Original Notice.

Preproposal statement of inquiry was filed as WSR 98-22-098.

Title of Rule: WAC 388-418-0025 Effect of changes on medical program benefits.

Purpose: To implement a federal option as allowed in the Balanced Budget Act (BBA) of 1997 which provides for twelve continuous months of medical benefits for children.

Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.530.

Statute Being Implemented: Section 4731 of the BBA (Public Law 105-33).

Summary: See Purpose above.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Joanie Scotson, Medical Assistance Administration, Mailstop 45530, Olympia, WA 98504-5530, (360) 753-7462.

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

Rule is necessary because of federal law, Section 4731 of the BBA of 1997.

Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose above.

Proposal Changes the Following Existing Rules: See Purpose above.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This proposed rule does not have an economic impact on small businesses. It concerns eligibility policy and affects only clients and staff.

RCW 34.05.328 applies to this rule adoption. These rules meet the definition of a significant legislative rule but the Department of Social and Health Services is exempt from preparing a cost benefit analysis under RCW 34.05.328 (5)(b)(vii).

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on April 27, 1999, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by April 16, 1999, phone (360) 902-7540, TTY (360) 902-8324, e-mail pwall@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 902-8292, by April 27, 1999.

Date of Intended Adoption: April 28, 1999.

March 19, 1999

Edith M. Rice

for Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

(1) ((Categorically needy (CN) medical and medically needy (MN) medical is continued until a redetermination of)) A client continues to receive Medicaid until the department determines the client’s eligibility ((is made for other)) or ineligibility for another medical ((programs when changes cause a client to become ineligible for)) program. This applies to a client who becomes ineligible for:

(a) A Medicaid program during the certification period; or

(b) Any of the following cash grants:

(i) TANF/SFA; ((or

(b))) (ii) SSI; ((or

(c))) (iii) GA-H; ((or

(d))) (iv) GA-S; or

(((e) CN medical))

(v) GA-X.

(2) ((When changes cause a refugee cash assistance client to be ineligible,)) A child remains continuously eligible for medical benefits for a period of twelve months from the date of certification for medical benefits or last review, whichever is later. This applies unless the child:

(a) Moves out of state;

(b) Loses contact with the department or the department does not know the child’s whereabouts;

(c) Turns eighteen years of age if receiving children’s health program benefits;

(d) Turns nineteen years of age if receiving children’s CN or CN scope of care program benefits; or

(e) Dies.

(3) When a client becomes ineligible for refugee cash assistance, refugee medical assistance can ((only)) be continued only through the eight-month ((residence)) limit, as described in WAC ((388-400-0030(6))) 388-400-0035(6).

(((3))) (4) A client receiving a TANF((/)) or SFA cash ((recipients are)) grant is eligible for a medical extension, as described under WAC 388-523-0100, when ((termination)) the client’s cash grant is ((a result of)) terminated because of:

(a) ((Increased employment)) Earned 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)) A change in income ((reported by clients)) during a certification period ((will not have an affect on medical)) does not affect eligibility for:

(a) ((The)) Pregnant women's medical programs; 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)) The first six months of the TANF/SFA-related medical extension.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090.  98-16-044, § 388-418-0025, filed 7/31/98, effective 9/1/98. Formerly WAC 388-508-0840, 388-509-0920, 388-509-0960, 388-522-2205 and 388-522-2210.]

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