Original Notice.

Preproposal statement of inquiry was filed as WSR 00-20-047.

Title of Rule: WAC 388-505-0210 Children's medical eligibility and 388-505-0220 Family medical eligibility.

Purpose: The proposed amendment is necessary to exclude from medical eligibility the client population receiving state family assistance (SFA) cash benefits when the only child in the household is nineteen or twenty years old.

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

Statute Being Implemented: RCW 74.08.090, 74.04.050, 74.04.055, and 74.04.057.

Summary: Medical benefits are not tied to receipt of SFA cash benefits when the only child in the household is nineteen or twenty years old.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Joanie Scotson, Mailstop 45534, 925 Plum Street, Olympia, WA 98504-5534, (360) 725-1330.

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

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

Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose 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 will not impact small businesses. It affects eligibility for medical assistance programs.

RCW 34.05.328 does not apply to this rule adoption. RCW 34.05.328 (5)(b)(vii) exempts DSHS rules that apply to eligibility.

Hearing Location: Office Building 2 Auditorium, 14th Avenue and Jefferson Street, Olympia, Washington 98504, on April 24, 2001, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Kelly Cooper by April 17, 2001, phone (360) 664-6094, e-mail coopekd@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, Kelly Cooper, P.O. Box 45850, Olympia, WA 98504, fax (360) 664-6178, by April 24, 2001.

Date of Intended Adoption: No sooner than April 25, 2001.

March 8, 2001

Bonita H. Jacques, Chief

Office of Legal Affairs

(a) The child's mother was eligible for and receiving coverage under a medical program at the time of the child's birth; and

(b) 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 meet the requirements for:

(a) Citizenship or U.S. national status as described in WAC 388-424-0005(1) or immigrant status as described in WAC 388-424-0010 (1) or (2);

(b) State residence as described in chapter 388-468 WAC;

(c) A social security number as described in chapter 388-476 WAC; and

(d) Family income levels as described in WAC 388-478-0075 (1)(c).

(3) ((Upon implementation of the children's health insurance program (CHIP) as described in chapter 388-542, WAC,)) Children under the age of nineteen are eligible for ((CHIP)) the children's health insurance program (CHIP), as described in chapter 388-542 WAC, when:

(a) They meet the requirements of subsection (2)(a) and (b) of this section;

(b) They do not have other creditable health insurance coverage; and

(c) Family income exceeds two hundred percent of the federal poverty level (FPL), but does not exceed two hundred fifty percent of the FPL as described in WAC 388-478-0075 (1)(c) and (d).

(4) Children under the age of nineteen who first physically entered the U.S. after August 21, 1996 are eligible for state-funded CN scope of care when they meet the:

(a) Eligibility requirements in subsection (2)(b), (c), and (d) of this section; and

(b) Qualified alien requirements for lawful permanent residents, parolees, conditional entrants, or domestic violence victims as described in WAC 388-424-0005 (3)(a), (c), (f), or (i).

(5) Children under the age of twenty-one are eligible for CN medical assistance when they meet:

(a) ((Meet)) Citizenship or immigrant status, state residence, and social security number requirements as described in subsection (2)(a), (b), and (c) of this section;

(b) ((Meet)) Income levels described in WAC 388-478-0075 when income is counted according to WAC 388-408-0055 (1)(c); and

(c) ((Meet)) One of the following criteria:

(i) Reside in a medical hospital, intermediate care facility for mentally retarded (ICF/MR), or nursing facility for more than thirty days;

(ii) Reside in a psychiatric or chemical dependency facility;

(iii) Are in foster care; or

(iv) Receive subsidized adoption services.

(6) Children are eligible for CN medical assistance if they:

(a) Receive Supplemental Security Income (SSI) payments based upon their own disability; or

(b) Received SSI ((payments)) cash assistance for August 1996, and except for the August 1996 passage of amendments to federal disability definitions, would be eligible for SSI ((payments)) cash assistance.

(7) Children under the age of nineteen are eligible for Medically Needy (MN) medical assistance as defined in chapter 388-500 WAC when they:

(a) Meet citizenship or immigrant status, state residence, and social security number requirements as described in subsection (2)(a), (b), and (c); and

(b) Have income ((at or)) above the income levels described in WAC 388-478-0075 (1)(c).

(8) Children described in subsection (4)(a) and (b) whose countable income exceeds the standard in WAC 388-478-0075 (1)(c) are eligible for state-funded MN scope of care.

(9) A child is eligible for SSI-related MN when the child:

(a) ((Meets the conditions in subsection (6)(a);

(b))) Meets the blind and/or disability criteria of the federal SSI program or the condition in subsection (6)(b); and

(((c) Has family))

(b) Has countable income above the level described in WAC 388-478-0070(1).

(((9) Nonimmigrant))

(10) Noncitizen children, including visitors or students from another country and undocumented children, under the age of eighteen are eligible for the state-funded children's health program, if:

(a) The department determines the child ineligible for any CN or MN scope of care medical program;

(b) They meet family income levels described in WAC 388-478-0075 (1)(a); and

(c) They meet state residency requirements as described in chapter 388-468 WAC.

(((10))) (11) There are no resource ((standards for the)) limits for children(('s)) under:

(a) CN or ((the)) MN coverage;

(b) State-funded CN or MN scope of care((,)); or

(c) The children's health programs.

(((11))) (12) Children may also be eligible for:

(a) ((Temporary assistance for needy families (TANF) or state)) Family ((assistance (SFA)-related)) medical as described in WAC 388-505-0220; ((and)) or

(b) ((TANF/SFA-related)) Medical extensions as described in WAC 388-523-0100.

(((12))) (13) Except for a client described in subsection (((4)(c))) (5)(c)(i) and (((d))) (ii), an inmate of a public institution, as defined in WAC 388-500-0005, is not eligible for CN or MN medical coverage.

[Statutory Authority: RCW 74.08.090 and 74.08A.100. 99-17-023, 388-505-0210, filed 8/10/99, effective 9/10/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-505-0210, filed 7/31/98, effective 9/1/98. Formerly WAC 388-509-0905, 388-509-0910 and 388-509-0920.]

(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 cash benefits but choose((s)) not to receive ((cash benefits)); or

(d) Not eligible for or receiving TANF cash assistance, but meet((s)) the eligibility criteria for aid to families with dependent children (AFDC) ((that were)) in effect on July 16, 1996 except that:

(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 and 388-470-0026 for recipients.

(2) A person is eligible for CN family medical coverage when ((they are)) the person is not eligible for or receiving cash benefits solely ((for one of the following reasons)) because the person:

(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 who is 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)) state-funded CN scope of care family medical when the person:

(a) Is eligible for or receiving SFA cash benefits; ((or))

(b) Is 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)(a) through (j) of this section; or

(d) Meets the criteria of (1)(d) of this section.

(4) An adult receiving TANF or SFA cash benefits is not eligible for a medical program when that adult is in noncooperation status with the division of child support.

(5) When the only eligible child in an SFA cash assistance unit is a nineteen or twenty year old student, none of the family members are eligible for a medical program.

(6) A person who is an inmate of a public institution, as defined in WAC 388-500-0005, is not eligible for CN or MN medical coverage.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-505-0220, filed 7/31/98, effective 9/1/98. Formerly WAC 388-507-0740 and 388-522-2210.]

Washington State Code Reviser's Office