);

(c) Supplemental Security Income (SSI); or

(d) General assistance cash programs.

(2) Some food assistance units are not categorically eligible to receive food benefits even after meeting the requirements in subsection (1) of this section. Categorical eligibility does not happen when the entire assistance unit or any member of the unit fits into the following situations:

(a) The entire food assistance unit is:

(i) Living in an institution;

(ii) Disqualified from receiving food assistance for any reason; or

(iii) Terminated from food assistance because of failure to meet monthly reporting requirements.

(b) Any member of the food assistance unit is:

(i) Disqualified from food assistance for an intentional program violation (IPV);

(ii) Disqualified from food assistance because of failure to meet work registration requirements;

(iii) Not eligible for food assistance because of their alien or student status; or

(iv) Receiving SSI as an essential person or an ineligible spouse, not eligible for SSI on their own behalf.

(3) A categorically eligible assistance unit has already met cash eligibility requirements. Some requirements are similar for food assistance. A food assistance unit determined to be categorically eligible does not have to meet food assistance eligibility requirements regarding:

(a) Residency;

(b) Social security number;

(c) Sponsored alien;

(d) Resources; and

(e) The gross and net income standards.



[]

SHS-2412:6

Chapter 388-416 WAC



CERTIFICATION PERIODS



NEW SECTION



WAC 388-416-0005  Certification periods for food assistance. A certification period is the specified time the assistance unit is determined eligible. Assistance units are certified for:

(1) Up to twenty-four months for assistance units without earned income and all members are elderly;

(2) Up to twelve months for assistance units:

(a) Receiving cash assistance;

(b) With earned income and required to report monthly; or

(c) Without earned income and all household members are disabled or elderly.

(3) Up to six months for:

(a) Assistance units with recent work history and required to report monthly; or

(b) Assistance units not likely to have any changes.

(4) Up to three months for assistance units:

(a) Consisting of migrants; or

(b) All other assistance units not included in this section.



[]



NEW SECTION



WAC 388-416-0010  Medical certification periods for recipients of cash assistance programs. (1) The certification period for medical services begins on the first day of the month of application when the client is determined eligible for cash assistance for one of the following programs:

(a) Temporary assistance for needy families (TANF) or state family assistance (SFA); or

(b) Supplemental Security Income (SSI); or

(c) General assistance for pregnant women (GA-S); or

(d) General assistance for children (GA-H); or

(e) Refugee assistance.

(2) The certification period for the medical programs associated with the cash programs in subsection (1) of this section continues as long as eligibility for these programs lasts. When a client's cash assistance is terminated, eligibility for medical assistance is continued until eligibility is redetermined as described in WAC 388-418-WAC.

(3) The certification period for medical can begin up to three months prior to the month of application for clients described in subsection (1) of this section if the conditions in WAC 388-416-0015(6) apply.

(4) The certification period for medical care services begins on the date eligibility begins for the following cash assistance programs:

(a) General assistance for unemployable persons (GA-U); or

(b) Alcohol and drug abuse treatment and support act (ADATSA) programs, when the client is either receiving a grant or waiting for treatment to begin.

(5) The certification period for medical care services for clients in subsection (4) of this section runs concurrently with the period of eligibility for the client's cash assistance program.



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NEW SECTION



WAC 388-416-0015  Certification periods for categorically needy (CN) programs. (1) Eligibility for categorically needy (CN) medical assistance begins on the first day of the month of application. Eligibility ends on the last day of the last month of the certification period.

(2) TANF/SFA-related, and SSI-related CN medical are each certified for twelve months.

(3) The pregnant women's program is certified through the end of the month which includes the sixtieth day from the day the pregnancy ends.

(4) The children's medical program is certified for twelve months or through the end of the month the child turns nineteen, whichever is earlier. This period can be extended when:

(a) The child is receiving inpatient services on the last day of the month when the child turns nineteen; and

(b) The inpatient stay continues into the following month or months; and

(c) The child remains eligible except for exceeding the age requirement.

(5) The newborn medical program is certified through the end of the month that the newborn turns one year old.

(6) The certification period can begin up to three months immediately prior to the month of application when:

(a) The client would have been eligible for medical assistance, had the client applied;

(b) The client received medical services which are covered by DSHS, as described in WAC 388-529-0100; and

(c) If eligibility is only for a retroactive period, that period is the only period of certification.

(7) Any months of a retroactive certification period are added to the designated certification period.

(8) Medical assistance is continued until eligibility is redetermined as described in chapter 388-418 WAC.



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NEW SECTION



WAC 388-416-0020  Certification periods for noninstitutionalized medically needy (MN) program. (1) The certification period for the noninstitutionalized medically needy (MN) program begins:

(a) On the first day of the month in which hospital expenses equal the spenddown amount; or

(b) On the day that spenddown is met, when hospital expenses are less then the spenddown amount or no hospital expenses are involved.

(2) The certification period continues through the last day of the final month of the base period as described in chapter 388-519 WAC.

(3) The certification period can begin up to three months immediately prior to the month of application as described in chapter 388-519 WAC.

(4) The certification period for MN clients with income below the medically needy income level (MNIL) is twelve months.



[]



NEW SECTION



WAC 388-416-0025  Certification period for children's health program. (1) The certification period for the children's health program begins on the first day of the month of application.

(2) The certification period continues for twelve months or through the end of the month the child turns eighteen, whichever is earlier. This period can be extended as described in WAC 388-416-0015(4).

(3) The certification period can begin up to three months immediately prior to the month of application, as described in WAC 388-416-0015 (6) and (7).



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NEW SECTION



WAC 388-416-0030  Certification periods for the medically indigent (MI) program. (1) A client must meet the emergency medical expense requirement (EMER), before eligibility can be determined for the medically indigent (MI) program.

(2) If the client is not required to spenddown excess income or resources, the certification period for MI begins on the date that the EMER was met.

(3) When an MI applicant must satisfy a spenddown amount, the certification period begins:

(a) On the first day of the month in which hospital expenses (excluding the EMER) equal the spenddown amount; or

(b) On the day that spenddown is met, when hospital expenses are less than the spenddown amount.

(4) The certification period cannot exceed three calendar months in a twelve month period.



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NEW SECTION



WAC 388-416-0035  Certification periods for Medicare cost sharing programs. (1) The certification period for the qualified Medicare beneficiary (QMB) program:

(a) Is for twelve months; and

(b) Begins the first day of the month following the month of QMB eligibility determination; and

(2) The certification period for the qualified disabled working individual (QDWI) program:

(a) Is twelve months; and

(b) May begin up to three months prior to the month of application if on the first day of the first month of the certification period the person:

(i) Is or had been enrolled in Medicare Part A; and

(ii) Meets or has met the department's eligibility requirements for QDWI.

(3) The certification period for the:

(a) Special low income medicare beneficiary (SLMB) program is twelve months in duration;

(b) Expanded special low income medicare beneficiary (ESLMB) program extends to the end of the calendar year.

(4) The certification periods for SLMB and ESLMB may begin up to three months prior to the month of application if on the first day of the first month of the certification period the person:

(a) Is or has been enrolled in Medicare Part B; and

(b) Meets or has met the department's eligibility requirements for SLMB or ESLMB.

(5) The certification period for SLMB coverage is twelve months in duration.



[]

SHS-2434:5

Chapter 388-418 WAC



CHANGE OF CIRCUMSTANCE



NEW SECTION



WAC 388-418-0005  Reporting requirements. (1) For cash and food assistance:

(a) Clients must report changes within ten days of the date the change becomes known to the assistance unit.

(b) Clients who report changes on a monthly report as specified under chapter 388-456 WAC are not required to report within the ten-day period.

(2) For medical care services, clients must report changes within twenty days of the date the change becomes known to the client.

(3) Food assistance clients are required to report the following:

(a) A change in the amount of gross monthly income of more than twenty-five dollars except for changes in public assistance income;

(b) A change in the source of income;

(c) A change in household size such as addition or loss of a household member;

(d) A change in residence and the resulting change in shelter cost;

(e) Obtaining a licensed vehicle;

(f) The end of a temporary disability when the temporary disability is the reason for excluding a vehicle; and

(g) When a change in the assistance unit's countable liquid resources exceeds the applicable resource limit as described under WAC 388-470-0005.

(4) For TANF/SFA, a caretaker relative must report the absence of a child within five days of the date that it becomes reasonably clear that the absence will exceed ninety days. If the relative fails to report timely, the relative:

(a) Is not eligible for one month; and

(b) The relative's countable income will be considered available to the remaining members of the assistance unit.



[]



NEW SECTION



WAC 388-418-0010  Requesting information or action needed. (1) A recipient must receive a written request for any information or action needed to maintain continuing eligibility.

(2) A recipient is allowed at least ten days from the date the request is mailed to provide the information or take the required action.

(3) The request must state:

(a) The information or action needed;

(b) The date the information must be provided or action taken; and

(c) That failure to provide the information or take the action requested may result in termination or reduction of benefits.

(4) The recipient's cash, medical and/or food assistance may be reduced, suspended, or terminated if the recipient:

(a) Does not take the action or provide the information within the ten day period; or

(b) Provides information or action which is inadequate or the information results in reduction or termination of benefits.



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NEW SECTION



WAC 388-418-0015  Recipient fails to provide requested information or take requested action. (1) When a recipient fails to provide information or take an action requested by the department, the recipient must receive adequate notice as defined under chapter 388-458 WAC for reduction, suspension or termination.

(2) When advance notice is required, assistance continues if the recipient does one of the following before the advance notice period ends:

(a) Takes the requested action; or

(b) Provides adequate information that does not result in reduction, suspension, or termination of assistance.

(3) A recipient will receive an additional adequate notice if the recipient provides the following before the advance notice period ends:

(a) Inadequate information; or

(b) Adequate information which results in reduction, suspension, or termination of assistance.



[]



NEW SECTION



WAC 388-418-0020  Effective dates for changes. The following rules apply to recipients of all programs unless otherwise specified.

(1) When a change causes a cash assistance recipient to become ineligible or results in a change in grant amount, the effective date of the change is the first day of the next month after the change occurred. However, for the following types of changes, the effective date is:

(a) The date a person who is added to the assistance unit enters the household or is determined eligible, whichever is later;

(b) The date of a change in shelter arrangement which makes the assistance unit eligible for a higher payment standard;

(c) The first regular monthly issuance when a person changes from one cash assistance program to another;

(d) The first regular monthly issuance after the advance notice period when a grant deduction is imposed to collect an overpayment;

(e) The date of termination when child support or spousal support is increased as specified in WAC 388-422-0030.

(f) In accordance with:

(i) Chapter 388-450 WAC when budgeting income;

(ii) Chapter 388-480 WAC when an assistance unit member is on strike;

(iii) WAC 388-462-0005(2) when pregnant woman receives GA-S and then relinquishes the child for adoption; and

(iv) As specified by the department for changes in law or regulation.

(g) For TANF/SFA, the date a sanctioned WorkFirst participant complies with the requirements of their individual responsibility plan as specified under chapter 388-310 WAC.

(2) Eligibility for medical care services ends at the same time a recipient's general assistance or ADATSA eligibility is terminated.

(3) When a change makes a recipient ineligible or reduces the benefit amount, assistance will continue without change through the advance notice period even when the advance notice is beyond the effective date.

(4) When cash and food assistance benefits are continued beyond the effective date of a reduction or termination of such benefits, an overpayment will be established for the amount the recipient was not eligible to receive.

(5) For prospectively budgeted food assistance households:

(a) The effective date of the change for an increase in benefits is the next allotment after the change is:

(i) Reported when the change is verified within the ten day period; or

(ii) Verified when the assistance unit does not send the requested verification within the ten day period.

(b) The effective date of the change for a decrease in benefits is the first of the next month after the advance notice period expires.

(6) For retrospectively budgeted food assistance households, the effective date of a change reported in the budget month is the first of the payment month.

(7) Eligibility for the newborn medical program ends on the last day of the month the child is no longer living with the mother. Eligibility is redetermined for other medical programs prior to the termination of newborn medical.



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NEW SECTION



WAC 388-418-0025  Effect of changes on medical. (1) Categorically needy (CN) medical and medically needy (MN) medical is continued until a redetermination of eligibility is made for other medical programs when changes cause a client to become ineligible for:

(a) TANF/SFA; or

(b) SSI; or

(c) GA-H; or

(d) GA-S; or

(e) CN medical.

(2) When changes cause a refugee cash assistance client to be ineligible, refugee medical assistance can only be continued through the eight-month residence limit, as described in WAC 388-400-0030(6).

(3) TANF/SFA cash recipients are eligible for a medical extension, as described under WAC 388-523-0100, when termination is a result of:

(a) Increased employment income; or

(b) Collection of, or increased collection of, child or spousal support.

(4) Clients who report changes in income or resources during a certification period will have their medical continued until eligibility is redetermined for:

(a) CN or medically needy (MN) for TANF/SFA-related, SSI-related, or refugee-related medical; or

(b) Medically indigent (MI) program.

(5) Changes in income reported by clients during a certification period will not have an affect on medical eligibility for:

(a) The pregnant women's program; or

(b) The children's CN program; or

(c) The children's health program; or

(d) The first six months of the TANF/SFA-related medical extension; or

(e) The newborn medical program.



[]



NEW SECTION



WAC 388-418-0030  Notifying a recipient of intent to reduce, suspend or terminate assistance. (1) For cash, medical and food assistance a recipient must be notified ten days in advance of an action to reduce, suspend or terminate assistance. Certain types of circumstances do not require advance notice.

(2) When a ten day advance notice is not required:

(a) For cash assistance and medical, the notice must be mailed or given to the recipient by the date of the action to reduce, suspend or terminate the benefits.

(b) For food assistance, the notice must be mailed or given to the recipient by the date the benefits are received or should have been received.

(3) The ten day advance notice period is not required:

(a) For recipients of cash and food assistance when:

(i) The recipient's whereabouts are unknown and mail was returned by the post office marked no forwarding address;

(ii) The recipient requests termination;

(iii) The department has factual information that the assistance unit has moved to another state or will move to another state before the next benefits are issued; or

(iv) The recipient states in writing that they understand the information they provided will reduce, suspend or terminate their benefits.

(b) For cash and food assistance when the action is based on information provided on a monthly report.

(c) For cash assistance when:

(i) The department has factual information that the recipient or nonrecipient caretaker has died when no other caretaker is available;

(ii) A recipient child is removed from the home under a court order or is voluntarily placed in foster care by the adult caring for the child; or

(iii) A recipient was admitted or committed to an institution which makes them ineligible for benefits.

(d) When a cash assistance recipient's benefits are reduced or terminated because of long-term hospital stay or the recipient is placed in a nursing home.

(e) For food assistance only, when:

(i) The department has factual information that all assistance unit members have died;

(ii) The federal or state government makes mass changes;

(iii) The benefits are reduced because cash assistance is approved;

(iv) An assistance unit member is disqualified for an intentional program violation and the benefits of the remaining members are reduced or terminated because of this disqualification; or

(v) The department reduces the allotment to collect for an overpayment and the assistance unit already received advance notice.

(4) A separate notice is not required:

(a) For cash and food assistance when:

(i) Benefits were approved the recipient was notified of the amount of benefits for each month because the amounts varied.

(ii) The recipient was already notified when a supplemental payment or increased allotment to restore lost benefits would end.

(b) For cash assistance, when the recipient was already notified that an emergent need payment was for one month only.

(5) A client continues to receive the same benefits received prior to a ten-day advance notice of reduction, suspension or termination of benefits (continued benefits) when:

(a) The client requests a fair hearing during this ten-day period; and

(b) For food assistance only, the client's certification period has not expired.

(6) A client receives continued benefits through the end of the month the fair hearing decision is mailed unless:

(a) The client:

(i) States in writing that the assistance unit does not want continued benefits;

(ii) Withdraws the fair hearing request in writing; or

(iii) Abandons the fair hearing request; or

(b) An administrative law judge issues a written order that ends continued benefits prior to the fair hearing.

(7) For food assistance clients, continued benefits end when the certification period expires.

(8) Any continued benefits a client receives pending a fair hearing decision are considered an overpayment when the fair hearing decision agrees with the department's action.

(9) When eligibility for medical care is terminated the client is provided with advance and adequate written notice.



[]

SHS-2444:2

Chapter 388-420 WAC



CHEMICAL DEPENDENCY FOOD ASSISTANCE



NEW SECTION



WAC 388-420-010  Alcohol and drug treatment centers. (1) Food assistance is only available to a resident of a drug or alcohol treatment center when the treatment center is:

(a) Administered by a public or private nonprofit agency; and

(b) Certified by the division of alcohol and substance abuse (DASA).

(2) A resident is considered a one person assistance unit. However if the resident's spouse or child is also living in the treatment center, the spouse or child is included in the resident's assistance unit.

(3) The resident must have a designated employee of the treatment center act as an authorized representative as specified in chapter 388-460 WAC.

(4) The authorized representative receives and uses the food assistance benefits for meals the resident is served in the treatment center.

(5) The authorized representative also has responsibilities as specified in chapter 388-460 WAC.



[]

SHS-2414:4

Chapter 388-422 WAC



CHILD SUPPORT



NEW SECTION



WAC 388-422-0005  Assignment of support rights. (1) To receive cash assistance under TANF, SFA, or GA-H, each client must assign to the state of Washington all rights to support for each person for whom the client is applying. This includes the rights to any support which has accrued before assignment is made. If a client fails to assign support rights for each person for whom assistance is requested, then cash assistance will be denied to the entire assistance unit.

(2) To receive medical assistance, each client must assign to the state of Washington all rights to medical support for each person for whom the client is applying. This includes the rights to any medical support which has accrued before assignment is made.

(3) Assignment is made when a client signs the application or accepts the cash or medical assistance.

(4) After assignment is made, a client must send any direct support they receive to the division of child support (DCS).



[]



NEW SECTION



WAC 388-422-0010  Cooperation with division of child support. (1) When applying for or receiving TANF, SFA, GA-H, or Medicaid, the following individuals must cooperate with the DCS in establishing paternity and collecting support as specified in WAC 388-14-201:

(a) All persons for whom benefits are applied for or received; and

(b) The caretaker relative or court-appointed guardian of a child for whom benefits are applied for or received.

(2) For TANF and SFA, if a caretaker relative fails to cooperate with DCS without good cause according to WAC 388-422-0020, the cash grant paid to the assistance unit will be reduced by twenty-five percent of what they would otherwise have received.

(3) For Medicaid, if a caretaker relative fails to cooperate with DCS without good cause according to WAC 388-422-0020, that individual will be denied medical assistance unless they are pregnant.

(4) Cooperation is determined by DCS.



[]



NEW SECTION



WAC 388-422-0020  Good cause for not cooperating with the division of child support. (1) An individual described under WAC 388-422-0010 is not required to cooperate with DCS if the department finds that cooperation is against the best interest of the child for whom child support is sought. A client has the right to claim good cause for refusing to cooperate and the department must determine if the claim is valid.

(2) Cooperation is against the best interest of the child and cash assistance can be continued when:

(a) The individual's cooperation can reasonably be anticipated to result in serious physical or emotional harm to:

(i) The child; or

(ii) The caretaker relative, if it reduces the caretaker relative's capacity to adequately care for the child; or

(b) Establishing paternity or securing support would be harmful to the child who:

(i) Was conceived as a result of incest or forcible rape; or

(ii) Is the subject of legal adoption proceedings pending before a superior court; or

(iii) Is the subject of ongoing discussions between the parent and a public or licensed child placement agency to decide whether the parent will keep the child or put the child up for adoption. The discussions cannot have gone on for more than three months.

(3) When cash assistance cannot be continued because a client's claim of good cause does not meet the standard in subsection (2) of this section, medical assistance may be able to be continued. The standard for good cause for medical assistance is broader in that good cause can be based solely on the best interests of the:

(a) Child as in subsection (2) of this section; or

(b) Person who is being asked to cooperate.

(4) A client has twenty days from the date good cause is claimed to provide information and evidence to support the claim, unless it cannot be obtained within such time.

(5) A client has the right to:

(a) Be informed of their right to claim good cause for refusing to cooperate;

(b) Receive a determination of their good cause claim within thirty days of the date the claim is made, as long as the necessary information and evidence was provided to the department within twenty days;

(c) Receive assistance without delay while their good cause claim is pending a determination, if they have provided supportive evidence and information;

(d) Receive information on their right to ask for a fair hearing if the department denies the claim of good cause; and

(6) Approved good cause claims will be reviewed at least every six months to determine if good cause continues to exist.



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NEW SECTION



WAC 388-422-0030  Child support in excess of the TANF grant payment. A TANF recipient is ineligible when current child support collected by the division of child support exceeds the TANF grant payment for two-consecutive months.



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SHS-2430:5

Chapter 388-424 WAC



CITIZENSHIP/ALIEN STATUS



NEW SECTION



WAC 388-424-0005  Citizenship and alien status--General eligibility conditions. (1) To receive benefits for temporary assistance for needy families (TANF), Medicaid, and federal food stamps, persons must be:

(a) U.S. citizens;

(b) U.S. nationals; or

(c) Qualified aliens who meet the additional conditions described in WAC 388-424-0010 relative to TANF and Medicaid and WAC 388-424-0020 relative to federal food stamps.

(2) Qualified aliens are aliens:

(a) Who are lawful permanent residents under the Immigration and Nationality Act (INA);

(b) Who are granted asylum under section 208 of the INA;

(c) Who are paroled into the U.S. under section 212 (d)(5) of the INA for at least one year;

(d) Who are admitted to the U.S. as refugees under section 207 of the INA;

(e) Who are aliens whose deportation is being withheld under section 243(h) of the INA;

(f) Who are granted conditional entry into the U.S. under section 203 (a)(7) of the INA as in effect prior to April 1, 1980;

(g) Who are Cuban and Haitian entrants as defined in section (501)(e) of the Refugee Education Assistance Act of 1980; or

(h) Who are victims of domestic violence, or whose children are victims of domestic violence, when:

(i) The domestic violence is committed in the U.S. by the alien's spouse, parent, or a member of the spouse or parent's family residing in the same household as the alien; and

(ii) In situations where the children are the victims of domestic violence, the alien did not actively participate in the violence against his or her own children; and

(iii) The alien no longer resides with the person who committed the domestic violence; and

(iv) There is a substantial connection between the domestic violence and the need for public assistance benefits; and

(v) The alien has an application with the Immigration and Naturalization Service (INS) either approved or pending for:

(A) Legal immigration status under sections 204 (a)(1)(A)(iii)(I) and 204 (a)(1)(A)(iv) of the INA; or

(B) Suspension of deportation or cancellation of removal under section 244 (a)(3) of the INA.

(3) To receive benefits under the general assistance and ADATSA programs, persons must be:

(a) U.S. citizens;

(b) U.S. nationals;

(c) Qualified aliens; or

(d) Aliens permanently residing in the U.S. under color of law (PRUCOL).

(4) Aliens are considered to be PRUCOL when they are permanently residing in the U.S., who do not meet the definition of a qualified alien as defined in subsection (2) of this section, and:

(a) The INS knows they are residing in the U.S., and

(b) The INS is not likely to enforce their departure.

(5) During the application process, one of the following persons must indicate on the application for benefits whether each household member is a U.S. citizen or qualified alien:

(a) An adult applicant in the household; or

(b) The person applying for benefits when there are no adults in the household.



[]



NEW SECTION



WAC 388-424-0010  Alien status--Eligibility requirements for the temporary assistance for needy families program and medical benefits. (1) Qualified aliens who were residing in the U.S. before August 22, 1996 can receive temporary assistance for needy families (TANF) and Medicaid benefits.

(2) Qualified aliens who first physically enter the U.S. on or after August 22, 1996 cannot receive TANF or Medicaid for five years after their date of entry, unless they are:

(a) Refugees admitted to the U.S. under section 207 of the Immigration and Nationality Act (INA);

(b) Aliens granted asylum under section 208 of the INA;

(c) Aliens whose deportation is being withheld under section 243(h) of the INA;

(d) Cuban and Haitian entrants as defined in section (501)(e) of the Refugee Education Assistance Act of 1980;

(e) Amerasians admitted to the U.S. under section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act, 1988 (as amended); or

(f) Lawful permanent residents who are:

(i) On active duty in the U.S. military, other than active duty for training;

(ii) Honorably discharged U.S. veterans;

(iii) Veterans of the military forces of the Philippines who served prior to July 1, 1946, as described in Title 38, section 107 of the U.S. code;

(iv) Hmong and Highland Lao veterans who served in the military on behalf of the U.S. Government during the Vietnam conflict; or

(v) The spouse or unmarried dependent children of a person described in subsections (i) through (iv).

(3) An alien who would qualify for Medicaid benefits, but is ineligible solely because of his or her alien status, can receive medical coverage as follows:

(a) State-funded categorically needy (CN) scope of care for

(i) Pregnant women, as specified in WAC 388-462-0015;

(ii) Children, through the children's health program, as specified in WAC 388-505-0210;

(iii) Persons eligible for or receiving cash assistance under the state family assistance program (SFA); and

(iv) Persons who were lawfully residing in the U.S. prior to August 22, 1996, including PRUCOL aliens as defined in WAC 388-424-0005(4).

(b) Alien emergency medical services as specified in WAC 388-438-0110.

(4) A person's alien status is not used to determine eligibility for the medically indigent program as described in WAC 388-438-0100.



[]



NEW SECTION



WAC 388-424-0015  Citizenship and alien status--Eligibility requirements for the state family assistance program. (1) Aliens who first physically enter the U.S. on or after August 22, 1996 can receive SFA only after an adult caretaker relative in the assistance unit has resided in Washington state for twelve consecutive months. This requirement:

(a) Applies to an alien only once during his or her lifetime; and

(b) Does not apply to North American Indians born in Canada who are allowed to cross the U.S./Canadian border freely under section 289 of the INA.

(2) To receive SFA benefits, persons must be:

(a) Qualified aliens who are not eligible for TANF benefits because of the five-year period of ineligibility described in WAC 388-424-0010(2); or

(b) Aliens who are permanently residing in the U.S. under color of law (PRUCOL) as defined in WAC 388-424-0005(4).



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NEW SECTION



WAC 388-424-0020  Citizenship and alien status--Eligibility requirements for the federal food stamp program. (1) Qualified aliens cannot receive federal food stamps unless they are:

(a) On active duty in the U.S. military, other than active duty for training;

(b) Honorably discharged U.S. veterans;

(c) Veterans of the military forces of the Philippines who served prior to July 1, 1946, as described in Title 38, section 107 of the U.S. code;

(d) The spouse or unmarried dependent children of a person described in sections (a) through (c) above.

(2) Lawful permanent residents who have earned enough money to qualify for forty quarters of coverage under Title II of the Social Security Act can receive federal food stamps.

(a) For purposes of this rule, an alien can receive credit for each qualifying quarter of coverage earned by a:

(i) Parent while the alien was under eighteen years of age; or

(ii) Step-parent while the alien was under eighteen years of age and residing in the same household as the step-parent; or

(iii) Spouse during their marriage if the alien remains married to the spouse or the spouse is deceased.

(b) Any quarter of coverage earned after January 1, 1997 in which an alien receives the following benefits does not count as a qualifying quarter:

(i) Food Stamps;

(ii) Temporary assistance for needy families (TANF); or

(iii) Medicaid, except for coverage provided under the alien emergency medical program.

(3) Aliens admitted to the U.S. as refugees under section 207 of the Immigration and Nationality Act (INA) can receive federal food stamps during the five-year period after their date of entry.

(4) The following aliens can receive federal food stamps during the five-year period after the date they are granted their immigration status:

(a) Aliens granted asylum under section 208 of the INA;

(b) Aliens whose deportation is withheld under section 243(h) or 241 (b)(3) of the INA;

(c) Cuban and Haitian entrants, as defined in section 501(e) of the Refugee Education Act of 1980; and

(d) Amerasians admitted to the U.S. under section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act, 1988 (as amended).



[]



NEW SECTION



WAC 388-424-0025  Citizenship and alien status--Eligibility requirements for the food assistance program for legal immigrants. To receive benefits under the food assistance program for legal immigrants (FAP), a person must be:

(1) A qualified alien who cannot receive federal food stamps because of the eligibility restrictions described in WAC 388-424-0020; or

(2) An alien who is:

(a) Allowed to enter the U.S. for permanent residence by permission of the U.S. Attorney General under section 249 of the Immigration and Nationality Act (INA);

(b) Admitted for temporary residence under section 245A of the INA and is aged, blind, or disabled as described in Title XVI of the Social Security Act;

(c) Granted temporary resident status by the Immigration and Naturalization Service (INS) as a special agricultural worker under section 210 of the INA;

(d) Granted family unity status by the INS and the alien's spouse or parent is eligible to participate in FAP or the federal food stamp program.



[]

SHS-2433:4

Chapter 388-426 WAC



CLIENT COMPLAINTS



NEW SECTION



WAC 388-426-0005  Client complaints. (1) Clients who believe they have been discriminated against by the department for reason of age, race, color, sex, disability, religious creed, political beliefs or national origin, have the right to file a written complaint.

(a) Clients wishing to file a complaint of discrimination regarding food stamp benefits must send complaints to food and nutrition services (FNS); and

(b) Clients of all other programs must send discrimination complaints to the state office of equal opportunity (OEO), Olympia WA.

(2) Clients with a complaint about a department decision or action have the right to present their complaint, in writing, to a supervisor. Within ten days of the receipt of the complaint:

(a) A decision will be made on the client's complaint; and

(b) The client will be sent written notice of the decision, including information about the right to further review by the local office administrator.

(3) Clients not satisfied with the decision of a supervisor have the right to present a written complaint to the local office administrator. Within ten days of the receipt of the complaint:

(a) A decision will be made on the complaint, and

(b) The client will be sent written notice of the decision.

(4) Written notice of the administrator's decision concludes the complaint procedure.

(5) The filing of a written complaint does not prevent a client from requesting a fair hearing under chapter 388-08 WAC.

(6) Clients have the right to speak to a worker's supervisor or have a decision or action reviewed by the supervisor, whether or not a formal complaint has been filed.



[]

SHS-2374:6

Chapter 388-428 WAC



CONFIDENTIALITY



NEW SECTION



WAC 388-428-0010  Request for address disclosure by a parent when a child is living with a nonparental caretaker. (1) When TANF or SFA has been approved for a child who is living with a nonparental caretaker, the address and location of the child may be released to the child's parent when:

(a) The parent has legal custody of the child or is allowed visitation rights or residential time with the child under a court order; and

(b) No court order restricts or limits the parent's right to contact or visit the child or the child's caretaker by imposing conditions to protect the child or the caretaker from harm;

(c) The department has not found that the caretaker has good cause for refusing to cooperate in child support enforcement activities related to the parent's support obligation; and

(d) There is no substantiated claim or pending investigation involving abuse or neglect of any child by the parent;

(e) There are no pending proceedings as listed in subsections (1)(b) through (d).

(2) A parent may request the child's address and location:

(a) In person, with satisfactory evidence of identity, at the community services office where the child's record is being maintained;

(b) Through an attorney; or

(c) If residing outside the state of Washington, by submitting a notarized request.

(3) If the request for the child's address and location is based on a court order granting the parent legal custody, visitation rights or residential time, the parent must also submit:

(a) A copy of the court order; and

(b) A sworn statement that the order has not been modified.

(4) Prior to release of the child's address and location, the child's caretaker will be notified that:

(a) The child's parent has requested the information; and

(b) The information will be released within thirty days from the date of the notice unless the caretaker:

(i) Provides proof of a current investigation or pending court case involving the abuse or neglect of any child by the parent;

(ii) Provides a copy of a court order which prevents disclosure of the address or restricts the parent's right to contact or visit the caretaker or the child by imposing conditions to protect the caretaker or child from harm;

(iii) Requests a fair hearing which results in a decision that disclosure must be denied because of the existence of one or more of the conditions in subsection (1) of this section.

(5) A parent's request for disclosure of a child's address and location will be responded to within thirty-five days. The response will notify the parent:

(a) Of the child's address and location if the information may be disclosed;

(b) The reasons for denying the request if the information may not be disclosed; or

(c) That a decision has not been made because the child's caretaker:

(i) Has requested a hearing and a final hearing decision has not been entered; or

(ii) Is claiming good cause for refusing to cooperate in child support enforcement activities related to the parent's support obligation and a final decision has not been made on the caretaker's claim.

(d) When the decision has not been made because of a pending fair hearing decision or good cause claim determination, the parent will be notified of the decision within ten days of the hearing decision or good cause determination.



[]

SHS-2375:7

Chapter 388-430 WAC



DEPRIVATION



NEW SECTION



WAC 388-430-0001  Establishing deprivation. (1) For TANF/SFA, a child must be deprived of the support and care of one or both parents due to one of the following reasons:

(a) Death;

(b) Absence;

(c) Incapacity; or

(d) Unemployment.

(2) Deprivation of a child due to death or absence ceases when the remaining parent marries.

(3) Deprivation of a child due to incapacity or unemployment does not apply when only one of the child's parents is living in the home.

(4) Deprivation for each child is established separately when children within a family have different parents.



[]



NEW SECTION



WAC 388-430-0005  Deprivation due to absence. (1) A child is deprived due to the absence of a parent when a parent resides outside the child's home and does not provide to the child one of the following elements of parental functions:

(a) Routine visits to the child;

(b) Maintaining support and in-kind contributions at least equal to the child's prorated share of the monthly need standard for the child's assistance unit as listed in WAC 388-478-0015;

(c) Performing or assisting with continuous day-to-day physical care of the child; or

(d) Participating in and being responsible for day-to-day guidance of the child's physical, emotional, and intellectual development.

(2) Deprivation due to absence includes a two parent family when a parent convicted of an offense is permitted to live in the family home but is required by the court to perform unpaid work or unpaid community service. The needs of the convicted parent are not considered in the determination of eligibility or benefit payment to the assistance unit.

(3) Deprivation due to absence does not exist if the reason for the parent's absence from the child's home is due solely to serving on active duty in the United States military services.

(4) For applicants, deprivation due to absence does not exist if the parent is expected to return to the home within the first benefit month. Payment may be made for the first benefit month, but not the second month, if the parent will return within the second month.

(5) For recipients after the first two months of benefits, deprivation due to absence ceases to exist at the end of the month in which the parent returns to the home.



[]



NEW SECTION



WAC 388-430-0010  Definition of maintenance, physical care and guidance. (1) Maintenance means the financial support and in-kind contributions paid directly to the child's household, including:

(a) Child support;

(b) Food;

(c) Clothing; and

(d) Other necessities.

(2) Physical care means continuous care of the child on a day-to-day basis by performing tasks, depending on the age of the child, required in the child's daily life including, but not limited to:

(a) Providing clean clothing and dressing the child;

(b) Preparing meals and feeding;

(c) Supervising bedtime; and

(d) Assisting with other personal care needs.

(3) Guidance means day-to-day parental participation in, and responsibility for, the child's physical, emotional, and intellectual development including, but not limited to:

(a) Accompanying the child to doctor visits;

(b) Attending school conferences;

(c) Disciplining; and

(d) Participating in decisions concerning the child's well-being and extracurricular activities.



[]



NEW SECTION



WAC 388-430-0015  Deprivation due to incapacity. A child is deprived due to the incapacity of a parent when the child's parent meets the conditions in WAC 388-448-0005.



[]



NEW SECTION



WAC 388-430-0020  Deprivation due to unemployment. (1) Deprivation due to the unemployment of a parent requires that a qualifying parent be established. The qualifying parent is the parent who has earned the most income within the twenty-four month period immediately preceding the month of the application for benefits.

(2) Once determined, the qualifying parent continues as the qualifying parent throughout the time the family remains on cash assistance as a result of that application. The qualifying parent can be changed when an error was made in the initial designation.

(3) For applicants, a child is deprived due to the unemployment of a parent when the qualifying parent meets all of the following conditions:

(a) Is not employed, or is employed less than one hundred hours per month;

(b) Has been in the above status for at least thirty days, and during this time has not refused a bona fide offer of employment or training for employment, nor voluntarily left a job without good cause; and

(c) Has not refused to apply for or accept unemployment compensation benefits; and

(d) Meets one of the following requirements:

(i) At least six calendar quarters of work within thirteen consecutive quarters. The thirteen consecutive calendar quarters must be within a maximum period of seventeen quarters with quarter number one containing the month of application; or

(ii) Received or was eligible for unemployment compensation benefits within one year of the date of application for assistance.

(4) For recipients, the child remains deprived due to the unemployment of a parent even when the qualifying parent is working over one hundred hours within any month, or with continuous employment.

(5) For recipients, cash assistance may be terminated due to earnings by the qualifying parent in excess of the payment standard. If that employment ends within thirty days of the termination and the household reapplies, the qualifying parent does not need to meet the thirty-day unemployed applicant rule.



[]



NEW SECTION



WAC 388-430-0025  Work quarters. The qualifying parent meets a quarter of work when the parent has:

(1) Earned or received earned income of fifty dollars or more in a calendar quarter;

(2) Participated in a department sponsored program of education, training or employment services during a calendar quarter; or

(3) Earned a quarter of coverage under Social Security Administration criteria.



[]

SHS-2436:4

Chapter 388-434 WAC



ELIGIBILITY REVIEWS AND RECERTIFICATIONS



NEW SECTION



WAC 388-434-0005  Eligibility reviews for cash and medical assistance. (1) Clients receiving cash assistance are required to have eligibility redetermined at least once every twelve months. The redetermination will be based on information provided on a form designated by the department. A family needs to complete only one form.

(2) A client's redetermination may be the scheduled review or initiated before the scheduled review when there are a number of eligibility changes to be reviewed. The redetermination includes:

(a) A review of each eligibility factor; and

(b) An evaluation of any change occurring since eligibility was established or last reviewed.

(3) For clients not receiving cash assistance, an eligibility redetermination date will be established in advance. For programs which require a fixed beginning and ending date, eligibility redetermination will be initiated prior to the end of coverage.

(4) Clients receiving assistance will be responsible for completing and responding to the eligibility redetermination request and attending an interview if required under WAC 388-452-0005.

(5) Clients who do not respond to a notice of redetermination will be considered to be withdrawing their request for continuing assistance. Termination of medical assistance will occur if there is insufficient information to redetermine medical program eligibility.

(6) Clients will receive a notice when the cash and food assistance is suspended, terminated, or a benefit error is discovered during the review as specified under chapter 388-458 WAC.

(7) Clients who become ineligible for cash assistance continue to receive the same medical coverage until a redetermination for other medical programs is completed.

(8) Clients not requesting a continuation of cash assistance have a right to be considered for other medical program eligibility.

(9) Clients receiving CN medical only remain eligible until a redetermination of eligibility for other medical programs is completed.

(10) Recipients who are assessed as needing necessary supplemental accommodation (NSA) services will be assisted in complying with the requirements of this section as specified under WAC 388-200-1300.



[]



NEW SECTION



WAC 388-434-0010  Recertification for food assistance. (1) A household reapplies timely when the department receives the application by:

(a) The fifteenth day of the last month of certification; or

(b) The fifteenth day after the household receives a notice of certification when the household's certification period is two months or less.

(2) A household completes the reapplication process when it:

(a) Submits a timely reapplication;

(b) Completes an interview; and

(c) Submits requested verification.

(3) A household receives uninterrupted benefits when the household completes the reapplication process timely. Uninterrupted benefits mean the household's benefits will continue to be mailed on the same mailing day of the month.

(4) A household that reapplies timely and completes the application process will receive a notice of approval or denial:

(a) By the end of the current certification period; or

(b) By the thirtieth day after the last allotment when the household was certified for one month.

(5) When a household that reapplies late, the reapplication is treated like an initial application and will be approved or denied under WAC 388-406-0035.

(6) See chapter 388-458 WAC for adequate notice and translation requirements.



[]



Chapter 388-436 WAC



EMERGENCY CASH ASSISTANCE



NEW SECTION



WAC 388-436-0001  Additional requirement for emergent needs (AREN). (1) Clients eligible for temporary assistance for needy families (TANF), state family assistance (SFA) and refugee cash assistance (RCA) may request additional cash assistance when they do not have funds available to meet the following emergency situations:

(a) To prevent eviction or foreclosure when the household has received a formal written notice of the eviction, notice to pay or vacate, or foreclosure;

(b) To secure new housing when:

(i) An eviction or foreclosure is not preventable;

(ii) It would cost less to obtain new housing than to prevent the eviction;

(iii) The dwelling puts the household's health or safety in danger and the landlord fails or refuses to correct the condition within the time allowed by law; or

(iv) Moving is necessary to escape an abusive spouse.

(c) To prevent a utility shutoff when the household has received a disconnect notice;

(d) To obtain necessary fuel for heating or cooking when the household has no fuel;

(e) To correct a sudden malfunction resulting in the loss of heat, water, electricity or cooking facilities. The household must be legally responsible for the repairs or replacement with no other alternative;

(f) To purchase food when no other resource is available; or

(g) To help the household obtain housing and necessary clothing in the event of a declared natural disaster when funds are not available through a disaster relief program.

(2) The additional cash payment is issued for the lower of:

(a) The amount necessary to prevent or relieve the emergency; or

(b) The TANF payment standard for an assistance unit of that family's size with an obligation to pay a shelter cost.



[]



NEW SECTION



WAC 388-436-0005  AREN good cause. (1) Clients requesting an additional cash benefit must show good reason why funds received or expected to be received during the month of request are not available to meet the emergency.

(2) Clients in the following situations have good reason for the funds not being available and resulting in an emergency:

(a) Cash from the grant has been stolen;

(b) The funds were used for necessities such as:

(i) Medical bills;

(ii) Dental care needed to obtain employment or because of pain;

(iii) Escape from abuse;

(iv) Paying for child care in an emergency;

(v) Temporary extra costs were needed for housing, food or clothing provided the action was reasonable. An expenditure is considered reasonable when:

(A) The expenditure is less than the amount specified in WAC 388-436-0050; or

(B) The specific circumstances and need for the expenditure is judged reasonable by the department.



[]



NEW SECTION



WAC 388-436-0010  Winterization. (1) Clients eligible for cash assistance under TANF/SFA may be eligible for additional cash benefits for the purpose of winterizing their home.

(2) Clients must meet all of the following conditions:

(a) The clients must own or be purchasing their home;

(b) The primary reason for the repairs is to minimize heat loss or to increase the efficiency of the home heating system;

(c) The repairs are necessary in order to make the home livable in the winter;

(d) Without the repairs, the clients would have to move to rental housing; and

(e) The cost of rental housing for two years would be more than the costs of remaining in their home, including the costs of the repairs.

(3) Clients can receive funds from this program only once.

(4) Payments under this program are made by vendor payment after the repairs have been completed.

(5) The maximum payment for winterizing a home is five hundred dollars.



[]



NEW SECTION



WAC 388-436-0015  Consolidated emergency assistance program (CEAP). (1) CEAP is available to the following persons:

(a) A pregnant woman in any stage of pregnancy; or

(b) Families with dependent children.

(2) Applicants must be residents of Washington state as defined in WAC 388-468-0010.

(3) Applicants must demonstrate a financial need for emergency funds for one or more of the following basic requirements:

(a) Food;

(b) Shelter;

(c) Clothing;

(d) Minor medical care;

(e) Utilities;

(f) Household maintenance supplies;

(g) Necessary clothing or transportation costs to accept or retain a job; or

(h) Transportation for a minor, not in foster care, to a home where care will be provided by family members or approved caretakers.

(4) Payment under this program is limited to not more than thirty consecutive days within a period of twelve consecutive months.



[]



NEW SECTION



WAC 388-436-0020  CEAP assistance unit composition. (1) To be eligible for CEAP, a child must be living with:

(a) A parent or a relative of specified degree as defined under WAC 388-454-0010; or

(b) Has lived with such a relative within six months of the request for assistance.

(2) The following persons living in the household must be included as members of the CEAP assistance unit:

(a) All full, half, or adopted siblings under eighteen years of age, including a minor parent; and

(b) The parent, adoptive parent, or stepparent living with the child or children.

(3) The following persons living in the household do not have to be included but may be included as members at the option of the applicant:

(a) One caretaker relative of specified degree when the child's parent does not live in the home;

(b) Stepbrothers or stepsisters to all children in the assistance unit.

(4) The following persons may make up a CEAP assistance unit without including others living in the home:

(a) The child of a parent who is a minor when the minor parent is not eligible due to the income and resources of his/her parents; or

(b) A pregnant woman when no other child is in the home.

(5) The following persons living in the household are not included as members of the CEAP assistance unit:

(a) A household member receiving Supplemental Security Income (SSI);

(b) A household member ineligible due to reasons stated in WAC 388-436-0025 and 388-436-0030.



[]



NEW SECTION



WAC 388-436-0025  Eligibility conditions for CEAP--Job refusal. (1) Within thirty days of the date of application, applicants for CEAP cannot have refused without good cause:

(a) A bona fide job offer; or

(b) Training for employment.

(2) Applicants have good cause for refusal when the applicant:

(a) Can not perform the work satisfactorily because of a physical, mental, or emotional inability;

(b) Is not able to get to and from the job without undue cost or hardship;

(c) Would be forced to perform hazardous work;

(d) Would be working for less than minimum wage or the wages are not customary for that type of work;

(e) Is offered the job only because of a labor dispute; or

(f) Is not able to obtain necessary child care.

(3) An applicant who cannot demonstrate good cause for refusing a job offer makes the entire assistance unit ineligible for CEAP:

(a) For thirty days from the date of refusal; or

(b) Until the applicant accepts employment, whichever comes first.



[]



NEW SECTION



WAC 388-436-0030  Eligibility conditions for CEAP--Other possible resources. (1) As a condition of eligibility for CEAP, applicants must take all necessary steps to establish eligibility for the following programs:

(a) Temporary assistance for needy families (TANF);

(b) State family assistance (SFA);

(c) Refugee cash assistance (RCA);

(d) Supplemental security income (SSI);

(e) Medical assistance for those applicants requesting emergency medical care;

(f) Food assistance for those applicants declaring an emergency food need; and

(g) Unemployment compensation, if the applicant is potentially eligible.

(2) CEAP applicants under a grant penalty for failure to comply with program requirements of TANF/SFA, WorkFirst under chapter 388-310 WAC, refugee cash assistance, general assistance or SSI are treated as follows:

(a) All members are ineligible and the CEAP application is denied if compliance could have prevented the need for emergency assistance.

(b) Only the member responsible for the grant penalty is ineligible for CEAP if the compliance could not have prevented the need for emergency assistance.



[]



NEW SECTION



WAC 388-436-0035  Income and resources for CEAP. (1) Estimated income, resources and circumstances of the following persons are used in determining need and payment for CEAP:

(a) All persons included as members of the CEAP assistance unit;

(b) If living in the home, the spouses and minor brothers and sisters of persons included as members of the CEAP assistance unit.

(2) Public assistance payments plus authorized additional requirements received in the calendar month of CEAP application are considered as income.

(3) The value of resources not listed as excluded in WAC 388-436-0040 is considered available to meet the emergent needs of the CEAP assistance unit.



[]



NEW SECTION



WAC 388-436-0040  Excluded income and resources for CEAP. Resources and income listed below will not be considered in determining need or payment for CEAP:

(1) A home as defined under WAC 388-470-0030;

(2) One vehicle, running and used regularly by the assistance unit, with an equity value not to exceed one thousand five hundred dollars);

(3) Household furnishings being used by the assistance unit;

(4) Personal items being used by members of the assistance unit;

(5) Tools and equipment being used in the applicant's occupation;

(6) The value of the coupon allotment under the Food Stamp Act of 1977, as amended;

(7) Benefits received under the women, infants and children program (WIC) of the child nutrition Act of 1966, as amended, and the special food service program for children under the National School Lunch Act, as amended;

(8) Energy assistance payments;

(9) Grants, loans, or work study to a student under Title IV of the Higher Education Amendments or Bureau of Indian Affairs for attendance costs as identified by the institution;

(10) Income and resources of an SSI recipient;

(11) Livestock when the products are consumed by members of the assistance unit;

(12) All resources and income excluded for the TANF program under WAC 388-450-0015, 388-470-0020, and 388-470-0025 and by federal law.



[]



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.



NEW SECTION



WAC 388-436-0045  Income deductions for CEAP. The following deductions are allowed when determining the CEAP assistance unit's net income:

(1) A ninety dollar work expense from each member's earned income;

(2) Actual payments made by a member with earned income for care of a member child up to the following maximums:

Hours

Worked

Per Month

Each Child Under Two Years Each Child

Two Years Or Older

0 - 40 $ 50.00 $ 43.75
41 - 80 100.00 87.50
81 - 120 150.00 131.25
121 or More 200.00 175.00

(3) Verified expenses for members of the assistance unit during the current month as follows:

(a) Medical bills;

(b) Child care paid in an emergency in order to avoid abuse;

(c) Dental care to relieve pain; or

(d) Costs incurred in obtaining employment.



[]

SHS-2451.1

NEW SECTION



WAC 388-436-0050  Determining financial need and benefit amount for CEAP. (1) To be eligible for CEAP assistance, the assistance unit's nonexcluded income, minus allowable deductions, must be less than ninety percent of the TANF payment standard for households with shelter costs. The net income limit for CEAP assistance units is:



Assistance

Unit Members

Net Income Limit
1 $ 314
2 396
3 491
4 577
5 666
6 756
7 873
8 or more 967



(2) The assistance unit's allowable amount of need is the lesser of:

(a) The TANF payment standard, based on assistance unit size, for households with shelter costs as specified under WAC 388-478-0020; or

(b) The assistance unit's actual emergent need, not to exceed maximum allowable amounts, for the following items:



Need Item: Maximum allowable amount by assistance unit size:



1 2 3 4 5 6 7 8 or more
Food $211 $268 $332 $391 $450 $511 $583 $645
Shelter 258 325 404 476 548 621 719 795
Clothing 30 38 47 56 64 73 83 94
Minor Medical Care 179 228 282 332 382 432 501 554
Utilities 87 110 136 160 184 210 243 268
Household maintenance 64 81 100 118 136 155 178 197
Job related transportation 349 440 546 642 740 841 971 1075


(3) The assistance unit's CEAP payment is determined by computing the difference between the allowable amount of need, as determined under subsection (2) of this section, and the total of:

(a) The assistance unit's net income, as determined under subsection (1) of this section;

(b) Cash on hand, if not already counted as income; and

(c) The value of other nonexcluded resources available to the assistance unit.

(4) The assistance unit is not eligible for CEAP if the amount of income and resources, as determined in subsection (3) of this section, is equal to or exceeds its allowable amount of need.



[]

SHS-2425:2

Chapter 388-437 WAC



EMERGENCY ASSISTANCE FOR FOOD STAMPS



NEW SECTION



WAC 388-437-0001  Disaster food stamp program. (1) Assistance units that suffer a loss as a result of a federally declared disaster may receive disaster food stamp benefits.

(2) Food and nutrition services (FNS) must approve use of this program when a disaster is declared.



[]

SHS-2394:4

Chapter 388-438 WAC



EMERGENCY ASSISTANCE FOR MEDICAL NEEDS



NEW SECTION



WAC 388-438-0100  Medically indigent (MI) program. (1) The medically indigent (MI) program is a state funded medical program limited to coverage for emergency medical services.

(a) An emergency medical condition is described in WAC 388-500-0005;

(b) The client must have had a qualifying emergency medical condition in the month of application or within the three months immediately preceding the month of application;

(c) A client must have incurred an emergency medical expense requirement (EMER) of two thousand dollars per family over a twelve-month period. Qualifying EMER expenses are:

(i) Emergency hospital services and related physician services in a hospital; and

(ii) Emergency ground or air ambulance transportation to a hospital.

(2) The EMER period:

(a) Begins on the first day of the month of certification for MI; and

(b) Continues through the last day of the following twelve-calendar months.

(3) If a client does not meet the EMER amount within the three month base period, as described in WAC 388-519-0100, the amount incurred can be applied to any other application for MI within twelve-month period described in subsection (2).

(4) A client is limited a singly three-month period of MI eligibility per twelve-month EMER period.

(5) A client in a nursing facility can exceed the three-month MI eligibility limit.

(6) Conditions which require the following services meet the definition of emergency for MI, but the client is exempt from the EMER requirement:

(a) Treatment under the involuntary treatment act (ITA); and

(b) DETOX services; and

(c) Institutional and/or waivered services.

(7) Pregnancy meets the definition of emergency for MI. A pregnant client must meet the EMER requirements.

(8) Resource rules for the MI program follow the TANF and TANF-related resource rules in chapter 388-470 WAC.

(9) If a client's income and/or resources exceed the standards for this program, as described in WAC 388-478-0070, the excess must be spent down as described in WAC 388-519-0100, for the client to be eligible for MI.

(10) A client is not eligible for MI if they:

(a) Are eligible for, or receiving, any other cash or medical program; or

(b) Entered the state specifically to obtain medical care; or

(c) Are an inmate of a federal or state prison.



[]



NEW SECTION



WAC 388-438-0110  Alien emergency medical. An alien who is not eligible for other medical programs, is eligible for emergency medical care and services:

(1) Regardless of their date of arrival in the United States;

(2) Except for citizenship, meets Medicaid eligibility requirements as described in WAC 388-505-0210, 388-505-0220 or WAC 388-505-0110; and

(3) Limited to the necessary treatment of an alien's emergency medical condition as defined in WAC 388-500-0005, except that organ transplants and related medical care services are not covered.



[]

SHS-2423:4

Chapter 388-440 WAC



EXCEPTION TO RULE



NEW SECTION



WAC 388-440-0001  Exception to rule. (1) The secretary of the department, or designee, authorizes department staff to request an exception to a rule in the Washington Administrative Code (WAC) for individual cases when:

(a) The exception would not contradict a specific provision of federal law or state statute; and

(b) The client's situation differs from the majority; and

(c) It is in the interest of overall economy and the client's welfare; and

(d) It increases opportunities for the client to function effectively; or

(e) A client has an impairment or limitation that significantly interferes with the usual procedures required to determine eligibility and payment.

(2) The secretary or the secretary's designee makes the final decision on all requests for exception to a rule.

(3) Clients have no fair hearing rights as defined under chapter 388-08 WAC regarding exception to rule decisions by department staff.

(4) Clients who do not agree with a decision on an exception to rule may file a complaint according to chapter 388-426 WAC.



[]



NEW SECTION



WAC 388-440-0005  Exception to rule--Notification requirement. (1) Clients are notified in writing within ten days of:

(a) The department staff's decision to file an exception to rule request; and

(b) The department's decision to approve or deny an exception to rule request.

(2) The notice will include the complaint procedures as specified in chapter 388-426 WAC.



[]



Chapter 388-442 WAC



FELONS



NEW SECTION



WAC 388-442-0010  Felons. (1) A person is not eligible for TANF/SFA, GA and/or food assistance if the person is:

(a) Fleeing to avoid prosecution, custody, or confinement after conviction of a crime, or an attempt to commit a crime which is considered a felony in the place from which they were fleeing; or

(b) Violating a condition of probation or parole as determined by an administrative body or court that has the authority to make this decision.

(2) A person is not eligible for TANF/SFA and/or food assistance if convicted of a felony committed after August 21, 1996 involving possession, use, or distribution of an illegal drug, unless the person:

(a) Was convicted only of possession or use of an illegal drug; and

(b) Was not convicted of a felony for illegal drugs within three years of the latest conviction; and

(c) Was assessed as chemically dependent by a program certified by the division of alcohol and substance abuse (DASA); and

(d) Is taking part in or has completed a rehabilitation plan consisting of chemical dependency treatment and job services.



[]



Chapter 388-444 WAC



FOOD STAMP EMPLOYMENT AND TRAINING



NEW SECTION



WAC 388-444-0005  The food stamp employment and training (FS E&T) program--General requirements. (1) To receive food assistance some clients must register for work and if required by the department, must participate in the food stamp employment and training (FS E&T) program.

(2) Clients who must register for work and may be required to participate in FS E&T are called nonexempt clients. All other members of the food assistance unit are called exempt clients.

(3) All nonexempt members of the food assistance unit are registered for work by the department, at the first food assistance application and once every twelve months thereafter. A person who enters an existing assistance unit will be registered for work and FS E&T, if not exempt.

(4) Clients must comply with all FS E&T program requirements as provided in subsection (5) of this section. Failure to comply without good cause will disqualify the client from receiving food assistance:

(a) Good cause rules are provided in WAC 388-444-0050; and

(b) Disqualification rules are provided in WAC 388-444-0055.

(5) Nonexempt clients are required to:

(a) Report to DSHS or the service provider and participate as required;

(b) Provide information regarding employment status and availability for work as requested;

(c) Report to an employer when referred by DSHS; and

(d) Accept a bona fide offer of suitable employment. Unsuitable employment is defined in WAC 388-444-0060.

(6) A nonexempt client will participate in one or more of the following activities:

(a) Job search;

(b) General education development (GED) classes; or

(c) English as a second language (ESL) classes.

(7) A client is not required to participate in FS E&T activities more than one hundred twenty hours in a month. Hours of participation may include a combination of FS E&T activities as described in subsection (6) of this section and hours worked for pay, either cash or in-kind.



[]



NEW SECTION



WAC 388-444-0010  Clients who are required to register for work and must participate in FS E&T. The following clients are nonexempt, must register for work and are required to participate in FS E&T:

(1) Age sixteen through fifty-nine with dependents;

(2) Age sixteen or seventeen, not attending secondary school and not the head-of-household;

(3) Age fifty through fifty-nine with no dependents.

(4) Age eighteen to fifty, able-bodied and with no dependents as provided in WAC 388-444-0030.



[]



NEW SECTION



WAC 388-444-0015  Clients who are not required to register for work or participate in FS E&T (exempt clients). Clients not required to register for work or to participate in FS E&T are those who are:

(1) Age sixteen or seventeen and not the head-of-household and:

(a) Attending school; or

(b) Enrolled in a program under temporary assistance for needy families (TANF), a program under Job Training Partnership Act (JTPA), a program under section 236 of the Trade Act of 1974, or other state or local employment and training programs at least half time.

(2) Physically or mentally unable to work;

(3) Responsible for the care of a dependent child under six years of age or of an incapacitated person;

(4) Applying for or receiving unemployment compensation (UC);

(5) Participating in an employment and training program under TANF;

(6) Employed or self-employed thirty hours or more per week, or receiving weekly earnings equal to the federal minimum wage multiplied by thirty. This includes migrant and seasonal farm workers under contract or agreement with an employer;

(7) Enrolled as a student as defined in chapter 388-482 WAC, Student status; or

(8) Regularly participating in a drug addiction or alcoholic treatment and rehabilitation program.



[]



NEW SECTION



WAC 388-444-0020  Clients who must register for work but are not required to participate in FS E&T. The following clients must register for work but are exempt from participation in the FS E&T program:

(1) Participants in a refugee assistance program;

(2) Clients living in an area where the FS E&T program is not provided (exempt area);

(3) Clients who live one hour or more travel distance from available FS E&T services;

(4) Clients who do not have a mailing address or message telephone;

(5) Clients who have a temporary incapacity expected to last sixty days or more; or

(6) Clients who have dependent care needs that exceed the maximum amount payable by the department. The exemption continues until:

(a) A different work activity is available; or

(b) Circumstances change and monthly dependent care costs no longer exceed the reimbursement limit set by the department.



[]



NEW SECTION



WAC 388-444-0025  Payments for FS E&T related expenses. (1) Some of a client's actual expenses needed to participate in the FS E&T program may be paid by the department. Allowable expenses are:

(a) Transportation related costs; and

(b) Dependent care costs for each dependent six through twelve years of age.

(2) Dependent care payments are not paid if:

(a) The child is thirteen years of age or older unless the child is:

(i) Physically and/or mentally incapable of self-care; or

(ii) Under court order requiring adult supervision; or

(b) Any member in the food assistance unit provides the dependent care.

(3) Dependent care payments paid by the department cannot be claimed as an expense and used in calculating the dependent care deduction as provided in WAC 388-450-0185.



[]



NEW SECTION



WAC 388-444-0030  Work requirements for persons who are able-bodied adults without dependents (ABAWDS). (1) Clients who are age eighteen to fifty and have no dependents must, unless exempt, participate in specific employment and training activities to receive food assistance.

(2) Nonexempt clients who fail to participate are eligible for no more than three months of food assistance in a thirty-six month period.

(3) Except as provided in WAC 388-444-0035, a person is not eligible to receive food assistance for more than three full months in the thirty-six month period beginning January 1, 1997 unless that person:

(a) Works at least twenty hours a week averaged monthly; or

(b) Participates in and complies with the requirements of a work program for twenty hours or more per week; or

(c) Participates in a workfare program as provided in WAC 388-444-0040.

(4) A work program is defined as a program under:

(a) The Job Training Partnership Act (JTPA);

(b) Section 236 of the Trade Act of 1974; or

(c) A state-approved employment and training program.



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NEW SECTION



WAC 388-444-0035  Clients who are exempt from ABAWD provisions. A client is exempt from the ABAWD rules provided in WAC 388-444-0030 when:

(1) Under eighteen or over forty-nine years of age;

(2) Physically or mentally unable to work;

(3) A parent or other member of a household with responsibility for a dependent child under eighteen years of age or an incapacitated person;

(4) A pregnant woman;

(5) Living in an exempt area approved by U.S. Department of Agriculture; or

(6) Otherwise exempt under food stamp employment and training as follows:

(a) Complying with the work requirements of the WorkFirst program;

(b) Receiving unemployment compensation;

(c) A student enrolled at least half time in any recognized school;

(d) A regular participant in a chemical dependency treatment program; or

(e) Employed a minimum of thirty hours per week or receiving weekly earnings which equal the minimum hourly rate multiplied by thirty hours.



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NEW SECTION



WAC 388-444-0040  Workfare. (1) Workfare is a work program available to clients eighteen to fifty years of age who are able to work and have no dependents.

(2) Workfare consists of:

(a) Thirty days of job search activities in the first month beginning with the first day of application or sixteen hours of volunteer work with a public or private nonprofit agency; and

(b) In subsequent months, sixteen hours per month of volunteer work with a public or private nonprofit agency.

(3) A client is not required to perform Workfare and paid work for more than a total of thirty hours a week.

(4) The department pays for a client's actual expenses needed for the client to participate in Workfare. Standards for paying expenses are set by the department.



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NEW SECTION



WAC 388-444-0045  Regaining eligibility for food assistance. (1) A client who is ineligible for food assistance because that client has exhausted the three-month limit in WAC 388-444-0030, can regain eligibility by:

(a) Working eighty hours or more during a thirty-day period;

(b) Participating in and complying with a work program for eighty hours or more during a thirty-day period; or

(c) Participating in and complying with a workfare program.

(2) A client who regains eligibility for food assistance under subsection (1) of this section is eligible as long as the requirements of subsection (1) of this section are met.

(3) If otherwise eligible, clients who regain eligibility in subsection (1) of this section and then loses employment or stops participating in a work program or in Workfare will receive an additional three-consecutive months of food assistance. The three-month certification is allowed only once in the thirty-six month period.



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NEW SECTION



WAC 388-444-0050  Good cause for failure to register for work or for not participating in the FS E&T program. (1) A nonexempt client may have good cause for refusing or failing to register for work or to participate in the FS E&T program.

(2) Good cause reasons include, but are not limited to:

(a) Illness of the client;

(b) Illness of another household member requiring the help of the client;

(c) A household emergency;

(d) The unavailability of transportation; or

(e) Lack of adequate dependent care for children six through twelve years of age.

(3) A client who is determined by the department to lack good cause for failing or refusing to participate in FS E&T is disqualified and is not eligible to receive food assistance.



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NEW SECTION



WAC 388-444-0055  FS E&T disqualifications. (1) A nonexempt client who refuses or fails to comply with the requirements of the FS E&T program without good cause as provided in WAC 388-444-0050, is disqualified and cannot receive food assistance. The disqualified client is an ineligible assistance unit member as provided in WAC 388-450-0140. The remaining members of the assistance unit continue to be eligible for food assistance.

(2) The client is disqualified for the following minimum periods of time and until the client complies with program requirements:

(a) For the first failure to comply, one month;

(b) For the second failure to comply, three months; and

(c) For the third or subsequent failure to comply, six months.

(3) If a client becomes exempt under WAC 388-444-0015, a disqualification ends when the client has served the one, three, or six month disqualification penalty period and if required, is registered for work.

(4) A nonexempt client disqualified under any of the following conditions is also disqualified under FS E&T and cannot receive food assistance:

(a) Under WorkFirst sanction as provided in chapter 388-310 WAC;

(b) Disqualified from receiving unemployment compensation for failure to comply with requirements comparable to FS E&T requirements; or

(c) Sanctioned for failing to comply with work requirements under the refugee cash assistance program as provided in chapter 388-466 WAC.

(5) At the end of a disqualification period, a client may apply to reestablish eligibility.

(6) Each client has a right to a fair hearing as provided in WAC 388-08-413.



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NEW SECTION



WAC 388-444-0060  FS E&T--Unsuitable employment. Nonexempt clients participating in FS E&T must accept a bona fide offer of suitable employment. Employment is considered unsuitable when:

(1) The wage offered is less than the federal or state minimum wage, whichever is highest;

(2) The job offered is on a piece-rate basis and the average hourly yield expected is less than the federal or state minimum wage, whichever is highest;

(3) The employee, as a condition of employment, is required to join, resign from or is barred from joining any legitimate labor union;

(4) The work offered is at a site subject to strike or lockout at the time of offer unless:

(a) The strike is enjoined under the Taft-Hartley Act; or

(b) An injunction is issued under section 10 of the Railway Labor Act.

(5) The degree of risk to health and safety is unreasonable;

(6) The client is physically or mentally unable to perform the job as documented by medical evidence or reliable information from other sources;

(7) The employment offered within the first thirty days of registration for FS E&T is not in the client's major field of experience;

(8) The distance from the client's home to the job is unreasonable considering the wage, time and cost of commute:

(a) The job is not suitable when daily commuting time exceeds two hours per day, not including transporting a child to and from child care; and

(b) The job is not suitable when the distance to the job prohibits walking and public or private transportation is not available.

(9) The working hours or nature of the job interferes with the client's religious observances, convictions, or beliefs.



[]



NEW SECTION



WAC 388-444-0065  Quitting a job. (1) A client who quits their most recent job without good cause is not eligible for food assistance if:

(a) The client was working twenty hours or more per week or the job provided weekly earnings equal to the federal minimum wage multiplied by twenty hours; and

(b) The quit occurred within sixty days prior to application for food assistance or any time thereafter;

(c) At the time of quit, the person would have been required to register for work.

(2) A client is not eligible to receive food assistance if the client has participated in a strike against a federal, state or local government and has lost their employment because of such participation.



[]



NEW SECTION



WAC 388-444-0070  Good cause for quitting a job. Unless otherwise specified the following rules apply to all food assistance clients. (1) Good cause for quitting a job includes the following:

(a) For all food assistance clients, the employment is unsuitable as defined under WAC 388-444-0060;

(b) The client is discriminated against by an employer based on age, race, sex, color, religious belief, national origin, political belief, marital status, or the presence of any sensory, mental, or physical disability or other reasons in RCW 49.60.180;

(c) Work demands or conditions make continued employment unreasonable, such as working without being paid on schedule;

(d) The client accepts other employment or is enrolled at least half time in any recognized school, training program, or institution of higher education;

(e) The client must leave a job because another assistance unit member accepts a job or is enrolled at least half time in any recognized school, training program, or institution of higher education in another county or similar political subdivision and the assistance unit must move;

(f) The client who is under age sixty and retires as recognized by the employer;

(g) The client accepts a bona fide offer of employment of twenty or more a week or where the weekly earnings are equivalent to the federal minimum wage multiplied by twenty hours. However, because of circumstances beyond the control of the client, the job either does not materialize or results in employment of twenty hours or less a week or weekly earnings of less than the federal minimum wage multiplied by twenty hours;

(h) The client leaves a job in connection with patterns of employment where workers frequently move from one employer to another, such as migrant farm labor or construction work; and.

(i) For FS E&T participants, circumstances included under WAC 388-444-0050;

(2) A client who quits the most recent job is eligible for food assistance if the circumstances of the job involve:

(a) Changes in job status resulting from reduced hours of employment while working for the same employer;

(b) Termination of a self-employment enterprise; or

(c) Resignation from a job at the demand of an employer.

(3) The client must verify good cause for quitting. Food assistance is not denied if the client and the department are unable to obtain verification.



[]



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.



NEW SECTION



WAC 388-444-0075  Disqualifications for quitting a job without good cause. (1) If the client quits a job without good cause, the client is disqualified. The client is disqualified for the following minimum periods of time and until the conditions in subsection (2) of this section are met:

(a) For the first quit, one month;

(b) For the second quit, three months; and

(c) For the third or subsequent quit, six months.

(2) The client may re-establish eligibility after the disqualification, if otherwise eligible by:

(a) Getting a new job;

(b) In nonexempt areas, participating in the FS E&T program;

(c) Participating in Workfare as provided in WAC 388-444-0040;

(d) Becoming exempt as provided in WAC-388-444-0015 or WAC 388-444-0020;

(e) Applying for or receiving unemployment compensation; or

(f) Participating in WorkFirst.

(3) If a disqualified client moves from the assistance unit and joins another assistance unit, the client continues to be treated as an ineligible member of the new assistance unit for the remainder of the disqualification period.



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Chapter 388-446 WAC



FRAUD



NEW SECTION



WAC 388-446-0001  Cash and medical assistance fraud. (1) All cash or medical assistance cases in which substantial evidence is found supporting a finding of fraud are referred to the county prosecuting attorney. The prosecuting attorney's office determines which cases are subject to criminal prosecution.

(2) An applicant or recipient is suspected of committing fraud if intentional misstatement or failure to reveal information affecting eligibility results in an overpayment.



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NEW SECTION



WAC 388-446-0005  Disqualification period for cash assistance. (1) An applicant or recipient who has been convicted of unlawful practices in obtaining cash assistance is disqualified from receiving further cash benefits if:

(a) For TANF/SFA, the conviction was based on actions which occurred on or after May 1, 1997; or

(b) For general assistance, the conviction was based on actions which occurred on or after July 23, 1995.

(2) The disqualification period must be determined by the court and will be:

(a) For a first conviction, no less than six months; and

(b) For a second or subsequent conviction, no less than twelve months.

(3) The disqualification applies only to the person convicted and begins on the date of conviction.

(4) A recipient's cash benefits are terminated following advance or adequate notice requirements as specified in WAC 388-418-0030.



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NEW SECTION



WAC 388-446-0010  TANF disqualification period for fraud convictions of misrepresenting interstate residence. (1) An applicant or recipient is disqualified from receiving cash benefits under TANF if convicted of fraud by misrepresentation of residence in order to receive assistance from two or more states at the same time from any assistance program funded by the following:

(a) TANF and any other benefit authorized by Title IV-A of the Social Security Act; or

(b) Any benefit authorized by The Food Stamp Act of 1997; or

(c) Any benefit authorized by Title XIX, Medicaid; or

(d) SSI benefits authorized by Title XVI.

(2) The disqualification penalty is applied as follows:

(a) Only to convictions based on actions which occurred on or after May 1, 1997; and

(b) Only to the person convicted of fraud in federal or state court; and

(c) For a disqualification period of ten years or a period determined by the court, whichever is longer.

(3) The disqualification period begins the date the person is convicted of fraud by misrepresentation of residence in order to receive assistance from two or more states at the same time.

(4) The provisions of subsections (1) through (3) of this section do not apply when the President of the United States has granted a pardon for the conduct resulting in the conviction of fraud by misrepresentation of residence. The disregard of the provisions because of a pardon is effective the date the pardon is granted and continues for each month thereafter.



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NEW SECTION



WAC 388-446-0015  Intentional program violation (IPV) and disqualification hearings for food assistance. (1) An intentional program violation (IPV) is defined as an act in which a person intentionally:

(a) Makes a false or misleading statement;

(b) Misrepresents, conceals or withholds facts; or

(c) Acts in violation of the Food Stamp Act, the food stamp program regulations, or any state statute relating to the use, presentation, transfer, acquisition, receipt, or possession of food stamp coupons or FCAs.

(2) Food assistance clients suspected of committing an (IPV) are subject to referral for an administrative disqualification hearing, if:

(a) The suspected IPV causes an overissuance of four hundred fifty dollars or more; and

(b) The administrative proceedings will not jeopardize criminal proceedings; and

(c) The person resides in Washington state, at the time of the referral; or

(d) The person resides outside Washington state, but is within one hour's reasonable drive to a CSO.

(3) An administrative disqualification hearing (ADH) is a formal hearing to determine if a person committed an IPV. ADHs are governed by the rules found in chapter 388-08 WAC. However, rules in this section are the overriding authority if there is a conflict.

(4) A client who commits one or more IPVs and is suspected of committing another, is referred for an ADH when the act of suspected violation occurred:

(a) After the department mailed the disqualification notice to the client for the most recent IPV; or

(b) After an order was entered in criminal proceedings for the most recent IPV.

(5) A person suspected of IPV is entitled to receive notice of an ADH at least thirty days in advance of the hearing date. The notice is sent by certified mail, or provided to the client by personal service and will contain the following:

(a) The date, time, and place of the hearing;

(b) The charges against the individual;

(c) A summary of the evidence, and how and where the evidence can be examined;

(d) A warning that a decision will be based solely on evidence provided by the department, if the individual fails to appear at the hearing;

(e) A statement that the individual has ten days from the date of the scheduled hearing to show good cause for failure to appear at the hearing and to request rescheduling;

(f) A warning that a determination of IPV will result in a disqualification period; and

(g) A statement that if a telephone hearing is scheduled, the individual can request an in-person hearing by filing a request with the administrative law judge one week or more prior to the date of the hearing.

(6) The person or a representative shall have the right to one continuance of up to thirty days if a request is filed ten days or more prior to the hearing date.

(7) The hearing will be conducted and a decision rendered even if the person or representative fail to appear, unless within ten days from the date of the scheduled hearing:

(a) The person can show good cause for failing to appear; and

(b) The person or representative requests the hearing be re-instated.

(8) A scheduled telephone hearing may be changed to an in-person hearing if requested one week or more in advance. If requested less than one week in advance the person must show good cause for the requested change.

(9) The ALJ issues a preliminary decision based on evidence presented by the department establishing the person committed and intended to commit an IPV. The department and the client each have the right to request a review of the ALJ's decision by writing to the department's board of appeals as specified in WAC 388-08-464.

(10) A final decision of the disqualification hearing is mailed by the department's board of appeals.

(11) A client's disqualification is not implemented and benefits continue at the current amount when:

(a) The client can show good cause for not attending the hearing within thirty days from the date the disqualification notice was mailed; and

(b) An administrative law judge determines the client had good cause; or

(c) The client files a petition for review to appeal the disqualification

(12) An administrative disqualification hearing and an overissuance hearing can be combined when the cause for both hearings is related. The hearing procedures and notice requirements are the same as for administrative disqualification hearings.



[]



NEW SECTION



WAC 388-446-0020  Food assistance disqualification penalties. (1) Disqualification penalties apply only to the person or persons found to have committed an intentional program violation (IPV) as follows:

(a) If the intentional program violation occurred in whole or in part after the household was notified of the following penalties:

(i) Twelve months for the first violation;

(ii) Twenty-four months for the second violation;

(iii) Permanently for the third violation.

(b) If the violation ended before the household was notified of the penalties in subsection (1)(a) of this section:

(i) Six months for the first violation;

(ii) Twelve months for the second violation;

(iii) Permanently for the third violation.

(2) The disqualification and penalty period for a person convicted in another state stays in effect until satisfied regardless of where a person moves.

(3) Multiple program violations are considered as one violation when determining the penalty for disqualification when the violations occurred before the department notified the household of the penalties, as described in subsection (1), (4) and (5) of this section.

(4) Disqualification penalties for persons convicted by a federal, state, or local court of trading or receiving food coupons for a controlled substance are:

(a) Two years for a first conviction; and

(b) Permanently for a second conviction.

(5) A first conviction by federal, state, or local court permanently disqualifies persons who:

(a) Trade or receive food coupons for firearms, ammunition, or explosives; or

(b) Knowingly buy, sell, trade, or present for redemption food coupons totalling five hundred dollars or more in violation of section 15 (b) & (c) of the Food Stamp Act of 1977, as amended.

(6) Persons convicted of providing false identification or residency information to receive multiple coupon benefits are disqualified for ten years.

(7) When a court convicts a person of an IPV, the disqualification penalties specified in subsection (1) through (5) apply as follows;

(a) In addition to any civil or criminal penalties; and

(b) Within forty-five days of the date of conviction; unless

(c) Contrary to the court order.

(8) Disqualification penalties are applied after notifying the household of the disqualification, the effective date, the amount of benefits the household will receive during the disqualification period and the need to reapply when the certification period expires.

(9) Even though only the individual is disqualified, the food assistance household is responsible for making restitution for the amount of any overpayment.



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Chapter 388-448 WAC



INCAPACITY



NEW SECTION



WAC 388-448-0001  Who is eligible for general assistance-unemployable. To be eligible for benefits under the general assistance-unemployable (GA-U) program a client must be:

(1) Eligible for payments based on Social Security Administration (SSA) disability criteria; or

(2) Eligible for services from the division of developmental disabilities (DDD); or

(3) Diagnosed as mentally retarded and the diagnosis is substantiated by a full scale score of seventy or lower on the Wechsler Adult Intelligence Scale (WAIS); or

(4) Sixty-five years of age or older; or

(5) Released from inpatient psychiatric treatment and for ninety days following the date of release if:

(a) Participating in direct outpatient mental health treatment services; and

(b) The release was not against medical advice; or

(6) Eligible for long-term care services from aging and adult services administration; or

(7) For ninety days after release from a medical institution where the person received long-term care services from the aging and adult services administration; or

(8) Approved by the Progressive Evaluation Process (PEP); or

(9) Still incapacitated at redetermination because their medical or mental condition has not clearly improved and no error is found in the previous incapacity determination.



[]



NEW SECTION



WAC 388-448-0005  The following criteria is used to determine if a child is deprived of parental support due to incapacity. Deprivation due to incapacity exists when one or both parents in a two parent household:

(1) Is physically and/or mentally impaired to such a degree that their ability to support or care for a child is substantially reduced or eliminated. The incapacity must be supported by medical evidence and be expected to last at least thirty days; or

(2) Is eligible for payments based on SSA disability criteria; or

(3) Has a fifty percent or greater disability rating from the Veteran's Administration.



[]



Chapter 388-450 WAC



INCOME



NEW SECTION



WAC 388-450-0005  Income--Ownership and availability. (1) For TANF/SFA, RCA, GA, TANF/SFA-related medical and food assistance programs:

(a) All available income owned or possessed by a client is considered when determining the client's eligibility and benefit level.

(b) Ownership of income is determined according to applicable state and federal laws pertaining to property ownership and eligibility for assistance programs. For married persons, ownership of separate and community income is determined according to chapter 26.16 RCW.

(c) Income owned by a client is considered available when it is at hand and may be used to meet the client's current need.

(d) When the department determines that a client may be entitled to or have an interest in income which may be used to reduce the client's need for assistance, the client may be denied assistance when the client fails or refuses to make a reasonable effort to make the income available or receive the entitlement.

(i) A client's eligibility is not affected until the income is received as long as the client makes reasonable efforts to make potential income available; and

(ii) A client may choose whether to receive TANF/SFA or Supplemental Security Income (SSI) benefits.

(e) The income of a person who is not a member of a client's assistance unit may be considered available to the client under the rules of this chapter if the person is financially responsible for the client and lives in the home with the client. For medical programs, financial responsibility is described in WAC 388-408-0055.

(f) For medical programs, the income of a financially responsible person, not living in the home is considered available to the extent it is contributed.

(g) Funds deposited into a bank account which is held jointly by a client and another are considered income possessed by and available to the client unless:

(i) The client can show that all or part of the funds belong exclusively to the other account holder and are held or used solely for the benefit of that holder; or

(ii) The funds have been considered by the Social Security Administration (SSA) when determining the other account holder's eligibility for SSI benefits.

(2) For TANF/SFA, RCA, GA and food assistance programs the income of an alien's sponsor is considered available to the alien under the rules of this chapter when determining the alien's eligibility and benefit level.

(3) For SSI-related medical:

(a) Income is considered available and owned when it is:

(i) Received; and

(ii) Can be used to meet the clients needs for food, clothing and shelter, except as provided in WAC 388-511-1130.

(b) Loans and certain other receipts are not defined as income for SSI-related purposes as described in 20 C.F.R. Sec. 416.1103.

(4) For medical programs, trusts are described in WAC 388-505-0595.



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NEW SECTION



WAC 388-450-0010  Liens against potential time-loss compensation. This section applies to TANF/SFA, RCA, GA and TANF/SFA-related medical programs.

(1) By accepting public assistance, adult and minor clients assign to the department the right to recover time-loss compensation.

(2) When an assistance unit consists of unmarried parents only, the portion of cash assistance received by the injured parent and the injured parent's natural, adoptive or stepchildren is recoverable by the department.

(3) When a client or client's attorney claims allowable attorney fees and costs incidental to an increased award, the office of financial recovery (OFR) will:

(a) Determine what portion of the award, if any, resulted directly from the attorney's involvement;

(b) Determine the department's proportionate share of attorney fees and costs applicable to the duplicate coverage period; and

(c) Deduct the department's share of cost in subsection (b) of this section from the lien for duplicated assistance; or

(d) Issue the proportionate share refund to the attorney with a copy of the account summary to the client.



[]



NEW SECTION



WAC 388-450-0015  Excluded and disregarded income. This section applies to TANF/SFA, RCA, GA, TANF/SFA-related medical and food assistance programs.

(1) Excluded income means income that is not counted when determining a client's eligibility and benefit level. Excluded income types are defined by state and federal laws. Types of excluded income include but are not limited to:

(a) Loans, except certain student loans as specified under WAC 388-450-0035.

(b) Federal earned income tax credit (EITC) payments;

(c) Title IV-E, state and or local foster care maintenance payments;

(d) Energy assistance payments;

(e) Educational assistance as specified in WAC 388-450-0035;

(f) Native American benefits and payments as specified in WAC 388-450-0040;

(g) Income from employment and training programs as specified in WAC 388-450-0045; and

(h) Any amount withheld from a client's benefit to repay an overpayment by the source agency. For food assistance, this exclusion does not apply when the amount is withheld to recoup an intentional noncompliance overpayment from a federal, state, or local means tested program.

(i) Child support payments received by TANF/SFA recipients which have been assigned to the department as a condition of receiving assistance.

(2) For food assistance programs, the following income types are excluded:

(a) Emergency additional requirements authorized to TANF/SFA and RCA clients under WAC 388-436-0001 and paid directly to a third party;

(b) Cash donations based on need received directly by the household if the donations are:

(i) Made by one or more private, nonprofit, charitable organizations; and

(ii) Do not exceed three hundred dollars in any federal fiscal year quarter.

(c) Infrequent or irregular income, received during a three-month period by a prospectively budgeted assistance unit, that:

(i) Cannot be reasonably anticipated as available; and

(ii) Does not exceed thirty dollars for all household members.

(3) All income that is not excluded is considered to be part of an assistance unit's gross income. Gross income is used to determine an assistance unit's eligibility as follows:

(a) For TANF/SFA, RCA, GA-S, and GA-H, the assistance unit is ineligible if its gross income exceeds 185 percent of the need standard as specified in WAC 388-478-0015; and

(b) For certain food assistance households, the assistance unit's gross income cannot exceed one hundred thirty percent of the federal poverty level for the forty-eight contiguous states as specified in WAC 388-478-0060.

(4) Disregarded income means income that is not excluded when determining an assistance unit's gross income but which is disregarded when determining an assistance unit's countable income. Types of disregarded income are defined by state and federal laws. Disregarded income includes but is not limited to:

(a) Earned income incentives and disregards for cash assistance; and

(b) Food assistance income deductions.



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NEW SECTION



WAC 388-450-0020  Income exclusions for SSI-related medical. This section describes the types of income which are excluded or not counted when determining how much of a client's income is compared to the income standards in WAC 388-478-0065 through 388-478-0085 to determine eligibility.

(1) The first twenty dollars per month of a client's earned or unearned income, which is not otherwise excluded in this section, is excluded. This exclusion:

(a) Can only be allowed once for a husband and wife; and

(b) Does not apply to income paid on the basis of an eligible person's needs, which is funded totally or partially by the federal government or a private agency.

(2) The first sixty-five dollars per month of a client's earned income, plus one-half of the remainder is considered a work incentive and is deducted from the earned income. This deduction does not apply to income already excluded in this section.

(3) Income a client does not reasonably anticipate or which a client receives infrequently or irregularly is excluded when it is:

(a) Unearned and does not exceed twenty dollars per month; or

(b) Earned and does not exceed ten dollars per month.

(4) A client's work related expenses including child care are excluded when they specifically enable:

(a) A blind client to work; or

(b) A permanently or totally disabled client to continue to work.

(5) Any portion of self-employment income normally allowed as an income deduction by the Internal Revenue Service (IRS) is excluded.

(6) Any payment a client receives for the foster care of a child who lives in the same household, is excluded when the child:

(a) Was placed in the client's home by a public or nonprofit child placement or child care agency; and

(b) Is not SSI eligible.

(7) One-third of any payment for child support a client receives from an absent parent for a minor child, who is not institutionalized, is excluded.

(8) A portion of an SSI-related person's income to meet the needs of an ineligible minor child living in the household is excluded when:

(a) The SSI-related parent is single; or

(b) If married, the spouse does not have income (see WAC 388-450-0150 if the spouse has income); and

(c) The excluded amount is:

(i) One-half of the one person federal SSI benefit rate, as described in WAC 388-478-0055; and

(ii) Minus any income of the child.

(9) Unless income is specifically contributed to the client, all earned income of an ineligible or nonapplying person, under twenty-one years of age, is excluded when this person is a student:

(a) Attending a school, college, or university; or

(b) Pursuing a vocational or technical training program designed to prepare the student for gainful employment.

(10) A client's veteran's benefits are excluded when they are designated for the veteran's:

(a) Dependent; or

(b) Aid and attendance/household allowance and unreimbursed medical expense allowance (UME). For an institutional client see WAC 388-513-1345.

(11) Any federal SSI income or state supplement payment (SSP), which is based on financial need is excluded.

(12) COLA increases in Title II Social Security Administration benefits are excluded for a noninstitutionalized client when:

(a) Received by the client after the client's termination from SSI/SSP or;

(b) Received by the client's spouse or other financially responsible person living in the household during the time period after the SSI/SSP termination.

(13) Income which causes a client to lose SSI eligibility due solely to the reduction in the SSP is excluded.

(14) Increases in a client's burial funds, established on or after November 1, 1982, are excluded if these increases are the result of:

(a) Interest earned on excluded burial funds;

(b) Appreciation in the value of an excluded burial arrangement which is left to accumulate and become part of separately identified burial funds.

(15) An essential expense incurred by a client to receive unearned income is excluded.

(16) A client's refund by any public agency of taxes paid on real property or on food is excluded.

(17) Tax rebates or special payments excluded under other statutes are excluded.

(18) The amount of a client's EITC payment is excluded.

(19) A fee a guardian or representative payee charges as reimbursement for providing services, when such services are a requirement for the client to receive payment of the income are excluded.

(20) Income a client's ineligible or nonapplying spouse receives from a governmental agency for services provided to an eligible client, such as chore services, are excluded.

(21) Certain cash payments a client receives from a governmental or nongovernmental medical or social service agency to pay for medical or social services are excluded.

(22) Payments to certain survivors of the Holocaust under the Federal Republic of Germany's Law for Compensation of National Socialist Persecution or German Restitution Act are excluded. Any interest earned on this income is considered as unearned income, under WAC 388-450-0025.

(23) Payments to a client under section 500 through 506 of the Austrian General Social Insurance Act are excluded. Any interest earned on this income is considered unearned income under WAC 388-450-0025.

(24) Payments to a client from the Dutch government, under the Netherlands' Act on Benefits for Victims of Persecution (WUV) are excluded. Any interest earned on this income is considered unearned income under WAC 388-450-0025.

(25) Other payments excluded under federal or state law, including but not limited to those described in WAC 388-450-0015 (1)(b) through (g).

(26) Payments from Susan Walker v. Bayer Corporation, et al., 96-c-5024 (N.D. Ill.) (May 8, 1997) settlement funds are excluded as income. Any interest earned on this income is considered unearned income under WAC 388-450-0025.



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NEW SECTION



WAC 388-450-0025  Unearned income. This section applies to TANF/SFA, RCA, GA, TANF/SFA-related medical and food assistance programs.

(1) Unearned income is income a person receives from a source other than employment or self-employment. Examples of unearned income include but are not limited to:

(a) Railroad retirement;

(b) Unemployment compensation; or

(c) Veteran administration benefits.

(2) For food assistance programs, unearned income includes the amount of cash benefits due the client prior to any reductions caused by the client's failure to perform an action required under a federal, state, or local means-tested public assistance program.

(3) Unearned income is budgeted in its entirety.



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NEW SECTION



WAC 388-450-0030  Earned income definition. Unless specifically stated, this section applies to TANF/SFA, RCA, GA, TANF/SFA-related medical and food assistance programs.

(1) Earned income means:

(a) Income a person receives in the form of cash or in-kind, which is a gain or benefit to the person, when earned as a wage, salary, tips, gratuities, commissions, or profit from self-employment activities.

(b) Income over a period of time for which settlement is made at one time, such as sale of farm crops, livestock, or poultry.

(2) Earned income from self-employment is determined as specified under WAC 388-450-0080.

(3) For TANF/SFA, RCA, GA, and TANF/SFA-related medical assistance, earned income includes time-loss compensation as specified in WAC 388-450-0075.

(4) For food assistance programs only, income in-kind is excluded.



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NEW SECTION



WAC 388-450-0035  Educational benefits. This section applies to TANF/SFA, RCA, GA, TANF/SFA-related medical and food assistance programs.

(1) A student can exclude educational assistance in the form of grants, loans or work study, issued from Title IV of the Higher Education Amendments (Title IV - HEA) and Bureau of Indian Affairs (BIA) education assistance programs. Examples of Title IV - HEA and BIA educational assistance include but are not limited to:

(a) College work study (federal and state);

(b) Pell grants; and

(c) BIA higher education grants.

(2) The following types of educational assistance, in the form of grants, loans, or work study, are not counted when determining a student's need:

(a) Assistance under the Carl D. Perkins Vocational and Applied Technology Education Act, P.L. 101-391 for attendance costs identified by the institution as specified in subsections (3) and (4) of this section; and

(b) Educational assistance made available under any program administered by the Department of Education (DOE) to an undergraduate student. Examples of programs administered by DOE include but are not limited to:

(i) Christa McAuliffe Fellowship Program;

(ii) Jacob K. Javits Fellowship Program; and

(iii) Library Career Training Program.

(3) Educational assistance under subsection (2)(a) of this section for the following attendance costs is not counted when a student is attending school less than half-time:

(a) Tuition;

(b) Fees; and

(c) Costs for purchase or rental of equipment, materials, or supplies required of all students in the same course of study.

(4) Educational assistance under subsection (2)(a) of this section for a student attending school at least half-time for the following attendance costs in addition to the costs specified in subsection (3) of this section:

(a) Books;

(b) Supplies;

(c) Transportation;

(d) Dependent care; and

(e) Miscellaneous personal expenses.

(5) For TANF/SFA, RCA, GA, and TANF/SFA-related medical assistance, the amount of a student's remaining educational assistance equal to the difference between the student's appropriate need standard and payment standard is excluded.

(6) Any remaining income is unearned income and budgeted using the appropriate budgeting method for the assistance unit.

(7) When a student participates in a work study program that is not excluded by subsections (1) and (2) of this section, the income received is treated as earned income:

(a) Applying the applicable earned income disregards;

(b) For TANF/SFA, RCA, GA, and TANF/SFA-related medical assistance, excluding the difference between the student's appropriate need standard and payment standard; and

(c) Budgeting remaining income using the appropriate budgeting method for the assistance unit.

(8) When a student receives Veteran's Administration Educational Assistance:

(a) All applicable attendance costs are subtracted; and

(b) The remaining unearned income is budgeted using the appropriate budgeting method for the assistance unit.

(9) When a student participates in graduate school studies, educational assistance made available to the student is treated as unearned income.



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NEW SECTION



WAC 388-450-0040  Native American benefits and payments. This section applies to TANF/SFA, RCA, GA medical and food assistance programs.

(1) The following types of income are not counted when a client's benefits are computed:

(a) Up to two thousand dollars per individual per calendar year received under the Alaska Native Claims Settlement Act, P.L. 92-203 and 100-241;

(b) Income received from Indian trust funds or lands held in trust by the Secretary of the Interior for an Indian tribe or individual tribal member. Income includes:

(i) Interest; and

(ii) Investment income accrued while such funds are held in trust.

(c) Income received from Indian judgement funds or funds held in trust by the Secretary of the Interior distributed per capita under P.L. 93-134 as amended by P.L. 97-458 and 98-64. Income includes:

(i) Interest; and

(ii) Investment income accrued while such funds are held in trust.

(d) Up to two thousand dollars per individual per calendar year received from leases or other uses of individually owned trust or restricted lands, P.L. 103-66;

(e) Payments from an annuity fund established by the Puyallup Tribe of Indians Settlement Act of 1989, P.L. 101-41, made to a Puyallup Tribe member upon reaching twenty-one years of age; and

(f) Payments from the trust fund established by the P.L. 101-41 made to a Puyallup Tribe member.

(2) Other Native American payments and benefits that are excluded by federal law are not counted when determining a client's benefits. Examples include but are not limited to:

(a) White Earth Reservation Land Settlement Act of 1985, P.L. 99-264, Section 16;

(b) Payments made from submarginal land held in trust for certain Indian tribes as designated by P.L. 94-114 and P.L. 94-540; and

(c) Payments under the Seneca Nation Settlement Act, P.L. 101-503.



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NEW SECTION



WAC 388-450-0045  Income from employment or training programs. This section applies to TANF/SFA, RCA, GA, and food assistance programs.

(1) Payments issued under the Job Training Partnership Act (JTPA) are treated as follows:

(a) Wages paid under JTPA are considered earned income.

(b) For TANF/SFA, RCA, and GA assistance, needs based payments issued under JTPA are considered as follows:

(i) Payments which cover special needs not covered in the need standard are excluded.

(ii) Payments which duplicate items contained in the need standard are excluded up to the difference between the student's appropriate need standard and payment standard.

(c) For food assistance, living allowances and incentive payments under JTPA are excluded as income.

(2) Payments issued under the National and Community Service Trust Act of 1993 (Americorps) are treated as follows:

(a) For cash assistance, living allowances or stipends paid under Americorps are considered earned income.

(b) For food assistance, living allowances or stipends paid under AmeriCorps are excluded income.

(3) Americorps/VISTA stipends and living allowances paid to VISTA volunteers under the Domestic Volunteer Act of 1973:

(a) For TANF/SFA, RCA, and GA assistance, are disregarded as income; and

(b) For food assistance, are disregarded as income, if the client received:

(i) Food assistance or cash assistance at the time they joined the Title I program; or

(ii) An income disregard for the Title I program at the time of conversion to the Food Stamp Act of 1977. Disregard of Title I program income will continue through temporary interruptions in food assistance participation.

(4) For TANF/SFA, RCA, and GA assistance, needs based payments issued under Americorps are treated like JTPA payments as provided in subsection (1)(b) of this section.

(5) For food assistance, training allowances from vocational and rehabilitative programs are earned income when:

(a) Recognized by federal, state, or local governments; and

(b) Not a reimbursement.

(6) For training allowances received by GA-U clients:

(a) The earned income incentive and work expense deduction specified under WAC 388-450-0175 is applied when applicable; and

(b) For clients enrolled in a remedial education or vocational training course, the actual cost of uniforms or special clothing required for the course is deducted from the training allowance.

(7) Support service payments received by or made on behalf of WorkFirst participants are not considered income.



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NEW SECTION



WAC 388-450-0050  Income from the community jobs program. This section applies to the TANF/SFA program.

(1) The monthly wage received by a TANF/SFA client who participates in the community jobs (CJ) wage subsidy program is:

(a) Not counted as income for the first month of CJ participation; and

(b) Budgeted prospectively as defined in WAC 388-450-0215 beginning with the second month of CJ participation.

(2) The CJ participant's grant amount is computed by disregarding twenty percent of the expected income and treating the remainder as countable income.

(3) CJ participants are not subject to monthly reporting or income reporting requirements.

(4) When a change in income or resources causes the assistance unit's grant amount to be less than ten dollars or results in ineligibility, a CJ participant's cash grant:

(a) Will be suspended following rules in WAC-388-450-0245;

(b) Will continue to be suspended until participation is redetermined according to WAC 388-310-1300(8); and

(c) Can be in suspense for no more than nine months.

(5) Each month a CJ participant's cash grant is suspended will count toward the assistance unit's sixty month lifetime time limit for receipt of TANF/SFA benefits.



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NEW SECTION



WAC 388-450-0055  Assistance from other agencies and organizations. Unless specifically stated, this section applies to TANF/SFA, RCA, GA, medical and food assistance programs.

(1) Funds received from other agencies and organizations are excluded when determining the amount of assistance to be paid as long as no duplication exists between the assistance provided by the other agency and that provided by the department.

(2) To assure nonduplication, aid from other agencies will be considered in relation to:

(a) The different purposes for which such aid is granted;

(b) The provision of goods and services not included in the department's standards; and

(c) Conditions that preclude its use for current living costs.

(3) For TANF/SFA, RCA, GA, and TANF/SFA-related medical assistance, if the assistance from another agency is available to meet need, the assistance shall be disregarded up to the difference between the need standard and the payment standard.



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NEW SECTION



WAC 388-450-0060  Lump sum payments. This section applies to TANF/SFA, RCA, GA, and TANF/SFA-related medical assistance. A one-time lump sum payment is treated as follows:

(1) Compensatory awards or related settlements are considered countable resources as provided in WAC 388-470-0080.

(2) For all other one-time lump sum payments, the amount equal to the difference between the client's countable resources and the resource limit is disregarded as income. The remaining amount is called the net lump sum payment and affects the client's eligibility and benefit amount as provided in WAC 388-450-0240.



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NEW SECTION



WAC 388-450-0065  Gifts--Cash and noncash. A gift is an item furnished to a client without work or cost on his or her part.

(1) A cash gift is a gift that is furnished as money, cash, checks or any other readily negotiable form.

(a) For TANF/SFA, RCA, GA-S, GA-H, and TANF/SFA-related medical programs, cash gifts of up to thirty cumulative dollars per calendar quarter for each assistance unit member are disregarded as income.

(b) For GA-U and food assistance programs, cash gifts are treated as unearned income.

(2) For TANF/SFA, RCA, GA-S, GA-H, GA-U and TANF/SFA-related medical programs, a noncash gift is treated as a resource.

(a) If the gift is a countable resource, its value is added to the value of the client's existing countable resources and the client's eligibility is redetermined as specified in chapter 388-470 WAC.

(b) If the gift is an excluded or noncountable resource, it does not affect the client's eligibility or benefit level.



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NEW SECTION



WAC 388-450-0070  A child's earned income. Unless otherwise specified, this section applies to TANF/SFA, RCA, GA-H and TANF/SFA-related medical programs. The earned income of a dependent child is:

(1) Excluded when determining if the total income of the assistance unit is more than one hundred eighty-five percent of the need standard in WAC 388-478-0015. This exclusion is limited to:

(a) Children who are full-time students; and

(b) No more than six month's in any calendar year.

(2) Not counted when determining the assistance unit's need and benefit level when the child is a:

(a) Full-time student; or

(b) Part-time student who is employed less than full-time.

(3) For food assistance programs, all earned income of a child is not counted when a child is:

(a) Seventeen years of age or younger; and

(b) Attending elementary or secondary school at least half time.



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NEW SECTION



WAC 388-450-0075  Income from time-loss compensation. (1) Temporary disability insurance payments and temporary worker's compensation payments are treated as earned income for TANF/SFA, RCA, GA-S, GA-H, and TANF/SFA-related medical when such payments are:

(a) Employer funded and are analogous to sick pay; and

(b) Made to an individual who remains employed during recuperation from a temporary illness or injury pending return to the job.

(2) Recurrent time loss benefits from the department of labor and industries are examples of benefits meeting this criteria.

(3) For TANF/SFA, RCA, GAS, GA-H and TANF/SFA-related medical programs, temporary disability insurance payments and temporary worker's compensation payments not considered to be earned income as described in subsection (1) and (2) of this section, are treated as unearned income as specified in WAC 388-450-0025.

(4) For the GA-U program, temporary disability insurance payments and temporary worker's compensation payments are treated as unearned income as specified in WAC 388-450-0025.



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NEW SECTION



WAC 388-450-0080  Self-employment income--General rules. This section applies to TANF/SFA, RCA, GA, TANF/SFA-related medical and food assistance programs.

(1) Self-employment earned income is used to reduce a client's need for assistance. The income is treated as earned income as provided in WAC 388-450-0030.

(2) Self-employment earned income is defined as gross business income minus total allowable business expenses as defined in WAC 388-450-0085.

(3) In order to establish eligibility for assistance, a self-employed client must maintain and make available to the department a record clearly documenting all business expenses and income.

(4) Income from the following is treated as self-employment income:

(a) Adult family home;

(b) Farming;

(c) Roomers and boarders;

(d) Rental and lease of personal property or real estate owned by the client; and

(e) Self-produced or supplied items.



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NEW SECTION



WAC 388-450-0085  Self-employment income--Allowable expenses. The following self-employment expenses are allowed as deductions from gross self-employment income for TANF/SFA, RCA, GA, medical and food assistance programs unless otherwise specified:

(1) Rent or lease of business equipment or property;

(2) Utilities;

(3) Postage;

(4) Telephone;

(5) Office supplies;

(6) Advertising;

(7) Business related insurance, taxes, licenses and permits;

(8) Legal, accounting, and other professional fees;

(9) For TANF/SFA, RCA, and GA assistance programs only, the cost of goods sold, including wages paid to employees producing salable goods, raw materials, stock, and replacement or reasonable accumulation of inventory, provided inventory has been declared exempt on the basis of an agreed plan pursuant to chapter 388-470 WAC;

(10) Repairs to business equipment and property, excluding vehicles;

(11) Interest on business loans used to purchase income-producing property or equipment;

(12) Wages and salaries paid to employees not producing salable goods;

(13) Commissions paid to agents and independent contractors;

(14) Seed, fertilizer, and feed grain for a self-employed farmer;

(15) Other reasonable and necessary costs of doing business;

(16) The cost of the place of business. If any portion of the client's home is used as the place of business, it must be used exclusively for business to be an allowable business expense. The percentage of the home used for business can be an allowable business expense;

(17) The following transportation expenses are allowed as a deduction from gross self-employment income:

(a) Actual, documented costs for:

(i) Gas, oil, and fluids;

(ii) Replacing worn items such as tires;

(iii) Registration and licensing fees;

(iv) Auto loan interest; and

(v) Business related parking and tolls; or

(b) A cost per mile established by the department.



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NEW SECTION



WAC 388-450-0090  Self-employment expenses that are not allowed as income deductions. (1) The following expenses cannot be deducted from self-employment income for TANF/SFA, RCA, GA, TANF/SFA-related medical or food assistance programs:

(a) Payments on the principle of the purchase price of income-producing:

(i) Real estate and capital assets;

(ii) Equipment;

(iii) Machinery; and

(iv) Other durable goods.

(b) Payments on the principal of loans to the business;

(c) Amounts claimed as depreciation;

(d) Any amount claimed as a net loss sustained in any prior period; and

(e) Entertainment expenses.

(2) The following expenses cannot be deducted from self-employment income for food assistance programs only:

(a) Federal, state, and local income taxes;

(b) Retirement funds; or

(c) Personal work-related expenses.



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NEW SECTION



WAC 388-450-0095  Allocating income--General. This section applies to TANF/SFA, RCA, and GA assistance programs.

(1) Allocation is the process of determining how much of a financially responsible person's income is considered available to meet the needs of legal dependents within or outside of an assistance unit.

(2) In-bound allocation means income possessed by a financially responsible person outside the assistance unit which is considered available to meet the needs of legal dependents in the assistance unit.

(3) Out-bound allocation means income possessed by a financially responsible assistance unit member which is set aside to meet the needs of a legal dependent outside the assistance unit.



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NEW SECTION



WAC 388-450-0100  Allocating income--Definitions. The following definitions apply to the allocation rules for TANF/SFA, RCA, and GA programs:

(1) "Dependent" means a person who:

(a) Is or could be claimed for federal income tax purposes by the financially responsible person; or

(b) The financially responsible person is legally obligated to support.

(2) A "disqualified assistance unit member" means:

(a) An unmarried pregnant or parenting minor under age eighteen who has not completed a high school education or general education development (GED) certification and is not participating in those educational activities which would lead to the attainment of a high school diploma or GED;

(b) An unmarried pregnant or parenting minor under age eighteen who is not living in a department-approved living situation; and

(c) The financially responsible person who does not report to the department within five days of the date it becomes reasonably clear that the absence of a child will exceed ninety days.

(3) "Financially responsible person" means a parent, stepparent, adoptive parent, spouse or caretaker relative.

(4) "Ineligible assistance unit member" means an individual who:

(a) Is ineligible for cash assistance due to citizenship/alien status requirement in chapter 388-424 WAC;

(b) Has been disqualified from receiving assistance under WAC 388-446-0010 based on a conviction in federal or state court of having made a fraudulent statement or representation with respect to their place of residence in order to receive assistance from two or more states at the same time;

(c) Has been disqualified from receiving assistance under WAC 388-446-0005 based on a conviction for unlawfully receiving public assistance;

(d) Has been disqualified from receiving assistance under WAC 388-442-0010 for having been convicted after August 21, 1996, under federal or state law, of possession, use or distribution of a controlled substance;

(e) Is disqualified from receiving assistance under WAC 388-442-0010 for fleeing to avoid prosecution or custody or confinement after conviction for a crime or attempt to commit a crime;

(f) Is disqualified from receiving assistance under WAC 388-442-0010 for violating a condition of probation or parole which was imposed under a federal or state law as determined by an administrative body or court of competent jurisdiction;

(g) Is the spouse of a woman who receives cash benefits from the GA-S program; and

(h) Is the adult parent of a minor parent's child.



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NEW SECTION



WAC 388-450-0105  Allocating the income of a financially responsible person included in the assistance unit. This section applies to TANF/SFA, GA-S, RCA, RMA and TANF-related medical programs. The income of a financially responsible person included in the assistance unit is countable to meet the needs of the assistance unit after the income is reduced by the following:

(1) Any applicable earned income incentive and work expense or deduction for the financially responsible person in the assistance unit, if that person is employed;

(2) The payment standard amount for the ineligible assistance unit members living in the home; and

(3) An amount not to exceed the department's standard of need for court or administratively ordered current or back support for legal dependents.



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NEW SECTION



WAC 388-450-0110  Allocating the income of a GA-U client to legal dependents. This section applies to the GA-U program.

(1) The income of a GA-U client is reduced by the following:

(a) The GA-U earned income disregard and work expense disregard, as specified in WAC 388-450-0175; and

(b) An amount not to exceed the department's standard of need for court or administratively ordered current or back support for legal dependents.

(2) When a GA-U client in a medical institution, alcohol or drug treatment center, congregate care facility or adult family home has income, the income is countable to meet the client's needs after the income is reduced by the following:

(a) The payment standard amount for the nonapplying spouse and legal dependents living in the home; and

(b) The standard of assistance the client is eligible for while in an alternative care facility.



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NEW SECTION



WAC 388-450-0115  Allocating the income of a financially responsible person excluded from the assistance unit. This section applies to TANF/SFA, RCA and GA-S programs.

The income of a financially responsible person excluded from the assistance unit is available to meet the needs of the assistance unit after the income is reduced by the following:

(1) A ninety dollar work expense deduction from the financially responsible person(s) excluded from the assistance unit who is employed;

(2) The payment standard amount for the ineligible assistance unit members living in the home; and

(3) An amount not to exceed the department's standard of need for court or administratively ordered current or back support for legal dependents.



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NEW SECTION



WAC 388-450-0120  Allocating the income of financially responsible parents to a pregnant or parenting minor. This section applies to TANF/SFA, RCA and GA-S programs.

The income of nonapplying financially responsible parent(s) of a pregnant or parenting minor is countable to meet the needs of the minor and the child(ren) after the income is reduced by the following:

(1) A ninety dollar work expense from the financially responsible parent's gross income from employment;

(2) An amount not to exceed the department's standard of need for:

(a) The financially responsible parent and dependent living in the home who are not applying for or receiving cash benefits and not a disqualified individual; and

(b) Court or administratively ordered current or back support for legal dependents.

(3) Spousal maintenance payments made to meet the needs of individuals not living in the home.



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NEW SECTION



WAC 388-450-0125  Allocating the income of the father of the unborn child to a pregnant woman. This section applies to TANF/SFA, RCA and GA-S programs.

(1) Income of the father of the unborn child is allocated to a pregnant woman under the following conditions:

(a) The need standard, as provided in WAC 388-478-0015 that reflects the number of people in the assistance unit as though the child were born when applying the one hundred eighty-five percent of need test as specified in WAC 388-450-0015. The father is included when he is residing in the client's home.

(b) The payment standard, as provided in WAC 388-478-0025 that reflects the number of people in the assistance unit as though the child were born. The father is included when he is residing in the client's home.

(2) When the parents are married and the father resides in the client's home, his income is allocated according to rules in WAC 388-450-0115.



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NEW SECTION



WAC 388-450-0130  Allocating the income of a nonapplying spouse to a caretaker relative. This section applies to TANF/SFA and RCA programs.

(1) The community income of the nonapplying spouse and applying spouse is combined. See WAC 388-450-0005 to determine what income is available as community income.

(2) Subtract a one person payment standard as specified in WAC 388-478-0020.

(3) The remainder is allocated to the caretaker relative.



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NEW SECTION



WAC 388-450-0135  Allocating income of an ineligible spouse to a GA-U client. (1) This section applies to the GA-U program.

(2) When a GA-U client is married and lives with the nonapplying spouse, the following income is available to the client:

(a) The remainder of the client's wages, retirement benefits or separate property after reducing the income by:

(i) The GA-U work incentive and work expense deduction, as specified in WAC 388-450-0175; and

(ii) An amount not to exceed the department's standard of need for court or administratively ordered current or back support for legal dependents.

(b) The remainder of the nonapplying spouse's wages, retirement benefits and separate property after reducing the income by:

(i) The GA-U work expense deduction;

(ii) An amount not to exceed the department's standard of need for court or administratively ordered current or back support for legal dependents; and

(iii) The payment standard amount as specified under WAC 388-478-0030 which includes ineligible assistance unit members.

(c) One-half of all other community income, as provided in WAC 388-450-0005.



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WAC 388-450-0140  Income of ineligible assistance unit members--Food assistance. (1) When a food assistance unit contains a person who is disqualified for intentional program violation or failure to meet work requirements as provided in chapter 388-444 WAC, all income of the disqualified person is included as part of the entire assistance unit's income:

(a) The standard deduction and allowable deductions for earned income, medical costs, dependent care, and excess shelter costs are applied; and

(b) The assistance unit's coupon allotment is not increased as a result of the exclusion of the disqualified person.

(2) When an assistance unit contains a person who is ineligible due to alien status or failure to sign the application attesting to citizenship or alien status or who has been disqualified for refusal to obtain or provide a Social Security number:

(a) A share of the income of the ineligible person is counted as income to the eligible assistance unit members after prorating the income among all members, including the ineligible member, and excluding the ineligible person's share;

(b) The twenty percent earned income deduction is applied to the ineligible person's earned income attributed to the assistance unit; and

(c) The portion of the assistance unit's allowable shelter and dependent care expense which is paid by or billed to the ineligible person is divided evenly among all members of the assistance unit, provided the ineligible members have income.

(3) The ineligible or disqualified assistance unit member is not counted when determining the assistance unit's size for purposes of:

(a) Comparing the assistance unit's total monthly income to the income eligibility standards; and

(b) Computing benefits.



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NEW SECTION



WAC 388-450-0145  Income of a person who is not a member of a food assistance unit. (1) A cash payment made to a food assistance unit from a person who is not a member of the assistance unit is counted as unearned income.

(2) The following types of income are not available to the assistance unit:

(a) The nonmember's income; and

(b) Payments made by a nonmember to a third party for the benefit of the assistance unit.

(3) When the nonmember's earnings are not clearly separate from the earnings of food assistance unit members, the earnings are:

(a) Divided equally among the working persons, including the nonmember; and

(b) The portion of the nonmember is not counted.



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NEW SECTION



WAC 388-450-0150  SSI-related medical income allocation. (1) When a client is applying for SSI-related categorically needy (CN) or medically needy (MN) medical assistance, a portion of the income of a spouse or parent is allocated to the needs of the applicant. This occurs when the spouse or parent is:

(a) Financially responsible for the SSI-related person as described in chapter 388-408 WAC; and

(b) Lives in the same household; and

(c) Is not receiving SSI; and

(d) Is either not related to SSI or is not applying for medical assistance.

(2) If the conditions in subsection (1) of this section are met, the income exclusions listed below are applied and the remainder of the parent's income is allocated to their SSI-related minor child applying for either (CN) or (MN) medical assistance:

(a) Income exclusions as described in WAC 388-450-0020; and

(b) One-half of the federal benefit rate (FBR), as described in WAC 388-478-0055, for each SSI ineligible child in the household, minus any income of that child; and

(c) A one person FBR for a single parent, or two person FBR for two parents.

(3) The income of the financially responsible spouse of an SSI-related client applying for CN or MN medical assistance is allocated to the applicant's needs.

(a) The income exclusions in WAC 388-450-0020 (3) through (26) are allowed to reduce the nonapplying spouse's income; and

(b) One-half of the FBR for any non-SSI eligible child in the household, minus any income of that child, is allowed as a deduction; and

(c) Allocate the applying spouse:

(i) Zero income when the financially responsible spouse's income equals or is less than one-half of the FBR after allowing the income exclusions in WAC 388-450-0020 (1) and (2); or

(ii) All of the financially responsible spouse's income when the income exceeds one-half of the FBR after allowing the income exclusions in WAC 388-450-0020 (1) and (2).

(4) If the income of the financially responsible spouse described in subsection (3) of this section is less than the MNIL, a portion of the SSI-related applicant's income is added to the financially responsible spouse's income to raise it to the MNIL.

(5) If an alien client is ineligible for SSI cash assistance because of income or resources of a sponsor allocated or deemed available to the client, the SSI-related client is still considered eligible for CN or MN medical assistance. Only the income or resources actually contributed to the alien client are considered available to that client.



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NEW SECTION



WAC 388-450-0155  Deeming income--Alien sponsorship. This section applies to TANF/SFA and GA programs.

(1) Deeming is the process of determining the amount of an alien's sponsor's income available to the alien.

(2) Any alien whose sponsor is a public or private organization is ineligible for assistance for three years from the date of entry for permanent residence into the United States, unless the agency or organization is:

(a) No longer in existence; or

(b) Has become unable to meet the alien's needs.

(3) A sponsor is any individual or public or private organization who executes an affidavit or similar agreement on behalf of an alien (who is not the dependent child of the sponsor or the sponsor's spouse) as a condition of the alien's entry into the United States.

(a) The affidavit or agreement is irrevocable, and

(b) Extends for a minimum of three years after the alien's entry for permanent residence into the United States.

(4) For a period of three years following entry for permanent residence into the United States, an individually sponsored alien is responsible for:

(a) Providing the department with any information and documentation necessary to determine the income of the sponsor that can be deemed available to the alien; and

(b) Obtaining any cooperation necessary from the sponsor.

(5) For all subsections in this section, the income of an individual sponsor (and the sponsor's spouse if living with the sponsor) is deemed to be the unearned income of an alien for three years following the alien's entry for permanent residence into the United States.

(6) Monthly income deemed available to the alien from the individual sponsor or the sponsor's spouse not receiving TANF/SFA or SSI is:

(a) The sponsor's total monthly unearned income, added to the sponsor's total monthly earned income reduced by twenty percent (not to exceed one hundred seventy-five dollars) of the total of any amounts received by the sponsor in the month as wages or salary or as net earnings from self-employment, plus the full amount of any costs incurred in producing self-employment income in the month.

(b) The amount described in (a) of this subsection reduced by:

(i) The basic requirements standard for a family of the same size and composition as the sponsor and those other persons living in the same household as the sponsor claimed by the sponsor as dependents to determine the sponsor's federal personal income tax liability but who are not TANF/SFA recipients;

(ii) Any amounts actually paid by the sponsor to persons not living in the household claimed by the sponsor as dependents to determine the sponsor's federal personal income tax liability; and

(iii) Actual payments of spousal maintenance or child support with respect to persons not living in the sponsor's household.

(7) In any case where a person is the sponsor of two or more aliens, the sponsor's income is divided equally among the aliens to the extent that the income would be deemed the income of any one of the aliens under provisions of this section.

(8) The income deemed to a sponsored alien in determining the need of other unsponsored members of the alien's family is not considered except to the extent that the income is actually available.

(9) For the GA-U program, the alien's sponsor's income is deemed as available to the alien as provided for the TANF/SFA program:

(a) At application, for applications filed on or after July 8, 1994. For the purposes of this rule, re-application filed following a break in assistance of thirty days or more is considered an application; and

(b) For all other GA-U clients, the income of an alien's sponsor is not deemed as available to the client.



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NEW SECTION



WAC 388-450-0160  Sponsored alien--Food assistance. For food assistance, this section applies to aliens for whom a sponsor has signed an affidavit of support or similar statement on or after February 1, 1983:

(1) Portions of the income of a sponsor and sponsor's spouse are counted as unearned income and applied to the food assistance benefits of a sponsored alien if living with the sponsor. The income of an alien's sponsor is available for three years following the alien's admission for permanent residence to the U.S.

(2) The income of the alien's sponsor and sponsor's spouse must be verified by the client if the client is living with the sponsor at application or recertification for food assistance.

(3) The available income is computed as follows:

(a) Total monthly earned and unearned income of the sponsor and sponsor's spouse:

(i) Minus twenty percent of the gross earned income; and

(ii) Minus the amount of the gross income eligibility standard for a household size equal to the sponsor, the sponsor's spouse, and all dependents.

(b) Plus any actual money paid to the alien by the sponsor or sponsor's spouse in excess of the amount computed in subsection (3)(a) of this section is treated as unearned income.

(4) The net income in subsection (3) of this section is available to a sponsored alien who:

(a) Applies for and receives food assistance; or

(b) Is recertified for food assistance.

(5) If the sponsored alien can show the sponsor is also sponsoring other aliens, the available income is divided by the number of sponsored aliens applying for, or receiving food assistance.

(6) If an alien changes sponsors during the certification period, available income is reviewed based on the required information about the new sponsor as soon as possible after the information is supplied and verified by the client.



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WAC 388-450-0165  Gross earned income limit for TANF/SFA. When applying the gross earned income limit as required under WAC 388-478-0035:

(1) "Family" means:

(a) All adults and children who would otherwise be included in the assistance unit under WAC 388-408-0015, but who do not meet TANF/SFA eligibility requirements;

(b) The unborn child of a woman in her third trimester of pregnancy; and

(c) The husband of a woman in her third trimester of pregnancy, when residing together.

(2) "Gross earned income" does not include excluded income, as provided in WAC 388-450-0015.

(3) The following amounts are disregarded when determining a family's gross earned income:

(a) Court or administratively ordered current or back support paid to meet the needs of legal dependents, up to:

(i) The amount actually paid; or

(ii) A one-person need standard for each legal dependent.

(b) Authorized ongoing additional requirement payment as defined in WAC 388-255-1050 through 388-255-1250.



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WAC 388-450-0170  TANF/SFA earned income incentive and deduction. (1) This section applies to:

(a) TANF/SFA, GA-S, GA-H; and

(b) TANF/SFA-related medical programs except as specified under WAC 388-450-0210.

(2) When determining countable income, fifty percent of a client's monthly gross earned income is disregarded as an incentive to employment.

(3) The actual cost of care of each dependent child or incapacitated adult living in the same home and receiving TANF/SFA is deducted when determining countable income under the following conditions:

(a) An applicant is eligible for a dependent care deduction for expenses incurred prior to the open effective date in the month of grant opening on a prorated basis;

(b) A recipient is eligible for a dependent care deduction if:

(i) The assistance unit received AFDC on October 13, 1988;

(ii) The dependent care deduction was applied when determining the benefit level for that month;

(iii) The assistance unit has remained continuously eligible for AFDC or TANF/SFA since that time; and

(iv) The assistance unit has chosen to use the deduction rather than state-paid dependent care.

(4) The dependent care deduction specified in subsection (3) of this section is not allowed unless:

(a) The care provided by a parent or stepparent;

(b) The care provider verifies the cost incurred;

(c) The cost is incurred for the month of employment being reported; and

(d) The amount deducted for each dependent child or incapacitated adult, depending on the number of hours worked per month does not exceed the following:

Dependent Care Maximum Deductions
Hours Worked Per Month Dependent Two Years of Age or Older Dependent Under Two Years of Age
0 - 40 $ 43.75 $ 50.00
41 - 80 $ 87.50 $100.00
81 - 120 $131.25 $150.00
121 or More $175.00 $200.00




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NEW SECTION



WAC 388-450-0175   GA-U earned income incentive and deduction. This section applies to the GA-U cash assistance program.

(1) When a client's countable income is determined, eighty-five dollars plus one half of the remainder of a client's monthly gross earned income is disregarded as an incentive to employment.

(2) In addition to the work incentive provided in subsection (1) of this section, work expenses are disregarded in an amount equal to twenty percent of the gross earned income; or

(3) At the option of the client, actual verified work expenses, including:

(a) Mandatory deductions required by law or as a condition of employment, such as FICA, income tax, and mandatory retirement contributions;

(b) Union dues when union membership is required for employment;

(c) Clothing costs when the clothing is necessary for employment;

(d) Tools necessary for employment;

(e) Other expenses reasonably associated with employment, such as legally binding contracts with employment agencies; and

(f) Transportation expenses as follows:

(i) If public transportation (other than for-hire vehicles such as taxis) is available and practical, the actual monthly cost, based on a commuter's pass, ticket book, or tokens at reduced quantity rates, even if the client does not use public transportation; or

(ii) If public transportation is not available or practical, the actual amount if the client pays another person to drive; or

(iii) If public transportation is not available or practical and the client uses his or her own vehicle, the costs, based on the percentage of work-related miles driven, for service and repairs, replacement of worn parts, registration and license fees, the interest on car payments, and either eight cents per mile or the actual cost for gas, oil, fluids, and depreciation.



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NEW SECTION



WAC 388-450-0180  Effect of countable income on eligibility and benefit level for cash assistance. (1) For TANF/SFA, RCA, GA assistance, countable income is income which:

(a) Cannot be excluded under the rules of this chapter;

(b) Cannot be allowed as a deduction, earned income incentive, out-bound allocation, or otherwise disregarded under the rules of this chapter; and

(c) Includes all in-bound income allocated or deemed from financially responsible persons who are not members of the assistance unit.

(2) A client's recurring monthly countable income is used to determine the client's eligibility and benefit amount following budgeting methods described in WAC 388-450-0215 or 388-450-0220.

(3) When an assistance unit's countable income is equal to or exceeds the appropriate payment standard plus authorized additional requirements, the client is not eligible for benefits.

(4) When an assistance unit's countable income is less than the appropriate payment standard plus authorized additional requirements, the client's benefit level is equal to the difference.

(5) Nonrecurring lump sums affect eligibility and benefit level as specified in WAC 388-450-0060 and 388-450-0240.

(6) When a change in income causes ineligibility for more than one month, the effective date of ineligibility is determined as follows:

(a) When recurrent income received in the budget month causes ineligibility, the assistance unit is ineligible on the first day of the payment month if the following circumstances are met:

(i) The assistance unit is subject to retrospective income budgeting as specified in WAC 388-450-0220; and

(ii) The income is reported timely as required under chapters 388-418 and 388-456 WAC.

(b) For all other changes in recurring income which cause ineligibility, the assistance unit is ineligible on the first day of the month the income is received.



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NEW SECTION



WAC 388-450-0185   General information regarding income deductions for food assistance programs. The following income deductions are used to compute food assistance program benefits:

(1) A standard deduction of one hundred thirty-four dollars per household per month;

(2) An earned income deduction of twenty percent gross earned income;

(3) A portion of the actual monthly amount of dependent care deduction:

(a) Needed for an assistance unit member to seek, accept or continue employment; or

(b) Needed for an assistance unit member to attend training or education preparatory to employment; and

(c) Not to exceed two hundred dollars for each dependent one year of age or younger; or

(d) Not to exceed one hundred seventy-five dollars for each other dependent.

(4) A deduction for nonreimbursable monthly medical expenses over thirty-five dollars incurred or anticipated to be incurred by an elderly or disabled household member as specified under WAC 388-450-0200.

(5) A deduction for legally obligated child support paid for a person who is not a member of the household.

(6) Shelter costs as provided in WAC 388-450-0190.



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NEW SECTION



WAC 388-450-0190  Shelter cost income deductions for food assistance. (1) Shelter costs include:

(a) Rent, lease payments and mortgage payments; and

(b) Utility costs.

(2) Shelter costs are deducted from gross income if the costs are in excess of fifty percent of the assistance unit's income after deducting the standard, earned income, medical, child support, and dependent care deductions:

(a) For an assistance unit containing an elderly or disabled member the entire amount of excess shelter costs is deducted;

(b) For all other assistance units the excess shelter cost deduction cannot exceed two hundred and fifty dollars.

(3) Shelter costs may include:

(a) Costs for a home not occupied because of employment, training away from the home, illness, or abandonment caused by casualty loss or natural disaster if the:

(i) Assistance unit intends to return to the home;

(ii) Current occupants, if any, are not claiming shelter costs for food assistance purposes; and

(iii) The home is not being leased or rented during the assistance unit's absence.

(b) Charges for the repair of the home which was substantially damaged or destroyed due to a natural disaster.

(c) The standard utility allowance or actual utility costs as provided in WAC 388-450-0195.



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NEW SECTION



WAC 388-450-0195  Utility allowances for food assistance programs. (1) The following utility allowances are used in calculating shelter costs:

(a) A standard utility allowance (SUA) for assistance units that incur any separate utility charges for heating or cooling costs;

(b) A limited utility allowance (LUA) for assistance units without heating or cooling costs, that incur utility charges other than telephone costs;

(c) A telephone utility allowance (TUA) for assistance units that incur any separate charges for phone service and not claiming the SUA or LUA.

(d) Actual utility costs if:

(i) Greater than the SUA or LUA; or

(ii) The assistance unit is not entitled to the SUA or LUA.

(2) As provided in federal law:

(a) The SUA up to two hundred twenty-three dollars;

(b) The LUA up to one hundred sixty-four dollars;

(c) The TUA up to twenty-nine dollars.



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NEW SECTION



WAC 388-450-0200  Medical cost income deductions for food assistance. (1) Excess medical and/or shelter deductions paid by the client are allowed when a client:

(a) Is elderly or disabled;

(b) Received food assistance as a noncash assistance unit until becoming categorically eligible due to the receipt of SSI; or

(c) Became categorically eligible due to the receipt of SSI after noncash assistance food stamps were denied as provided under chapter 388-414 WAC.

(2) One-time medical expenses are averaged over the certification period, at the client's option.

(3) A medical expense deduction is not allowed when the expense is:

(a) A reimbursement;

(b) A vendor payment, except for Low Income Home Energy Assistance Act (LIHEAA) payments;

(c) Claimed after the initial billing, even though:

(i) Not reported when first due;

(ii) Included in the most recent billing; and

(iii) Actually paid.

(d) Allowed as a deduction once but not paid, and subsequently included in a repayment agreement;

(e) Included in a timely but defaulted repayment agreement and then included in a subsequent repayment agreement;

(f) Claimed by a client after presumptive SSI is denied;

(g) Considered overdue to the provider; or

(h) Already paid by a prospectively budgeted assistance unit.



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NEW SECTION



WAC 388-450-0205  Budgeting income deductions for food assistance. (1) Allowable medical expenses are budgeted prospectively for the entire certification period.

(2) Income exclusions and deductions other than allowable medical expenses are budgeted:

(a) Prospectively when all assistance unit income is budgeted prospectively;

(b) Retrospectively when all assistance unit income is budgeted retrospectively; or

(c) Retrospectively when part of the assistance unit's income is budgeted prospectively and part is budgeted retrospectively.

(3) Additional public assistance payments are budgeted either prospectively or retrospectively, using only the amount authorized for the month the income is received.

(4) Expenses are averaged either prospectively or retrospectively over the period the expense is intended to cover if the assistance unit:

(a) Has expenses that fluctuate or are billed less often than monthly; and

(b) Chooses to have the expense averaged.

(5) For food assistance, countable income is income which:

(a) Cannot be excluded under the rules of this chapter;

(b) Cannot be allowed as a deduction, earned income incentive, out-bound allocation, or otherwise disregarded under the rules of this chapter; and

(c) Includes all in-bound income allocated or deemed from financially responsible persons who are not members of the assistance unit.

(6) An assistance unit's monthly countable income is used to:

(a) Determine eligibility, if required, based on the monthly net earned income standard specified in WAC 388-478-0060; and

(b) Calculate the assistance unit's monthly benefit level.



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NEW SECTION



WAC 388-450-0210  Countable income for medical programs. (1) For purposes of medical program eligibility, a client's countable income is income which remains when:

(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 unless:

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

(b) The program makes an allowance for those limits to be exceeded.

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

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

(b) TANF/SFA-related CN extended medical 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) 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 specified in chapter 388-408 WAC;

(b) Income is always prospectively budgeted for medical;

(c) Actual work related child 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) Court or administratively ordered current or back support paid to meet the needs of legal dependents, are income deductions;

(e) Income actually contributed to an alien client from the alien's sponsor;

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

(g) The fifty percent work incentive is not used to calculate countable income for 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 care expenses, as described in subsection (4)(c) of this section.

(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.

(5) SSI income methodology is used to determine a client's countable income for:

(a) SSI-related CN or MN; and

(b) Medicare cost sharing programs.

(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.



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NEW SECTION



WAC 388-450-0215  Prospective budgeting. Unless specifically stated, this section applies to TANF/SFA, RCA, GA, medical and food assistance programs.

(1) Prospective budgeting means an assistance unit's benefit amount for the month is computed using the best estimate of income and circumstance for that month.

(2) Best estimate means a reasonable expectation and knowledge of current, past and future circumstances. For TANF/SFA, RCA and GA assistance:

(a) An overpayment is established if the income is underestimated; and

(b) A corrective payment is issued if the income is overestimated.

(3) For medical assistance programs, the assistance unit's income is always prospectively budgeted.

(4) For TANF/SFA, RCA, GA, and food assistance programs, an assistance unit's income and circumstances are prospectively budgeted:

(a) For the first two months of benefit eligibility;

(b) When the benefits have been closed for less than one month and were closed in the first prospectively budgeted month; or

(c) When the assistance unit's benefits are suspended, as defined in WAC 388-450-0245 and the assistance unit experiences a significant change in their income, such as loss of employment, in the budget or process month.

(5) For each month of benefit eligibility certain assistance units will have their income prospectively budgeted. This applies to assistance units in which:

(a) All adult members are elderly or disabled and do not have earned income or recent work history, as defined in WAC 388-404-0015, 388-400-0040 and 388-456-0010;

(b) The members are migrant workers. A migrant worker is a person who works in seasonal agricultural employment that requires the person to be away from their permanent place of residence overnight;

(c) All members are homeless as defined in WAC 388-408-0050; or

(d) For food assistance programs the only income is from seasonal farm work:

(i) A seasonal farm worker is a person working in seasonal agricultural employment but not required to be away from their permanent place of residence overnight; and

(ii) A seasonal farm worker assistance unit means an assistance unit which receives its only income from seasonal farm work or unemployment compensation.

(6) Public assistance income is budgeted prospectively.



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NEW SECTION



WAC 388-450-0220  Retrospective budgeting. This section applies to all TANF/SFA, RCA, GA, and food assistance programs.

(1) Retrospective budgeting means the assistance unit's benefit amount for the payment month is computed using the actual income and circumstances of the budget month.

(a) The budget month is the month in which the income is received by the client.

(b) The process month is the month following the budget month. It is the month during which the department computes the client's benefit amount when income from the budget month is reported timely.

(c) The payment month is the month following the process month.

(2) After the first two months of benefit eligibility, an assistance unit's income and circumstances are retrospectively budgeted, except when the assistance unit:

(a) Is listed in WAC 388-450-0215(5); and

(b) Has discontinued income, as defined in WAC 388-450-0235.

(3) An assistance unit's initial month's benefits are retrospectively budgeted when:

(a) The assistance unit's benefits are reopened after being closed in error;

(b) The assistance unit's benefits are reopened after being closed less than one month and closed after the first initial month of eligibility;

(c) A person with income is added to the assistance unit and their income had been allocated to the assistance unit; or

(d) The assistance unit's benefits were suspended, as defined in WAC 388-450-0245, and:

(i) The first month of eligibility follows the month of suspension; and

(ii) The assistance unit has not experienced a significant change, as provided in WAC 388-450-0245.

(4) Income from a discontinued source that was prospectively budgeted during the first two months of eligibility, may be excluded for retrospective budgeting as specified in WAC 388-450-0235.



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NEW SECTION



WAC 388-450-0225  Budgeting income for cash assistance applicants. The grant amount for the month of application is computed as follows:

(1) All countable income to be budgeted during the first calendar month of eligibility is subtracted from the payment level plus authorized additional requirements; and

(2) The grant is prorated for the remaining number of days in the month beginning with the effective date of eligibility. This prorated figure is the benefit level for the first month of eligibility.



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NEW SECTION



WAC 388-450-0230  Treatment of income in the month of application for destitute food assistance households. (1) When a migrant or seasonal farm worker is determined destitute under WAC 388-406-0020, eligibility and benefit amount for the month of application is determined by:

(a) Counting the household's income that is received from the first of the month through the date of application; and

(b) Excluding income from a new source that the household expects to receive during the ten days after the date of application.

(2) A household member changing jobs but continuing to work for the same employer is considered to be receiving income from the same source.



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NEW SECTION



WAC 388-450-0235  Discontinued income. (1) For TANF/SFA, RCA, GA, and food assistance programs, discontinued income means income which was available but is no longer received.

(2) When income of an assistance unit was used to determine the benefit amount in the first two months of eligibility has stopped, the income is not used to determine benefits for the following months.

(3) For food assistance programs, clients who report during the budget month that income stopped that month will not have the income counted for the corresponding payment month.



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NEW SECTION



WAC 388-450-0240  Effect of net lump sum payments for cash assistance. For TANF/SFA, RCA, and GA assistance, a net lump sum payment, as determined under WAC 388-450-0060, effects the client's eligibility and benefit amount as follows:

(1) When the net lump sum payment is less than the client's payment standard plus additional requirements for one month, the payment is retrospectively budgeted as specified in WAC 388-450-0220.

(2) When the net lump sum payment is more than one month's payment standard plus additional requirements but less than two months, the payment is budgeted following the retrospective monthly budgeting cycle specified in WAC 388-450-0220. The lump sum payment effects the client's eligibility and benefit level as follows:

(a) The grant for the payment month corresponding to the month the payment was received is suspended; and

(b) The remainder of the lump sum payment is treated as countable income when determining the benefit level for the month following the grant suspension month.

(3) When the net lump sum payment is at least twice a client's payment standard plus additional requirements, the client is not eligible for cash benefits for the month the lump sum payment was received and the following month.

(4) A client's period of ineligibility as established in subsection (3) of this section can be reduced when:

(a) The client's payment standard increases;

(b) For reasons beyond a client's control, any or all of the one-time lump sum payment becomes unavailable; or

(c) The client or other members of the assistance unit become responsible for or pay medical expenses.

(5) When an ineligible or disqualified client receives a one-time lump sum payment:

(a) The payment is first allocated to meet the needs of the ineligible or disqualified client, as specified in WAC 388-450-0105; and

(b) The remaining income is treated as a lump sum payment according to the rules of this section.

(6) To avoid a period of ineligibility as specified in subsection (3) of this section, a client may request termination of their cash benefits the month before the receipt of a lump sum payment.

(7) For TANF/SFA-related medical programs, nonrecurring lump sum payments are:

(a) Counted as income in the month received; and

(b) Any money that remains on the first of the next month is counted as a resource.



[]



NEW SECTION



WAC 388-450-0245  Suspending benefits. This section applies to TANF/SFA, RCA, GA and food assistance programs.

(1) An assistance unit's benefits are suspended when the assistance unit's countable net income makes the assistance unit ineligible for one payment month.

(2) An assistance unit's benefits will be suspended rather than terminated when:

(a) There is reason to believe the assistance unit would be ineligible for benefits for only one payment month; and

(b) The cause was due to income or other circumstances in the corresponding budget month.



[]



NEW SECTION



WAC 388-450-0250  Income of a new assistance unit member. This section applies to all TANF/SFA, RCA, GA, medical and food assistance programs.

(1) A client's income is treated as specified in chapter 388-418 WAC when the client enters an assistance unit.

(2) When a recipient establishes a separate assistance unit:

(a) That client is removed from the prior assistance unit; and

(b) The method of income budgeting that was in effect in the prior assistance unit is used for the new assistance unit.



[]

SHS-2410:4

Chapter 388-452 WAC



INTERVIEW REQUIREMENTS



NEW SECTION



WAC 388-452-0005  Interview requirements. (1) Persons applying for assistance programs have a single in-office interview unless an alternate type of interview is requested and approved. The interview is conducted in:

(a) A community services office; or

(b) A Social Security Administration district office for SSI applicant or recipient assistance units applying for food assistance programs.

(2) The person who attends the eligibility interview is:

(a) For food assistance, a responsible member of the assistance unit or an authorized representative as defined in WAC 388-462-0005; or

(b) For cash assistance and medical, an applicant or someone representing the applicant when the applicant is unable to come into the office.

(3) TANF and SFA assistance units are required to have an in-office interview at least once every twelve months for redetermination of eligibility.

(4) A client may bring anyone to the interview.

(5) Persons applying for medical only are not required to have an in-office interview when the person:

(a) Is pregnant and the application is for a pregnancy-related program; or

(b) Is applying only for a child under nineteen years of age and the application is for a medical program for children.

(6) Applicants may have an alternate type of interview rather than an in-office interview. An alternate type of interview is completed:

(a) By telephone;

(b) By a scheduled home visit; or

(c) For medical only programs, through the mail.

(7) Applicants may have an alternate type of interview when they request an alternate type and:

(a) They are unable to appoint an authorized representative;

(b) They do not have a responsible assistance unit member able to come into the office because of hardships; or

(c) For medical programs, there is adequate information to determine eligibility.



[]



NEW SECTION



WAC 388-452-0010  What does the family violence amendment mean for TANF/SFA recipients? The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), also known as the Welfare Reform Act, gave every state the option to have a program to address issues of family violence for temporary assistance for needy families (TANF) and state family assistance (SFA) recipients.

(1) For TANF/SFA, it is family violence when a recipient, or family member or household member has been subjected by another family member or household member as defined in RCW 26.50.010(2) to one of the following:

(a) Physical acts that resulted in, or threatened to result in, physical injury;

(b) Sexual abuse;

(c) Sexual activity involving a dependent child;

(d) Being forced as the caretaker relative or a dependent child to engage in nonconsensual sexual acts or activities;

(e) Threats of or attempts at, physical sexual abuse;

(f) Mental abuse;

(g) Neglect or deprivation of medical care; or

(h) Stalking.

(2) DSHS shall:

(a) Screen and identify TANF/SFA recipients for a history of family violence;

(b) Notify TANF/SFA recipients about the family violence amendment both verbally and in writing;

(c) Maintain confidentiality as stated in RCW 74.04.060;

(d) Offer referral to social services or other resources for clients who meet the criteria in subsection (1) of this section;

(e) Waive WorkFirst requirements that unfairly penalize victims of family violence, would make it more difficult to escape family violence or place victims at further risk. Requirements to be waived may include:

(i) Time limits for TANF/SFA recipients, for as long as necessary (after fifty-two months of receiving TANF/SFA);

(ii) Cooperation with the division of child support.

(f) Develop specialized work activities for instances where participation in regular work activities would place the recipient at further risk of family violence.



[]

SHS-2415:4

Chapter 388-454 WAC



LIVING WITH A RELATIVE



NEW SECTION



WAC 388-454-0005  Living in the home of a relative or guardian requirement for TANF, SFA and GA-H. (1) To be eligible for TANF or SFA, a child must live in the home of a parent or other relative as defined in WAC 388-454-0010.

(2) To be eligible for GA-H, a child must be living in the home of a person who is:

(a) A court-appointed legal guardian or court-appointed custodian; and

(b) Not a relative as defined in the TANF program.

(3) A home is defined as a family setting that is being maintained or is in the process of being established. A family setting exists when the relative or guardian assumes and continues to be responsible for the day to day care and control of the child. A family setting exists when a family is living in temporary shelter or has no shelter.

(4) A child or caretaker temporarily absent from the home remains eligible for assistance under the conditions described in WAC 388-454-0015 and 388-454-0020.



[]



NEW SECTION



WAC 388-454-0010  Definition of a parent or other relative for TANF and SFA. To be eligible for TANF or SFA, a child must be living with a person who meets the following definition of a parent or relative.

(1) A child's parent is the child's natural or adoptive parent or a step-parent who is legally obligated to support the child.

(2) A man is considered to be a child's natural father if the relationship is:

(a) Established under a judgment or order determining the parent and child relationship entered under RCW 26.26.130; or

(b) Presumed under the Uniform Parentage Act (RCW 26.26.040).

(3) Nonparental relatives include:

(a) The following blood relatives (including those of half blood): siblings, first cousins (including first cousins once removed), nephews and nieces, and persons of preceding generations (including aunts, uncles and grandparents) as denoted by prefixes of great, great-great, or great-great-great;

(b) A natural parent whose parental rights have been terminated by a court order;

(c) A stepparent whose obligation to support the child has been terminated by the death of the child's natural or adoptive parent or the entry of a court order; and

(d) A step sibling even though the marriage of the step sibling's parent to the child's natural or adoptive parent is terminated by death, divorce or dissolution.



[]



NEW SECTION



WAC 388-454-0015  Temporary absence from the home. The child or the caretaker is temporarily absent from the home as long as the caretaker continues to be responsible for the care and control of the child. Temporary absences cannot exceed ninety days except as described below. A caretaker must report a child's absence in excess of ninety days as required under WAC 388-418-0005. Temporary absences include:

(1) Receiving care in a hospital or public or private institution. If the temporary care exceeds ninety days, the assistance payment for the person is reduced to the CPI amount specified under chapter 388-478 WAC.

(2) Receiving care in a substance abuse treatment facility. If the care exceeds ninety days, the assistance payment for the person is reduced to the CPI amount specified under chapter 388-478 WAC.

(3) Visits in which the child or parent will be away for ninety days or less, including visits of a child to a parent who does not reside in the child's home.

(4) Placement of a child in foster care when the child's caretaker is receiving care in a residential treatment facility or for other reasons as determined by the division of children and family services (DCFS). DCFS must determine that the child is expected to return to the home within ninety days of the foster care placement.

(5) Placement of a child in foster care or in the temporary care of a relative, when:

(a) A parent or other relative applies for TANF or SFA on behalf of the child;

(b) DCFS has determined the child will be placed in the care of the applying relative within thirty days following the authorization of assistance; and

(c) No concurrent TANF or SFA payments are made for the child while in the temporary care of a relative.

(6) The child or caretaker is attending school or training as described in WAC 388-454-0020.



[]



NEW SECTION



WAC 388-454-0020  Temporary absence to attend school or training. A child or caretaker is temporarily absent from the home to attend school or training when:

(1) The child's caretaker is attending a department approved vocational training program; or

(2) The child attends school or training away from home, as long as:

(a) The child returns to the family home during a year's period, at least for summer vacation; and

(b) The absence is necessary because:

(i) Isolation of the child's home makes it necessary for the child to be away to attend school;

(ii) The child is enrolled in an Indian boarding school administered through the Bureau of Indian Affairs; or

(iii) Specialized education or training is not available in the child's home community and is recommended by local school authorities.



[]



NEW SECTION



WAC 388-454-0025  Notice to parent when child lives with nonparental relative. (1) When TANF/SFA has been approved for a child who is living with a nonparental caretaker relative, the department will make reasonable efforts to notify the parent with whom the child most recently lived that:

(a) Assistance has been authorized for the child;

(b) Family reconciliation services may be requested from the department; and

(c) The parent has the right to request the child's address and location.

(2) The parent will be notified within seven calendar days of assistance authorization.

(3) The parent will not be notified if there is a substantiated claim that the parent has abused or neglected the child.

(4) Release of the child's address and location will be subject to the requirements of chapter 388-428 WAC.



[]

SHS-2422:5

Chapter 388-456 WAC



MONTHLY REPORTING



NEW SECTION



WAC 388-456-0001  Monthly reporting. (1) Monthly reporting requirements affect the following programs:

(a) TANF/SFA, and RCA cash assistance;

(b) GA-S;

(c) GA-H; and

(d) Food assistance program.

(2) Medical-only clients are not required to report monthly.

(3) Assistance units which must report the income and circumstances of all members monthly are:

(a) Those with earned income;

(b) Those with recent work history as defined in WAC 388-456-0010; and

(c) Those which have income allocated or deemed to them from persons with earned income who are financially responsible for a member of the assistance unit.

(4) Assistance units subject to monthly reporting must return a completed report on a form specified by the department.

(a) A report is considered complete when:

(i) All questions on the report are answered;

(ii) The report is signed; and

(iii) Income and changes are verified.

(b) The process month is the month following the month in which the income was received.

(5) Assistance units are notified when:

(a) Information or action is needed because the report is incomplete;

(b) The information reported changes the benefit amount or causes termination of benefits; or

(c) The report has not been received by the department. Assistance units are notified ten days in advance of the termination of cash and food assistance benefits. The effective date is the last day of the process month.

(6) When a food assistance unit is required to report monthly the requirements to report changes of circumstance in chapter 388-418 WAC do not apply.



[]



NEW SECTION



WAC 388-456-0005  Processing a late report. (1) A cash assistance unit can return a completed report before the end of the process month and receive reinstated benefits if information contained in the report establishes eligibility. The reinstated benefits are calculated to include work incentives.

(2) A food assistance unit can return a completed report before the end of the payment month and receive reinstated benefits if information contained in the report establishes eligibility.

(3) Cash and food assistance units will be notified of:

(a) The new benefit amount; or

(b) The termination of benefits and the reason if information contained in the report causes the termination of benefits.



[]



NEW SECTION



WAC 388-456-0010  Recent work history. Recent work history means that the assistance unit has had employment in one of the two months prior to the payment month as defined in WAC 388-450-0240.

(1) Newly approved assistance units with recent work history must report income and circumstances monthly for two months beginning with the month following their approval for assistance.

(2) Recipient assistance units who report that their earned income has stopped must continue to report monthly for two months after the last receipt of income from employment.



[]



NEW SECTION



WAC 388-456-0015  Exceptions to monthly reporting. The following assistance units with earned income or recent work history are exempt from monthly reporting:

(1) Migrant assistance units as defined in WAC 388-450-0215;

(2) Homeless assistance units as defined in WAC 388-408-0050;

(3) Assistance units with a recent work history in which all adult members are:

(a) Elderly as defined in WAC 388-404-0015; or

(b) Disabled as defined in WAC 388-400-0040; or

(4) Assistance units whose sole income is from college work study issued from either:

(a) Title IV of the Higher Education Amendments; or

(b) Bureau of Indian Affairs student assistance programs; and

(5) For food assistance programs only, seasonal farm worker assistance units as defined in WAC 388-450-0216.



[]

SHS-2431:3

Chapter 388-458 WAC



NOTICES TO CLIENTS



NEW SECTION



WAC 388-458-0005  Adequate notice of denial or withdrawal. (1) When a client's application for cash, medical or food assistance is denied or withdrawn, the client receives a written notice of denial or withdrawal which includes:

(a) The reason or reasons for the denial or withdrawal and the rules to support the department's decision;

(b) The date of the decision; and

(c) The right to a fair hearing.

(2) When the applicant does not provide requested information and there is not enough information available for the department to determine eligibility, the denial notice also includes:

(a) A description of the information that was requested and not provided, including the date the information was requested;

(b) A statement that eligibility for assistance cannot be established based on information available to the department; and

(c) That eligibility will be redetermined if, within thirty days from the date of the denial notice, the applicant:

(i) Provides all specified information previously requested but not provided; and

(ii) The applicant's circumstances have not changed.

(3) Notice of a decision to deny or withdraw an application must be provided as required under chapter 388-406 WAC.

(4) Notices to clients who qualify for necessary supplemental accommodation services will be provided as required under WAC 388-200-1300.



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NEW SECTION



WAC 388-458-0010  Adequate notice of adverse action to recipients. An adequate written notice of a decision to terminate, suspend, reduce or restrict cash, medical or food assistance benefits includes a statement of:

(1) The action the department intends to take;

(2) The reasons for the intended action;

(3) The specific rule, regulation or law supporting the action;

(4) The recipient's right to request a fair hearing, including the circumstances under which assistance may be continued if a hearing is requested;

(5) Timely notice of a decision to terminate, suspend, or reduce assistance must be provided as required under WAC 388-418-0030; and

(6) Notices to clients who qualify for necessary supplemental accommodation services will be provided as required under WAC 388-200-1300.



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NEW SECTION



WAC 388-458-0015  Translation of written communications with limited English proficient clients. The following written communications concerning cash, medical and food assistance programs are translated into the primary language of clients with limited English proficiency:

(1) Notices requesting information or action which require a response from the client to determine:

(a) Initial eligibility; or

(b) Continuing eligibility for assistance.

(2) Notices of approval, denial, or withdrawal of applications for assistance;

(3) Notices of termination, suspension, reduction or restriction of assistance;

(4) Notices describing client rights and responsibilities;

(5) Notices requiring a client's signature or informed consent; and

(6) Notice of overpayments of cash, medical and food assistance.



[]

SHS-2429:4

Chapter 388-460 WAC



PAYEES ON BENEFIT ISSUANCES



NEW SECTION



WAC 388-460-0001  Payee for cash, medical and food assistance benefits. (1) Cash assistance may be issued in the name of the following persons:

(a) A client who is the recipient of the benefits;

(b) An ineligible parent or other relative receiving benefits on behalf of an eligible child;

(c) A person, facility, organization, institution or agency acting as a protective payee or representative payee for a client;

(d) A guardian or agent acting on behalf of a client; or

(e) A vendor of goods or services supplied to an eligible client.

(2) When medical coverage accompanies cash assistance, the medical identification (MAID) card for the assistance unit members is issued in the name of the person listed as payee for the cash benefit.

(3) For other medical assistance units, the MAID card is issued to the person named as the head of the assistance unit.

(4) Food assistance benefits are issued to the person named as the head of the food assistance unit.



[]



NEW SECTION



WAC 388-460-0005  Authorized representative for food assistance benefits. An authorized representative is an adult who is not a member of the food assistance unit but has the knowledge and consent of the assistance unit to act on their behalf.

(1) A responsible member of the food assistance unit can name, in writing, an authorized representative. An authorized representative has authority to:

(a) Apply for food assistance on behalf of the food assistance unit;

(b) Redeem the food coupon authorization (FCA) card for the unit; and

(c) Purchase food for the food assistance unit using the unit's authorized benefit allotment.

(2) A responsible member of the food assistance unit can name, in writing, an emergency authorized representative to transact a particular FCA card when no responsible member is able to transact the card. Both the responsible member of the food assistance unit and the person named must sign the written statement.

(3) The food assistance unit members are liable for any over-issuance that may result from information supplied to the department by the authorized representative.

(4) An authorized representative may act on behalf of more than one food assistance unit when approved by the CSO administrator.



[]



NEW SECTION



WAC 388-460-0010  Food assistance authorized representative--Treatment centers and group homes. (1) Residents in group homes may choose to have food assistance benefits authorized as follows:

(a) On their own behalf;

(b) Through an authorized representative of their choosing; or

(c) Through a facility acting as authorized representative.

(2) Residents in chemical dependency treatment centers are required to have a designated employee of the facility act as an authorized representative.

(3) The authorized representative for residents in a chemical dependency treatment center or a group home must:

(a) Be aware of the resident's circumstances;

(b) Notify the department of any changes in income, resources or circumstances within ten days of the change; and

(c) Use the resident's food assistance benefit allotment for meals served to the resident.

(4) When assigning an employee as the authorized representative for residents, a facility accepts responsibility for:

(a) Any misrepresentation or intentional program violation; and

(b) Liability for food assistance benefits held at the facility on behalf of the resident.



[]



NEW SECTION



WAC 388-460-0015  Persons who may not be an authorized representative for a food assistance unit. (1) A person acting as an authorized representative for a food assistance unit will be disqualified for one year when that person:

(a) Knowingly provides false information to the department;

(b) Misrepresents the food assistance unit's circumstances; or

(c) Misuses the food assistance benefits.

(2) The authorized representative and the head of the food assistance unit are notified thirty days prior to the disqualification taking effect.

(3) The following persons may act as an authorized representative for a food assistance unit only with written approval of the CSO administrator and only when no one else is available:

(a) An employee of the department;

(b) Any person disqualified from the food assistance program because of an intentional program violation;

(c) A retailer authorized to accept coupons;

(4) A public or private nonprofit organization providing meals for homeless persons may not be an authorized representative under any conditions.



[]



Chapter 388-462 WAC



PREGNANCY



NEW SECTION



WAC 388-462-0005  Pregnancy requirement for GA-S. (1) A woman may be eligible for GA-S at any stage of pregnancy if:

(a) The pregnancy is medically verified; and

(b) She meets the requirements of WAC 388-400-0020.

(2) A woman is eligible for GA-S until the end of the month containing the last day of the six week period following the child's birth if:

(a) She relinquishes the child for adoption; and

(b) She was receiving:

(i) GA-S at the time of the child's birth; or

(ii) TANF at the time of the child's birth and later becomes ineligible for TANF because no eligible child resides in the home.



[]



NEW SECTION



WAC 388-462-0010  Pregnancy requirement for TANF and SFA. A woman who is not a caretaker relative of a TANF or SFA eligible child may be eligible for TANF or SFA if:

(1) She is in the third trimester of pregnancy (the three calendar months preceding the expected month of birth) as medically verified; and

(2) The unborn, if born and living with the woman in the month of payment, would be deprived of parental support and care as defined in chapter 388-430 WAC.



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NEW SECTION



WAC 388-462-0015  Medical programs for pregnant women. (1) A pregnant woman is eligible for medical services described in this chapter only when her pregnancy is confirmed by a licensed medical practitioner, licensed laboratory, community clinic, family planning clinic, or health department clinic.

(2) A pregnant woman is eligible for CN medical coverage if she meets the following requirements as described in WAC 388-503-0505:

(a) Citizenship or immigration status (chapter 388-424 WAC); and

(b) Social Security Account Number (chapter 388-474 WAC); and

(c) Washington state residence (chapter 388-468 WAC); and

(d) Countable income meets the standard described in WAC 388-478-0075.

(3) A pregnant woman is considered for medically needy (MN) program coverage if she meets the requirements in subsection (2)(a) through (c) of this section and:

(a) Her countable income is greater than the standard in subsection (2)(d) of this section; and

(b) Her countable resources do not exceed the standard in WAC 388-478-0070.

(4) A pregnant woman is eligible for CN scope of care under the state-funded pregnant woman program if she is not eligible for programs in subsection (2) of this section due to citizenship, immigrant or Social Security Number requirements.

(5) A pregnant woman is considered for MN scope of care under the state-funded pregnant woman program if:

(a) She is not eligible for the program under subsection (4) of this section because her income exceeds the standard; and

(b) Her resources do not exceed the standard in WAC 388-478-0070.

(6) A pregnant woman is considered for the medically indigent (MI) program if her resources exceed the standards in WAC 388-478-0070.

(7) Only the income of an unmarried father of an unborn actually contributed to a pregnant woman is considered as income to her.

(8) There are no resource limits for the programs described in subsections (2) and (4) of this section.

(9) The assignment of child support and medical support rights as described in chapter 388-422 WAC do not apply to pregnant women.

(10) Unless stated otherwise, this section contains the only eligibility requirements for pregnant women to qualify for medical coverage.

(11) A woman who was eligible for and received medical on the last day of pregnancy is eligible for extended medical benefits for postpartum care through the end of the month:

(a) Which includes the sixtieth day from the end of the pregnancy, for a pregnant woman receiving Medical in any program except Medically Indigent (MI); or

(b) The pregnancy ends, for a pregnant woman receiving MI benefits.

(12) A woman who was eligible for a medical program on the last day of pregnancy is eligible for family planning services for twelve months from the end of the pregnancy.



[]

SHS-2405:3

Chapter 388-464 WAC



QUALITY ASSURANCE



NEW SECTION



WAC 388-464-0001  Requirement to cooperate with quality assurance. (1) To be eligible for temporary assistance for needy families (TANF), state family assistance (SFA), or federal food stamp benefits, the following clients are required to cooperate in the quality assurance review process:

(a) All adult recipients or payees in a TANF or SFA assistance unit; or

(b) All household members in a food assistance unit.

(2) Assistance units become ineligible for benefits upon a determination of noncooperation by quality assurance and remain ineligible until the client meets quality assurance requirements or:

(a) For TANF/SFA clients, one hundred twenty days from the end of the annual quality assurance review period; or

(b) For food assistance household members, ninety-five days from the end of the annual quality assurance review period.

(3) The quality assurance review period covers the federal fiscal year which runs from October 1st of one calendar year through September 30th of the following year.

(4) Individuals reapplying for TANF, SFA, or federal food stamps after the sanction period has ended must provide verification of all eligibility requirements. However, individuals meeting expedited service criteria only need to provide expedited service verification requirements.



[]

SHS-2432:3

Chapter 388-466 WAC



REFUGEE PROGRAM



NEW SECTION



WAC 388-466-0005  Immigration status requirement for refugee assistance. (1) To be eligible for refugee cash assistance (RCA) and refugee medical assistance (RMA), a person must prove, by providing documentation issued by the Immigration and Naturalization Service (INS), that he or she was:

(a) Admitted as a refugee under section 207 of the Immigration and Nationalities Act (INA);

(b) Paroled into the U.S. as a refugee or asylee under section 212 (d)(5) of the INA;

(c) Granted conditional entry under section 203 (a)(7) of the INA;

(d) Granted asylum under section 208 of the INA;

(e) Admitted as an Amerasian Immigrant from Vietnam through the orderly departure program, under section 584 of the Foreign Operations Appropriations Act, incorporated in the FY88 Continuing Resolution P.L. 100-212;

(f) A Cuban-Haitian entrant who was admitted as a public interest parolee under section 212 (d)(5) of the INA.

(2) A permanent resident alien meets the immigration status requirements for RCA and RMA if the individual was previously in one of the statuses described in subsections (1)(a) through (f) of this section.



[]



NEW SECTION



WAC 388-466-0010  Treatment of income and resources for refugee assistance. The income and resources of refugee cash assistance and refugee medical assistance (RCA/RMA) clients are treated according to the rules for the TANF program in chapters 388-450 and 388-470 WAC, except that RCA/RMA clients do not qualify for:

(1) The fifty percent work incentive allowed under WAC 388-450-0190. Instead, the first ninety dollars of an RCA/RMA client's monthly gross earned income is disregarded;

(2) The three thousand dollars savings account exclusion allowed to recipients under WAC 388-470-0050;

(3) The exclusion of a motor vehicle used to transport a physically disabled household member under WAC 388-470-0070; and

(4) The five thousand dollars vehicle equity value exclusion in WAC 388-470-0070. Instead, the equity value exclusion for a vehicle owned by an RCA/RMA client is fifteen hundred dollars.



[]



NEW SECTION



WAC 388-466-0015  Work and training requirements for refugee cash assistance. To be eligible for refugee cash assistance, clients must meet the following work and training requirements unless they are exempt from participation under WAC 388-466-0020:

(1) Register for employment with the employment security department or other employment agency designated by the department.

(2) Enroll and participate in department-approved employability training programs. Training means available and appropriate programs which:

(a) Provide job or language training as approved in the client's personal employment plan; and

(b) Are intended to have a definite (less than one year) employment objective.

(3) Accept appropriate offers of employment.



[]



NEW SECTION



WAC 388-466-0020  Exemptions to work and training requirements. (1) Clients are exempt from refugee cash assistance work and training requirements when they are:

(a) Fifteen years of age or younger;

(b) Eighteen years of age or younger and enrolled full-time in high school or vocational/technical training and reasonably expected to complete the program before reaching nineteen years of age;

(c) Sixty-five years of age or older;

(d) Suffering from an illness or injury that is serious enough to temporarily prevent participation in work or training;

(e) Incapacitated as determined by a physician or licensed psychologist;

(f) Needed in the home as the primary care provider for an ill, injured, or incapacitated household member;

(g) A single parent or other caretaker relative of a child five years of age or younger;

(h) A parent or other caretaker of a child when a nonexempt spouse or other nonexempt adult relative in the home is meeting work and training requirements; or

(i) Employed at least thirty hours per week.

(2) A person is not exempt from work and training requirements solely because of an inability to communicate in English.



[]



NEW SECTION



WAC 388-466-0025  Penalties for not complying with work and training requirements. (1) A person who is not exempt from the work and training requirements of WAC 388-466-0015 is not eligible for refugee cash assistance if he or she is:

(a) An applicant who:

(i) Has voluntarily quit employment or refused an offer of employment or a training opportunity within the past thirty days, unless there was good cause to quit or refuse the employment or training under WAC 388-55-027; or

(ii) Is a former recipient who applies during a period of ineligibility established under subsection (2) of this section; or

(b) A recipient who, without good cause as defined under WAC 388-55-027:

(i) Voluntarily quits employment; or

(ii) Fails or refuses to comply with the work and training requirements of WAC 388-466-0015(2).

(2) Assistance to a recipient who is ineligible under subsection (1)(b) of this section will be terminated after the recipient is provided with advance and adequate notice:

(a) Assistance will not be terminated if, during the advance notice period, the recipient:

(i) Decides to accept employment or to participate in required training at any time before the date of termination; and

(ii) Is otherwise eligible for assistance.

(b) If the recipient does not accept employment or does not participate in required training before the date of termination, he or she will be ineligible for a period of:

(i) Three months from the date of termination after the first occurrence; or

(ii) Five months from the date of termination after the second occurrence.



[]

SHS-2378:5

Chapter 388-468 WAC



RESIDENCY



NEW SECTION



WAC 388-468-0005  Residency. (1) A resident is an individual who:

(a) Currently lives in Washington and intends to continue living here; or

(b) Entered the state looking for a job; or

(c) Entered the state with a job commitment.

(2) A person does not need to live in the state for a specific period of time to be considered a resident.

(3) With the exception of subsection (4) of this section, a client can temporarily be out of the state for more than one month. If so, they must supply the department with adequate information to demonstrate their intent to continue to reside in the state of Washington.

(4) Noncategorically eligible food assistance households remaining out of the state more than one calendar month lose their state residence status.

(5) Residency is not a requirement for the following:

(a) The medically indigent (MI) program; or

(b) Detoxification services.

(6) It is not necessary for a person moving from another state directly to a nursing facility in Washington state to establish residency, prior to entering the facility.

(7) A person who enters Washington state temporarily just to get medical care does not meet the definition of a resident and is not eligible for those services.

(8) For purposes of medical programs a client's residence is the state:

(a) Making a state Supplemental Security Income (SSI) payment; or

(b) Making federal payments for foster or adoption assistance under Title IV-E of the Social Security Act; or

(c) Of residence of the parent or legal guardian, if appointed, for an institutionalized:

(i) Minor child; or

(ii) Client twenty-one years of age or older, who became incapable of determining residential intent before reaching age twenty-one.

(d) Where a client is residing if the person becomes incapable before reaching twenty-one years of age; or

(e) Making a placement in an out-of-state institution.

(9) In a dispute between states as to which is a person's state of residence, the state of residence is the state in which the person is physically located.

(10) A former resident of the state can apply for the GA-U program while living in another state if:

(a) The person:

(i) Plans to return to this state; and

(ii) Intends to maintain a residence in this state; and

(iii) Lives in the United States at the time of the application.

(b) In addition to the conditions in subsection (10)(i), (ii), and (iii) being met, the absence must be the result of one of the following:

(i) Is enforced and beyond the person's control; or

(ii) Is essential to the person's welfare and is due to physical or social needs.



[]

SHS-2391:10

Chapter 388-470 WAC



RESOURCES



NEW SECTION



WAC 388-470-0005  Resource eligibility and limits. (1) A resource is personal property or real property or certain types of payments that are not considered income that is owned by and available to a client.

(2) A client may own and keep excluded resources or countable resources up to the resource limit.

(3) For SSI-related medical a resource is considered available when the client or spouse:

(a) Owns the resource; and

(b) Has the authority to convert the resource to cash; and

(c) Is not legally restricted from using the resource for the person's support and maintenance.

(4) For an SSI-related client a resource is available on the first day of the month following receipt of the resource.

(5) Available resources may be:

(a) Excluded which means it is not counted toward the resource limit;

(b) Partially excluded:

(i) The resource is not counted up to a specified dollar amount; but

(ii) Any amount over that amount is counted toward the resource limit; or

(c) Countable which means the entire value is counted toward the resource limit.

(6) For medical programs, if the household consists of more than one medical assistance unit (MAU), the resources for each MAU are considered according to the related program.

(7) An assistance unit's resources are determined by:

(a) Disregarding all excluded resources;

(b) Adding the value of:

(i) Resources that are in excess of the excluded dollar amounts; and

(ii) Resources that are countable; and

(c) Comparing the total countable resources to the applicable resource limit for the assistance unit;

(d) If the total resources exceed the applicable resource limit, the assistance unit's benefits are denied or terminated except for institutional medical programs as described in WAC 388-513-1395.

(8) The value of a resource is the equity value. The equity value is the amount a person could receive for the resource (fair market value) minus the legal amount still owing. Limits for countable resources are:

(a) For cash assistance and TANF-related medical, an eligible assistance unit's countable resources must be at or below one thousand dollars;

(b) For food assistance, an eligible assistance unit's countable resources must be at or below:

(i) Three thousand dollars for any household with an elderly member; or

(ii) Two thousand dollars for all other households.

(9) For food assistance, assistance units in which all members are receiving cash assistance or SSI do not have to meet the resource limits in subsection (8)(b) of this section.



[]



NEW SECTION



WAC 388-470-0010  How to determine who owns a resource. Unless specifically stated, this section applies to all cash, TANF-related medical and food assistance programs. (1) A client owns a resource when the client holds the title to real or personal property or has possession of the property but there is no title.

(2) A client may provide evidence to clarify ownership when doubt exists about:

(a) Ownership (full or partial);

(b) Legal control; or

(c) Value.

(3) Community property is an available resource unless the client can provide proof to the contrary.

(4) Real or personal property is considered to be community property when it is in the name of either the husband or wife or both and can be disposed of by either of them.

(5) For cash assistance, community property owned by the husband or wife or both will be used to determine eligibility for the assistance unit, regardless that one or both are clients.

(6) Resources are considered separate property rather than community property when the property was:

(a) Acquired and paid for by either spouse before marriage;

(b) Acquired and paid for entirely out of income from separate property; or

(c) Received by one of the spouses as a gift or inheritance.

(7) Property is no longer considered separate when both community and separate properties are used to purchase or improve real or personal property.



[]



NEW SECTION



WAC 388-470-0015  Availability of resources. (1) A resource is considered available when a cash, TANF/SFA-related medical or food assistance program client has:

(a) Actual title;

(b) Control over and can legally dispose of it; and

(c) The ability to transfer it to a buyer or convert it into cash.

(2) Only resources that are actually available will affect eligibility. However, for cash assistance only, the client must take reasonable action to make the resource available.

(3) A client may provide evidence that a resource is unavailable.

(4) For medical programs a resource is considered unavailable when the client or spouse:

(a) Does not own the resource;

(b) Does not have the authority to convert the resource to cash;

(c) Is legally restricted from using the resources for the person's support and maintenance;

(d) Cannot convert the resource to cash within twenty work days; and

(e) Makes a reasonable effort to convert noncash resources to cash.

(5) Resources of persons residing in a shelter for battered women and children are not considered available when:

(a) The resource is owned jointly with members of the former household; and

(b) Availability of the resource depends on an agreement of the joint owner.



[]



NEW SECTION



WAC 388-470-0020  Excluded resources. Resources that do not count toward a cash, medical or food assistance client's resource limit are:

(1) Burial plot:

(a) For cash assistance and TANF/SFA-related medical programs other than SSI-related, one burial plot for each assistance unit member is excluded.

(b) For food assistance, one burial plot for each assistance unit member including ineligible members is excluded.

(c) For SSI-related medical the limits are described in WAC 388-470-0040 (14) and (15).

(2) Energy assistance payments;

(3) Household goods such as furniture;

(4) Noncash Resources are excluded for categorically needy (CN) and medically needy (MN) medical programs when the client:

(a) Cannot convert the noncash resource to cash within twenty work days; and

(b) Makes an ongoing attempt to convert the noncash resources to cash.

(5) Personal items such as clothing is excluded. For cash assistance programs, personal property of "great sentimental value" can be excluded due to personal attachment or hobby interest, without consideration to its value;

(6) The value of a sales contract is excluded for TANF-related medical. Sales contracts for SSI-related medical are described in WAC 388-470-0040;

(7) Resources excluded by federal law;

(8) Trust accounts when not available to the assistance unit except as specified in WAC 388-470-0015(2).



[]



NEW SECTION



WAC 388-470-0025  Excluded resources. The following resources do not count toward the resource limits:

(1) Adoption support payments when the adopted child is excluded from the assistance unit.

(2) Bona fide loans which means the loan is a debt a client owes and has an obligation to repay.

(3) Earned income tax credit in the month received and the following month.

(4) For cash assistance only, excess real property on which a client is not living:

(a) When, for a period not to exceed nine months, a client:

(i) Makes a good-faith effort to sell the excess property; and

(ii) Signs an agreement to repay the amount of benefits received or the net proceeds of the sale, whichever is less.

(b) Upon cash assistance approval, the agreement to repay is sent to office of financial recovery to file a lien without a specified amount; or

(c) Is used in a self-employment enterprise and meets the criteria in subsection (10) of this section.

(5) Food coupon allotment from the food assistance programs.

(6) Food service payments provided for children under the National School Lunch Act of 1966, PL 92-433 and 93-150.

(7) Foster care payments provided under Title IV-E, State or Local foster care maintenance payments.

(8) Housing and Urban Development (HUD) community development block grant funds.

(9) Income tax refunds are excluded in the month the refund is received.

(10) A bank account jointly owned with an SSI recipient when SSA counted the funds to determine the SSI recipient's eligibility.

(11) Real and personal property used in a self-employment enterprise if:

(a) The property is necessary to restore the client's independence or will aid in rehabilitating the client or the client's dependents; and

(b) The client has signed an agreed plan with the department.

(12) Retroactive cash benefits or TANF benefits resulting from a court order modifying a department policy.

(13) Self-employment-accounts receivable that a client bills to the client's customer but has been unable to collect.

(14) SSI recipient's income and resources.



[]



NEW SECTION



WAC 388-470-0030  Excluding a home as a resource. (1) For cash and TANF-related medical assistance programs a home with a reasonable amount of surrounding property is excluded when the home is owned and used as a resident by the client or the client's dependents.

(2) If a client and his or her dependents are absent from the home for more than ninety consecutive days, the total value of the home will count toward the resource limit, unless the absence is due to:

(a) Hospitalization; or

(b) Other health reasons; or

(c) A natural disaster.

(3) If the absence is due to hospitalization or other health reasons the client may be absent for more than ninety days and continue to have the home excluded as a resource when:

(a) At least one of three physicians provides a written statement that in their medical opinion, the client can return to the home during the client's lifetime; or

(b) The home continues to be occupied by a spouse or dependent children or children with disabilities.

(4) If the absence is due to a natural disaster the client may be absent for more than ninety days and continue to have the home excluded as a resource when:

(a) The home is not fit to live in; and

(b) The home will become fit to live in with reasonable effort and expense to the client.



[]



NEW SECTION



WAC 388-470-0035  Excluded resources for food assistance. The following resources do not count toward a client's resource limit.

(1) Earned income tax credit is excluded:

(a) In the month it is received and the following month if the person was not a food assistance recipient when the credit was received; or

(b) For twelve months when the person:

(i) Was a food assistance recipient when the credit was received; and

(ii) Remains a food assistance recipient continuously during this period.

(2) Essential property needed for employment or self-employment of a household member is excluded. Property excluded under this section and used by a self-employed farmer or fisher retains its exclusion for one year after the household member stops farming or fishing.

(3) Excluded funds that are deposited in a bank account with countable funds continue to be excluded up to six months from the date of deposit.

(4) Governmental disaster payments to repair a damaged home when the household can be sanctioned if the funds are not used for this purpose.

(5) A home a client is living in including the surrounding property that is not separated by property owned by others is excluded. Public right of ways do not affect this exclusion;

(6) A home that the household is not living in and surrounding property is excluded if the household:

(a) Is making a good faith effort to sell; or

(b) Is planning to return to the home and it is not occupied due to:

(i) Employment;

(ii) Training for future employment;

(iii) Illness; or

(iv) Unlivable conditions caused by a natural disaster or casualty.

(7) Indian lands that are held jointly by the tribe or can be sold only with the approval from the Bureau of Indian Affairs (BIA) are excluded;

(8) Installment contracts:

(a) Installment contracts or agreements for the sale of land or property are excluded when they are producing income consistent with their fair market value;

(b) Value of property sold under an installment contract or held for security is excluded if the purchase price is consistent with fair market value.

(9) Insurance policies and pension funds:

(a) Cash value of life insurance policies and pension funds (excluding IRAs and Keogh Plans) are excluded.

(b) Prepaid burial plans are excluded when the plan:

(i) Is death insurance as opposed to a bank account; and

(ii) Requires repayment for allowable withdrawals.

(10) Land. Where a client plans to build a permanent home or is excluded where their property is not separated by land owned by others. The land is countable if the assistance unit owns another home.

(11) A resource is excluded when it is owned by an assistance

unit member who receives TANF/SFA or SSI.

(12) Resources that are owned by persons who are not members of the household are excluded.

(13) A resource is excluded when, if it is sold, would only result in a gain to the household of one-half of the applicable resource limit as defined under WAC 388-470-0005. The resource must be something other than stocks, bonds, negotiable financial instruments, or a vehicle.

(14) Prorated income for self-employed persons or ineligible students. These monies retain their exclusion for the period of time the income is prorated even when commingled with other funds.

(15) Real or personal property when:

(a) It produces yearly income that is equal to its fair market value even when used only on a seasonal basis;

(b) Secured by a lien for a business loan and the lien prevents the household from selling it; or

(c) It is directly related to the maintenance or use of a vehicle excluded in WAC 388-470-0075.



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NEW SECTION



WAC 388-470-0040  Additional excluded resources for SSI-related medical assistance. In addition to other SSI-related resource exclusions in this chapter the resources in this section are excluded when a client's eligibility for SSI-related medical assistance is determined.

(1) A client's household goods and personal effects are excluded.

(2) One home, which may be any shelter in which the client has ownership interest, is excluded when:

(a) The client uses the home as the principal place of residence;

(b) The client's spouse resides in the home; or

(c) The client does not currently live in the home and the client:

(i) Intends to return to the home; and

(ii) Provides the department with an oral or written statement of their intent to return; or

(d) A relative resides in the home when:

(i) The relative is financially or medically dependent on the client; and

(ii) The client or dependent relative provides the department with a written statement of the dependency.

(3) Proceeds, including cash or a sales contract, from the sale of the home described in subsection (2) of this section are excluded when the client purchases another home within three months of receipt of the proceeds of the sale. Only the portion of the sales contract payment which represents interest is counted as unearned income. See WAC 388-450-0040.

(4) The value of a sales contract is excluded:

(a) When the current market value of the contract is zero or the contract is unsalable; or

(b) When combined with other resources, it exceeds the resource limit, and the sales contract was executed:

(i) On or before November 30, 1993; or

(ii) On or after December 1, 1993, and:

(A) Was received as compensation for the sale of the client's principle place of residence;

(B) Provides interest within the prevailing interest rate at the time of the sale;

(C) Requires the repayment of a principal amount equal to the fair market value of the property; and

(D) Payment on the amount owed does not exceed thirty years.

The income a client receives which represents the principle and interest portion of a sales contract meeting the definition of this subsection is counted as unearned income. See WAC 388-450-0040.

(5) A sales contract is a nonexcluded resource when:

(a) It does not meet the conditions in subsection (4); or

(b) The client transferred it to someone other than the client's spouse. See WAC 388-513-1365.

(6) When a client owns a sales contract as described in subsection (5), the portion of the payment which represents the:

(a) Principle is counted as an available resource; and

(b) Interest is counted as unearned income.

(7) The equity value of one vehicle up to five thousand dollar is excluded. The five thousand dollars limitation does not apply when the client or a member of the client's household, uses the vehicle which is:

(a) Necessary for employment; or

(b) Necessary for the treatment of specific or regular medical problem; or

(c) Modified for operation by, or transportation of, a person with disabilities; or

(d) Necessary due to climate, terrain, distance, or similar factors to provide the client transportation to perform essential daily activities.

(8) Property which is essential to self-support is excluded when:

(a) The client uses the property for an income producing activity:

(i) In a trade or business; or

(ii) As an employee for work.

(b) The client uses nonbusiness property with a value up to six thousand dollars in equity, to produce:

(i) Goods or services essential to daily activities, solely for the client's household;

(ii) An annual income return of six percent or more of the exempt equity; or

(iii) A six percent return within a twenty-month period when the client uses the property, or is expected to resume using the property within twelve months, for the activities described in this subsection.

(9) Resources necessary for a client, who is blind or disabled, to enable them to fulfill an approved self-sufficiency plan are excluded.

(10) Alaska Native Claims Settlement Act benefits are excluded, including:

(a) Shares of stock held in a regional or village corporation;

(b) Cash or dividends on stock received from a native corporation up to two thousand dollars per person per year;

(c) Stock issued by a native corporation as a dividend;

(d) A partnership interest;

(e) Land or an interest in land; and

(f) An interest in a settlement trust.

(11) The total cash surrender value (CSV) of a life insurance policy or policies when the total face value of all policies held by the client is fifteen hundred dollars or less are not counted. The CSV of a client's policies in excess of fifteen hundred dollars is applied to the client's resource limit as described in WAC 388-478-0070 and 388-478-0080.

(12) Restricted allotted land owned by an enrolled tribal member and spouse, if the land cannot be disposed of without the permission of the other person, the tribe, or an agency of the federal government is not counted.

(13) A settlement the client receives for the purpose of repairing or replacing a specific excluded resource is not counted for a period of:

(a) Nine months when the client uses the total amount of the cash to repair or replace the excluded resource;

(b) Nine additional months when:

(i) Circumstances beyond the control of the client prevent the repair or replacement of the excluded resource; and

(ii) The client uses the total amount of the cash to repair or replace the excluded resource.

(c) Twelve additional months, for a maximum of thirty months, when:

(i) The settlement is a result of a catastrophe which is declared a major disaster by the President of the United States;

(ii) The excluded resource is geographically within the disaster area as defined by the presidential order;

(iii) The client intends to repair or replace the excluded resource; and

(iv) Circumstances beyond the control of the client prevented the repair or replacement of the excluded resource in the time frames described under subsection (13)(a) and (b) of this section.

(d) Except, any settlement excluded and not used within the allowable time period as described under this subsection as an available resource.

(14) Burial spaces for the client and any member of the client's immediate family, as described in subsection (16) are not counted. Burial spaces include:

(a) Conventional grave sites;

(b) Crypts;

(c) Mausoleums; or

(d) Urns and other repositories customarily used for the remains of deceased persons.

(15) A burial space purchase agreement is also defined as a burial space. The value of the purchase agreement is excluded, as well as any interest accrued on the purchase agreement, which is left to accumulate as part of the value of the burial space purchase agreement.

(16) Immediate family, for purposes of subsection (14) of this section includes the client's:

(a) Spouse;

(b) Minor and adult children, including adopted and stepchildren;

(c) Siblings;

(d) Parents and adoptive parents;

(e) Spouses of any of the above.

None of the family members listed above need to be dependent upon or living with the client, to be considered immediate family members.

(17) The following types of burial funds are excluded as resources:

(a) Up to fifteen hundred dollars each for a client or a client's spouse when funds are specifically set aside solely for burial expenses;

(b) A revocable burial contract, burial trust, cash, account, or other financial instrument with a definite cash value; and

(c) Any interest earned and appreciation in the value of excluded burial funds when left to accumulate and become part of the burial fund.

(18) Funds which a client has specifically set aside solely for burial expenses, as described in subsection (17) of this section are funds which:

(a) Are kept separate from all other resources except nonexcluded funds the client intends to use solely for burial related items or services and identified as a burial fund; and

(b) May be designated as burial funds back to the first day of the month in which the person intended the funds to be set aside for burial.

(19) The limitation described under subsection (17)(a) of this section is reduced by:

(a) The face value of insurance polices owned by the client or spouse if the policies have been excluded as provided in subsection (11) of this section; and

(b) Amounts in an irrevocable burial trust.

(20) A client's burial funds lose excluded status when:

(a) They are mixed with other resources; or

(b) The burial funds, interest, or appreciated values are used for other purposes. These funds are then considered available income:

(i) On the first of the month of use; if

(ii) When added to other nonexcluded resources, the amount exceeds the resource limit as described in WAC 388-478-0080.

(21) All resources specifically excluded by federal statute are not counted.

(22) Retroactive SSI payments, including benefits a client receives under the interim assistance reimbursement agreement with the Social Security Administration, or Social Security Disability Insurance (OASDI) payments are excluded for six months following the month of receipt. This exclusion applies to:

(a) Payments received by the client, spouse, or any other person the client is financially responsible for;

(b) SSI payments made to the client for benefits due for a month before the month of payment;

(c) OASDI payments made to the client for benefits due for a month that is two or more months before the month of payment; and

(d) Payments held as cash, in a checking account, or in a saving account. This exclusion does not apply once the payments have been converted to any other type of resource.

(23) Cash payments an SSI recipient receives from a medical or social service agency to pay for medical or social services are excluded for one calendar month following the month of receipt.

(24) Payments from the Dutch government under the Netherlands' Act on Benefits for Victims of Persecution (WUV) are excluded. Interest earned on these payments is counted as unearned income as specified under chapter 388-450 WAC.

(25) Payments to survivors of the Holocaust under the Federal Republic of Germany's Law for Compensation of National Socialist Persecution or German Restitution Act are excluded. Interest earned on these payments is counted as unearned income as specified under chapter 388-450 WAC.

(26) Earned income tax credit refunds and payments are excluded as resources during the month of receipt and the following month.

(27) Payments from a state administered victim's compensation program are excluded for a period of nine calendar months after the month of receipt.

(28) Payments under section 500 through 506 of the Austrian General Social Insurance Act are not counted as a resource or income when a client's eligibility or post-eligibility (for institutionalized clients) is determined. A post-eligibility determination is the process of determining a client's share of the cost of institutional or waivered services care.

Any interest earned on the payments in this subsection is counted as unearned income as specified under WAC 388-450-0025.

(29) Payments from Susan Walker v. Bayer Corporation, et al., 96-c-5024 (N.D. Ill.) (May 8, 1997) settlement funds are excluded. Any interest earned on these payments is counted as unearned income as specified under WAC 388-450-0025.

(30) Cash received from the sale of an excluded resource is not counted when it is:

(a) Used to replace an excluded resource; or

(b) Invested in an excluded resource within the same month, unless specified differently under this section.



[]



NEW SECTION



WAC 388-470-0045  Resources that are counted toward the resource limits for cash, food assistance and TANF-related medical programs. (1) The following resources are counted toward the resource limits for cash, food assistance and TANF-related medical programs:

(a) Liquid resources such as cash on hand, monies in checking or savings accounts;

(b) Motor home when not used as a residence; or

(d) Stocks or bonds minus any early withdrawal penalty.

(2) A resource owned with a person other than a spouse, contract vendor, mortgage or lien holder (jointly owned) is counted as follows:

(a) For cash assistance and TANF-related medical, the client's share of the equity value; or

(b) For food assistance, resources jointly owned by separate assistance units are considered available in their entirety to each assistance unit.

(3) A client may provide evidence that all or a portion of a jointly owned resource:

(a) Belongs to the other owner; and

(b) Is held for the benefit of the other owner.



[]



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.



NEW SECTION



WAC 388-470-0050  Resources that count. Unless otherwise specified the following resources count toward a cash or TANF-related medical assistance unit's resource limit:

(1) Burial insurance and term insurance: The cash surrender value in excess of fifteen hundred dollars.

(2) Child's irrevocable educational trust: Trust funds in excess of four thousand dollars per child.

(3) Life insurance: The cash surrender value of life insurance policies.

(4) Sales contracts, real estate mortgages, security interest: With the exception of sales contracts for the purposes of TANF-related medical, countable cash discount values.

(5) Savings accounts: For recipient's only, value in excess of three thousand dollars.



[]



NEW SECTION



WAC 388-470-0055  Resources that are counted for food assistance. The following resources are counted toward an assistance unit's resource limit:

(1) Excluded funds that are deposited in an account with countable funds (commingled) for more than six months from the date of deposit.

(2) Lump sums such as insurance settlements, refunded cleaning and damage deposits.

(3) Resources of ineligible household members, as described in WAC 388-408-0035(9).



[]



NEW SECTION



WAC 388-470-0060  Resources of an alien's sponsor. (1) Resources of a sponsor and the spouse who lives with the sponsor affects the eligibility of an alien for three years from the alien's date of entry into the U.S.

(2) A sponsor is any person or organization that signed an affidavit of support on behalf of the alien to allow the alien entry for permanent residence.

(3) The sponsor's countable resources are determined by:

(a) Totaling the countable resources of the sponsor and the sponsor's spouse (if they are living together); and

(b) Subtracting fifteen hundred dollars.

(4) Subsection (3) above does not apply when:

(a) The alien is receiving cash or food assistance as a member of the sponsor's assistance unit;

(b) An alien is sponsored by an organization; or

(c) An alien is not required to have a sponsor.

(5) The sponsor's countable resources are counted towards the alien's resource limit until:

(a) The three year time period expires; or

(b) The sponsor dies.

(6) For medical programs, the resources of the sponsor are excluded resources unless:

(a) The sponsor is a member of the alien's assistance unit; or

(b) The sponsor actually contributes resources to the alien's assistance unit.



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NEW SECTION



WAC 388-470-0065  Individual development accounts for TANF recipients. (1) A TANF recipient's individual development account (IDA) established under RCW 74.08A.220 is excluded when determining TANF eligibility.

(2) When a TANF recipient withdraws funds from an IDA, for a purpose other than specified in RCW 74.08A.220, the funds are a countable resource, as specified under WAC 388-470-0015(2).



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NEW SECTION



WAC 388-470-0070  How vehicles are counted toward the resource limit for cash assistance and TANF/SFA-related medical. (1) A vehicle is any device for carrying persons and objects by land, water, or air.

(2) The entire value of a licensed vehicle needed to transport a physically disabled assistance unit member is excluded.

(3) The equity value of one vehicle up to five thousand dollars is excluded when the vehicle is used by the assistance unit or household as a means of transportation. Each separate medical assistance unit is allowed this exclusion.



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NEW SECTION



WAC 388-470-0075  How vehicles are counted for food assistance. (1) The entire value of a licensed vehicle even during periods of temporary unemployment is excluded if the vehicle is:

(a) Used over fifty percent of the time for income-producing purposes. An excluded vehicle used by a self-employed farmer or fisher retains its exclusion for one year from the date the household member ends this self-employment.

(b) Used to produce income annually that is consistent with its fair market value (FMV).

(c) Necessary for long-distance travel that is essential to the employment of an assistance unit member whose resources are considered available to the assistance unit. Vehicles needed for daily commuting are not excluded under this provision.

(d) Necessary for hunting or fishing to support the household.

(e) Used as the assistance unit's home.

(f) Used to carry fuel for heating or water for home use when this is the primary source of fuel or water for the assistance unit.

(g) Needed to transport a temporarily or permanently physically disabled household member.

(2) The FMV in excess of four thousand six hundred fifty dollars is counted toward the assistance unit's resource limit for the following licensed vehicles if not excluded in subsection (1) above:

(a) One per assistance unit regardless of use;

(b) Used for transportation to and from work, training, or education; or

(c) Used for seeking employment.

(3) For all other licensed vehicles, the larger value of the following is counted toward the assistance unit's resource limit:

(a) FMV in excess of four thousand six hundred fifty dollars; or

(b) Equity value.

(4) Unlicensed vehicles driven by tribal members on the reservation are treated like a licensed vehicle.

(5) For unlicensed vehicles the equity value is counted towards the assistance unit's resource limit unless the vehicle is:

(a) Used to produce income annually that is consistent with its FMV even if used on a seasonal basis; or

(b) Work-related equipment necessary for employment or self-employment of an assistance unit member.



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NEW SECTION



WAC 388-470-0080  Compensatory award or related settlement lump sum payments. This section applies to cash and TANF-related medical assistance programs. (1) A nonrecurring lump sum compensatory award or related settlement payment is excluded as a resource for the month payment was received.

(a) Compensatory awards are court awarded payments for wrongful death, personal injury, damage or loss of property.

(b) Related settlements are payments awarded without court intervention for wrongful death, personal injury, damage or loss of property.

(2) The portion of the compensatory award or related settlement payment received for repair or replacement of damaged or lost property or for medical bills is excluded as a resource for sixty days from the end of the month the payment was received.

(3) Any portion of the payment described under subsection (2) of this section is treated as an available resource when not used within sixty days from the month the payment was received.

(4) On the first of the month following receipt of the payment, the portion of the lump sum not excluded under subsection (1) of this section, is added to the client's existing resource value.

(a) If the client's total resource value is more than the resource limit, the client is not eligible for cash benefits beginning the first of the month following the month the payment was received.

(b) If the client's total resource value is less than the resource limit, the client is eligible for continued cash benefits, provided the client did not transfer the lump sum funds for less than adequate consideration as described in WAC 388-488-0005.



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SHS-2377:5

Chapter 388-472 WAC



RIGHTS AND RESPONSIBILITIES



NEW SECTION



WAC 388-472-0005  Rights and responsibilities. Unless specifically stated, the following rules apply to cash, food and medical assistance programs.

(1) A person who applies for or receives public assistance has the right to:

(a) Be treated politely and fairly without regard to race, color, creed, political affiliation, national origin, religion, age, sex, disability, birthplace, or marital status;

(b) File an application on the same day, during regular business hours, that the person contacts the department. A client has the right to get a receipt when leaving an application or other materials with the department;

(c) Have an application promptly accepted and promptly acted upon;

(d) Ask that the application be processed without delay if the person is experiencing an emergency such as having no money for food, facing an eviction, needing medical care that cannot wait or being pregnant. If a pregnant client requests an interview, she has a right to have one within five working days;

(e) Get a written decision in most cases within thirty days. Medical and some disability cases may take forty-five to sixty days. Food stamps will be authorized within thirty days if the person is eligible. If the person is eligible and has little or no money, food stamps will be authorized within five days;

(f) Be fully informed, in writing, of all legal rights and responsibilities in connection with public assistance;

(g) Have information kept private. The department may share some facts with other agencies for efficient management of federal and state programs;

(h) For cash and medical assistance programs, ask the department not to collect child support if the absent parent may harm the person or person's child;

(i) For cash assistance programs, ask for extra money to help in an emergency, such as an eviction or a utility shutoff;

(j) Get a written notice, in most cases, at least ten days before the department makes changes to lower or stop benefits;

(k) Ask for a fair hearing if the person does not agree with the department about a decision. Without affecting the right to a fair hearing, the person can also ask a supervisor or administrator to review an employee decision or action;

(l) Have interpreter or translator services at no cost or undue delay;

(m) Refuse to speak to a fraud early detection (FRED) investigator from the division of fraud investigations. The person does not have to let an investigator into the home. The person may ask the investigator to come back at another time. Such a request will not affect the person's eligibility for benefits;

(n) For medical assistance programs only: A person applying for or receiving medical assistance, limited casualty programs, medical care services, or children's health services has the same rights as cash assistance clients; and

(o) Receive help from the department to register to vote.

(2) A client is responsible for:

(a) Reporting any changes to the department within ten days for all cash and food assistance programs and twenty days for all medical assistance programs;

(b) Giving all the facts needed to determine eligibility;

(c) Giving the department proof of any facts for which proof is needed;

(d) For most cash or medical assistance programs related to children, cooperating with the department to get child support or medical care support unless it can be shown that harm to the person or child may occur;

(e) For cash or medical assistance programs, applying for and taking any benefits from other programs, if eligible;

(f) Completing reports and reviews when asked to do so;

(g) Seeking and taking a job or training if required; and

(h) For medical assistance programs only, showing the medical identification card or other adequate department generated notification of eligibility to the medical care provider.

(3) Clients will be screened and provided with necessary supplemental accommodation as specified under WAC 388-200-1300.



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SHS-2438:5

Chapter 388-474 WAC



SUPPLEMENTAL SECURITY INCOME



NEW SECTION



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

(2) The SSI program replaced state programs for aged, blind and disabled persons beginning in January, 1974. Persons who received state assistance in December, 1973, as aged, blind or disabled or were needed in the home to care for an eligible person, automatically became eligible for SSI in January, 1974.

(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.



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NEW SECTION



WAC 388-474-0005  Medical coverage. (1) An SSI recipient qualifies for categorically needy (CN) medical coverage without a medical determination, except when the SSI recipient:

(a) Refuses to provide private medical insurance information or 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.

(2) A person designated as an essential person in January, 1974, qualifies for CN medical coverage as long as they continue to reside with the SSI recipient.

(3) The spouse of an SSI recipient designated as 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.



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NEW SECTION



WAC 388-474-0010  Eligibility for other programs. (1) The spouse of an SSI recipient is not eligible for the state supplement for an ineligible spouse when they are authorized for TANF.

(2) The spouse of an eligible SSI recipient qualifies for inclusion in the SSI grant and is not eligible for general assistance benefits.



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NEW SECTION



WAC 388-474-0015  Termination of SSI. (1) A person terminated from SSI cash assistance will have CN medical coverage continued 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 medical coverage is continued until 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 medical coverage for a period of up to one hundred twenty days from the date of termination of SSI cash benefits while eligibility for other cash or medical programs is being determined.

(3) A terminated SSI or SSI-related client will have their disability redetermined under certain conditions. These conditions are:

(a) The person presents new medical evidence;

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

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

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



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NEW SECTION



WAC 388-474-0020  Duplicate assistance and overpayments. (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 sign DSHS 18-235(X), interim assistance reimbursement agreement (IARA) as a condition of eligibility for assistance.

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



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SHS-2379:5

Chapter 388-476 WAC



SOCIAL SECURITY NUMBER



NEW SECTION



WAC 388-476-0005  Social Security Number requirements. (1) With certain exceptions, each person who applies for or receives cash, medical or food assistance benefits must provide to the department a Social Security Number (SSN), or numbers if more than one has been issued.

(2) If the person is unable to provide the SSN, either because it is not known or has not been issued, the person must:

(a) Apply for the SSN;

(b) Provide proof that the SSN has been applied for; and

(c) Provide the SSN when it is received.

(3) Assistance will not be delayed, denied or terminated pending the issuance of an SSN by the Social Security Administration. However, a person who does not comply with these requirements is not eligible for assistance.

(4) For food assistance programs:

(a) A person can receive benefits for the month of application and the following month if the person attempted to apply for the SSN and made every effort to provide the needed information to the Social Security Administration.

(b) A newborn may receive benefits for up to six months from the date of birth if the household is unable to provide proof of application for an SSN at the time of birth.

(5) For medical programs, a newborn as described in WAC 388-505-0210(1) is eligible for categorically needy (CN) medical without meeting the SSN requirement. These coverage provisions continue until one of the following occurs:

(a) The newborn leaves the household of the birth mother; or

(b) The newborn's first birthday.

(6) There is no SSN requirement for the following programs:

(a) The consolidated emergency assistance program;

(b) The refugee cash and medical assistance program;

(c) The medically indigent program;

(d) The alien emergency medical program;

(e) The state-funded pregnant woman program;

(f) The children's health program; and

(g) Detoxification services.



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Chapter 388-478 WAC



STANDARDS FOR PAYMENTS



NEW SECTION



WAC 388-478-0005  Cash assistance need and payment standards and grant maximum. (1) Need standards for cash assistance programs represent the amount of income required by individuals and families to maintain a minimum and adequate standard of living. Need standards are based on assistance unit size and include basic requirements for food, clothing, shelter, energy costs, transportation, household maintenance and operations, personal maintenance, and necessary incidentals.

(2) Payment standards for assistance units in medical institutions and other facilities are based on the need for clothing, personal maintenance, and necessary incidentals (see WAC 388-478-0040 and 388-478-0045).

(3) Need and payment standards for persons and families who do not reside in medical institutions and other facilities are based on their obligation to pay for shelter.

(a) Eligibility and benefit levels for persons and families who meet the requirements in WAC 388-478-0010 are determined using standards for assistance units with an obligation to pay shelter costs.

(b) Eligibility and benefit levels for all other persons and families are determined using standards for assistance units who have shelter provided at no cost.

(c) For recent arrivals to Washington state who apply for temporary assistance for needy families (TANF), see WAC 388-478-0025.

(4) The monthly grant for an assistance unit containing eight or more persons cannot exceed the grant maximum of one thousand seventy-five dollars.



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NEW SECTION



WAC 388-478-0010  Households with obligations to pay shelter costs. The monthly need and payment standards for cash assistance are based on a determination of assistance unit size and whether the assistance unit has an obligation to pay shelter costs.

Eligibility and benefit level is determined using standards for assistance unit with obligations to pay shelter costs if the assistance unit:

(1) Owns, purchases or rents its place of residence, even if costs are limited to property taxes, fire insurance, sewer, water, or garbage;

(2) Resides in a lower income housing project which is funded under the United States Housing Act of 1937 or Section 236 of the National Housing Act, if the household either pays rent or makes a utility payment in lieu of a rental payment; or

(3) Is homeless. Homeless households include persons or families who:

(a) Lack a fixed, regular, and adequate nighttime residence; or

(b) Reside in a public or privately operated shelter designed to provide temporary living accommodations; or

(c) Live in temporary lodging provided through a public or privately funded emergency shelter program.



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NEW SECTION



WAC 388-478-0015  Cash assistance need standards. (1) The cash assistance need standards (and one hundred eighty-five percent of the need standards) for assistance units with obligations to pay shelter costs are:

Assistance Unit Size Need Standard 185% Assistance Unit Size Need Standard 185%
1 $ 795 $1,471 6 $1,914 $3,540
2 1,005 1,860 7 2,210 4,088
3 1,244 2,302 8 2,446 4,525
4 1,463 2,707 9 2,686 4,969
5 1,686 3,119 10 or more 2,919 5,400

(2) The cash assistance need standards (and one hundred eighty-five percent of the need standards) for assistance units with shelter provided at no cost are:

Assistance Unit Size Need Standard 185% Assistance Unit Size Need Standard 185%
1 $ 478 $ 884 6 $1,152 $2,131
2 605 1,119 7 1,332 2,460
3 749 1,386 8 1,472 2,723
4 880 1,628 9 1,617 2,991
5 1,014 1,876 10 or more 1,757 3,250




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NEW SECTION



WAC 388-478-0020  Payment standards for TANF, SFA, GA-S, GA-H and RCA. (1) The payment standards for temporary assistance for needy families (TANF), state family assistance (SFA), general assistance for pregnant women (GA-S), general assistance for children (GA-H) and refugee cash assistance (RCA) assistance units with obligations to pay shelter costs are:
Assistance Unit Size Payment Standard Assistance Unit Size Payment Standard
1 $349 6 $ 841
2 440 7 971
3 546 8 1,075
4 642 9 1,180
5 740 10 or more 1,283

(2) The payment standards for TANF, SFA, GA-S, GA-H and RCA assistance units with shelter provided at no cost are:
Assistance Unit Size Payment Standard Assistance Unit Size Payment Standard
1 $212 6 $ 511
2 268 7 591
3 332 8 654
4 391 9 718
5 451 10 or more 780





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NEW SECTION



WAC 388-478-0025  TANF payment standards for recent arrivals to Washington state. (1) Eligibility and benefit levels for temporary assistance for needy families (TANF) clients are determined according to length of residency and payment standard requirements established under RCW 74.08.025 (amended in section 101, chapter 58, Laws of 1997).

(2) The length of residency requirement does not apply to a dependent child who lives with a caretaker relative if the relative has resided in Washington for twelve or more consecutive months prior to applying for TANF benefits for the child.



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NEW SECTION



WAC 388-478-0030  Payment standards for GA-U and ADATSA. (1) The payment standards for general assistance - unemployable (GA-U) and alcohol and drug addiction treatment and support act (ADATSA) program assistance units with obligations to pay shelter costs are:

Assistance Unit Size Payment Standard
1 $ 339
2 428

(2) The payment standards for GA-U and ADATSA assistance units with shelter provided at no cost are:

Assistance Unit Size Payment Standard
1 $ 206
2 261




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NEW SECTION



WAC 388-478-0035  Maximum earned income limits for TANF and SFA. To be eligible for temporary assistance for needy families (TANF) or state family assistance (SFA), a family's gross earned income must be below the following levels:

Number of Family Members Maximum Earned Income Level Number of Family Members Maximum Earned Income Level
1 $ 698 6 $1,682
2 880 7 1,942
3 1,092 8 2,150
4 1,284 9 2,360
5 1,480 10 or more 2,566




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NEW SECTION



WAC 388-478-0040  Payment standard for persons in medical institutions. (1) "Medical institutions" include skilled nursing homes, public nursing homes, general hospitals, tuberculosis hospitals, intermediate care facilities, and psychiatric hospitals approved by the joint commission on accreditation of hospitals (JCAH).

(2) The monthly payment standard for eligible persons in medical institutions is forty-one dollars and sixty-two cents. The payment covers the person's need for clothing, personal maintenance, and necessary incidentals (CPI).



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NEW SECTION



WAC 388-478-0045  Payment standard for persons in certain group living facilities. (1) A monthly grant payment of thirty-eight dollars and eighty-four cents will be made to eligible persons in the following facilities:

(a) Congregate care facilities (CCF);

(b) Adult residential rehabilitation centers/adult residential treatment facilities (AARC/ARTF); and

(c) Division of developmental disabilities (DDD) group home facilities.

(2) The payment covers the person's need for clothing, personal maintenance, and necessary incidentals (CPI).



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NEW SECTION



WAC 388-478-0050  Payment standards for recurring additional requirements. Payment standards for recurring additional requirements approved under WAC 388-255-1050 through 388-255-1300:

(1) Restaurant meals: $187.09 per month (or $6.04 per day with the payment rounded down to the nearest dollar amount);

(2) Laundry: $11.13 per month;

(3) Guide dog or service animal food: $33.66 per month;

(4) Home delivered meals: The amount charged by the agency providing the meals;

(5) Telephone: The minimum residential rate for the area; or the discounted amount established under the Washington telephone assistance program (WTAP), whichever is less;

(6) Winterizing homes: A maximum of $500.



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NEW SECTION



WAC 388-478-0055  SSI standards. (1) Supplemental Security Income (SSI) is a 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 supplemental the federal benefit level with state funds, known as the SSI state supplement. Persons found eligible for SSI receive cash assistance based on the combined federal and state supplement benefit levels, minus countable income.

(2) Effective January 1, 1998, the federal, state and combined benefit levels for an eligible individual and couple are:

(a) Area I: King, Pierce, Snohomish, Thurston, and Kitsap Counties.

(i) Living alone (own household or alternate care, except nursing homes or medical institutions.

living alone Federal Benefit Level State Supplement Benefit Level Combined Federal/State Benefit Level
Individual $494.00 $27.00 $521.00
Individual with One Essential Person1 $741.00 $21.00 $762.00
Couple, both Eligible $741.00 $21.00 $762.00
Couple with One Essential Person2 $741.00 $21.00 $762.00
Couple includes Ineligible Spouse $494.00 $167.20 $661.20

(ii) Shared living (supplied shelter).

shared living Federal Benefit Level State Supplement Benefit Level Combined Benefit Level
Individual $329.34 $4.81 $334.15
Individual with One Essential Person3 $494.00 $5.30 $499.30
Couple, Both Eligible $494.00 $5.30 $499.30
Couple includes One Essential Person4 $494.00 $5.30 $499.30
Couple includes Ineligible Spouse $329.34 $102.76 $432.10

(b) Area II: All counties other than the above.

(i) Living alone (own household or alternate care, except nursing homes or medical institutions).

living alone Federal Benefit Level State Supplement Benefit Level Combined Federal/State Benefit Level
Individual $494.00 $6.55 $500.55
Individual with One Essential Person1 $741.00 $0 $741.00
Couple, Both Eligible $741.00 $0 $741.00
Couple with One Essential Person2 $741.00 $0 $741.00
Couple includes Ineligible Spouse $494.00 $137.25 $631.25

(ii) Shared living (supplied shelter).

shared living Federal Benefit Level State Supplement Benefit Level Combined Benefit Level
Individual $329.34 $4.81 $334.15
Individual with One Essential Person3 $494.00 $5.30 $499.30
Couple, Both Eligible $494.00 $5.30 $499.30
Couple includes One Essential Person4 $494.00 $5.30 $499.30
Couple includes Ineligible Spouse $329.34 $102.76 $432.10

(c) Residing in a medical institution: Area I and II
medical institution Federal Benefit Level State Supplement Benefit Level Combined Benefit Level
Individual $30.00 $11.62 $41.62

(d) Mandatory income level (MIL) for grandfathered claimant. "Grandfathered" refers to a person who qualified for assistance from the state as aged, blind, or disabled, was converted from the state to federal disability assistance under SSI in January 1974, and has remained continuously eligible for SSI since that date.

The combined federal/state SSI benefit level for MIL clients is the higher of the following:

(i) The state assistance standard they received in December 1973, except for those converted in a "D" living arrangement (residing in a medical institution at the time of conversion), plus the federal cost-of-living adjustments (COLA) since then; or

(ii) The current standard.

1 Eligible individual with more than one essential person living alone: $494.00 for the eligible individual plus $247.00 for each essential person (no state supplement).

2 Eligible couple with one or more essential persons living alone: $741.00 for eligible couple plus $247.00 for each essential person (no state supplement).

3 Eligible individual with more than one essential person in shared living: $329.34 for eligible individual plus $164.66 for each essential person (no state supplement).

4 Eligible couple with one or more essential persons in shared living: $494.00 for eligible couple plus $164.66 for each essential person (no state supplement).



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NEW SECTION



WAC 388-478-0060  Income eligibility standards for food assistance. To be eligible for food assistance, assistance units must have income at or below both the maximum gross and net monthly income standards except as follows:

(1) Assistance units with an elderly or disabled member must have income at or below only the maximum net monthly income standard.

(2) Assistance units in which all members are receiving cash assistance or SSI do not have to meet the maximum gross or net monthly income standards.

EFFECTIVE 10-1-97
Household Size Maximum Gross Monthly Income Maximum Net Monthly Income 165% of the Poverty Level Maximum Allotment
1 $ 855 $ 658 $1,085 $122
2 1,150 885 1,459 224
3 1,445 1,111 1,833 321
4 1,739 1,338 2,207 408
5 2,034 1,565 2,581 485
6 2,329 1,791 2,955 582
7 2,623 2,018 3,329 643
8 2,918 2,245 3,703 735
9 3,213 2,472 4,077 827
10 3,508 2,699 4,451 919
Each Additional Member +295 +227 +374 +92




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NEW SECTION



WAC 388-478-0065  TANF/SFA-Related categorically needy income level (CNIL) and resource standards. (1) The categorically needy income level (CNIL) standard for TANF-related medical is the same as the grant payment standards for the TANF cash program as stated in WAC 388-478-0020.

(2) The countable resource standards for TANF/SFA-related categorically needy (CN) medical are the same as those of the TANF/SFA cash program as stated in WAC 388-470-0005.

(3) For all medical programs an unborn child is counted as a household member when determining household size.



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NEW SECTION



WAC 388-478-0070  Monthly income and countable resource standards for medically needy and medically indigent (MN and MI) programs. (1) Beginning January 1, 1998, the medically needy income level (MNIL) and MI standards to be applied to a medical assistance unit are as follows:

(a) One person $521
(b) Two persons $592
(c) Three persons $667
(d) Four persons $742
(e) Five persons $858
(f) Six persons $975
(g) Seven persons $1,125
(h) Eight persons $1,242
(i) Nine persons $1,358
(j) Ten persons and more $1,483

(2) For persons meeting the institutional status requirements of chapter 388-513 WAC, a special MNIL is used. That standard is in WAC 388-513-1305(2).

(3) The MN and MI program countable resource standards are:

(a) One person $2,000
(b) A legally married couple $3,000
(c) For each additional family member add $50




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NEW SECTION



WAC 388-478-0075  Monthly income standards for federal poverty level income based programs. (1) Income eligibility for the following medical programs is based upon the Federal Poverty Level (FPL) as established by the U.S. Department of Labor and updated annually:

(a) Children's health program is one hundred percent of FPL,

(b) Pregnant women's program is one hundred eighty-five percent of FPL, and

(c) Children's categorically needy program is two hundred percent of FPL.

(2) The FPL is effective as of April 1, 1998.
family size 100% FPL 185% FPL 200% FPL
1 $ 671 $1242 $1342
2 $ 905 $1673 $1809
3 $1138 $2105 $2275
4 $1371 $2537 $2742
5 $1605 $2968 $3209
6 $1838 $3400 $3675
7 $2071 $3832 $4142
8 $2305 $4263 $4609
9 $2538 $4695 $5075
10 $2771 $5127 $5542
Add to the ten person standard for each person over ten:
$ 234 $ 432 $467

(3) There are no resource limits for the programs under this section.



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NEW SECTION



WAC 388-478-0080  SSI-related CNIL medical monthly income and countable resource standards. (1) The SSI-related CNIL standard is the same as the SSI payment standard based upon the area of the state where the person lives. Area 1 is defined as the following counties: King, Pierce, Snohomish, Thurston and Kitsap. Area 2 is all other counties. The CNIL standards are as follows:

Area 1 Area 2
(a) Single person $521.00 $500.55
(b) A legally married couple
both eligible $762.00 $741.00

(2) The resource standards for the SSI-related CN medical program are:

(a) One person $2,000
(b) A legally married couple $3,000




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NEW SECTION



WAC 388-478-0085  Medicare cost sharing program monthly income and countable resources standards. (1) The qualified Medicare beneficiary (QMB) program income standard is based upon one hundred percent of the Federal Poverty Level (FPL). Beginning April 1, 1998, this program's income standards are:

(a) One person $ 671
(b) Two persons $ 905

(2) The special low-income Medicare beneficiary (SLMB) program income standard is over one hundred percent of the FPL, but under one hundred twenty percent of the FPL. Beginning April 1, 1998, this program's income standards are:

Minimum Maximum
(a) One person $ 671.01 $ 805
(b) Two persons $ 905.01 $1085

(3) The expanded special low-income Medicare beneficiary (ESLMB) program income standard is over one hundred twenty percent of the FPL, but under one hundred thirty-five percent of the FPL. Beginning April 1, 1998, this program's income standards are:
Minimum Maximum
(a) One person $ 805.01 $ 906
(b) Two persons $1085.01 $1221

(4) The qualified disabled working individual (QDWI) program income standard is standard is based upon two hundred percent of the FPL. Beginning April 1, 1998, this program's income standards are:
(a) One person $1342
(b) Two persons $1809

(5) The qualified individual (QI) program income standard is over one hundred thirty-five percent of the FPL, but under one seventy-five percent of the FPL. Beginning April 1, 1998 this program's income standards are:
Minimum Maximum
(a) One person $ 906.01 $1174
(b) Two persons $1221.01 $1583

(6) The countable resource standards for all of the Medicare cost sharing programs in this sections are the same. These resource standards are:

(a) One person $4000
(b) Two persons $6000




[]

SHS-2406:3

Chapter 388-480 WAC



STRIKERS



NEW SECTION



WAC 388-480-0001  Strikers. (1) A strike is defined as a concerted work stoppage, slowdown or other interruption of work initiated by employees.

(2) An individual is not considered a striker if:

(a) Locked out by the employer;

(b) Unable to work as a result of striking employees;

(c) Not part of the bargaining unit on strike and fearful of personal injury from crossing picket lines;

(d) Exempt from work registration the day before the strike (for reasons other than employment over thirty hours per week).

(3) TANF/SFA, GA-H or RCA recipients are not eligible for any month in which a parent or the only eligible child is participating in a strike on the last day of the month.

(4) In TANF/SFA, GA-H or RCA assistance units, if a member other than the parent or only eligible child is on strike on the last day of the month, only that person is ineligible.

(5) Applicants for food assistance are ineligible if participating in a strike unless:

(a) The household met all income and resource eligibility standards the day prior to the strike; and

(b) Is otherwise eligible at the time of application.

(6) Food assistance households are not eligible for an increase in benefits solely due to a decrease in income as a direct result of participation in a strike.



[]

SHS-2419:2

Chapter 388-482 WAC



STUDENT STATUS



NEW SECTION



WAC 388-482-0005  Student status for food assistance. (1) A food assistance client is considered a student when the client is:

(a) Aged eighteen through forty-nine years;

(b) Physically and mentally able to work; and

(c) Enrolled at least half time in an institution of higher education as defined by the institution.

(2) An institution of higher education is:

(a) Any educational institution requiring a high school diploma or general education development certificate (GED);

(b) Business, trade or vocational schools requiring a high school diploma or GED; or

(c) A two-year or four-year college or university offering a degree but not requiring a high school diploma or GED.

(3) To be an eligible student in the food assistance programs, a student as defined in subsection (1) of this section must meet one of the following:

(a) Work and receive pay for a average of twenty hours each week. A self-employed student's weekly earnings must be equal to or above the federal minimum wage multiplied by twenty hours.

(b) Work and receive money from a federal or state work study program;

(c) Be responsible for the care of their child age five or younger;

(d) Be responsible for the care of their child six through eleven years of age and the department has determined that there is not adequate child care available during the school year to allow the student to:

(i) Attend class and satisfy the twenty hour work requirement; or

(ii) Take part in a work study program.

(e) Be a single parent responsible for the care of their child eleven years old or younger even if child care is available;

(f) Be an adult who has parental control of a child eleven years of age or younger and neither the adult's spouse nor the child's parents reside in the home;

(g) Participate in the WorkFirst program as required under WAC 388-310-400;

(h) Receive benefits from TANF or SFA;

(i) Attend an institution of higher education through:

(i) The job training partnership act (JTPA);

(ii) Food assistance employment and training program (FS E&T);

(iii) An approved state or local employment and training program; or

(iv) Section 236 of the Trade Act of 1974.

(4) Student status:

(a) Begins the first day of the school term; and

(b) Continues through vacations. Vacations include the summer when the student plans to return to school for the next term.

(5) If the only reason a student is eligible for food assistance is the participation in work study, the student becomes ineligible during the summer months if the student is not working and receiving money from work study. Consider other student eligibility criteria during the summer months.

(6) Student status ends when a student:

(a) Graduates;

(b) Is suspended or expelled;

(c) Drops out; or

(d) Does not intend to register for the next school term other than summer.



[]

SHS-2380:2

Chapter 388-484 WAC



TANF/SFA FIVE YEAR TIME LIMIT



NEW SECTION



WAC 388-484-0005  Five year time limit for TANF and SFA. (1) A family is not eligible for TANF or SFA if the family includes an adult who has received TANF or SFA for sixty months after August 1, 1997.

(2) In calculating the number of months an adult family member has received TANF or SFA, a month is not counted if the adult received assistance:

(a) As a minor child who was not the head of a household or married to the head of a household. A minor child is not the head of a household when residing with a parent, legal guardian, or other adult relative, or living in a department-approved living arrangement under the supervision of a nonrelated adult; or

(b) When living in Indian country, as defined under 18 U.S.C. 1151, or an Alaskan Native village, if during the months the individual received TANF or SFA at least fifty percent of the adults living on the reservation or in the village were unemployed.

(3) An adult who has received fifty-two months of TANF or SFA may be exempted from the five-year time limit for reasons of hardship or family violence if the total number of exempted cases does not exceed twenty percent of the average monthly number of TANF and SFA cases statewide during a fiscal year.



[]

SHS-2428:2

Chapter 388-486 WAC



TEEN PARENTS



NEW SECTION



WAC 388-486-0005  Unmarried pregnant or parenting minors--Required living arrangement. (1) This rule affects only the minor's eligibility for cash assistance. It does not affect the eligibility of the minor parent's child for a cash grant.

(2) The following definitions apply to terms used in this section:

(a) "Unmarried" means a person who have never been married or whose marriage has been annulled. It does not include a person who has been divorced or widowed.

(b) "Minor" means a person younger than eighteen years of age.

(c) "Legal guardian" means a court-appointed legal guardian or court-appointed permanent custodian.

(d) "Relative" is a person who related to the pregnant or parenting minor as defined under RCW 74.15.020(4).

(3) An unmarried pregnant or parenting minor is not eligible for TANF, SFA or GA-S unless the person:

(a) Has been emancipated by a court; or

(b) Lives in a home approved by the department and has a protective payee.

(4) The home of a minor's parent, legal guardian, or adult relative may be approved unless:

(a) The minor has no living parent, legal guardian, or adult relative that can be located or those persons do not want the minor to live with them;

(b) The minor or the minor's child is being or has been seriously harmed either physically, emotionally or sexually in the home of the parent, legal guardian, or adult relative;

(c) Substantial evidence exists of an act or failure to act by the parent, legal guardian, or adult relative that presents imminent or serious harm to the minor or the minor's child if they lived there; or

(d) The department determines that it is in the best interest of the minor or the minor's child to waive the requirement of living in the home of a parent, legal guardian, or adult relative.

(5) If the home of a minor's parent, legal guardian, or adult relative is not available or suitable, one of the following alternatives may be approved:

(a) A facility or home licensed under chapter 74.15 RCW that provides a supportive and supervised living arrangement requiring residents to learn parenting skills;

(b) A maternity home;

(c) Other adult-supervised living arrangement; or

(d) The minor's current or proposed living arrangement, if the department determines it is appropriate.

(6) A home that includes the other natural parent of the minor's child or unborn child is never approved if:

(a) The minor is under age sixteen; and

(b) The other parent is eighteen or older and meets the age criteria for rape of a child as set forth in RCW 9A.44.073, 9A.44.076, and 9A.44.079.

(7) The income of a minor parent found ineligible under this section is treated according to WAC 388-450-0100 and 388-450-0115 when determining the eligibility and benefit level of the minor parent's child.



[]



NEW SECTION



WAC 388-486-0010  Unmarried pregnant or parenting minors--Required school attendance. (1) This rule affects only the minor's eligibility for cash assistance. It does not affect the eligibility of the minor parent's child for a cash grant.

(2) To be eligible for TANF or SFA, an unmarried pregnant or parenting minor who has not completed high school or a general education development (GED) certificate program must participate in educational activities leading to the attainment of a high school diploma or GED.

(3) The minor must meet the standard for satisfactory attendance set by the school or program in which the minor is enrolled.

(4) An unmarried minor is exempt from this rule if the minor has:

(a) Been emancipated by a court; or

(b) A child who is less than twelve weeks old.

(5) The income of a minor parent found ineligible under this section is treated according to WAC 388-450-0100 and 388-450-0115 when determining the eligibility and benefit level of the minor parent's child.



[]



Chapter 388-488 WAC



TRANSFER OF PROPERTY



NEW SECTION



WAC 388-488-0005  Transfer of property to qualify for cash assistance. This rule applies to cash assistance programs only and does not affect Medicaid eligibility for a person who is not institutionalized. For transfer of property for institutional medical see WAC 388-513-1365.

(1) An assistance unit is disqualified from receiving benefits when it transferred or transfers real or personal property for less than its market value in an attempt to qualify for benefits:

(a) Two years prior to the date of application;

(b) During the application process; or

(c) Anytime while receiving benefits.

(2) When an assistance unit transferred property for less than its fair market value in an attempt to qualify for benefits, the disqualification period:

(a) For applicants, begins the first day of the month the property was transferred.

(b) For recipients, begins the first day of the month after the month the property was transferred.

(3) To determine the number of months an assistance unit will be disqualified, divide the uncompensated resource value of the transferred property by the state gross median income. The uncompensated resource value is the equity value minus the amount the client received when transferring a resource.

(4) An assistance unit can provide evidence to clarify the reasons for transferring the property when the department presumes that the assistance unit transferred the property in an attempt to qualify for benefits.

(5) The benefits received by an assistance unit are not affected by the transfer of separate property of a spouse who is not a member of the assistance unit.

(6) An assistance unit's disqualification period is reduced when the client:

(a) Verifies undue hardship will exist if the benefits are denied such as an eviction;

(b) Secures a return of some or all of the transferred property or the equivalent value of the transferred property;

(c) Verifies an unforeseen change in circumstances such as extensive hospitalization; or

(d) Is responsible for and can verify medical expenses.

(7) When a disqualification period has been adjusted and the client is otherwise eligible, benefits will be authorized. Any benefits authorized because of the reason(s) in subsection (6) of this section, are not considered an overpayment.



[]



NEW SECTION



WAC 388-488-0010  Transfer of property to qualify for food assistance. (1) An assistance unit is disqualified from the program when it transfers a resource to qualify or attempt to qualify for benefits:

(a) Three months prior to the month of application; or

(b) Beginning the month the household is approved for benefits.

(2) The length of disqualification depends on the dollar amount the household is over the resource limit. The countable resources transferred are added to the assistance unit's other countable resources. This total is compared to the resource limit. The amount in excess of the resource limit is located on the chart below to determine the length of the disqualification period.

Amount Over the Resource Limit Disqualification

Period

$ 0 - $ 249.99 1 month
250 - 999.99 3 months
1,000 - 2,999.99 6 months
3,000 - 4,999.99 9 months
5,000 and over 12 months

(3) The disqualification period begins:

(a) For applicants, the month of application; or

(b) For recipients, the first of the month after the advance notice period expires.

(4) An assistance unit will not be disqualified for transferring the following:

(a) Excluded resources that do not affect eligibility;

(b) Resources sold or traded at or near fair market value (FMV);

(c) Resources transferred between assistance unit members of the same household including ineligible household members; and

(d) Resources transferred for reasons other than to qualify for benefits.



[]

SHS-2392:4

Chapter 388-490 WAC



VERIFICATION



NEW SECTION



WAC 388-490-0005  Documents or information needed to determine eligibility. The department requires clients to provide documents or information to establish the accuracy of a client's circumstances or statements. This is called mandatory verification and varies by program. The following requirements are for cash, food assistance and medical unless otherwise specified.

(1) A client has primary responsibility for providing information and verification.

(2) Time frames and notice requirements for requested information are stated in:

(a) WAC 388-406-0030 and 388-406-0035 for applicants; and

(b) WAC 388-418-0010 for recipients.

(3) The department requests verification from clients when it is needed to determine eligibility.

(4) The department accepts readily available verification that reasonably supports the client's statement or circumstances. Readily available means verification that can be obtained by the client within three working days.

(5) A client's signature on the application, eligibility review, or change of circumstance form gives the department consent to obtain supporting evidence from the following sources:

(a) A collateral contact. A collateral contact is an oral or written statement from someone outside of the assistance unit that confirms a client's circumstances; or

(b) A home visit.

(6) When a client is required to provide a document that requires a fee, the department will pay the fee.

(7) A client's benefits are not denied, terminated or delayed because of a failure to provide a specific type or form of verification.

(8) If all requested verification is not received, a client's eligibility is determined based on all available evidence.

(9) If eligibility cannot be determined from the available evidence that was provided, the client's benefits are denied or terminated.

(10) When verification was previously provided before and the document is not subject to change, a client is not required to provide the verification again. This applies when the department determines eligibility at:

(a) The next application;

(b) Reinstatement of a program; or

(c) Redetermination of eligibility.



[]

SHS-2399:3

NEW SECTION



WAC 388-503-0505  General eligibility requirements for medical programs. (1) Persons applying for benefits under the medical coverage programs established under chapter 74.09 RCW must meet the eligibility criteria established by the department in chapters 388-400 through 388-555 WAC.

(2) Persons applying for medical coverage are considered first for federally funded or federally matched programs. State-funded programs are considered after federally funded programs are not available to the client except for brief periods when the state-funded programs offer a broad scope of care which meet a specific client need.

(3) Unless otherwise specified in program specific WAC, the eligibility criteria for each medical program are as follows:

(a) Verifiable of age and identity (chapters 388-404, 388-406, and 388-490 WAC); and

(b) Residence in Washington state (chapter 388-468 WAC); and

(c) Citizenship or immigration status in the United States (chapter 388-424 WAC); and

(d) Possession of a valid Social Security Account Number (chapter 388-474 WAC); and

(e) Assignment of medical support rights to the state of Washington (WAC 388-505-0540); and

(f) Cooperation in securing medical support (chapter 388-422 WAC); and

(g) Countable resources which are within program limits (chapters 388-470 and 388-478 WAC); and

(h) Countable income which are within program limits (chapters 388-450 and 388-478 WAC).

(4) In addition to the general eligibility requirements in subsection (3) of this section, each program has specific eligibility requirements as described in applicable WAC.

(5) Persons living in correctional institutions are not eligible for the department's medical coverage programs.

(6) Persons terminated from SSI or TANF cash grants and those who lose eligibility for categorically needy (CN) medical coverage have their CN coverage extended while their eligibility for other medical programs is redetermined. This extension of medical coverage is described in chapter 388-434 WAC.



[]



NEW SECTION



WAC 388-503-0510  How a client is determined "related to" a categorical program. (1) A person is related to the Supplemental Security Income (SSI) program if they are:

(a) Aged, blind, or disabled as defined in WAC 388-511-1105(1); or

(b) Considered as eligible for SSI under WAC 388-511-1105(5); or

(c) Children meeting the requirements of WAC 388-505-0210(6).

(2) A person or family is considered to be related to the temporary assistance for needy families (TANF) program or the state-funded assistance (SFA) program if they meet:

(a) The program requirements for the TANF or the SFA cash assistance programs or the requirements of WAC 388-505-0220, 388-505-0210 (3) or (4), or 388-503-0310 (17)(b); or

(b) Would meet such requirements except that:

(i) The assistance unit's countable income exceeds the TANF or the SFA program standards in chapter 388-478 WAC; or

(ii) The assistance unit's countable resources exceed the cash program standards in chapter 388-470 WAC.

(3) Persons related to SSI or to TANF are eligible for categorically needy (CN) or medically needy (MN) medical coverage if they meet the other eligibility criteria for these medical programs. See chapters 388-505 and 388-519 WAC for these eligibility criteria.

(4) Persons related to SSI or to TANF and who receive the related CN medical coverage have redetermination rights as described in WAC 388-503-0505(6).

(5) Persons related to SFA are eligible for state-funded medical coverage as long as they meet the other eligibility criteria for the medical program. The state-funded medical coverage has the same scope of coverage as CN or MN coverage described in subsection (3) of this section.



[]



NEW SECTION



WAC 388-503-0515  Medical coverage resulting from a cash grant. (1) Families or individuals eligible for SSI, SSI state supplement or TANF cash grants are automatically eligible for categorically needy (CN) medical coverage. These clients receive medical coverage benefits without making a separate application. Certification for CN medical coverage parallels that for the cash benefits.

(2) Upon termination of cash benefits as described in subsection (1) of this section, medical coverage continues until the client's eligibility for other medical coverage can be completed. Continuing medical coverage is terminated if the client does not cooperate with the eligibility re-determination process.

(3) Families or individuals eligible for or related to state financial assistance (SFA) cash grants are eligible for state-funded medical coverage. For this program, the term "related-to" is defined parallel to WAC 388-503-0510(2). The scope of medical coverage parallels that for the federally funded CN program.



[]

SHS-2390:7

NEW SECTION



WAC 388-505-0110  Medical assistance coverage for adults not covered under family medical programs. (1) An adult who does not meet the institutional status requirements as defined in WAC 388-513-1320 and who does not receive waiver services as described in chapter 388-515 WAC is considered for categorically needy (CN) coverage under this chapter. Persons excluded from this section have rules applied to eligibility from chapter 388-513 WAC. Under this section a person is eligible for CN coverage when the person:

(a) Meets citizenship/immigrant, residency, and Social Security number requirements as described in WAC 388-503-0505; and

(b) Has CN countable income and resources that do not exceed the income and resource standards in WAC 388-478-0080; and

(c) Is sixty-five years of age or older, or meets the blind and/or disability criteria of the federal SSI program.

(2) An adult not meeting the conditions of subsection (1)(b) is eligible for CN medical coverage if the person:

(a) Is a current beneficiary of Title II of the Social Security Act (SSA) benefits who:

(i) Was a concurrent beneficiary of Title II and Supplemental Security Income (SSI) benefits;

(ii) Is ineligible for SSI benefits and/or state supplementary payments (SSP); and

(iii) Would be eligible for SSI benefits if certain cost-of-living (COLA) increases are deducted from the client's current Title II benefit amount:

(A) All Title II COLA increases under P.L. 94-566, section 503 received by the client since their termination from SSI/SSP; and

(B) All Title II COLA increases received during the time period in subsection (1)(d)(iii)(A) of this section by the client's spouse or other financially responsible family member living in the same household.

(b) Is an SSI beneficiary, no longer receiving a cash benefit due to employment, who meets the provisions of section 1619(b) of Title XVI of the SSA;

(c) Is a currently disabled client receiving widow's or widower's benefits under section 202 (e) or (f) of the SSA if the disabled client:

(i) Was entitled to a monthly insurance benefit under Title II of the SSA for December 1983; and

(ii) Was entitled to and received a widow's or widower's benefit based on a disability under section 202 (e) or (f) of the SSA for January 1984;

(iii) Became ineligible for SSI/SSP in the first month in which the increase provided under section 134 of P.L. 98-21 was paid to the client;

(iv) Has been continuously entitled to a widow's or widower's benefit under section 202 (e) or (f) of the SSA;

(v) Would be eligible for SSI/SSP benefits if the amount of that increase, and any subsequent COLA increases provided under section 215(i) of the SSA, were disregarded;

(vi) Is fifty through fifty-nine years of age; and

(vii) Filed an application for Medicaid coverage before July 1, 1988.

(d) Was receiving, as of January 1, 1991, Title II disabled widow or widower benefits under section 202 (e) or (f) of the SSA if the person:

(i) Is not eligible for the hospital insurance benefits under Medicare Part A;

(ii) Received SSI/SSP payments in the month before receiving such Title II benefits;

(iii) Became ineligible for SSI/SSP due to receipt of or increase in such Title II benefits; and

(iv) Would be eligible for SSI.SSP if the amount of such Title II benefits or increase in such Title II benefits under section 202 (e) or (f) of the SSA, and any subsequent COLA increases provided under section 215(i) of the act were disregarded.

(e) Is a disabled or blind client receiving Title II Disabled Adult Childhood (DAC) benefits under section 202(d) of the SSA if the client:

(i) Is at least eighteen years old;

(ii) Lost SSI/SSP benefits on or after July 1, 1988, due to receipt of or increase in DAC benefits; and

(iii) Would be eligible for SSI/SSP if the amount of the DAC benefits or increase under section 202(d) of the DAC and any subsequent COL increases provided under section 215(i) of the SSA were disregarded.

(f) Is a client who:

(i) In August 1972, received:

(A) Old age assistance (OAA);

(B) Aid to blind (AB);

(C) Aid to families with dependent children (AFDC); or

(D) Aid to the permanently and totally disabled (APTD); and

(ii) Was entitled to or received retirement, survivors, and disability insurance (RSDI) benefits; or

(iii) Is eligible or OAA, AB, AFDC, SSI, or APRD solely because of the twenty percent increase in Social Security benefits under P.L. 92-336.

(3) An adult who does not meet the institutional status requirement as defined in WAC 388-513-1320 and who does not receive waiver services as described in chapter 388-515 WAC is considered for medically needy (MN) coverage under this chapter. Persons excluded from this section have rules applied to eligibility from chapter 388-513 WAC. Under this section a person is eligible for MN coverage when the person:

(a) Meets citizenship/immigrant, residency, and Social Security number requirements as described in WAC 388-503-0505; and

(b) Has MN countable income that does not exceed the income standards in WAC 388-478-0070, or meets the excess income spenddown requirements in WAC 388-519-0110; and

(c) Meets the countable resource standards in WAC 388-478-0070; and

(d) Is sixty-five years of age or older or meets the blind and/or disability criteria of the federal SSI program.

(4) MN coverage is available for an aged, blind, or disabled ineligible spouse of an SSI recipient. See WAC 388-519-0100 for additional information.

(5) An adult may be eligible for the alien emergency medical program as described in WAC 388-438-0110.

(6) An adult is eligible for the state-funded general assistance - expedited Medicaid disability (GA-X) program when they:

(a) Meet the requirements of the cash program in WAC 388-400-0025 and 388-478-0030; or

(b) Meet the SSI-related disability standards but cannot get the SSI cash grant due to immigration status or sponsor deeming issues.

Clients may be eligible for GA cash benefits and CN medical coverage due to different sponsor deeming requirements.

(7) An adult is eligible for the state-funded medical care services (MCS) program when the person is eligible for GAU or ADATSA program coverage as described in WAC 388-478-0030.

(8) An adult is eligible for the state-funded medical indigent (MI) program when the person meets the requirements listed in WAC 388-438-0100.



[]



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.

SHS-2441:5

Chapter 388-505 WAC



FAMILY MEDICAL



NEW SECTION



WAC 388-505-0210  Children's medical eligibility. (1) A child is eligible for newborn categorically needy (CN) children's medical assistance when:

(a) The child's mother, was eligible for and receiving medical assistance at the time of the child's birth; and

(b) The child is under one year of age; and

(c) The child remains with the mother and resides in the state.

(2) Children under the age of nineteen are eligible for CN medical assistance when they:

(a) Meet the requirements of:

(i) Citizenship or immigrant status as described in chapter 388-424 WAC; and

(ii) State residence as described in chapter 388-468 WAC; and

(iii) Social security number as described in chapter 388-476 WAC; and

(b) Meet family income levels described in WAC 388-478-0075; or

(c) Meet the requirements of WAC 388-505-0220 or 388-523-0100.

(3) Children under the age of twenty-one are eligible for CN medical assistance when they:

(a) Meet citizenship or immigrant status, state residence, and social security number requirements as described in subsection (2)(a) of this section; and

(b) Meet income levels described in WAC 388-478-0075 when income is counted according to WAC 388-408-0055 (1)(c); and

(c) Reside in an institution (medical hospital, intermediate care facility for mentally retarded (ICF/MR), or nursing home facility) as described in WAC 388-513-1320 for more than thirty days; or

(d) Reside in a psychiatric or chemical dependency facility as described in WAC 388-513-1320.

(4) Children under the age of twenty-one are eligible for CN if they:

(a) Are in foster care; or

(b) Receive subsidized adoption.

(5) Children, regardless of age, are eligible for CN medical if they are eligible to receive Supplemental Security Income (SSI) payments based upon their own disability.

(6) Children are eligible for CN medical if they received SSI payments for August 1996, and except for the passage of amendments to federal disability definitions would be eligible for SSI.

(7) Children under the age of nineteen are eligible for Medically Needy (MN) medical assistance when they:

(a) Meet citizenship, state residence and social security number requirements as described in subsection (2)(a); and

(b) Have income at or above the income levels described in WAC 388-478-0070.

(8) A child is eligible for SSI-related MN when:

(a) They meet the conditions in subsection (7)(a) and (b); and

(b) They meet the blind and/or disability criteria of the federal SSI program.

(9) Children under the age of eighteen are eligible for the state funded children's health program, if they:

(a) Are ineligible for any CN medical program; and

(b) Meet income levels described in WAC 388-478-0075.

(10) There are no resource standards for either the children's CN or the state funded children's health programs.

(11) The requirements in WAC 388-503-0505 (3)(c) and (d) do not apply to persons applying for the state funded children's health program.

(12) Children may also be eligible for:

(a) Temporary assistance for needy families (TANF) or state funded assistance (SFA)-related medical as described in WAC 388-505-0220; and

(b) TANF/SFA-related medical extensions as described in WAC 388-523-0100.

(13) Except for a client in subsection (3)(c) and (d), an inmate of a public institution, as defined in WAC 388-500-0005, is not eligible for CN or MN medical coverage.



[]



NEW SECTION



WAC 388-505-0220  Family medical eligibility. (1) A person is eligible for categorically needy (CN) medical coverage when they are:

(a) Receiving temporary assistance for needy families (TANF) cash benefits; or

(b) Receiving cash diversion assistance described in chapter 388-222 WAC; or

(c) Eligible for TANF but chooses not to receive cash benefits; or

(d) Not eligible for or receiving TANF cash assistance, but meets the eligibility criteria for aid to families with dependent children (AFDC) that were in effect on July 16, 1996 except:

(i) Earned income is treated as described in WAC 388-450-0210; and

(ii) Resources are treated as described in WAC 388-470-0005 for applicants and 388-470-0050 for recipients.

(2) A person is eligible for CN medical coverage when they are not eligible for or receiving cash benefits solely for one of the following reasons:

(a) Received sixty months of TANF cash benefits or is a member of an assistance unit which has received sixty months of TANF cash benefits; or

(b) Failed to meet the school attendance requirement in chapter 388-400 WAC; or

(c) Is an unmarried minor parent not in a department-approved living situation; or

(d) Is a parent or caretaker relative who fails to notify the department within five days of the date the child leaves the home and the child's absence will exceed ninety days; or

(e) Is a fleeing felon or fleeing to avoid prosecution for a felony charge, or a probation and parole violator; or

(f) Was convicted of a drug related felony; or

(g) Was convicted of receiving benefits unlawfully; or

(h) Was convicted of misrepresenting residence to obtain assistance in two or more states; or

(i) Has gross earnings exceeding the TANF gross income level; or

(j) Does not meet work quarter requirements; or

(k) Does not meet the unemployment requirement; or

(l) Is not cooperating with WorkFirst requirements.

(3) A person is eligible for SFA medical when:

(a) Eligible for or receiving SFA cash benefits; or

(b) Receiving SFA cash diversion assistance described in chapter 388-222 WAC; or

(c) Is not eligible for or receiving SFA solely due to factors described in subsection (2) of this section; or

(d) Meets the criteria of (1)(d) of this section.



[]

SHS-2418:4

NEW SECTION



WAC 388-517-0300  Medicare cost-sharing programs. (1) Clients eligible for the following programs receive benefits which help pay their Medicare coverage out-of-pocket costs:

(a) The qualified medicare beneficiary (QMB); and

(b) The special low-income medicare beneficiary (SLMB) and the expanded special low income Medicare beneficiary (ESLMB); and

(c) The Medicare buy-in program; and

(d) The qualified disabled working individual (QDWI); and

(e) The qualified individual (QI).

(2) To be eligible for any of these programs, clients must not have countable resources which exceed the resource standard in WAC 388-478-0085(6).

(3) Clients eligible for or receiving Medicare Part A and meeting the department's income standards have their Medicare Part A and Part B premiums, coinsurance, and deductibles paid for them under the QMB program. A person is income-eligible for QMB:

(a) When their countable income does not exceed the standard in WAC 388-478-0085(1); or

(b) When they meet the requirements of subsection (a) if their annual Social Security cost-of-living increase is not counted as income until April 1 of each year.

(4) Clients eligible for or receiving Medicare Part A benefits and meeting the department's income standards have their Part B Medicare premium paid for them under the SLMB or ESLMB program. In determining eligibility for SLMB or ESLMB, the annual Social Security cost-of-living increase is not counted as income until April 1 of each year. A person is income-eligible:

(a) For SLMB when their countable income is within the range specified in 388-478-0085(2);

(b) For ESLMB when:

(i) Their countable income is within the range specified in WAC 388-478-0085(3); and

(ii) They are not otherwise eligible for categorically needy (CN) or medically needy (MN) coverage; and

(iii) Until December 31st of each year or until the date that the annual allotment of federal funds is exhausted.

(5) Clients who are eligible for categorically needy (CN) or medically needy (MN) medical coverage, but not eligible for QMB or SLMB programs may be eligible for a third Medicare cost-sharing program. If they are eligible for or receiving Medicare Part A coverage, they receive the state-funded buy-in program. Under the buy-in program the department pays the following:

(a) Their Medicare Part A premiums, if any; and

(b) Their Medicare Part B premiums; and

(c) Their Medicare Part B coinsurance, and deductibles.

(6) Clients who are not eligible for QMB, SLMB or buy-in may be eligible for assistance with their Medicare out-of pocket costs. Clients who meet the following conditions have their Medicare Part A premium(s) paid for them under the QDWI program. A person is income-eligible for QDWI when:

(a) They are not otherwise eligible for CN or MN medical coverage; and

(b) They are eligible for Medicare Part A; and

(c) Their countable income does not exceed the standard in WAC 388-478-0085(4).

(7) Persons not eligible for any other Medicare cost-sharing program discussed in this section may receive compensation of one dollar and seven cents per month under the QI program. Total reimbursement is limited to the amount of money made available for this program from the federal government. The benefit is payable annually as partial reimbursement of their Medicare Part B premiums. A person is income-eligible for QI when:

(a) They are not otherwise eligible for CN or MN medical coverage; and

(b) Their countable income does not exceed the standard in WAC 388-478-0085(5).



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SHS-2398:4

NEW SECTION



WAC 388-519-0100  Eligibility for the medically needy program. (1) A person who meets the following conditions is considered for medically needy (MN) coverage under the special rules in chapter 388-513 WAC.

(a) A person who meets the institutional status requirements of WAC 388-513-1320; or

(b) A person who receives waiver services under chapter 388-515 WAC.

(2) MN coverage is considered under this chapter when a person:

(a) Is not excluded under subsection (1) of this section; and

(b) Is not eligible for categorically needy (CN) medical coverage because they have CN countable income which is above the CN income standard.

(3) MN coverage is available for children, for persons who are pregnant or for persons who are SSI-related. MN coverage is available to an aged, blind, or disabled ineligible spouse of an SSI recipient even though that spouse's countable income is below the CN income standard. Adults with no children must be SSI related in order to be qualified for MN coverage.

(4) A person not eligible for CN medical and who is applying for MN coverage has the right to income deductions in addition to those used to arrive at CN countable income. The following deductions are used to calculate their countable income for MN. Those deductions to income are applied to each month of the base period and determine MN countable income:

(a) All health insurance premiums expected to be paid by the client during the base period are deducted from their income; and

(b) For persons who are SSI-related and who are married, see the income provisions for the nonapplying spouse in WAC 388-450-0210; and

(c) For persons who are not SSI-related and who are married, an income deduction is allowed for a nonapplying spouse:

(i) If the nonapplying spouse is living in the same home as the applying person; and

(ii) The nonapplying spouse is receiving community and home based services under chapter 388-515 WAC; then

(iii) The income deduction is equal to the one person MNIL less the nonapplying spouse's actual income.

(5) A person who meets the above conditions is eligible for MN medical coverage if their MN countable income is at or below the medically needy income level (MNIL) in WAC 388-478-0070. They are certified as eligible for up to twelve months of MN medical coverage. Certain SSI or SSI-related clients have a special MNIL. That MNIL exception is described in WAC 388-513-1305.

(6) A person whose MN countable income exceeds the MNIL may become eligible for MN medical coverage when they have or expect to have medical expenses. Those medical expenses or obligations may be used to offset any portion of their income which is over the MNIL.

(7) That portion of a person's MN countable income which is over the department's MNIL standard is called "excess income."

(8) When a person has or will have "excess income" they are not eligible for MN coverage until they have medical expenses which are equal in amount to that excess income. This is the process of meeting "spenddown."

(9) A person who is considered for MN coverage under this chapter may not spenddown excess resources to become eligible for the MN program. Under this chapter a person is ineligible for MN coverage if their resources exceed the program standard in WAC 388-478-0070. A person who is considered for MN coverage under chapter 388-513 WAC is allowed to spenddown excess resources.

(10) No extensions of coverage or automatic redetermination process applies to MN coverage. A client must submit an application for each eligibility period under the MN program.



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NEW SECTION



WAC 388-519-0110  Spenddown of excess income for the medically needy program. (1) The person applying for MN medical coverage chooses a three month or a six month base period for spenddown calculation. The months must be consecutive calendar months unless one of the conditions in subsection (4) of this section apply.

(2) A person's base period begins on the first day of the month of application, subject to the exceptions in subsection (4) of this section.

(3) A separate base period may be made for a retroactive period. The retroactive base period is made up of the three calendar months immediately prior to the month of application.

(4) A base period may vary from the terms in subsections (1), (2), or (3) of this section if:

(a) A three month base period would overlap a previous eligibility period; or

(b) A client is not or will not be resource eligible for the required base period; or

(c) The client is not or will not be able to meet the TANF-related or SSI-related requirement for the required base period; or

(d) The client is or will be eligible for categorically needy (CN) coverage for part of the required base period; or

(e) The client was not otherwise eligible for MN coverage for each of the months of the retroactive base period.

(5) The amount of a person's "spenddown" is calculated by the department. The MN countable income from each month of the base period is compared to the MNIL. The excess income from each of the months in the base period is added together to determine the "spenddown" for the base period.

(6) If income varies and a person's MN countable income falls below the MNIL for one or more months, the difference is used to offset the excess income in other months of the base period. If this results in a spenddown amount of zero dollars and cents, see WAC 388-519-0100(5).

(7) Once a person's spenddown amount is known, their qualifying medical expenses are subtracted from that spenddown amount to determine the date of eligibility. The following medical expenses are used to meet spenddown:

(a) First, Medicare and other health insurance deductibles, coinsurance charges, enrollment fees, or copayments;

(b) Second, medical expenses which would not be covered by the MN program;

(c) Third, hospital expenses paid by the person during the base period;

(d) Fourth, hospital expenses, regardless of age, owed by the applying person;

(e) Fifth, other medical expenses, potentially payable by the MN program, which have been paid by the applying person during the base period; and

(f) Sixth, other medical expenses, potentially payable by the MN program which are owed by the applying person.

(8) If a person meets the spenddown obligation at the time of application, they are eligible for MN medical coverage for the remainder of the base period. The beginning date of eligibility would be determined as described in WAC 388-416-0020.

(9) If a person's spenddown amount is not met at the time of application, they are not eligible until they present evidence of additional expenses which meets the spenddown amount.

(10) To be counted toward spenddown, medical expenses must:

(a) Not have been used to meet a previous spenddown; and

(b) Not be the confirmed responsibility of a third party. The entire expense will be counted unless the third party confirms its coverage within:

(i) Forty-five days of the date of the service; or

(ii) Thirty days after the base period ends; and

(c) Meet one of the following conditions:

(i) Be an unpaid liability at the beginning of the base period and be for services for:

(A) The applying person; or

(B) A family member legally or blood-related and living in the same household as the applying person.

(ii) Be for services received and paid for during the base period; or

(iii) Be for services received and paid for during a previous base period if that client payment was made necessary due to delays in the certification for that base period.

(11) An exception to the provisions in subsection (10) of this section exists. Medical expenses the person owes are applied to spenddown even if they were paid by or are subject to payment by a publicly administered program during the base period. To qualify, the program cannot be federally funded or make the payments of a person's medical expenses from federally matched funds. The expenses do not qualify if they were paid by the program before the first day of the base period.

(12) The following medical expenses which the person owes are applied to spenddown. Each dollar of an expense or obligation may count once against a spenddown cycle that leads to eligibility for MN coverage:

(a) Charges for services which would have been covered by the department's medical programs as described in chapter 388-529 WAC, less any confirmed third party payments which apply to the charges; and

(b) Charges for some items or services not typically covered by the department's medical programs, less any third party payments which apply to the charges. The allowable items or services must have been provided or prescribed by a licensed health care provider; and

(c) Medical insurance and Medicare copayments or coinsurance (premiums are income deductions under WAC 388-519-0100(4)); and

(d) Medical insurance deductibles including those Medicare deductibles for a first hospitalization in sixty days.

(13) Medical expenses may be used more than once if:

(a) The person did not meet their total spenddown amount and did not become eligible in that previous base period; and

(b) The medical expense was applied to that unsuccessful spenddown and remains an unpaid bill.

(14) To be considered toward spenddown, written proof of medical expenses must be presented to the department. The deadline for presenting medical expense information is thirty days after the base period ends unless good cause for delay can be documented.

(15) Once a person meets their spenddown and they are issued a medical identification card for MN coverage, newly identified expenses cannot be considered toward that spenddown. Once the application is approved and coverage begins the beginning date of the certification period cannot be changed due to a clients failure to identify or list medical expenses.



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NEW SECTION



WAC 388-519-0120  Spenddown--Medically indigent program. (1) Persons ineligible for CN or MN coverage are considered for the medically indigent (MI) program under chapter 388-438 WAC. Medically indigent spenddown differs from medically needy spenddown in the following ways:

(a) In addition to spending down income in excess of the MNIL, the amount of countable resources which is in excess of the standard in WAC 388-478-0070 is spent down.

(b) The base period for MI begins on the first day of the month in which the following occurred:

(i) Emergency ambulance transportation; or

(ii) Hospital emergency room services were received; or

(iii) The person was hospitalized for the emergency condition.

(c) The base period for MI is three months and it can join retroactive and prospective months into the same base period.



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SHS-2420:4

NEW SECTION



WAC 388-523-0100  Medical extensions. (1) A family who received temporary assistance for needy families (TANF) or state family assistance (SFA) cash or related medical assistance in any three of the last six months is eligible for extended medical benefits when they are ineligible for TANF/SFA-related medical because:

(a) They receive child or spousal support, which exceeds the payment standard described in WAC 388-478-0020, and they are not eligible for any other categorically needy (CN) medical program; or

(b) Their earnings increased resulting in income exceeding the TANF/SFA payment standard described in subsection (1)(a).

(2) A family described in subsection (1)(a) is eligible to receive four months of extended medical benefits beginning the month after termination from cash or TANF/SFA-related medical assistance, provided the family includes a child as defined in WAC 388-404-0005.

(3) A family described in subsection (1)(b) is eligible to receive six months of extended medical benefits when:

(a) They continue to meet the eligibility requirements of a TANF/SFA-related medical program, other than income; and

(b) The family incudes a child.

(4) A family described in subsection (3) will not receive extended medical benefits for any family member who has been found ineligible for cash assistance because of fraud in any of the six months prior to the extended medical period.

(5) A family receiving extended medical benefits described in subsection (4) of this section is eligible for up to an additional six calendar months of extended medical benefits as long as:

(a) The family continues to include a child; and

(b) The family's gross earned income, after child care deductions in the preceding three months averages less than, one hundred eighty-five percent of the Federal Poverty Level (FPL), as described in WAC 388-478-0075; and

(c) A caretaker relative has had earnings in each of the three previous months, prior to the month of request for the second six month extension; and

(d) The family reports to the department family earnings and child care costs relating to employment by the twenty-first day of the:

(i) Fourth month of the initial six month extension period; and

(ii) First month of the second six month extension; and

(iii) Fourth month of the second six month extension.

(6) Certain circumstances may prevent a family from meeting the requirements in subsection (5)(b), (c) and (d) of this section. If that occurs, good cause may exist and the family remains eligible for the additional six month medical extension. Reasons for good cause include, but are not limited to:

(a) Illness, mental impairment, injury, trauma, or stress; or

(b) Lack of understanding the reporting requirement due to a language barrier; or

(c) Transportation problems; or

(d) Payment for work in each month of the reporting period was paid in a different month than it was earned; or

(e) The client expected to be able to meet the family medical needs, but could not; or

(f) The client was given incorrect information about the reporting requirements.

(7) Postpartum and family planning extensions are described in WAC 388-462-0015.



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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.



NEW SECTION



WAC 388-529-0100  Scope of covered medical services by program. (1) The scope of medical care which clients can receive is based on the medical program for which they are eligible. Clients eligible for the following medical programs have coverage for the medically necessary services indicated in the specific columns in the chart provided in WAC 388-529-0200:

(a) Categorically needy (CN) medical coverage is provided as described in the "CN" column. Coverage is modified by the provisions in this section and those found in chapter 388-86 WAC;

(b) Medically needy (MN) medical coverage is provided as described in the "MN" column and as modified in this section and in chapter 388-86 WAC;

(c) General assistance - unemployable (GAU) or alcohol and drug abuse treatment and support act (ADATSA) medical coverage is provided as described in the "MCS" column. Coverage is modified by the provisions in WAC 388-86-120;

(d) The state-funded children's health program has medical coverage as described in the "CN" column and in subsection (1)(a) of this section;

(e) State-funded medically indigent (MI) program has medical coverage as described in the "MI" column to the extent that services are related to the qualifying emergency condition. Coverage begins after the client has met the annual emergency medical expense requirement (EMER) as described in WAC 388-438-0100.

(f) Pregnant undocumented aliens have medical coverage as described in the "CN" column and in subsection (1)(a) of this section.

(2) "Medically necessary" is a standard for coverage of services under the CN and MN programs. The term is defined in WAC 388-500-0005.

(3) Entries in WAC 388-529-0200 have the following meanings and conditions:

(a) "Yes":

(i) The service must be medically necessary as defined by the program; and

(ii) The service may have conditions placed on coverage in order to ensure that medical necessity exists. Examples are:

(A) The prior authorization requirement,

(B) The primary care provider referral requirement,

(C) The limit on eyeglasses to be covered for adults only once in a twenty-four-month period without documentation of special circumstances, etc.

(b) "HK" - the services are provided to children under the healthy kids program as described in WAC 388-86-027. This is consistent with the broader scope of coverage under the healthy kids program.

(c) "No" - This entry is used to describe coverage limitations of state-funded programs and indicates that the services are not covered. However, medically necessary services may be available under an "exception to rule" as described in chapter 388-440 WAC.

(d) "L" - the services are provided under limited circumstances described further under WAC 388-529-0200.

(e) "R" - the services are provided only as they are directly connected to emergency medical conditions. These program restrictions are described in WAC 388-438-0100.

(4) Coverage described in this chapter may be further limited by the notations defined in WAC 388-529-0200 and the provisions in chapters 388-86 and 388-87 WAC. Services may require prior authorization to ensure that medical necessity exists.

(5) Medical service categories not listed in WAC 388-529-0200 may not be covered under typical circumstances. Seeking specific coverage decisions in advance of service delivery is advised. Medical service providers may request authorization for any service which they see as medically necessary under WAC 388-501-0165.



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NEW SECTION



WAC 388-529-0200  Medical services available to eligible clients. The following chart lists the medically necessary services available to clients eligible for a variety of assistance programs. Eligibility groups for CN, MCS, MN, and MI coverage are described in WAC 388-529-0100.

medical services CN1/ MCS MN MI
Adult day health Yes Yes Yes No
Advanced RN practitioner services Yes Yes Yes No
Ambulance/ground and air Yes Yes Yes R2/
Anesthesia services Yes Yes Yes R2/
Audiology (hearing exams) Yes Yes HK only No
Blood/blood derivatives/
Blood administration Yes3/ Yes3/ Yes3/ R2/-3/
Case management - maternity L4/ No L4/ No
Chiropractic care HK only No HK only No
Clinic services Yes Yes Yes No
Community mental health centers Yes L5/ Yes No
Dental services Yes No Yes No
Dentures only Yes Yes Yes No
Detoxification Yes Yes Yes Yes2/
Drugs and pharmaceutical supplies Yes Yes Yes No
Elective surgery Yes Yes Yes No
Emergency room services Yes Yes Yes R2/
Emergency surgery Yes Yes Yes R2/
Eyeglasses and exams Yes6/ Yes6/ Yes6/ No
Family planning services7/ Yes Yes Yes No
Healthy kids (HK) (EPSDT) Yes No Yes No
Hearing aids Yes Yes HK only No
Home health services Yes Yes Yes No
Hospice Yes No Yes No
Indian health clinics Yes No Yes No
Inpatient hospital care Yes Yes Yes R2/
Intermediate care facility/services
for mentally retarded Yes Yes Yes N/A
Involuntary commitment Yes Yes Yes Yes2/
Maternity support services Yes No Yes No
Medical equipment, durable (DME) Yes Yes Yes No
Midwife services Yes Yes Yes R2/
Neuromuscular centers Yes No Yes No
Nursing facility services Yes Yes Yes Yes2/
Nutrition therapy HK only No HK only No
Optometry Yes Yes Yes No
Organ transplants Yes Yes Yes R2/
Out-of-state care Yes No Yes No
Outpatient hospital care Yes Yes Yes R2/
Oxygen/respiratory therapy Yes Yes Yes R2/
Pain management (chronic) Yes Yes Yes No
Personal care services Yes8/ No HK only8/ No
Physical/speech/occupational therapy Yes Yes HK and L9/ No
Physical medicine and rehabilitation Yes Yes Yes R2/
Physician Yes Yes Yes R2/
Podiatry Yes Yes Yes No
Private duty nursing L10/ L10/ L10/ No
Prosthetic devices/mobility aids Yes Yes Yes R2/
Psychiatric services Yes No Yes No
Psychological evaluation L11/ L11/ L11/ No
Rural health services and Yes Yes Yes No
Federally qualified health Centers (FQHC) Yes No Yes No
School medical services 12/ Yes No Yes No
Substance abuse/outpatient Yes No Yes No
Surgical appliances Yes Yes Yes R2/
Total enteral/parenteral nutrition Yes Yes Yes No
Transportation other than ambulance Yes Yes Yes No
X-ray and lab services Yes Yes Yes R2/

(1) Notation 1/ indicates that the CN column applies to all categorically needy (CN) programs, the state-funded children's health program. It also describes the services available to pregnant women who are undocumented aliens.

(2) Notation 2/ restricts the coverage to those services directly connected to an emergency medical condition which requires hospital services. Emergency requirements are described in WAC 388-438-0100.

(3) Notation 3/ indicates that services are limited as described in WAC 388-87-045.

(4) Notation 4/ indicates that the services are limited to pregnant women who have been identified as being in a "high-risk" circumstance under WAC 388-86-017.

(5) Notation 5/ indicates that clients must meet the program definitions and program priorities of the community mental health act. Limited grants are available to counties for the funding of these services.

(6) Notation 6/ indicates that eyeglasses are limited under WAC 388-86-030. Special circumstances and specific approval apply to more frequent services than those specified in WAC 388-86-030.

(7) Notation 7/ indicates that family planning services are available to all clients of the medical programs except for the medically indigent program. Some clients are eligible only for family planning services which is noted on the medical identification card. These services are described in WAC 388-462-0015.

(8) Notation 8/ indicates that services which are not medical services may be covered under certain qualifying conditions. These benefits are covered under the direction of the aging and adult services administration for CN eligible adults under home and community based programs; the division of developmental disabilities; or the children's services administration under WAC 388-86-087.

(9) Notation 9/ indicates that the services are not normally provided to clients, however, they are covered when the client is receiving department approved home health care services as described in WAC 388-86-045.

(10) Notation 10/ indicates that services are authorized according to the conditions listed in WAC 388-86-071.

(11) Notation 11/ indicates that the department limits services as described in WAC 388-86-067 and 388-86-095.

(12) Notation 12/ indicates a special medical program for children who are Medicaid eligible under an individualized education plan under the special education program of a school. This medical program is described further in WAC 388-86-022.



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SHS-2389:5

AMENDATORY SECTION (Amending WSR 90-12-061, filed 5/31/90, effective 7/1/90)



WAC 388-86-027  ((Early and periodic screening, diagnosis and treatment of eligible individuals twenty years of age and younger)) Healthy kids/EPSDT. (1) ((To the extent provided under these rules, the department shall make available to Medicaid recipients twenty years of age and younger, early and periodic screening and diagnosis and treatment (EPSDT))) Persons who are eligible for Medicaid are eligible for healthy kids (HK) coverage up through the day before their twenty-first birthday. This coverage is called early and periodic screening, diagnosis and treatment (EPSDT) in federal rule.

(2) ((Early and periodic screening and diagnosis shall be provided at intervals:

(a) Meeting reasonable standards of dental and medical practice as determined by the division of medical assistance; and

(b) When indicated as medically necessary to determine the existence of a suspected physical or mental illness or condition)) Access and services for healthy kids are governed by federal rules at 42 CFR, Part 441, Subpart B which were in effect as of January 1, 1998.

(a) The standard for coverage for healthy kids is that the services, treatment or other measures are:

(i) Medically necessary;

(ii) Safe and effective; and

(iii) Not experimental.

(b) Healthy kids services are exempt from specific coverage or service limitations which are imposed on the rest of the CN and MN program. Examples of service limits which do not apply to the healthy kids program are the specific numerical limits in WAC 388-86-073(4), 388-86-090(2), 388-86-098(3), etc.

(c) Services not otherwise covered under the Medicaid program are available to children under healthy kids. The services, treatments and other measures which are available include but are not limited to:

(i) Nutritional counseling;

(ii) Chiropractic care;

(iii) Orthodontics; and

(iv) Occupational therapy (not otherwise covered under the MN program).

(d) Prior authorization and referral requirements are imposed on medical service providers under healthy kids. Such requirements are designed as tools for determining that a service, treatment or other measure meets the standards in subsection (2)(a) of this section.

(3) ((In obtaining EPSDT services, the recipient shall be free to choose from participating providers.

(4) The following services are included in the program:

(a) Screening by providers of screening services authorized by the division of medical assistance to provide screening. The screening services shall, at a minimum, include:

(i) A comprehensive health and developmental history;

(ii) An assessment of physical and mental health development and nutritional status;

(iii) A comprehensive unclothed physical exam;

(iv) Appropriate immunizations according to age and health history;

(v) Laboratory tests, including lead blood level assessment appropriate for age and risk factors; and

(vi) Health education, including anticipatory guidance.

(b) Vision services which shall, at a minimum, include diagnosis and treatment for defects in vision, including eyeglasses;

(c) Dental services which shall, at a minimum, include relief of pain and infections, restoration of teeth, and dental health maintenance;

(d) Hearing services which shall, at a minimum, include diagnosis and treatment for defects in hearing, including hearing aids; and

(e) Other medically necessary health care, diagnostic services, treatment, and other measures provided under Medicaid program, to correct or ameliorate defects and physical and mental illnesses and conditions the screening services discover. In addition, the department shall provide any of the following services, provided the screening services provider determines the necessity for such services during an EPSDT screening process:

(i) Occupational therapy;

(ii) Nutritional counseling; and

(iii) Chiropractic services.

(5) EPSDT services are subject to utilization controls as the department may impose.

(6) See WAC 388-86-005 and 388-86-020 for limitations of the dental program, WAC 388-86-030 for eyeglasses and examinations, and WAC 388-86-040 for management of hearing defects)) Transportation requirements of 42 CFR 441, Subpart B are met through a contract with transportation brokers throughout the state.



[Statutory Authority: RCW 74.08.090. 90-12-061 (Order 3019), 388-86-027, filed 5/31/90, effective 7/1/90; 82-01-001 (Order 1725), 388-86-027, filed 12/3/81; 81-10-015 (Order 1647), 388-86-027, filed 4/27/81; 80-15-034 (Order 1554), 388-86-027, filed 10/9/80; 79-12-047 (Order 1457), 388-86-027, filed 11/26/79; Order 1112, 388-86-027, filed 4/15/76; Order 738, 388-86-027, filed 11/22/72.]

SHS-2407:3

AMENDATORY SECTION (Amending WSR 97-03-038, filed 1/9/97, effective 2/9/97)



WAC 388-501-0135  Patient requiring regulation. (1) ((The department shall operate a)) Patient requiring regulation (PRR) ((program to identify a client overutilizing, unnecessarily, or inappropriately obtaining medical care under the federally funded and state-funded medical programs. The department may restrict such a client to a single primary care provider and pharmacy for medical care.

(2) The purpose of the PRR program shall be to:

(a) Protect the client's health and safety;

(b) Provide continuity of medical care;

(c) Avoid duplication of services by providers;

(d) Avoid excessive, contraindicated, or potentially harmful use of prescription medications.

(3) For the purposes of this section, "primary care provider (PCP)" means a provider who has responsibility for supervising, coordinating and providing initial and primary care to clients, initiating referrals for specialist care, and maintaining the continuity of patient care. A PCP shall be either:

(a) A physician who meets the criteria under WAC 388-87-007;

(b) An advanced registered nurse practitioner (ARNP) who meets the criteria under WAC 388-87-007; or

(c) A licensed physician assistant, practicing with a sponsoring or supervising physician.

(4) For a client not enrolled in a department-contracted managed care plan, the department shall designate staff to determine the client's overuse, inappropriate, or unnecessary usage of medical care by reviewing medical assistance administration (MAA) payment records and other medical information.

(5) For a client enrolled in a department-contracted managed care plan, the department shall designate staff to evaluate the medical records and other documents provided by the client's managed care plan to determine the client's inappropriate or unnecessary use of medical care.

(6) When a client has been enrolled in more than one managed care plan during the review period, the department shall obtain and evaluate the client's medical records and other documents from all department-contracted managed care plan(s) in which the client is or has been enrolled during the review period.

(7) The department shall use medical review guidelines established by nurse advisors, physicians, pharmacy consultants, and other reference sources.

(8) The department shall consider the following levels of utilization during a period of three consecutive months or less as medical review guidelines for the PRR program:

(a) Repeated and documented efforts by the client to seek medically unnecessary health services, including but not limited to prescription medication, after having been counseled at least once by a health care provider or managed care plan representative concerning appropriate utilization of health care services;

(b) Services from four different physicians;

(c) Prescriptions from four different pharmacies;

(d) Ten prescriptions received;

(e) Two emergency room visits; or

(f) Four prescribers.

(9) The department shall notify the client in writing that the client is assigned to PRR, when the medical review indicates the client overuses medical services, or uses medical services inappropriately or unnecessarily as determined by the department's review of the client's:

(a) Medical records and other documents which indicate the client's use of medical services meets the criteria in subsection (8)(a) of this section or meets or exceeds three of the five guidelines under subsections (8)(b) through (f) of this section; and

(b) Diagnoses, the history of services provided or other medical information supplied by the health care provider or managed care plan.

(10) The department shall notify the client of the right to:

(a) A fair hearing as required under chapter 388-08 WAC; and

(b) Continue as unrestricted when a fair hearing is requested in a timely manner.

(11) A client shall respond to the department's notice within twenty calendar days by:

(a) Writing or calling the PRR representative identified in the notice;

(b) Requesting a fair hearing;

(c) Selecting a PCP and pharmacy. For a client enrolled with a department-contracted managed care plan, the client must select a PCP and pharmacy from those identified as available within their managed care plan;

(d) Requesting assistance in selecting a PCP and pharmacy; or

(e) Submitting additional medical information.

(12) The department shall assign a PCP and pharmacy for any client who fails to select a PCP and pharmacy within twenty calendar days, unless the client requests a fair hearing. The selected or assigned PCP and pharmacy shall be:

(a) Located in the client's local geographic area; or

(b) Reasonably accessible to the client.

(13) The client shall not change PCP or pharmacy for twelve months except when the:

(a) Client moves to a new residence outside the designated geographic area of the providers;

(b) PCP or pharmacy moves from the client's geographical area;

(c) PCP or pharmacy refuses to continue as the designated provider;

(d) A client may change, once within the initial sixty days, the PCP and pharmacy assigned by the department under subsection (12) of this section. For a client enrolled with a department-contracted managed care plan, the client must select a PCP and pharmacy from those identified as available within their managed care plan;

(e) PCP or pharmacy no longer participates in a department-contracted managed care plan;

(f) PCP is no longer contracted with the client's managed care plan. The client shall have the option of:

(i) Selecting a new PCP from the list of available PCPs provided by the plan; or

(ii) Transferring enrollment of all family members to the new department-contracted plan which the established PCP has joined.

(g) Client chooses a new plan during an open enrollment period which occurs in the twenty-four-month restriction period.

(14) For a client enrolled in the PRR program, the department shall:

(a) Assign a client to the program for a period of twenty-four months;

(b) Review the client's utilization at the end of the twenty-four-month period;

(c) Continue the client in the PRR program when the client continues to meet the criterion in subsection (8)(a) of this section or meet or exceed three of the five criteria in subsection (8)(b) through (f) of this section;

(d) Review continuation of the client in the PRR program at least every twelve months thereafter; and

(e) Allow the client the opportunity to change PCP or pharmacy after twelve months; except as allowed under subsection (13)(d) of this subsection.

(15) When the department designates a PCP and pharmacy for the client, the department shall issue a medical identification card identifying the client as a patient requiring regulation.

(16) When an emergency occurs as defined under WAC 388-500-0005, a provider other than the selected PCP may see the client.

(17) The PCP may refer the client to a specialist.

(18) For a client not enrolled in a department-contracted managed care plan, the department shall only pay for MAA-covered services authorized by the PCP, referred specialist, selected pharmacy, and those services specified in subsections (16) and (20) of this section.

(19) The client shall be responsible for payment of covered services not authorized by the PCP, referred specialists or selected pharmacist with the exception of services described under subsections (16) and (20) of this section.

(20) A client assigned to the PRR program may self-refer for family planning services.

(21) A client may self-refer to women's health care services. For a client enrolled with a department-contracted plan, the client must self-refer within the plan network)) is a health and safety program for clients needing help in the appropriate use of medical services. A client in PRR is restricted to one primary care provider (PCP) and one pharmacy. Enrollment in the PRR program is for twenty-four months.

(2) Any client of the department's medical programs is reviewed for assignment to PRR if:

(a) The client has:

(i) Made repeated and documented efforts to seek medically unnecessary health services; and

(ii) Been counseled at least once by a health care provider or managed care plan representative about the appropriate use of health care services; or

(b) Any three of the following conditions have been met or exceeded in a ninety-day period. The client:

(a) Received services from four different physicians; or

(b) Had prescriptions filled by four different pharmacies; or

(c) Received ten prescriptions; or

(d) Had prescriptions filled by four different prescribers; or

(e) Used two emergency room (ER) visits.

(3) If subsections (2)(a) or (b) of this section apply, then the client's use of medical services is reviewed by the department. The review considers the client's diagnoses, history of services provided, or other medical information supplied by the health care provider or managed care plan. The review is done by a nurse consultant, physician, or other qualified medical staff according to established medical review guidelines.

(4) If the medical review finds that the client uses inappropriate or medically unnecessary services the client receives written notice which:

(a) Asks the client to select a primary care provider and one pharmacy; and

(b) Notifies the client of their right to request a fair hearing within ninety days (see subsection (6) of this section); and

(c) Requires the client to respond within twenty days by:

(i) Selecting a primary care provider and pharmacy; or

(ii) Submitting additional medical information, which justifies the client's use of medical services; or

(iii) Writing or calling the PRR representative, who is identified in the PRR notice, requesting assistance; or

(iv) Requesting a fair hearing (see subsection (6) of this section).

(5) A client who does not respond to the notice within twenty days is assigned to the PRR program. The department assigns the client to a PCP and pharmacy. The client may change the assigned PCP and pharmacy once within the initial sixty days. The assigned providers will be:

(a) Located in the client's local geographic area; and

(b) Reasonably accessible to the client.

(6) A client has ninety days to request a fair hearing. A client who requests a fair hearing within twenty days from the date they receive notice under subsection (4) of this section will not be assigned to the PRR program until a fair hearing decision is made. A client who requests a fair hearing after twenty days may have been assigned a PCP and pharmacist. An assigned client will remain in PRR until a fair hearing decision is made.

(7) When a PRR client chooses or the department assigns a PCP and pharmacy, the PCP and pharmacy requirements are:

(a) A PCP supervises and coordinates medical care for the client. The PCP makes referrals for specialist care and provides continuity of care. A PCP must be:

(i) A physician who meets the criteria under WAC 388-87-007; or

(ii) An advanced registered nurse practitioner (ARNP) who meets criteria under WAC 388-87-007; or

(iii) A licensed physician assistant, practicing with a sponsoring supervising physician.

(b) A single pharmacy fills all prescriptions for the client. For fee for service clients the pharmacy must be contracted with MAA.

(c) For clients enrolled in a managed care plan, the pharmacy and PCP must be contracted with the client's managed care plan.

(8) The PRR client's medical assistance identification card (MAID) will be marked in the "restricted" column.

(9) A client in PRR cannot change their PCP or pharmacy for twelve months unless the:

(a) Client changes to a residence outside the provider's geographic area; or

(b) PCP or pharmacy moves out of the client's geographical area; or

(c) PCP or pharmacy refuses to continue as the client's provider; or

(d) Client was assigned providers. The client may change the assigned providers once within sixty days of the initial assignment.

(10) A PRR client enrolled in a managed care plan must select a PCP and pharmacy from those identified as available within their plan. In addition to the reasons given in subsection (9) of this section, the client may change a provider if the:

(a) Chosen or assigned PCP or pharmacy no longer participates with their plan. The client may:

(i) Select a new PCP from the list of available PCPs provided by the plan; or

(ii) Transfer enrollment of all family members to the new department-contracted plan which the established PCP has joined.

(b) Client chooses a new plan during the managed care program's open enrollment period, which occurs during the twenty-four-month PRR enrollment period as defined in subsection (1) of this section.

(11) After twenty-four months, a PRR client's use of services is reviewed. A client is removed from PRR if:

(a) The billing records show the care received was reasonable and appropriate; or

(b) The PCP reports the services requested and received were reasonable and appropriate.

(12) If the client is not removed from PRR under subsection (11) of this section, the client continues to be in PRR for an additional twelve months. After that twelve-period, the client is reviewed again according to subsection (11)(a) and (b) of this section.

(13) Under the PRR program, MAA or the client's managed care plan will pay for only:

(a) Those services authorized by the PCP, the PCP-referred specialist, or the pharmacist; or

(b) Emergencies services; or

(c) Family planning services; or

(d) Women's health care services. A client enrolled with a managed care plan must self-refer to providers within the plan's network.

The client may be responsible for payment of services not covered by the PRR program.



[Statutory Authority: RCW 74.08.090 and 74.09.522. 97-03-038, 388-501-0135, filed 1/9/97, effective 2/9/97. Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-501-0135, filed 5/3/94, effective 6/3/94. Formerly WAC 388-81-100.]



Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.

SHS-2448:2

AMENDATORY SECTION (Amending WSR 97-04-005, filed 1/24/97, effective 2/24/97)



WAC 388-505-0540  Assignment of ((medical support)) rights and cooperation. (1) ((As a condition of eligibility)) When a person becomes eligible for any of the department's medical programs, ((a client shall assign)) they make assignment of certain rights to the state of Washington ((all right, title, and interest)). This assignment includes all rights to any type of coverage or payment for medical care ((support available as a result of)) which results from:

(a) A court order; ((or))

(b) An administrative agency order; or

(c) Any third-party benefits or payment((s)) obligations for medical care which are the result of subrogation or contract (see WAC 388-87-020).

(2) ((When payments for covered services have been made under medical care programs under chapter 74.09 RCW, or under a contract between a managed health care plan and the department under RCW 74.09.522, for health care items or services furnished to an eligible client, if a third party has a legal or contractual liability to make payments, the state acquires the rights of the client to payment from any other party for those health care items or services.

(3) The client shall assign rights of payment to any medical care support the client may have in the client's own behalf or on the behalf of any other client for whom the client can legally assign such rights.

(4) As assignee of the eligible client's right to receive medical support payments, the department may sign coordination of benefit forms or other forms, as necessary, to ensure the efficient and proper payment of medical care support)) Subrogation is a legal term which describes the method by which the state acquires the rights of a client for whom or to whom the state has paid benefits. The subrogation rights of the state are limited to the recovery of its own costs.

(3) The person who signs the application makes the assignment of rights to the state. Assignment is made on their own behalf and on behalf of any eligible person for whom they can legally make such assignment.

(4) A person must cooperate with the department in the identification, use or collection of third-party benefits. Failure to cooperate results in a termination of eligibility for the responsible person. Other obligations for cooperation are located in chapters 388-14 and 388-422 WAC. The following clients are exempt from termination of eligibility for medical coverage as a result of noncooperation:

(a) A pregnant woman, and

(b) Minor children, and

(c) A person who has been determined to have "good cause" for noncooperation (see WAC 388-422-0015).

(5) A person will not lose eligibility for medical assistance programs due solely to the noncooperation of any third party.

(6) A person will be responsible for the costs of otherwise covered medical services if:

(a) The person received and kept the third-party payment for those services; or

(b) The person refused to provide to the provider of care their legal signature on insurance forms.



[Statutory Authority: RCW 74.08.090 and 74.09.522. 97-04-005, 388-505-0540, filed 1/24/97, effective 2/24/97. Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-505-0540, filed 5/3/94, effective 6/3/94. Formerly WAC 388-83-012.]

SHS-2402:5

AMENDATORY SECTION (Amending WSR 95-18-046, filed 8/29/95, effective 9/1/95)



WAC 388-538-060  ((Eligible client)) Healthy options eligibility and choice. (1) ((The department shall require)) A client((, eligible for certain designated medical program categories, to)) is required to enroll in the department's "healthy options" (HO) managed care when ((the)) that client ((resides in the contracted managed care service area, except as provided in WAC 388-538-080.

(2) The department shall assign a client to a plan or a PCCM provider when the client does not choose a plan or PCCM.

(3) The department shall enroll an)):

(a) Is eligible for one of the medical programs subject to mandatory enrollment as determined by the department;

(b) Resides in one of the department's contracted managed care service areas;

(c) Is not exempted by the department per WAC 388-538-080; and

(d) Is not removed from HO enrollment by the department per WAC 388-538-130.

(2) American Indian((, as defined under))s or Alaskan Natives (AI/AN) are those individuals meeting the provisions of 25 U.S.C. 1603 (c)-(d)((, in a plan when such plan includes an Indian health service direct care clinic, a tribally-operated clinic, or urban Indian health center and the Indian resides in the plan service area. If an Indian selects another plan or requests an exemption, this subsection shall not apply.

(4) The department shall not enroll Medicare beneficiaries in managed care)) as of April 30, 1998 (printed format available from the Government Printing Office, Washington, DC). They have the following options:

(a) Enrolling with an HO primary care case manager (PCCM), which include Indian health service direct-care clinics, clinics operated by tribes, and urban Indian health centers; or

(b) Voluntarily selecting an HO contracted managed care plan; or

(c) Requesting an exemption from enrollment in managed care based solely on their status as an AI/AN.

(3) An AI/AN who does not make a choice under subsection (2) of this section will be assigned to an HO PCCM if the client lives in a PCCM area. HO PCCMs are described in subsection (2)(a) of this section. A client who is assigned under this subsection is entitled to request and obtain removal from the PCCM assignment at any time.

(4) A client who is a Medicare beneficiary is not currently eligible to enroll with an HO managed care plan.

(5) Except for clients who are AI/AN, if the client does not choose an HO managed care plan, the department assigns the client to a HO plan in the client's area.

(6) The client will be given an opportunity to select a primary care provider from their HO managed care plan's available providers.

(7) If the client does not choose a primary care provider (PCP), the plan assigns the client a PCP.

(8) A client may change their PCP once a year for any reason. For more frequent PCP changes, the client must notify the plan of the request and a reason showing good cause. If the plan denies the change, the client may:

(a) Appeal to the plan; or

(b) Ask the department for a fair hearing; or

(c) Appeal to the plan and request a fair hearing from the department.



[Statutory Authority: RCW 74.08.090 and 1995 2nd sp.s. c 18. 95-18-046 (Order 3886), 388-538-060, filed 8/29/95, effective 9/1/95. Statutory Authority: RCW 74.08.090. 93-17-039 (Order 3621), 388-538-060, filed 8/11/93, effective 9/11/93.]



AMENDATORY SECTION (Amending WSR 96-24-074, filed 12/2/96, effective 1/1/97)



WAC 388-538-080  Healthy options managed care exemptions. (1) ((The department shall not require a)) Only a client ((to enroll in managed care when:

(a) (i) According to objective medical evidence, a client has multiple, complex medical diagnoses or a severe, complex manifestation of a single medical diagnosis; and

(A) The client is currently receiving care under a written treatment plan;

(B) The treatment plan requires frequent modification or monitoring due to the nature of the client's health condition;

(C) The client's health care provider is not affiliated with an available managed care plan; and

(D) Disruption of care currently being received would adversely affect the client's health condition; or

(ii) Prior to enrollment, the client has a surgical procedure scheduled to occur in the next thirty calendar days with a health care provider who is not affiliated with an available managed care plan;

(b) The client is an Indian, as defined under 25 U.S.C. 1603 (c)-(d); or

(c) Medically necessary care is not reasonably available and accessible under managed care offered to the client.

(2) The department shall consider, on a case-by-case basis, medically necessary care not reasonably available and accessible when:

(a) The limited English-speaking or hearing-impaired client can communicate in the client's primary language with a health care provider not participating in a plan or under PCCM;

(b)(i) The distance is over twenty-five miles one-way or travel time is greater than forty-five minutes one-way to the nearest primary care provider who is in managed care and accepting clients and the client's current primary health care provider is located closer to the client; or

(ii) Other transportation difficulties make it unreasonably difficult for a client to obtain primary medical care under managed care;

(c) The client is homeless or is expected to reside in temporary housing or a shelter for less than one hundred and twenty days from date the client requests an exemption;

(d)(i) Before enrollment, a pregnant woman has started prenatal care with an obstetrical provider who is not available under managed care; or

(ii) In order for a pregnant woman to continue her established course of prenatal care with an obstetrical provider who is no longer affiliated with any available managed care plan;

(e) The client's circumstances, as evaluated by the department with available information, support the client's claim that medically necessary care is not reasonably available and accessible under managed care as offered to the client.

(3) A client or a)) or their representative((, as authorized under)) (RCW 7.70.065((, or other provision of law, shall make a))) may request ((in writing or by telephone to the department to be exempted from enrolling in managed care. The department shall timely notify the client by telephone or in writing of an adverse)) an exemption ((decision and the reasons therefor before enrolling the client in managed care. If the department denies the request for exemption, the department shall provide notice containing the following information before enrolling the client in managed care:

(a) Action the department intends to take;

(b) Reasons for the intended action;

(c) The specific rule or regulation supporting the action;

(d) Client's right to request a fair hearing, including the circumstances under which the fee-for-service status is continuing, if a hearing is requested; and

(e) Full translation into the primary language of the limited English proficient recipient.

(4) The client shall remain exempted until a decision is made on the exemption request by the department. A client who is dissatisfied with the exemption decision has the right to an adjudicative hearing (fair hearing) as described under WAC 388-526-2610.

(5) If an exemption is authorized as a result of a time-limited circumstance, the department may limit the time period for which the exemption is granted to the period of time that the circumstance is expected to continue.

(6) The department may offer a client who qualifies for an exemption the option to participate in PCCM with a contracted PCCM provider of the client's choice)) from enrollment to a healthy options (HO) managed care plan. "Exemption" means the client is excused from mandatory enrollment when they have not yet enrolled with or been assigned to an HO plan. If a client asks for an exemption, they are not enrolled until the department approves or denies the request and any related fair hearing is held and decided.

(2) A client is exempted from mandatory enrollment in an HO managed care plan if:

(a) Based on the department's evaluation of objective medical evidence, all of the following are met:

(i) The client has multiple, complex, or severe medical diagnoses; and

(ii) The client's established provider is not with any available managed care plan; and

(iii) There is a written treatment plan; and

(iv) The treatment plan requires frequent change or monitoring; and

(v) Disruption of client's care would be harmful; or

(b) Prior to enrollment, the client scheduled a surgery with a provider not available to the client in an HO managed care plan (or after enrollment it is discovered that the provider is not in the client's current plan) and the surgery is scheduled within the first thirty days of enrollment; or

(c) The client is an AI/AN as specified in WAC 388-538-060(2) and requests exemption; or

(d) On a case-by-case basis, the client presents evidence that the HO program does not provide medically necessary care which is reasonably available and accessible as offered to the client. Medically necessary care is not considered reasonably available and accessible when the client:

(i) Is homeless or is expected to live in temporary housing for less than one hundred twenty days from the date the client requests the exemption; or

(ii) Is limited English speaking or hearing impaired, and the client can communicate with a provider not in an HO managed care plan who speaks in the client's language; or

(iii) Shows that travel to a Medicaid HO provider is unreasonable when compared to travel to a non-HO Medicaid provider. This is shown when the client has:

(A) To travel over twenty-five miles one-way to the nearest managed care PCP who is accepting clients and the current PCP is closer and not in an available HO managed care plan; or

(B) A travel time of over forty-five minutes one-way to the nearest HO managed care PCP who is accepting clients, when the travel time to the current PCP, who is not in an available HO managed care plan, is less; or

(C) Other transportation difficulties making it unreasonable to get primary medical services under managed care; or

(iv) Is pregnant and wishes to continue her established course of prenatal care with an obstetrical provider who is not available to her through an HO plan (or, after enrollment, when the established provider becomes unavailable through HO during the course of treatment); or

(v) Presents other evidence that exemption is appropriate based on their circumstances, as evaluated by the department.

(3) The client's period of exemption is limited by the department to the time period the circumstances or conditions that caused the exemption are expected to exist.

(4) The client remains exempt as provided in subsection (1) of this section and receives timely notice by telephone or in writing when their request is denied. The department's reasons for the denial are given before the client is required to enroll in HO. The notice to the client contains:

(a) The action the department intends to take;

(b) The reasons for the intended action;

(c) The specific rule or regulation supporting the action;

(d) The client's right to request a fair hearing, including the circumstances under which the fee-for-service status is continuing, if a hearing is requested; and

(e) A full translation into the client's primary language when the client has limited English proficiency.



[Statutory Authority: RCW 74.08.090. 96-24-074, 388-538-080, filed 12/2/96, effective 1/1/97. Statutory Authority: RCW 74.08.090 and 1995 2nd sp.s. c 18. 95-18-046 (Order 3886), 388-538-080, filed 8/29/95 effective 9/1/95. Statutory Authority: RCW 74.08.090. 93-17-039 (Order 3621), 388-538-080, filed 8/11/93, effective 9/11/93.]



AMENDATORY SECTION (Amending WSR 95-18-046, filed 8/29/95, effective 9/1/95)



WAC 388-538-095  ((Medical services)) Healthy options scope of care. ((The department shall pay separately, on a fee-for-service basis, only for medical services covered under the department's medical care programs that a managed care contract does not cover)) A client in the healthy options (HO) managed care program is eligible for the categorically needy scope of medical care as described in WAC 388-529-0100. Those covered services not provided by the HO contracted plan are provided through the department's on fee-for-service basis.



[Statutory Authority: RCW 74.08.090 and 1995 2nd sp.s. c 18. 95-18-046 (Order 3886), 388-538-095, filed 8/29/95, effective 9/1/95. Statutory Authority: RCW 74.08.090. 93-17-039 (Order 3621), 388-538-095, filed 8/11/93, effective 9/11/93.]



AMENDATORY SECTION (Amending WSR 95-18-046, filed 8/29/95, effective 9/1/95)



WAC 388-538-130  ((Enrollment termination and disenrollments)) Removal of client from healthy options. (1) Only the department has authority to remove a client from the healthy options (HO) program, but requests for removal can be made by the client, their representative as defined in RCW 7.70.065, or by the client's HO plan. Pending the department's final decision, the client remains enrolled unless staying in HO managed care would adversely affect the client's health status.

(2) The department may ((terminate)) remove a client from enrollment ((of a client in managed care)) in HO when ((a)) the client:

(a) ((Client loses eligibility)) Is no longer eligible for a medical ((eligibility category which requires)) program subject to enrollment; or

(b) ((Client)) Requests to be removed from HO, and the department approves ((disenrollment under the conditions for granting exemptions under)) according to the same criteria given in WAC 388-538-080 (Exemption); or

(c) ((Client requests disenrollment and is an Indian, as defined under 25 U.S.C. 1603 (c)-(d); or

(d) Client)) Is a Medicare beneficiary.

(((2) When a client requests disenrollment under subsection (1)(b) of this section, the client shall remain enrolled in managed care until the decision is made on the disenrollment request unless continuing in managed care pending the decision would adversely affect the client's health status.))

(3) ((Managed care contractors may request a client be disenrolled if the managed care contractor establishes, in writing, to the department's satisfaction that)) The department may remove a client from HO plan enrollment when the client's HO plan substantiates in writing, to the department's satisfaction that:

(a) The client's behavior is inconsistent with the ((managed care contractor's)) HO plan's rules and regulations, such as intentional misconduct; and

(b) After medical review and treatment interventions, the client's behavior ((is such that it has become medically infeasible to)) continues to prevent the provider from safely or prudently ((provide)) providing medical care to the client; and

(c) ((The managed care contractor has offered to the client, in writing, the opportunity to utilize the grievance procedure described in WAC 388-538-110, unless the client's conduct presents the threat of imminent harm to others.

(4) When a managed care contractor makes a request to disenroll a client as described in subsection (3) of this section, the client shall not be disenrolled until the department approves the contractor's request. The department shall make a decision on the request within thirty days from the day of receipt of the request after contacting the client, if possible, to learn the client's perspective. The department shall notify the client ten days in advance of the effective date of disenrollment.

(5) Managed care contractors shall not request disenrollment of a client solely due to an adverse change in the client's health or the cost of meeting the client's health care needs)) The client received written notice from their HO plan of the plan's intent to request the client's removal. The plan's notice to the client must include the client's right to use the plan's appeal process to review the plan's request and the client's right to use the department fair hearing process.

The requirement that the plan notify the client is waived if the client's conduct presents the threat of imminent harm to others.

(4) Within thirty days of receiving the plan request to remove a client from HO enrollment, a decision is made by the department. Before a decision is made an attempt is made by the department to contact the client and learn the client's perspective. If the plan's request to remove the client from HO enrollment is approved, the client will be given advance and adequate notice including hearing rights information (ten days in advance of the effective date of the removal).

(5) An HO plan's request to remove a client from HO enrollment will not be approved when it is solely due to an adverse change in the client's health or the cost of meeting the client's needs.



[Statutory Authority: RCW 74.08.090 and 1995 2nd sp.s. c 18. 95-18-046 (Order 3886), 388-538-130, filed 8/29/95, effective 9/1/95. Statutory Authority: RCW 74.08.090. 93-17-039 (Order 3621), 388-538-130, filed 8/11/93, effective 9/11/93.]

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