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Washington DSHS Attachment 2 - Groups Covered and Eligibility

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Washington DSHS Attachment 2 - Groups Covered and Eligibility

    Attachment 2

    Groups Covered and Eligibility Determinations

     _________________________________________________________________________________

    Contents

    2.1-A State Definition of a Health Maintenance Organization

    2.2-A Groups Covered

    A. Mandatory Coverage Categorically Needy and Other

    Required Special Groups

    B. Optional Groups Other Than the Medically Needy

    C. Optional Coverage of the Medically Needy Requirements

    Relating to Determining Eligibility for Medicare Prescription

    Drug Low-Income Subsidies

    Supplements to Attachment 2.2-A

    1. Reasonable Classifications of Individuals Under the Age of 21, 20, 19, and 18

    3. Method for Determining Cost Effectiveness of Caring for

    Certain Disabled Children at Home

    2.6-A Eligibility Conditions and Requirements

    A. General Conditions of Eligibility

    B. Post eligibility Treatment of Institutionalized Individuals’

    Incomes

    C. Financial Eligibility

    Supplements to Attachment 2.6-A

    1. Income Eligibility Levels

    2. Resource Levels

    3. Reasonable Limits on Amounts for Necessary Medical or

    Remedial Care not Covered Under Medicaid

    4. Methods for Treatment of Income that Differ From Those of

    the SSI Program

    5. More Restrictive Methods of Treating Resources Than Those

    of the SSI Program

    5a.Methods for Treatment of Resources for Individuals with

    Incomes Related to Federal Poverty Levels

    6. Federally Administrated Optional State Supplement

    7. Income Levels for 1902(f) States

    8. Resource Standards for 1902(f) States

    8a.More Liberal Method of Treating Income Under Section

    1902(r)(2) of the Act

    8a Addendum

    8b.More Liberal Method of Treating Income Under Section

    1902(r)(2) of the Act

    8b Addendum

9. Transfer of Resources

    9a.Transfer of Assets

    9b.Transfer of Assets

    10. Undue Hardship Provisions

    11. Cost Effectiveness Methodology for COBRA Continuation

    Beneficiaries

    12. Variations From the Basic Personal Needs Allowance (PNA) 12. Addendum

    13. Section 1924 Provisions

    14. PNA for Individuals with Greater Need

    16. Asset Verification System

    17. Disqualification for Long-Term Care Assistance for

    Individuals with Substantial Home Equity

    2.7-A Medicaid Furnished Out of State

REVISION ATTACHMENT 2.1-A

    STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

     State WASHINGTON

    State Definition of a Health Maintenance Organization:

    A "Health Maintenance organization" is: any organization receiving a certificate of registration or a certificate of authority by the insurance commissioner which provides comprehensive health care services to enrolled participants on a group practice per capita prepayment basis or on a prepaid individual practice plan or otherwise accepts prepayment for health care services and which qualifies as a health maintenance. organization pursuant to chapter 48.46 Revised Code of Washington (RCW) or as a health care service contractor pursuant to chapter 48.44 RCW: or the Washington Basic Health Plan operating pursuant to chapter 70.47 RCW.

     An Health Maintenance Organization also meets the requirements of 42 CFR 434.20 (c)(2).

    Back to TOC

TN# 91-13 Approval Date: 12/18/91 Effective Date: 10/01/91

    Supersedes

    TN# 91-05

null

    Revision: HCFA-PM-91-4 (BPD) ATTACHMENT 2.2-A

     August 1991 Page 2

     OMB No.: 0938-

    STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

     State WASHINGTON

Agency* Citation(s) Groups Covered

IV-A A. Mandatory Coverage - Categorically Needy and Other Required

     Special Groups (Continued)

    2. Deemed Recipients of AFDC.

    1902(a)(10)(A)(i)(I) b. Effective October 1, 1990, participants in of the Act a work supplementation program under title

     IV-A and any child or relative of such

     individual (or other individual living in the

     same household as such individuals) who

     would be eligible for AFDC if there were no

     work supplementation program, in

     accordance with section 482(e)(6) of the

     Act.

    402(a)(22)(A) c. Individuals whose AFDC payments are of the Act reduced to zero by reason of recovery

     of overpayment of AFDC funds.

    406(h) and d. An assistance unit deemed to be receiving 1902(a)(10)(A) AFDC for a period of four calendar months (i)(I) of the Act because the family becomes ineligible for

     AFDC as a result of collection or increased

     collection of support and meets the

     requirements of section 406(h) of the Act.

    1902(a) of e. Individuals deemed to be receiving AFDC the Act who meet the requirements of section

     473(b)(1) or (2) for whom an adoption

     assistance agreement is in effect or foster

     care maintenance payments are being made under

     title IV-E of the Act.

    *Agency that determines eligibility for coverage.

    Back to TOC

    TN# 91-22 Approval Date: 1/21/92 Effective Date: 11/1/91 Supersedes

    TN# 90-13 HCFA ID: 7983E

    Revision: HCFA-PM-91-4 (BPD) ATTACHMENT 2.2-A

     August 1991 Page 2a

     OMB No.: 0938-

    STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

     State WASHINGTON

Agency* Citation(s) Groups Covered

IV-A A. Mandatory Coverage - Categorically Needy and Other Required

     Special Groups (Continued)

407(b), 1902 3. Qualified Family Members

    (a)(10)(A)(i)

    and 1905(m)(1) Effective October 1, 1990, qualified of the Act family members who would be eligible to

     receive AFDC under section 407 of the Act

     because the principal wage earner is

     unemployed.

     /X/ Qualified family members are not included

     because cash assistance payments may be made

     to families with unemployed parents for 12 months

     per calendar year.

    1902(a)(52) 4. Families terminated from AFDC solely because of and 1925 of earnings, hours of employment, or loss of earned the Act income disregards entitled up to twelve months of

     extended benefits in accordance with section 1925

     of the Act. (This provision expires on September 30,

     1998.)

    *Agency that determines eligibility for coverage.

    Back to TOC

    TN# 91-22 Approval Date: 1/21/92 Effective Date: 11/1/91 Supersedes

    TN# 87-20 HCFA ID: 7983E

Revision: HCFA-PM-91-4 (BPD) ATTACHMENT 2.2-A

     August 1991 Page 3

     OMB No.: 0938-

    STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

     State WASHINGTON

Agency* Citation(s) Groups Covered

IV-A A. Mandatory Coverage - Categorically Needy and Other Required

     Special Groups (Continued)

    42 CFR 435.113 5. Individuals who are ineligible for AFDC solely

     because of eligibility requirements that are

     specifically prohibited under Medicaid. Included are:

    a. Families denied AFDC solely because of income and

    resources deemed to be available from--

    (1) Stepparents who are not legally liable for support

     of stepchildren under a State law of general

     applicability;

    (2) Grandparents;

    (3) Legal guardians; and

    (4) Individual alien sponsors (who are not spouses of the

    individual or the individual's parent);

    b. Families denied AFDC solely because of the involuntary

    inclusion of siblings who have income and resources of

    their own in the filing unit.

     c. Families denied AFDC because the family

     transferred a resource without receiving adequate

     compensation.

*Agency that determines eligibility for coverage.

    Back to TOC

    TN# 91-22 Approval Date: 1/21/92 Effective Date: 11/1/91 Supersedes

    TN# 86-14 HCFA ID: 7983E

Revision: HCFA-PM-91-4 (MB) ATTACHMENT 2.2-A

     August 1991 Page 3a

     OMB No.: 0938-

    STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

     State WASHINGTON

Agency* Citation(s) Groups Covered

IV-A A. Mandatory Coverage - Categorically Needy and Other

     Required Special Groups (Continued)

    42 CFR 435.114 6. Individuals who would be eligible for AFDC except

     for the increase in OASDI benefits under Pub.

     L. 92-336 (July 1, 1972), who were entitled to OASDI

     in August 1972, and who were receiving cash

     assistance in. August 1972.

     X Includes persons who would have been

     eligible for cash assistance but had not applied in

    August 1972 (this group was included in this

    State's August 1972 plan).

     X Includes persons who would have been

     eligible for cash assistance in August 1972

     if not in a medical institution or intermediate

     care facility (this group was included in this

     State's August 1972 plan).

    ___ Not applicable with respect to intermediate

     care facilities; State did or does not cover

     this service.

    1902(a)(10) 7. Qualified Pregnant Women and Children. (A)(i)(III)

    and 1905(n) of a. A pregnant woman whose pregnancy has the Act been medically verified who -

     (1) Would be eligible for an AFDC cash

     payment if the child had been born

     and was living with her;

*Agency that determines eligibility for coverage.

    Back to TOC

    TN# 92-08 Approval Date: 5/5/92 Effective Date: 1/1/92 Supersedes

    TN# 91-22 HCFA ID: 7983E

    Revision: HCFA-PM-92-1 (MB) ATTACHMENT 2.2-A

     February 1992 Page 4

    STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

     State WASHINGTON

    COVERAGE AND CONDITIONS OF ELIGIBILITY

Citation(s) Groups Covered

     A. Mandatory Coverage - Categorically Needy and Other

     Required Special Groups (Continued)

     7. a. (2) Is a member of a family that would be

     eligible for aid to families with dependent

     children of unemployed parents if the

     State had an AFDC-unemployed parents

     Program; or

     (3) Would be eligible for an AFDC cash

     payment on the basis of the income and

     resource requirements of the State’s

     approved AFDC plan.

1902(a)(10)(A) b. Children born after September 30, 1983 who are

    (i)(III) and under age 19 and who would be eligible for an 1905(n) of the AFDC cash payment on the basis of the income Act and resource requirements of the State’s approved

     AFDC plan.

     X Children born after

     December 31, 1972

     (specify optional earlier date)

     who are under age 19 and who would be

     eligible for an AFDC cash payment on the

     basis of the income and resource

     requirements of the State’s approved

     AFDC plan.

    Back to TOC

    TN# 92-16 Approval Date: 7/9/92 Effective Date: 4/1/92 Supersedes

    TN# 92-10

    REVISION: HCFA-PM-92-1 (MB) ATTACHMENT 2.2-A

     February 1992 Page 4a

    STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

     State WASHINGTON

    COVERAGE AND CONDITIONS OF ELIGIBILITY

Citation(s) Groups Covered

     A. Mandatory Coverage - Categorically Needy and Other

     Required Special Groups (Continued)

    1902(a)(10)(A) 8. Pregnant women and infants under 1 year of (i)(IV) and age with family incomes up to 133 percent 1902(1)(1)(A) of the Federal poverty level who are described and (B) of the in section 1902(a)(10)(A)(i)(IV) and 1902(1) Act (1)(A) and (B) of the Act. The income level for

     this group is specified in Supplement 1 to

     ATTACHMENT 2.6-A.

     X The State uses a percentage greater than

     133 but not more than 185 percent of the Federal

     poverty level, as established in its State plan, State

     legislation, or State appropriations as of

     December 19, 1989.

     9. Children:

    1902(a)(10)(A) a. who have attained 1 year of age but have (i)(VI) and not attained 6 years of age, with family 1902(1)(1)(C) incomes at or below 133 percent of the of the Act Federal poverty levels.

    1902(a)(10)(A)(i) b. born after September 30, 1983, who have (VII) and 1902(1) attained 6 years of age but have not (1)(D) of the Act attained 19 years of age, with family incomes at

     or below 100 percent of the Federal poverty levels.

    Income levels for these groups are specified in

    Supplement 1 to ATTACHMENT 2.6A.

    Back to TOC

    TN# 92-16 Approval Date: 7/9/92 Effective Date: 4/1/92 Supersedes

    TN# 92-08

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