Copayment is Higher than Cost of Care

Created on: 
Feb 01 2016

Related WACs and Clarifying Information

Child Care Subsidy

Seasonal Child Care

DEL Clarifying Information (published February 1, 2017)

WAC 170-290-0005

Copay Greater Than Cost of Care

DSHS will not authorize payments to eligible child care providers when the consumer’s copayment is more than the total cost of care for their family.  When determining the total monthly cost of care consider the maximum of what would be authorized to that provider and include the cost of any special needs payments.

WAC 170-290-0075

Copayment Amounts

DSHS will not authorize payments to eligible child care providers for any month when the consumer’s copayment is more than the total cost of care for their family. The total cost of care includes both the regular cost of care and any special needs authorization.

Splitting Copayments Between Multiple Providers

A consumer may request the copayment to be split among providers. The consumer may choose which provider to assign the copayment.

WAC 170-290-0090

When the ongoing copayment is higher than cost of care and the consumer is eligible for the minimum copayment, DSHS will authorize care for the first two months only if the consumer is eligible for a $15 copay for the first two months.  If later during the eligibility period, the cost of care exceeds the ongoing copayment amount care will be authorized.

WAC 170-290-0110

Copay Greater Than Cost of Care

When the total monthly cost of care of what would be authorized to the family is less than the ongoing copayment, the family may remain eligible.  DSHS will not authorize payments to eligible child care providers until the consumer’s ongoing copayment is less than the total cost of care for their family. 

Additional Information

Example: A client has a $600 copayment. They want to use a child care center in Spokane County. The client has one pre-school age child who needs 23 full days of care.

The state base rate for a child care center in Spokane for a 39-month-old child is $25 per full day. $25 x 23 full days = $575. Because the cost of care is less than the copayment, care will not be authorized to this provider.  The family will be responsible for paying for the cost of care to this provider. 

Some child care providers have a private pay rate that is less than the state rate. In this case, the Department will determine if a client is eligible using the provider’s private pay rate.

Example: A client has a $500 copayment. They want to use a child care center in Yakima County. The client has a child who is 42 months old and is eligible for 23 full days of care.

Yakima County is located in Region 2. The state rate for a child care center in Region 2 for a 42-month-old child is $24.61 per full day. However, the center the client wants to use only charges $20 per full day, which is less than the state rate. $20 x 23 full days = $460, which is less than the $500 copayment. Because the provider's rate is less than the copayment, care will not be authorized to this provider.  

However, if this provider charged the same as, or more than the state rate, the cost of care would be $566.03 ($24.61 x 23 full days).  Because the $500 copayment is less than the cost of the base rate, care would be authorized.  The client would pay the first $500 and the Department would pay the remaining $66.03 per month.