Effective Date of Rule: February 1, 2010.

     Purpose: The recent passage of the federal Children's Health Insurance Act of 2009 requires amendment to department rules regarding newborn eligibility for medical assistance.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-505-0210.

     Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, and 74.08.090; Apple Health for Kids Act (ESHB 2128); and Children's Health Insurance Act of 2009 (42 U.S.C. 1305).

     Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

     Reasons for this Finding: Adopting this emergency rule will allow the department to extend medical assistance to newborns who are not eligible under the current rule, while the department completes the permanent rule-making process begun under WSR 10-03-027.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 1, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

     Date Adopted: January 20, 2010.

Don Goldsby, Manager

Rules and Policies Assistance Unit

     (1) Newborns are eligible for federally matched categorically needy (CN) coverage through their first birthday when:

     (a) The child's mother was eligible for ((and receiving)) medical assistance ((at the time)):

     (i) On the date of the child's birth, including a retroactive eligibility determination; ((and)) or

     (ii) Based on meeting a medically needy (MN) spenddown liability with expenses incurred on or prior to the date of the child's birth.

     (b) The child remains ((with the mother and resides in the state)) a resident of the state of Washington.

     (2) Children under the age of nineteen who are U.S. citizens, U.S. nationals, or qualified aliens as described in WAC 388-424-0001 and 388-424-0006 (1), (4), and (5) are eligible for free federally matched CN coverage when they meet the following criteria:

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

     (b) A Social Security number or application as described in chapter 388-476 WAC;

     (c) Proof of citizenship or immigrant status and identity as required by WAC 388-490-0005(11);

     (d) Family income is at or below two hundred percent federal poverty level (FPL), as described in WAC 388-478-0075 at each application or review; or

     (e) They received supplemental security income (SSI) cash payments in August 1996 and would continue to be eligible for those payments except for the August 1996 passage of amendments to federal disability definitions; or

     (f) They are eligible for SSI-related CN ((or MN)) coverage.

     (3) Noncitizen children under the age of nineteen, who do not meet qualified alien status as described in WAC 388-424-0006, are eligible for free state-funded CN coverage when they meet the following criteria:

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

     (b) Family income is at or below two hundred percent FPL at each application or review.

     (4) Children under the age of nineteen who are U.S. citizens, U.S. nationals, or qualified aliens as described in WAC 388-424-0001 and 388-424-0006 (1), (4), and (5) are eligible for premium-based federally-matched CN coverage as described in chapter 388-542 WAC when they meet the following criteria:

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

     (b) A social security number or application as described in chapter 388-476 WAC;

     (c) Proof of citizenship or immigrant status and identity as required by WAC 388-490-0005(11);

     (d) Family income is over two hundred percent FPL, as described in WAC 388-478-0075, but not over three-hundred percent FPL at each application or review;

     (((c))) (e) They do not have other creditable health insurance as described in WAC 388-542-0050; and

     (((d))) (f) They pay the required monthly premiums as described in WAC 388-505-0211

     (5) Noncitizen children under the age of nineteen, who do not meet qualified alien status as described in WAC 388-424-0006, are eligible for premium-based state-funded CN coverage when they meet the following criteria:

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

     (b) Family income is over two-hundred percent FPL, as described in WAC 388-478-0075, but not over three-hundred percent FPL at each application or review;

     (c) They do not have other creditable health insurance as described in WAC 388-542-0050; and

     (d) They pay the required monthly premium as described in WAC 388-505-0211.

     (6) Children under age nineteen are eligible for the medically needy (MN) medicaid program when they meet the following criteria:

     (a) Citizenship or immigrant status, state residence, and Social Security number requirements as described in subsection (2)(a), (b), and (c);

     (b) Are ineligible for other ((federal medicaid)) federally-matched CN programs; and

     (c) Meet their spenddown ((obligation)) liability as described in WAC 388-519-0100 and 388-519-0110.

     (((6))) (7) Children under the age of ((twenty-one)) nineteen who reside or are expected to reside in a medical institution, intermediate care facility for the mentally retarded (ICF/MR), hospice care center, nursing home, institution for mental diseases (IMD) or inpatient psychiatric facility may be eligible for apple health for kids healthcare coverage based upon institutional rules described in WAC 388-505-0260. Individuals between the age of nineteen and twenty-one may still be eligible for healthcare coverage but not under apple health for kids. See WAC 388-505-0230 "Family related institutional medical" and WAC 388-513-1320 "Determining institutional status for long-term care((.))" for more information.

     (((7))) (8) Children who are in foster care under the legal responsibility of the state, or a federally recognized tribe located within the state, and who meet eligibility requirements for residency, social security number, and citizenship are eligible for federally-matched CN medicaid coverage through the month of their:

     (a) Eighteenth birthday;

     (b) Twenty-first birthday if children's administration determines they remain eligible for continued foster care services; or

     (c) Twenty-first birthday if they were in foster care on their eighteenth birthday and that birthday was on or after July 22, 2007.

     (((8))) (9) Children are eligible for state-funded CN coverage through the month of their eighteenth birthday if they:

     (a) Are in foster care under the legal responsibility of the state or a federally-recognized tribe located within the state; and

     (b) Do not meet social security number and citizenship requirements in subsection (2)(a) and (b) of this section.

     (10) Children who receive subsidized adoption services are eligible for federally-matched CN ((medicaid)) coverage.

     (((9))) (11) Children under age of nineteen may also be eligible for:

     (a) Family medical as described in WAC 388-505-0220;

     (b) Medical extensions as described in WAC 388-523-0100; or

     (c) SSI-related MN if they:

     (i) Meet the blind and/or disability criteria of the federal SSI program, or the condition of subsection (2)(e); and

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

     (((10))) (12) Children who are ineligible for ((other programs included in)) apple health for kids may be eligible for the alien ((emergency)) medical program (((AEM))) if they meet the following criteria:

     (a) They have a documented emergent medical condition as defined in WAC 388-500-0005;

     (b) They meet the other ((AEM)) alien medical program requirements as described in WAC 388-438-0110; and

     (c) They have income that exceeds three hundred percent FPL; or

     (d) They ((are disqualified from receiving)) have income less than three-hundred percent FPL, but do not qualify for premium-based coverage as described in subsection (((4))) (5) of this section because of creditable coverage or nonpayment of premiums.

     (((11))) (13) Except for a ((client)) child described in subsection (((6))) (7), an inmate of a public institution, as defined in WAC 388-500-0005, is not eligible for any ((children's healthcare)) apple health for kids program.

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.402, 74.09.470, and 2008 session law. 09-07-086, § 388-505-0210, filed 3/17/09, effective 4/17/09. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530, 74.09.700, and 2007 c 5. 08-05-018, § 388-505-0210, filed 2/12/08, effective 3/14/08. Statutory Authority: RCW 74.08.090, 74.09.530, and 74.09.415. 05-23-013, § 388-505-0210, filed 11/4/05, effective 1/1/06. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 04-15-057, § 388-505-0210, filed 7/13/04, effective 8/13/04. Statutory Authority: RCW 74.08.090 and 74.04.050. 03-14-107, § 388-505-0210, filed 6/30/03, effective 7/31/03. Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-505-0210, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.08.090, 74.04.050, [74.04.]055, and [74.04.]057. 01-11-110, § 388-505-0210, filed 5/21/01, effective 6/21/01. 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.]

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