reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1410 - LTC partnership policy qualifications

Current through Register Vol. 24-14, July 15, 2024
A LTC partnership policy is a LTC policy that has been
				  approved by the office of insurance commissioner as a LTC partnership policy
				  described in chapter 284-83 WAC.
WSR 13-01-017, recodified as §
											182-513-1410, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005, WAC
					 284-83-140,
					 284-83-400,
					 284-83-405,
					 284-83-410,
					 284-83-415,
					 284-83-420, and chapter 48.83
					 RCW. WSR 11-23-106, § 388-513-1410, filed 11/18/11, effective
					 12/19/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1415 - Assets that can't be protected under the LTC partnership provisions

Current through Register Vol. 24-14, July 15, 2024
The following assets cannot be protected under a LTC
				  partnership policy.
(1) Resources in a
				trust under WAC
				182-516-0100(6) and
				(7).
(2) Annuity interests in which Washington
				must be named as a preferred remainder beneficiary as under WAC
				182-516-0201.
(3) Home equity in excess of the standard
				under WAC
				182-513-1350. Individuals who
				have excess home equity interest are not eligible for long-term care medicaid
				services.
(4) Any portion of the
				value of an asset that exceeds the dollar amount paid out by the LTC
				partnership policy.
(5) The
				unprotected value of any partially protected asset is subject to estate
				recovery described in chapter 182-527 WAC.
WSR 13-01-017, recodified as §
											182-513-1415, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005, WAC
					 284-83-140,
					 284-83-400,
					 284-83-405,
					 284-83-410,
					 284-83-415,
					 284-83-420, and chapter 48.83
					 RCW. WSR 11-23-106, § 388-513-1415, filed 11/18/11, effective
					 12/19/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1420 - Eligibility for asset protection under a partnership policy

Current through Register Vol. 24-14, July 15, 2024
(1) The LTC
				partnership policy must meet all the requirements in chapter 284-83 WAC. For
				existing LTC policies which are converted to a LTC partnership policy via an
				exchange or through the addition of a policy rider or endorsement, the
				conversion must take place on or after December 1, 2011 unless the policy is
				paying out benefits at the time the policy is exchanged.
(2) You meet all applicable eligible
				requirements for LTC medicaid and:
(a) Your
				LTC partnership policy benefits have been exhausted and you are in need of LTC
				services.
(b) Your LTC partnership
				policy is not exhausted and is:
(i) Covering
				all costs in a medical institution and you are still in need for medicaid;
				or
(ii) Covering a portion of the
				LTC costs under your LTC partnership policy but does not meet all of your LTC
				needs.
(c) At the time
				of your LTC partnership policy has paid out more benefits than you have
				designated as protected. In this situation your estate can designate additional
				assets to be excluded from the estate recovery process up to the dollar amount
				the LTC partnership policy has paid out.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1425 - Not qualifying for LTC medicaid if an LTC partnership policy is in pay status

Current through Register Vol. 24-14, July 15, 2024
You are not eligible for long-term care (LTC) medicaid when
				  the following applies:
(1) The income
				you have available to pay toward your cost of care under WAC
				182-513-1380, combined with the
				amount paid under the qualifying LTC partnership policy, exceeds the monthly
				private rate at the institution.
(2) The income you have available to pay
				toward your cost of care on a home and community based (HCB) waiver under
				chapter 182-515 WAC, combined with the amount paid under the qualifying LTC
				partnership policy, exceeds the monthly private rate in a home or residential
				setting.
(3) You fail to meet
				another applicable eligibility requirement for LTC medicaid.
WSR 13-01-017, recodified as §
											182-513-1425, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005, WAC
					 284-83-140,
					 284-83-400,
					 284-83-405,
					 284-83-410,
					 284-83-415,
					 284-83-420, and chapter 48.83
					 RCW. WSR 11-23-106, § 388-513-1425, filed 11/18/11, effective
					 12/19/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1430 - Change of circumstances that must be reported when there is an LTC partnership policy paying a portion of care

Current through Register Vol. 24-14, July 15, 2024
You must report changes described in WAC
				  182-504-0105 plus the
				  following:
(1) You must report and
				verify the value of the benefits that your issuer has paid on your behalf under
				the long-term care (LTC) partnership policy upon request by the agency, and at
				each annual eligibility review.
(2)
				You must provide proof when you have exhausted the benefits under your LTC
				partnership policy.
(3) You must
				provide proof if you have given away or transferred assets that you have
				previously designated as protected. Although, there is no penalty for the
				transfer of protected assets once you have been approved for LTC medic-aid, the
				value of transferred assets reduces the total dollar amount that is designated
				as protected and must be verified.
(4) You must provide proof if you have sold
				an asset or converted a protected asset into cash or another type of asset. You
				will need to make changes in the asset designation and verify the type of
				transaction and new value of the asset.
WSR 13-01-017, recodified as §
											182-513-1430, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005, WAC
					 284-83-140,
					 284-83-400,
					 284-83-405,
					 284-83-410,
					 284-83-415,
					 284-83-420, and chapter 48.83
					 RCW. WSR 11-23-106, § 388-513-1430, filed 11/18/11, effective
					 12/19/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1435 - When Washington recognizes an LTC partnership policy purchased in another state

Current through Register Vol. 24-14, July 15, 2024
The Washington long term care partnership program provides
				  reciprocity with respect to qualifying long-term care insurance policies
				  covered under other state long-term care insurance partnerships. This allows
				  you to purchase a partnership policy in one state and move to Washington
				  without losing your asset protection. If your LTC policy is in pay status at
				  the time you move to Washington and you are otherwise eligible for LTC
				  medicaid, Washington will recognize the amount of protection you accumulated in
				  the other state.
WSR 13-01-017, recodified as §
											182-513-1435, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005, WAC
					 284-83-140,
					 284-83-400,
					 284-83-405,
					 284-83-410,
					 284-83-415,
					 284-83-420, and chapter 48.83
					 RCW. WSR 11-23-106, § 388-513-1435, filed 11/18/11, effective
					 12/19/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1440 - Determining how many of my assets can be protected

Current through Register Vol. 24-14, July 15, 2024
You can protect assets based on the amount paid by your LTC
				  partnership policy. Assets are protected in both LTC eligibility and estate
				  recovery. If the partnership for long-term care program is discontinued, an
				  individual who purchased an approved plan before the date the program is
				  discontinued remains eligible to receive dollar-for-dollar asset disregard and
				  asset protection under the long-term care (LTC) medicaid
				  program.
WSR 13-01-017, recodified as WAC
					 182-513-1440, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005, WAC
					 284-83-140,
					 284-83-400,
					 284-83-405,
					 284-83-410,
					 284-83-415,
					 284-83-420, and chapter 48.83
					 RCW. WSR 11-23-106, § 388-513-1440, filed 11/18/11, effective
					 12/19/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1445 - Designating a protected asset and required proof

Current through Register Vol. 24-14, July 15, 2024
(1) Complete a
				department of social and health services (DSHS) 10-438 long-term care
				partnership (LTCP) asset designation form listing assets and the full fair
				market value that are earmarked as protected at the time of initial application
				for long-term services and supports under medicaid.
(a) The full fair market value (FMV) of real
				property or interests in real property will be based on the current assessed
				value for property tax purposes for real property. A professional appraisal by
				a licensed appraiser can establish the current value if the assessed value is
				disputed.
(b) The value of a life
				estate in real property is determined using the life estate tables found at
www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/determining-value-life-estates
.
(c) If you own an asset with others, you can
				designate the value of your pro rata equity share.
(d) If the dollar amount of the benefits paid
				under a LTCP policy is greater than the fair market value of all assets
				protected at the time of the application for long-term care medicaid, you may
				designate additional assets for protection under this section. The DSHS LTCP
				asset designation form must be submitted with the updated assets indicated
				along with proof of the current value of designated assets.
(e) The value of your assets protected for
				you under your LTC partnership policy do not carry over to your spouse should
				the spouse need medicaid LTC services during or after your lifetime. If your
				surviving spouse has an LTC partnership policy the spouse may designate assets
				based on the dollar amount paid under the spouse's own policy.
(f) Assets designated as protected under this
				subsection will not be subject to transfer penalties under WAC
				182-513-1363.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1450 - How the transfer of assets affects LTC partnership and medicaid eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) If you
				transfer an asset within the sixty months prior to the medicaid application or
				after medicaid eligibility has been established, the agency will evaluate the
				transfer based on WAC
				182-513-1363 and determine if a
				penalty period applies unless:
(a) You have
				already been receiving institutional services;
(b) Your LTC partnership policy has paid
				toward institutional services for you; and
(c) The value of the transferred assets has
				been protected under the LTC partnership policy.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1455 - What happens to protected assets under a LTC partnership policy after death

Current through Register Vol. 24-14, July 15, 2024
Assets designated as protected prior to death are not
				  subject to estate recovery for medical or long-term care (LTC) services paid on
				  your behalf under chapter 182-527 WAC as long as the following requirements are
				  met:
(1) A personal representative who
				asserts an asset is protected under this section has the initial burden of
				providing proof under chapter 182-527 WAC.
(2) A personal representative must provide
				verification from the LTC insurance company of the dollar amount paid out by
				the LTC partnership policy.
(3) If
				the LTC partnership policy paid out more than was previously designated, the
				personal representative has the right to assert that additional assets should
				be protected based on the increased protection. The personal representative
				must use the DSHS LTCP asset designation form and send it to the office of
				financial recovery.
(4) The amount
				of protection available to you at death through the estate recovery process is
				decreased by the FMV of any protected assets that were transferred prior to
				death.
WSR 13-01-017, recodified as §
											182-513-1455, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005, WAC
					 284-83-140,
					 284-83-400,
					 284-83-405,
					 284-83-410,
					 284-83-415,
					 284-83-420, and chapter 48.83
					 RCW. WSR 11-23-106, § 388-513-1455, filed 11/18/11, effective
					 12/19/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1505

Current through Register Vol. 24-14, July 15, 2024
WSR 16-15-042, recodified as § 182-513-1505, filed
					 7/14/16, effective 7/14/16. Statutory Authority:
					 RCW
					 11.92.180,
					 43.20B.460.
					 WSR 03-16-022, §
											388-79-010, filed
					 7/28/03, effective 8/28/03; WSR 98-10-055, §
											388-79-010, filed
					 4/30/98, effective 5/31/98.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1510

Current through Register Vol. 24-14, July 15, 2024
WSR 16-15-042, recodified as § 182-513-1510, filed
					 7/14/16, effective 7/14/16. Statutory Authority:
					 RCW
					 11.92.180,
					 43.20B.460.
					 WSR 03-16-022, §
											388-79-020, filed
					 7/28/03, effective 8/28/03; WSR 98-10-055, §
											388-79-020, filed
					 4/30/98, effective 5/31/98.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1515 - Maximum guardianship fees and related costs before June 1, 2018

Current through Register Vol. 24-14, July 15, 2024
(1) This section
				sets the maximum guardianship fees and related costs when:
(a) The court order was entered before June
				1, 2018; and
(b) The client under
				guardianship was receiving medic-aid-funded long-term care before June 1,
				2018.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1520

Current through Register Vol. 24-14, July 15, 2024
WSR 16-15-042, recodified as § 182-513-1520, filed
					 7/14/16, effective 7/14/16. Statutory Authority:
					 RCW
					 11.92.180,
					 43.20B.460.
					 WSR 03-16-022, §
											388-79-040,
					 filed 7/28/03, effective 8/28/03; WSR 98-10-055, §
											388-79-040,
					 filed 4/30/98, effective 5/31/98.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1525 - Procedure for allowing guardianship fees and related costs from client participation before June 1, 2018

Current through Register Vol. 24-14, July 15, 2024
(1)
				This section describes the procedure for allowing guardianship fees and related
				costs from client participation when:
(a) A
				court order was entered before June 1, 2018; and
(b) The client under guardianship was
				receiving medic-aid-funded long-term care before June 1, 2018.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1530 - Maximum guardianship fee and related cost deductions allowed from a client's participation or room and board on or after June 1, 2018

Current through Register Vol. 24-14, July 15, 2024
(1) General
				information.
(a) This section sets the
				maximum guardianship fee and related cost deductions when:
(i) A court order was entered on or after
				June 1, 2018; or
(ii) The client
				under guardianship began receiving medicaid-funded long-term services and
				supports on or after June 1, 2018.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1600 - Medicaid alternative care (MAC) - Overview

Current through Register Vol. 24-14, July 15, 2024
Medicaid alternative care (MAC) is a Washington apple health
				  benefit authorized under section 1115 of the Social Security Act. It enables
				  the medicaid agency and the agency's designees to deliver an array of
				  person-centered long-term services and supports (LTSS) to unpaid caregivers
				  caring for a medicaid-eligible person who meets nursing facility level of care
				  under WAC
				  388-106-0355.
(1) For services included with the MAC
				benefit package, see WAC 388-106-1900 through 388-106-1990.
(2) For financial eligibility for MAC
				services, see WAC 182-513-1605.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1605 - Medicaid alternative care (MAC)-Eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) The person
				receiving care must meet the financial eligibility criteria for medicaid
				alternative care (MAC).
(2) To be
				eligible for MAC services, the person receiving care must:
(a) Be age 55 or older;
(b) Be assessed as meeting nursing facility
				level of care under WAC
				388-106-0355, and choose to
				receive services under the MAC program instead of other long-term services and
				supports;
(c) Meet residency
				requirements under WAC
				182-503-0520;
(d) Live at home and not in a residential or
				institutional setting;
(e) Have an
				eligible unpaid caregiver under WAC
				388-106-1905;
(f) Meet citizenship and immigration status
				requirements under WAC
				182-503-0535(2)(a) or
				(b); and
(g) Be eligible for either:
(i) A noninstitutional medicaid program,
				which provides categorically needy (CN) or alternative benefit plan (ABP) scope
				of care under WAC
				182-501-0060; or
(ii) An SSI-related CN program by using
				spousal impoverishment protections institutionalized (SIPI) spouse rules under
				WAC 182-513-1660.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1610 - Tailored supports for older adults (TSOA) - Overview

Current through Register Vol. 24-14, July 15, 2024
(1) The tailored supports for older adults
				(TSOA) program is a federally funded program approved under section 1115 of the
				Social Security Act. It enables the medicaid agency and the agency's designees
				to deliver person-centered long-term services and supports (LTSS) to a person
				who:
(a) Meets nursing facility level of care
				described in WAC
				388-106-0355; and
(b) Meets the functional requirements under
				WAC 388-106-1900 through 388-106-1990.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1615 - Tailored supports for older adults (TSOA)-General eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) The person
				receiving care must meet the financial eligibility criteria for tailored
				supports for older adults (TSOA).
(2) To be eligible for the TSOA program, the
				person receiving care must:
(a) Be age 55 or
				older;
(b) Be assessed as meeting
				nursing facility level of care under WAC
				388-106-0355;
(c) Meet residency requirements under WAC
				182-503-0520;
(d) Live at home and not in a residential or
				institutional setting;
(e) Have an
				eligible unpaid caregiver under WAC
				388-106-1905, or meet the
				criteria under WAC
				388-106-1910 if the person does
				not have an eligible unpaid caregiver;
(f) Meet citizenship or immigration status
				requirements under WAC
				182-503-0535. To be eligible for
				TSOA, a person must be a:
(i) U.S. citizen
				under WAC
				182-503-0535(1)(c);
(ii) U.S. national under WAC
				182-503-0535(1)(d);
(iii) Qualifying American Indian born abroad
				under WAC
				182-503-0535(1)(f);
				or
(iv) Qualified alien under WAC
				182-503-0535(1)(b)
				and have either met or is exempt from the five-year bar requirement for
				medicaid.
(g) Provide a
				valid Social Security number under WAC
				182-503-0515;
(h) Have countable resources within specific
				program limits under WAC
				182-513-1640; and
(i) Meet income requirements under WAC
				182-513-1635.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1620 - Tailored supports for older adults (TSOA)-Presumptive eligibility (PE)

Current through Register Vol. 24-14, July 15, 2024
(1) A person may be
				determined presumptively eligible for tailored supports for older adults (TSOA)
				services upon completion of a prescreening interview.
(2) The prescreening interview may be
				conducted by either:
(a) The area agency on
				aging (AAA); or
(b) A home and
				community services intake case manager or social worker.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1625 - Tailored supports for older adults (TSOA)-Applications

Current through Register Vol. 24-14, July 15, 2024
(1) Applications for tailored supports for
				older adults (TSOA) are submitted:
(a) Online
				at Washington Connection at
www.washingtonconnection.org
;
(b) By sending a completed HCA 18-005
				application for TSOA form to P.O. Box 45826, Olympia, WA 98605;
(c) By faxing a completed HCA 18-005
				application for TSOA form to 1-855-635-8305;
(d) By contacting the local area agency on
				aging (AAA) office at 1-855-567-0252; or
(e) By contacting the local home and
				community services (HCS) office. To find the local HCS office, see
https://www.dshs.wa.gov/ALTSA/resources
.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1630 - Tailored supports for older adults (TSOA) - Rights and responsibilities

Current through Register Vol. 24-14, July 15, 2024
(1) A person
				applying for or receiving tailored supports for older adults (TSOA) has the
				right to:
(a) Have TSOA rights and
				responsibilities explained and provided in writing;
(b) Be treated politely and fairly without
				regard to race, color, political beliefs, national origin, religion, age,
				gender (including gender identity and sex stereotyping), sexual orientation,
				disability, honorably discharged veteran or military status, or
				birthplace;
(c) Get help with the
				TSOA application if requested;
(d)
				Have an application processed promptly and no later than the timelines
				described in WAC
				182-503-0060;
(e) Have at least ten calendar days to give
				the medicaid agency or the agency's designee information needed to determine
				eligibility and be given more time if asked for;
(f) Have personal information kept
				confidential. The agency or the agency's designee may share information with
				other state and federal agencies for purposes of eligibility and enrollment in
				other Washington apple health programs;
(g) Get written notice, in most cases, at
				least ten calendar days before the agency or the agency's designee denies,
				terminates, or changes eligibility for TSOA;
(h) Ask for an appeal if the person disagrees
				with the agency or the agency's designee's decision. A person can also ask a
				department supervisor or administrator to review the decision or action without
				affecting the right to a fair hearing;
(i) Ask for and get interpreter or translator
				services at no cost and without delay;
(j) Ask for voter registration
				assistance;
(k) Refuse to speak to
				an investigator if the person's case is audited. If the person does not want to
				let the investigator enter their home, there is no requirement to do so and the
				person may ask the investigator to come back at another time. Such a request
				will not affect a person's eligibility for TSOA; and
(1) Get equal access services under WAC
				182-503-0120 if
				eligible.
(2) An applicant or
				recipient of TSOA is responsible to:
(a)
				Report changes in household or family circumstances as required under WAC
				182-513-1650;
(b) Provide the
				agency or the agency's designee with any information or proof needed to
				determine eligibility. If the person has trouble getting proof, the agency or
				the agency's designee helps get the proof needed or contacts other persons or
				agencies for it;
(c) Provide a
				valid Social Security number or immigration document number in order to verify
				identity, citizenship, immigration status, date of birth, and whether the
				person has other health care coverage. This information is not shared with the
				department of homeland security;
(d) Complete renewals when requested;
				and
(e) Cooperate with quality
				assurance when requested.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1635 - Tailored supports for older adults (TSOA)-Income eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) To determine
				income eligibility for the tailored supports for older adults (TSOA) program,
				the medicaid agency or the agency's designee uses the following rules depending
				on whether the person is single or married.
(2) If the TSOA applicant is single, the
				agency or the agency's designee:
(a)
				Determines available income under WAC
				182-513-1325;
(b) Excludes income under WAC
				182-513-1340; and
(c) Compares remaining gross nonexcluded
				income to 400 percent of the federal benefit rate (FBR) for the supplemental
				security income (SSI) cash grant program. To be eligible, a person's gross
				income must be equal to or less than 400 percent of the FBR.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1640 - Tailored supports for older adults (TSOA)-Resource eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) The resource
				standard for a single applicant for tailored supports for older adults (TSOA)
				is six times the Washington state average monthly private nursing facility
				rate, as determined by the department of social and health services under
				chapter 74.46 RCW.
(2) The resource
				standard for a married couple is six times the Washington state average monthly
				private nursing facility rate, as determined by the department of social and
				health services under chapter 74.46 RCW, for the TSOA applicant plus the state
				spousal resource standard for the spousal impoverishment protections community
				(SIPC) spouse. The state spousal resource standard may change annually on July
				1st.
(3) The medicaid agency or the
				agency's designee uses rules in WAC
				182-513-1350 (1), (3) and
				(4) to determine general eligibility relating
				to resources, availability of resources, and which resources count.
(4) The TSOA recipient has one year from the
				date of initial eligibility of TSOA to transfer resources in excess of the TSOA
				standard to the SIPC spouse.
(5)
				The resource standard for TSOA changes annually on January 1st based on the
				current average private nursing facility rate, as determined by the department
				of social and health services under chapter 74.46 RCW.
(6) The current TSOA standards and the
				current average private nursing facility rate are found on the Washington apple
				health income and resource standards chart, institutional standards section;
				see
www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources
.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1645 - Tailored supports for older adults (TSOA) - Certification periods

Current through Register Vol. 24-14, July 15, 2024
(1) A certification
				period is the period of time a person is determined eligible for the tailored
				supports for older adults (TSOA) program. It begins on the first day of the
				month that the medicaid agency or the agency's designee determines the person
				is eligible for TSOA services, and continues through the last day of the month
				of the certification period.
(2)
				TSOA is certified for twelve months of continuous coverage regardless of a
				change in circumstances, unless the person:
(a) Moves out-of-state;
(b) Meets institutional status under WAC
				182-513-1320;
(c) Becomes eligible for a categorically
				needy or alternate benefit plan Washington apple health program; or
(d) Dies.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1650 - Tailored supports for older adults (TSOA) - Changes of circumstances requirements

Current through Register Vol. 24-14, July 15, 2024
(1) Changes
				in tailored supports for older adults (TSOA) household and family circumstances
				described in subsection
(2) of this
				section must be reported to the medicaid agency or the agency's designee within
				thirty days of the date of the change.
(2) The following changes must be reported:
(a) A change in residential or mailing
				address, including if the TSOA recipient moves out-of-state;
(b) When the TSOA recipient admits to an
				institution, as defined in WAC
				182-500-0050, and is likely to
				reside there for thirty days or longer; or
(c) When the TSOA recipient dies.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1655 - Tailored supports for older adults (TSOA) - Renewals

Current through Register Vol. 24-14, July 15, 2024
(1) A person who receives tailored supports
				for older adults (TSOA) services must complete a renewal of all eligibility
				factors for the program at least every twelve months.
(2) Forty-five days prior to the end of the
				certification period, notice is sent to the recipient with the HCA 18-008
				application for TSOA form. The TSOA recipient may complete the TSOA renewal in
				any of the following ways:
(a) Complete the
				TSOA application form, sign it, and mail it to P.O. Box 45826, Olympia, WA
				98605 by the due date on the letter;
(b) Complete the TSOA application form, sign
				it, and fax it to 1-855-635-8305 by the due date on the letter;
(c) Renew online at Washington connection at
				www. washingtonconnection.org by the due date on the letter; or
(d) Call the local home and community
				services office at the telephone number on the letter by the due date on the
				letter.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1660 - Medicaid alternative care (MAC) and tailored supports for older adults (TSOA)-Spousal impoverishment

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				agency or the agency's designee determines financial eligibility for medicaid
				alternative care (MAC) or tailored supports for older adults (TSOA) using
				spousal impoverishment protections under this section, when an applicant or
				recipient:
(a) Is married to, or marries, a
				person who is not in a medical institution; and
(b) Is ineligible for a noninstitutional
				categorically needy (CN) SSI-related program or the TSOA program due to:
(i) Spousal deeming rules under WAC
				182-512-0920 for MAC;
(ii) Exceeding the resource limit in WAC
				182-512-0010 for MAC, or the
				limit under WAC
				182-513-1640 for TSOA;
				or
(iii) Both (b)(i) and (ii) of
				this subsection.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-514 - Long-term care for families and children › Section 182-514-0230 - Purpose

Current through Register Vol. 24-14, July 15, 2024
(1) This chapter
				describes eligibility requirements for the Washington apple health (WAH)
				modified adjusted gross income (MAGI)-based long-term care program (LTC) for
				children and adults who have been admitted to an institution as defined in WAC
				182-500-0050 for at least 30
				days. The rules are stated in the following sections:
(a) WAC
				182-514-0240 General
				eligibility;
(b) WAC
				182-514-0245 Resource
				eligibility;
(c) WAC
				182-514-0250 Program for adults
				age 19 and older;
(d) WAC
				182-514-0260 Program for children
				under age 19;
(e) WAC
				182-514-0263 Non-SSI-related
				institutional medically needy coverage for pregnant women and people age 20 and
				younger.
(f) WAC
				182-514-0270 Involuntary
				commitment to Eastern or Western State Hospital.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-514 - Long-term care for families and children › Section 182-514-0235

Current through Register Vol. 24-14, July 15, 2024
12-02-034, recodified as §
											182-514-0235, filed 12/29/11,
					 effective 1/1/12. Statutory Authority:
					 RCW
					 74.04.055,
					 74.04.057,
					 74.08.090,
					 74.09.530, and
					 42 C.F.R.
					 441.151. 09-06-029, § 388-505-0235,
					 filed 2/24/09, effective 3/27/09.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-514 - Long-term care for families and children › Section 182-514-0240 - General eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) To be
				eligible for modified adjusted gross income (MAGI)-based long-term care (LTC)
				coverage under this section, a person must:
(a) Meet institutional status under WAC
				182-513-1320;
(b) Meet the general eligibility requirements
				under WAC
				182-503-0505, unless the
				applicant is a noncitizen, in which case WAC
				182-503-0505(3)(c) and
				(d) do not apply;
(c) Have countable income below the
				applicable standard described in WAC
				182-514-0250(2)
				or 182-514-0260(3),
				unless the applicant is eligible as medically needy;
(d) Satisfy the program requirements in WAC
				182-514-0250 and
				182-514-0260; and
(e) Meet the nursing facility level of care
				under WAC
				388-106-0355 if admitted to a
				nursing facility for nonhospice care. Hospice patients are exempt from this
				requirement.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-514 - Long-term care for families and children › Section 182-514-0245 - Resource eligibility

Current through Register Vol. 24-14, July 15, 2024
Applicants for and recipients of the modified adjusted gross
				  income (MAGI)-based long-term care program are exempt from the
				  transfer-of-asset evaluation under WAC
				  182-513-1363, and there is no
				  resource test.
12-02-034, recodified as §
											182-514-0245, filed 12/29/11,
					 effective 1/1/12. Statutory Authority:
					 RCW
					 74.04.055,
					 74.04.057,
					 74.08.090,
					 74.09.530, and
					 42 C.F.R.
					 441.151. 09-06-029, § 388-505-0245,
					 filed 2/24/09, effective 3/27/09.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-514 - Long-term care for families and children › Section 182-514-0250 - Program for adults age nineteen and older

Current through Register Vol. 24-14, July 15, 2024
(1) To qualify for coverage under the
				modified adjusted gross income (MAGI)-based long-term care (LTC) program under
				this section, a person age nineteen or older must be eligible for one of the
				following Washington apple health (WAH) programs:
(a) WAC
				182-505-0240 Washington apple
				health-Parents and caretaker relatives;
(b) WAC
				182-523-0100 Washington apple
				health-Medical extension;
(c) WAC
				182-505-0250 Washington apple
				health-MAGI-based adult medical;
(d) WAC
				182-505-0115 Washington apple
				health-Eligibility for pregnant women; or
(e) WAC
				182-507-0110 Washington apple
				health-Alien medical programs.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-514 - Long-term care for families and children › Section 182-514-0255

Current through Register Vol. 24-14, July 15, 2024
12-02-034, recodified as §
											182-514-0255, filed 12/29/11,
					 effective 1/1/12. Statutory Authority:
					 RCW
					 74.04.055,
					 74.04.057,
					 74.08.090,
					 74.09.530, and
					 42 C.F.R.
					 441.151. 09-06-029, § 388-505-0255,
					 filed 2/24/09, effective 3/27/09.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-514 - Long-term care for families and children › Section 182-514-0260 - Institutional program for children under age nineteen

Current through Register Vol. 24-14, July 15, 2024
(1) To qualify for the modified adjusted
				gross income (MAGI)-based long-term care (LTC) program under this section, you
				(a child under age nineteen) must meet:
(a)
				The general eligibility requirements in WAC
				182-514-0240; and
(b) Program requirements under WAC
				182-505-0210 or
				182-505-0117.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-514 - Long-term care for families and children › Section 182-514-0263 - Non-SSI-related institutional medically needy coverage for pregnant people and people age 20 and younger

Current through Register Vol. 24-14, July 15, 2024
(1) Medically
				needy (MN) coverage under this section is only available for people age 20 and
				younger or pregnant people. The medicaid agency determines a client who meets
				SSI-related criteria under WAC
				182-512-0050
				eligible for institutional MN coverage under WAC
				182-513-1395.
				If a client meets requirements in both this section and WAC
				182-513-1395,
				the client may choose which program to enroll in for coverage.
(2) A client whose income exceeds the
				categorically needy (CN) standards under WAC
				182-514-0250
				and
				182-514-0260
				is:
(a) Eligible for MN coverage with no
				spenddown if the client's countable income (CI) is equal to or less than the
				department-contracted daily rate times the number of days in the
				institution;
(b) Eligible for MN
				coverage after a spenddown under WAC
				182-519-0110
				is met if the client's CI is above the department-contracted daily rate times
				the number of days in the institution but less than the institution's private
				rate;
(c) Not eligible for payment
				of long-term care services provided by the institution if the person's CI
				exceeds the institution's private rate;
(d) Responsible for paying up to the monthly
				state rate for the facility as participation in the cost of care; and
(e) Allowed to keep a monthly personal needs
				allowance (PNA) under WAC
				182-513-1105.
				Current PNA and long-term care standards can be found at the agency's program
				standard for income and resources web page.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-514 - Long-term care for families and children › Section 182-514-0270 - When involuntary commitment to Eastern or Western State Hospital

Current through Register Vol. 24-14, July 15, 2024
(1) A person who is
				involuntarily committed to Eastern or Western State Hospital under chapter
				71.34 RCW is eligible for categorically needy (CN) coverage if the person:
(a) Is under age twenty-one;
(b) Meets institutional status under WAC
				182-513-1320; and
(c) Has countable income below:
(i) Two hundred ten percent of the federal
				poverty level if under age nineteen; or
(ii) One hundred thirty-three percent of the
				federal poverty level if age nineteen or twenty.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1500

Current through Register Vol. 24-14, July 15, 2024
WSR 13-03-096, recodified as §
											182-515-1500, filed 1/15/13,
					 effective 1/15/13. WSR 13-01-017, recodified as § 182-513-1500, filed
					 12/7/12, effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.055,
					 74.04.057 and
					 74.08.090. WSR 98-16-044, §
					 388-478-0045, filed 7/31/98, effective
					 9/1/98.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1505 - Home and community based (HCB) waiver services authorized by home and community services (HCS)

Current through Register Vol. 24-14, July 15, 2024
This chapter describes the general and financial eligibility
				  requirements for categorically needy (CN) home and community based (HCB) waiver
				  services authorized by home and community services (HCS) . The definitions in
				  WAC 182-513-1100 and chapter 182-500 WAC apply throughout this chapter.
(1) The HCS waivers are:
(a) Community options program entry system
				(COPES);
(b) New Freedom
				consumer-directed services (New Freedom); and
(c) Residential support waiver
				(RSW).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1506 - Home and community based (HCB) waiver services authorized by home and community services (HCS)-General eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) To be eligible
				for home and community based (HCB) waiver services a person must:
(a) Meet the program and age requirements for
				the specific program:
(i) Community options
				program entry system (COPES), under WAC
				388-106-0310;
(ii) Residential support waiver (RSW), under
				WAC 388-106-0310; or
(iii) New Freedom, under WAC
				388-106-0338.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1507 - Home and community based (HCB) waiver services authorized by home and community services (HCS)-Financial eligibility if a client is eligible for an SSI-related noninstitutional categorically needy (CN) medicaid program

Current through Register Vol. 24-14, July 15, 2024
(1) A client is
				financially eligible for home and community based (HCB) waiver services if the
				client:
(a) Is receiving coverage under one
				of the following categorically needy (CN) medicaid programs:
(i) SSI program under WAC
				182-510-0001. This includes SSI
				clients under Section 1619(b) of the Social Security Act;
(ii) SSI-related noninstitutional CN program
				under chapter 182-512 WAC; or
(iii)
				Health care for workers with disabilities program (HWD) under chapter 182-511
				WAC.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1508 - Home and community based (HCB) waiver services authorized by home and community services (HCS)-Financial eligibility using SSI-related institutional rules

Current through Register Vol. 24-14, July 15, 2024
(1) If a person is
				not eligible for a categorically needy (CN) program under WAC
				182-515-1507, the agency
				determines eligibility for home and community based (HCB) waiver services
				authorized by home and community services (HCS) using institutional medicaid
				rules. This section explains how a person may qualify using institutional
				rules.
(2) A person must meet:
(a) General eligibility requirements under
				WAC 182-513-1315 and
				182-515-1506;
(b) The resource requirements under WAC
				182-513-1350;
(c) The following income requirements:
(i) Available income must be at or below the
				special income level (SIL), defined under WAC
				182-513-1100; or
(ii) If available income is above the SIL,
				net available income is no greater than the effective one-person medically
				needy income level (MNIL). Net income is calculated by reducing available
				income by:
(A) Medically needy (MN) disregards
				found under WAC
				182-513-1345;
(B) The average monthly nursing facility
				state rate;
(C) Health insurance
				premiums, other than medicare; and
(D) Outstanding medical bills, prorated
				monthly over a 12-month certification period, that meet the requirements of WAC
				182-513-1350.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-515 - Alternate living-Institutional medical › Section 182-515-1509 - Home and community based (HCB) waiver services authorized by home and community services (HCS)-Client financial responsibility

Current through Register Vol. 24-14, July 15, 2024
(1) A client
				eligible for home and community based (HCB) waiver services authorized by home
				and community services (HCS) under WAC
				182-515-1508 must pay toward the
				cost of care and room and board under this section.
(a) Post-eligibility treatment of income,
				participation, and participate are all terms that refer to a client's
				responsibility towards cost of care.
(b) Room and board is a term that refers to a
				client's responsibility toward food and shelter in an alternate living facility
				(ALF).