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Copayments
Revised: September 23, 2004
This category contains the following information:

Calculating the Copayment

Effective May 28, 2004

WAC 388-290-0075  What steps does the WCCC program take to determine my family's WCCC eligibility and copayment amount?

  1. The WCCC program takes the following steps to determine your WCCC income eligibility and copayment:

    1. Determine your family size (under WAC 388-290-0015); and

    2. Determine your countable income (under WAC 388-290-0065).

  2. If your family's countable income falls within the range below, then your copayment is:
YOUR INCOME: YOUR COPAYMENT IS:
At or below 82% of the FPL $15
From 82% to 137.5% of the FPL $50
From 137.5% to 200% of the FPL The dollar amount equal to subtracting 137.5% of FPL from countable income, multiplying by 44%, then adding $50.
Income above 200% of the FPL, you are not eligible for WCCC benefits.  

  1. We do not pro rate the copayment when you use care for part of a month.
Click on the Washington State Register (WSR) numbers below to go to the official filings for this WAC at the Washington State Code Reviser's web site.
 Current Version:  WSR 04-08-134, effective 5/28/04
Previous Version:  WSR 04-08-021, effective 4/29/04
 Previous Version: WSR 03-06-045, effective 3/1/03 (Emergency)
Previous Version:  WSR 02-14-067, effective 8/1/02

clarifying information

The Working Connections Child Care program requires that all families pay a portion of the child care costs. This is called a "copayment".

  1. The minimum copayment is $15 a month and any increase varies according to the family size and income.

  2. The copayment does not vary with:

    1. The number of children in care;

    2. The amount of care required; or

    3. The type of care a parent selects.

  3. The copayment is automatically deducted from the DSHS payment.

  4. The consumer must pay the copayment directly to the provider.

  5. A family becomes ineligible for WCCC if they:

    1. Fail to pay the copayment to the provider; and

    2. Fail to make satisfactory arrangements to pay.

EXAMPLE

Kim has two children. Her expected average monthly income is $2,500. She pays $300 in child support for a child who does not live with her. Take the following steps to determine the child care copayment:

  1. $2,500 is the "expected average monthly income". Kim's countable income is $2,200 or ($2,500 - 300).

  2. Kim's countable income, $2,200, is the figure used to determine her monthly copayment amount. Since her countable income is over 137.5% ($1,796) and less than 200% ($2,612) of the FPL for a family of three, Kim's copayment is calculated by subtracting 137.5% of the FPL from the countable income, multiplying by 44%, and then adding $50. ($2,200 - 1796) x 44% + $50). Therefore, Kim's regular monthly copayment to her child care provider is $228.

WORKER RESPONSIBILITIES

If a reimbursement for an incorrect copayment amount is needed refer to the Reimbursement section of the manual.

Effective May 28, 2004

WAC 388-290-0085  When might my WCCC copayment change?

  1. Once we determine that you are eligible for WCCC benefits, your copayment could change when:

    1. Your monthly income decreases;

    2. Your family size increases;

    3. We make an error in your copayment computation;

    4. You did not report all income, activity and household information;

    5. You are no longer eligible for the minimum copayment under WAC 388-290-0090;

    6. We make a mass change in benefits due to a change in law or program funding; or

    7. You are approved for a new eligibility period.

  2. If your copayment changes during your eligibility period, the change is effective the first of the month following our becoming aware of the change.

  3. We do not increase your copayment during your current eligibility period when your countable income remains at or below two hundred percent of the FPL, and:

    1. Your monthly countable income increases; or

    2. Your family size decreases.
Click on the Washington State Register (WSR) numbers below to go to the official filings for this WAC at the Washington State Code Reviser's web site.
 Current Version:  WSR 04-08-134, effective 5/28/04
Previous Version:  WSR 04-08-021, effective 4/29/04
 Previous Version: WSR 03-06-045, effective 3/1/03 - Rev. 1

CLARIFYING INFORMATION

  1. If the consumer remains at or under 200% of the FPL due to an income increase or family size decrease, the copayment is NOT increased during their established eligibility period.  However, the copayments can be decreased.

EXAMPLE 1

Jean is authorized for child care June 1st - Nov. 30th with a $50 copayment. She receives a $1.00 an hour raise on July 1st. The AW recalculates Jean's new countable income and it does not exceed 200% of the FPL. Jean's situation does not meet any of the criteria in WAC 388-290-0085 for refiguring her copayment. The copayment will remain at $50 until the end of her eligibility period, Nov. 30th, unless future changes required a copayment change.

EXAMPLE 2

Jason was authorized for child care from January 1st to May 31st with a $75 copayment. On March 13th, Jason reports that he was married on March 2nd. His new wife, who is working, has one child who needs child care.

Using the new household size and income the family's eligibility and copayment would need to be re-determined.  If the family remains income eligible, the copayment does not increase during the remaining months of the current eligibility period.

EXAMPLE 3

A consumer’s copayment was established at $50 for 5/1 to 10/31. On July 15th, the worker discovers that the copayment was calculated incorrectly and it originally should’ve been $250 per month. The copayment should be increased to the $250 effective 8/1 with advance and adequate notice to the consumer. An overpayment to the consumer is established for the months of May, June and July.

EXAMPLE 4

A reapplication was completed on 7/15/02 for 8/1-1/31 with a $50 copayment.  The consumer did not know at the time of the reapplication they would be starting a new job 8/1. The consumer reports this change July 25th.  The consumer’s continued eligibility is redetermined based on the new income information.   The new income would cause the copayment to be $125 instead of the $50.  The copayment is not increased since the consumer did not withhold this information as it was not available at the time of the reapplication.  Since the eligibility period has already been established, the copayment will remain at $50 until 1/31 unless the consumer meets the criteria in WAC 388-290-0085 for a copayment change.

EXAMPLE 5

Daisy is approved for WCCC until July 31, 2004 with a $200 copayment. Daisy receives a raise April 10th, but she does not report the increased income until May 15th. You determine she remains eligible for WCCC with the increase in income and inform her that her copayment at her next review will most likely increase. No change is made to Daisy’s current copayment due to her income increase during this eligibility period.

EXAMPLE 6

Same situation as in Example 5, but Daisy’s increase in income makes her ineligible for WCCC. Daisy is sent a termination notice, following advance and adequate notice procedures,  and she is assessed an overpayment from April 10th, the date she began receiving the raise.

Minimum Copayments

Effective May 28, 2004

WAC 388-290-0090  When do I pay the minimum copayment?

You pay the minimum copayment :

  1. If your countable monthly income is at or below eighty two percent of the FPL;

  2. If you are a minor parent, and are:

    1. Receiving TANF; or

    2. Part of your parent's or relative's TANF assistance unit.

  3. For the first full month following the month you get a job or apply for WCCC and we pay benefits;

  4. If there is a break of at least thirty days in your WCCC benefits due to your activity ending; or

  5. If you received child care benefits within the last thirty days immediately prior to the eligibility period and you do not meet the qualifications in subsections (1) through (4) of this section, your copayment will be computed according to WAC 388 290 0075.
Click on the Washington State Register (WSR) numbers below to go to the official filings for this WAC at the Washington State Code Reviser's web site.

Current Version:  WSR 04-08-134, effective 5/28/04
Previous Version:  WSR 04-08-021, effective 4/29/04

CLARIFYING INFORMATION

The intent of applying the minimum copayment for the first full month following the month of application/benefits to the WCCC program is to provide relief to families just applying for WCCC or the newly employed. Although the WAC language does not directly specify, the intent is also to allow for the minimum copayment in the first month of benefits.

The rule is not intended as a one-time lifetime limit for families. The minimum copayment rule can be applied again if a consumer has a break in their WCCC of more than 30 days due to their approved activity ending.

EXAMPLE 1

Mrs. Jones (non-TANF) has received child care from April-August. She received the $15 copayment in April (her first month) and May (the first full month following her eligibility according to WAC 388-290-0090(3)).

Mrs. Jones' eligibility was due to end on August 31st. She was sent a reapplication packet and asked to return it on or before August 15th. Mrs. Jones didn't return the packet and child care was terminated effective August 31st. Mrs. Jones finally sends the reapplication packet in on October 10th.  From the reapplication packet, it is determined she has not worked for 45 days but now has new employment.  Mrs. Jones is determined eligible for WCCC and is allowed the minimum copayment again for October and November.

EXAMPLE 2

Same example as above, but Mrs. Jones remained at her same place of employment.  Her break in WCCC was due to her not returning her reapplication information. She is not eligible for the minimum copayment rule.

Non-TANF minor parents

Non-TANF minor parents can be assessed a copayment above the minimum amount. See WAC 388-290-0075.  All non-exempt income would be verified and counted toward eligibility and the copayment, as with other non-TANF families.

Third Party Copayments

The child care consumer may make arrangements for someone else, such as a "third party", to pay a portion of or all of the copayment directly to the child care provider.

This arrangement would not be considered income received by the parent and is not counted towards household income.

Copayments and the Social Service Authorization (DSHS 14-154)

SSPS only deducts the copayment from the overall child care payment when it is included on a Social Services Authorization (DSHS 14-154) that has other service lines specific to payment for care.

For this reason, many workers set up the copayment(s) to be on the first several lines, followed by a payment for daily care.  WCAP defaults to entering the copayment on the first line of an authorization.  See the figure below as an example.

Splitting Copayments

  1. The WCCC program does not advocate splitting copayments as customary practices.  However, there may be unusual circumstances in a child care case that call for splitting the copayment.  A consumer may also request their copayment be split among providers.

EXAMPLE

Juanita has been determined eligible for WCCC with a $250 copayment. She has 2 children who require care; a school-age child and an infant.

The school-age child requires half-day care only in the afternoon at an after-school program. The total cost of care for the school-age child is $158.24 ($9.89 x 16 days per month).

The infant requires half-day care at a family home. The total cost of care for the infant is $224 ($14.00 x 16 days per month).

The copayment may be split as follows:
School-age Child
Line 1 2963 $125.00/ea 1 $125.00
Line 2 2947 $9.89/da 16 $158.24
Infant
Line 1 2963 $125.00/ea 1 $125.00
Line 2 2948 $14.00/da 16 $224.00

  1. If a consumer has both a licensed and in-home / relative care provider, it is not necessary to split the copayment unless this is a specific request by the consumer.  Additionally, the copayment is not required to be assigned to the licensed provider exclusively.  The consumer must be given a choice of assigning the copayment to either provider.
 

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