reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0940 - SSI-related medical - Deeming income from an ineligible parent(s) to a child applying for SSI-related medical

Current through Register Vol. 24-14, July 15, 2024
The agency considers income of financially responsible
				  persons to determine if a portion of that income must be regarded as available
				  to other household members.
(1) A
				portion of the income of a parent(s) is considered available to the SSI-related
				applicant child when the child is age seventeen or younger and the parent(s)
				is:
(a) Financially responsible for the
				SSI-related child as described in WAC
				182-506-0015;
(b) The natural, adoptive, or step-parent of
				the child;
(c) Living in the same
				household with the child;
(d) Not
				receiving a needs-based payment such as TANF, SFA or SSI; and
(e) Not related to SSI or not applying for
				medical assistance.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0950 - SSI-related medical-Child-related resource exclusions and allocations

Current through Register Vol. 24-14, July 15, 2024
The agency considers resources of financially responsible
				  people to determine if a portion of the resources must be regarded as available
				  to other household members.
(1) A
				portion of the resources of a parent or parents is available to the SSI-related
				child when the child is age seventeen or younger and the parent or parents are:
(a) Financially responsible for the
				SSI-related child as described in WAC
				182-506-0015;
(b) The natural, adoptive, or step-parent of
				the child;
(c) Living in the same
				household with the child;
(d) Not
				receiving a needs-based payment such as temporary assistance to needy families
				(TANF), state-funded cash assistance (SFA) or SSI; and
(e) Not related to SSI or not applying for
				medical assistance.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0960 - SSI-related medical - Allocating income Determining eligibility for a spouse when the other spouse receives long-term services and supports

Current through Register Vol. 24-14, July 15, 2024
(1) General
				information.
(a) This section describes how
				the agency determines household income and resources when the household
				contains both institutional and noninstitutional household members.
(b) A separate medical assistance unit is
				established for people who meet institutional status under WAC
				182-513-1320. See WAC
				182-506-0015 for rules on how to
				determine medical assistance units for households that include people related
				to the supplemental security income (SSI) program.
(c) Throughout this section, "home" means
				"own home" as defined in WAC
				388-106-0010.
(d) The income and resources of each spouse
				are available to the other through the end of the month in which the spouses
				stopped living together, unless subsection (3) of this section
				applies.
(e) The agency determines
				income and resources separately starting the first day of the month following
				the month of separation if spouses stop living together in the same
				home.
(f) When one, or both members
				of a couple live in an alternative living facility (ALF), the agency considers
				the couple to be living:
(i) Apart when:
(A) Only one spouse enters the ALF;
(B) Both spouses enter the same ALF but have
				separate rooms; or
(C) Both spouses
				enter separate ALFs.
(ii) Together when both spouses share a room
				in an ALF.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1105 - Personal needs allowance (PNA) and room and board standards in a medical institution and alternate living facility (ALF)

Current through Register Vol. 24-14, July 15, 2024
(1) This section describes the personal needs
				allowance (PNA), which is an amount set aside from a client's income that is
				intended for personal needs, and the room and board standard.
(2) The PNA in a state veteran's nursing
				facility:
(a) Is indicated on the chart
				described in subsection (8) of this section as "All other PNA Med Inst.", for a
				veteran without a spouse or dependent children receiving a needs-based
				veteran's pension in excess of $90;
(b) Is indicated on the chart described in
				subsection (8) of this section as "All other PNA Med Inst.", for a veteran's
				surviving spouse with no dependent children receiving a needs-based veteran's
				pension in excess of $90; or
(c) Is
				$160 for a client who does not receive a needs-based veteran's
				pension.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1110 - Presumptive eligibility (PE)-Long-term services and supports (LTSS) in a home setting authorized by home and community services (HCS)

Current through Register Vol. 24-14, July 15, 2024
(1) A person may be
				determined presumptively eligible for long-term services and supports (LTSS) in
				their own home, as defined in WAC
				388-106-0010:
(a) Upon completion of a screening interview;
				and
(b) When authorized by home and
				community services (HCS).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1200 - Long-term services and supports (LTSS) authorized under Washington apple health programs

Current through Register Vol. 24-14, July 15, 2024
(1) Long-term
				services and supports (LTSS) programs available to people eligible for
				noninstitutional Washington apple health coverage who meet the functional
				requirements.
(a) Noninstitutional apple
				health coverage in an alternate living facility (ALF) under WAC
				182-513-1205.
(b) Community first
				choice (CFC) under WAC 182-513-1210.
(c) Medicaid personal care (MPC) under WAC
				182-513-1225.
(d) For people who do
				not meet institutional status under WAC
				182-513-1320, skilled nursing or
				rehabilitation is available under the CN, medically needy (MN) or alternative
				benefits plan (ABP) scope of care if enrolled into a managed care
				plan.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1205 - Determining eligibility for non-institutional coverage in an alternate living facility (ALF)

Current through Register Vol. 24-14, July 15, 2024
(1) This section
				describes the eligibility determination for noninstitutional coverage for a
				client who lives in an agency-contracted alternate living facility (ALF)
				defined under WAC
				182-513-1100.
(2) The eligibility criteria for
				noninstitutional Washington apple health (medicaid) coverage in an ALF follows
				SSI-related rules under WAC
				182-512-0050
				through
				182-512-0960,
				with the exception of the higher income standard under subsection (3) of this
				section.
(3) A client is eligible
				for noninstitutional coverage under the categorically needy (CN) program if the
				client's monthly income after allowable exclusions under chapter 182-512 WAC:
(a) Does not exceed the special income level
				(SIL) defined under WAC
				182-513-1100;
				and
(b) Is less than or equal to
				the client's assessed state rate at an agency-contracted facility. To determine
				the CN standard: ((y × 31) + $38.84), where "y" is the state daily rate.
				$38.84 is based on the cash payment standard for a client living in an ALF
				setting under WAC
				388-478-0006.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1210 - Community first choice (CFC) -Overview

Current through Register Vol. 24-14, July 15, 2024
(1) Community first choice (CFC) is a
				Washington apple health state plan benefit authorized under Section 1915(k) of
				the Social Security Act.
(2) CFC
				enables the agency and its contracted entities to deliver person-centered home
				and community based long-term services and supports (LTSS) to medicaid-eligible
				people who meet the institutional level of care under WAC
				388-106-0355. See:
(a) WAC
				388-106-0270 through
				388-106-0295 for services
				included within the CFC benefit package.
(b) WAC 182-513-1215 for financial
				eligibility for CFC services.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1215 - Community first choice (CFC)-Eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) A client who is
				determined functionally eligible for community first choice (CFC) services
				under WAC
				388-106-0270 through
				388-106-0295 is financially
				eligible to receive CFC services if the client is:
(a) Eligible for a noninstitutional
				Washington apple health (medicaid) program which provides categorically needy
				(CN) or alternative benefits plan (ABP) scope of care;
(b) Through September 30, 2027, a spousal
				impoverishment protections institutional (SIPI) spouse under WAC
				182-513-1220; or
(c) Determined eligible for a home and
				community based (HCB) waiver program under chapter 182-515
				WAC.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1220 - Community first choice (CFC)-Spousal impoverishment protections for noninstitutional Washington apple health clients

Current through Register Vol. 24-14, July 15, 2024
(1) This section is
				effective through September 30, 2027.
(2) The agency or its designee determines
				eligibility for community first choice (CFC) using spousal impoverishment
				protections under this section, when an applicant:
(a) Is married to, or marries, a person not
				in a medical institution;
(b) Meets
				institutional level of care and eligibility for CFC services under WAC
				388-106-0270 through
				388-106-0295;
(c) Is ineligible for a noninstitutional
				categorically needy (CN) SSI-related program:
(i) Due to spousal deeming rules under WAC
				182-512-0920, or due to exceeding
				the resource limit in WAC
				182-512-0010, or both;
				or
(ii) In an ALF due to combined
				spousal resources exceeding the resource limit in WAC
				182-512-0010;
				and
(d) Meets the aged,
				blindness, or disability criteria under WAC
				182-512-0050.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1225 - Medicaid personal care (MPC)

Current through Register Vol. 24-14, July 15, 2024
(1) Medicaid
				personal care (MPC) is a state-plan benefit available to a client who is
				determined:
(a) Functionally eligible for MPC
				services under WAC
				388-106-0200 through
				388-106-0235; and
(b) Financially eligible for a
				noninstitutional categorically needy (CN) or alternative benefits plan (ABP)
				Washington apple health (medicaid) program.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1230 - Program of all-inclusive care for the elderly (PACE)

Current through Register Vol. 24-14, July 15, 2024
(1) The program of all-inclusive care for the
				elderly (PACE) provides long-term services and supports (LTSS), medical, mental
				health, and substance use disorder (SUD) treatment through a
				department-contracted managed care plan using a personalized plan of care for
				each enrollee.
(2) Program rules
				governing functional eligibility for PACE are listed under WAC
				388-106-0700,
				388-106-0705,
				388-106-0710,
				and
				388-106-0715.
(3) A person is financially eligible for PACE
				if the person:
(a) Is age:
(i) Fifty-five or older and disabled under
				WAC
				182-512-0050;
				or
(ii) Sixty-five or
				older;
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1235 - Roads to community living (RCL)

Current through Register Vol. 24-14, July 15, 2024
(1)
				Roads to community living (RCL) is a demonstration project authorized under
				Section 6071 of the Deficit Reduction Act of 2005 (
				P.L.
				109-171 ) and extended through the Patient
				Protection and Affordable Care Act ( P.L. 111148 ).
(2) Program rules governing functional
				eligibility for RCL are described in WAC
				388-106-0250
				through 388-1060265. RCL services are authorized by the department.
(3) A person must have a stay of at least
				sixty consecutive days in a qualified institutional setting such as a hospital,
				nursing home, or residential habilitation center, to be eligible for RCL. The
				sixty-day count excludes days paid solely by medicare, must include at least
				one day of medicaid paid inpatient services immediately prior to discharge, and
				the person must be eligible to receive any categorically needy (CN), medically
				needy (MN), or alternate benefit plan (ABP) medicaid program on the day of
				discharge. In addition to meeting the sixty-day criteria, a person who is being
				discharged from a state psychiatric hospital must be under age twenty-two or
				over age sixty-four.
(4) Once a
				person is discharged to home or to a residential setting under RCL, the person
				remains continuously eligible for medical coverage for three hundred sixty-five
				days unless the person:
(a) Returns to an
				institution for thirty days or longer;
(b) Is incarcerated in a public jail or
				prison;
(c) No longer wants RCL
				services;
(d) Moves out-of-state;
				or
(e) Dies.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1240 - The hospice program

Current through Register Vol. 24-14, July 15, 2024
(1) General
				information.
(a) The hospice program provides
				palliative care to people who elect to receive hospice services and are
				certified as terminally ill by their physician.
(b) Program rules governing election of
				hospice services are under chapter 182-551 WAC.
(c) A person may revoke an election to
				receive hospice services at any time by signing a revocation
				statement.
(d) Transfer of asset
				rules under WAC
				182-513-1363 do not apply to the
				hospice program in any setting, regardless of which apple health program the
				person is eligible to receive.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1245 - Medically needy hospice program in a medical institution

Current through Register Vol. 24-14, July 15, 2024
(1) General
				information.
(a) When living in a medical
				institution, a person may be eligible for medically needy coverage under the
				hospice program. A person must:
(i) Meet
				program requirements under WAC
				182-513-1315;
(ii) Have available income that exceeds the
				special income level (SIL), defined under WAC 182-513-1100, but is below the
				institution's monthly state-contracted rate;
(iii) Meet the financial requirements of
				subsection (4) or (5) of this section; and
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1300

Current through Register Vol. 24-14, July 15, 2024
WSR 13-01-017, recodified as §
											182-513-1300, 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, §
					 388-478-0040, filed 7/31/98, effective
					 9/1/98.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1301

Current through Register Vol. 24-14, July 15, 2024
WSR 13-01-017, recodified as §
											182-513-1301, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005 (DRA), and 2010 1st sp.s. c 37§ 209(1). WSR
					 12-21-091, § 388-513-1301, filed 10/22/12, effective 11/22/12. Statutory
					 Authority:
					 RCW
					 71A.12.030,
					 71A.10.020, chapters 71A.10 and
					 71A.12 RCW, 2004 c 276. WSR 04-18-054, § 388-513-1301, filed 8/27/04,
					 effective 9/27/04. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090, and
					 74.09.575. WSR 02-09-052, §
					 388-513-1301, filed 4/12/02, effective 5/13/02. Statutory Authority:
					 RCW
					 11.92.180,
					 43.20B.460,
					 48.85.020,
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.530, 74.[09.]575, 74.09.585;
					 20 C.F.R. 416.1110-1112, 1123 and 1160;
					 42 C.F.R.
					 435.403(j)(2) and 1005; and
					 Sections 17, 1915(c), and 1924 (
					 42 U.S.C.
					 1396 ) of the Social Security Act. WSR
					 00-01-051, § 388-513-1301, filed 12/8/99, effective
					 1/8/00.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1305

Current through Register Vol. 24-14, July 15, 2024
WSR 13-01-017, recodified as §
											182-513-1305, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005 (DRA), and 2010 1st sp.s. c 37§ 209(1). WSR
					 12-21-091, § 388-513-1305, filed 10/22/12, effective 11/22/12. Statutory
					 Authority:
					 RCW
					 74.08.090. WSR 06-07-077, §
					 388-513-1305, filed 3/13/06, effective 4/13/06. Statutory Authority:
					 RCW
					 11.92.180,
					 43.20B.460,
					 48.85.020,
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.530, 74.[09.]575, 74.09.585;
					 20 C.F.R. 416.1110-1112, 1123 and 1160;
					 42 C.F.R.
					 435.403(j)(2) and 1005; and
					 Sections 17, 1915(c), and 1924 (
					 42 U.S.C.
					 1396 ) of the Social Security Act. WSR
					 00-01-051, § 388-513-1305, filed 12/8/99, effective 1/8/00. Statutory
					 Authority:
					 RCW
					 74.08.090 and
					 74.09.500. WSR 99-06-045, §
					 388-513-1305, filed 2/26/99, effective 3/29/99. Statutory Authority:
					 RCW
					 74.08.090. WSR 94-10-065 (Order 3732), §
					 388-513-1305, filed 5/3/94, effective 6/3/94. Formerly parts of WAC 388-83-036
					 and 388-99-036.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1316 - General eligibility requirements for long-term care (LTC) programs

Current through Register Vol. 24-14, July 15, 2024
(1) To be eligible
				for long-term care (LTC) services, a person must:
(a) Meet the general eligibility requirements
				for medical programs under WAC
				182-503-0505, except:
(i) An adult age nineteen or older must meet
				citizenship and immigration status requirements under WAC
				182-503-0535(2)(a) or
				(b);
(ii) A person under age nineteen must meet
				citizenship and immigration status requirements under WAC
				182-503-0535(2)(a), (b), (c), or
				(d); and
(iii) If a person does not meet the
				requirements in (a)(i) or (ii) of this subsection, the person is not eligible
				for medic-aid and must have eligibility determined under WAC
				182-513-1319.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1317 - Income and resource criteria for an institutionalized person

Current through Register Vol. 24-14, July 15, 2024
(1) This section
				provides an overview of the income and resource eligibility rules for a person
				who lives in an institutional setting.
(2) To determine income eligibility for an
				SSI-related long-term care (LTC) applicant under the categorically needy (CN)
				program, the agency or its designee:
(a)
				Determines available income under WAC
				182-513-1325 and
				182-513-1330;
(b) Excludes income under WAC
				182-513-1340; and
(c) Compares remaining available income to
				the special income level (SIL) defined under WAC 182-513-1100. A person's
				available income must be equal to or less than the SIL to be eligible for CN
				coverage.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1318 - Income and resource criteria for home and community based (HCB) waiver programs and hospice

Current through Register Vol. 24-14, July 15, 2024
(1) This section
				provides an overview of the income and resource eligibility rules for a person
				to be eligible for a categorically needy (CN) home and community based (HCB)
				waiver program under chapter 182-515 WAC or the hospice program under WAC
				182-513-1240 and 182-513-1245.
(2)
				To determine income eligibility for an SSI-related long-term care (LTC) HCB
				waiver, the agency or its desig-nee:
(a)
				Determines income available under WAC
				182-513-1325 and
				182-513-1330;
(b) Excludes income under WAC
				182-513-1340;
(c) Compares remaining gross nonexcluded
				income to:
(i) The special income level (SIL)
				defined under WAC 182-513-1100; or
(ii) For HCB service programs authorized by
				the aging and long-term supports administration (ALTSA), a higher standard is
				determined following the rules under WAC
				182-515-1508 if a client's income
				is above the SIL but net income is below the medically needy income level
				(MNIL).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1319 - State-funded programs for non-citizens who are not eligible for a federally funded program

Current through Register Vol. 24-14, July 15, 2024
(1) This section
				describes the state-funded programs available to a person who does not meet the
				citizenship and immigration status criteria under WAC 182-513-1316 for
				federally funded coverage.
(2) If a
				person meets the eligibility and incapacity criteria of the medical care
				services (MCS) program under WAC
				182-508-0005, the person may
				receive nursing facility care or state-funded residential services in an
				alternate living facility (ALF).
(3) Noncitizens age nineteen or older may be
				eligible for the state-funded long-term care services program under WAC
				182-507-0125. A person must be
				preapproved by the aging and long-term support administration (ALTSA) for this
				program due to enrollment limits.
(4) Noncitizens under age nineteen who meet
				citizenship and immigration status under WAC
				182-503-0535(2)(e)
				are eligible for:
(a) Nursing facility
				services if the person meets nursing facility level of care; or
(b) State-funded personal care services if
				functionally eligible based on a department assessment under chapter 388-106 or
				388-845 WAC.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1320 - Determining institutional status for long-term care (LTC) services

Current through Register Vol. 24-14, July 15, 2024
(1) To attain
				institutional status outside a medical institution, a person must be approved
				for and receive:
(a) Home and community based
				(HCB) waiver services under chapter 182-515 WAC;
(b) Roads to community living (RCL) services
				under WAC 182-513-1235;
(c) Program
				of all-inclusive care for the elderly (PACE) under WAC 182-513-1230;
(d) Hospice services under WAC
				182-513-1240(3); or
(e)
				State-funded long-term care service under WAC
				182-507-0125.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1325 - Determining available income for an SSI-related single client for long-term care (LTC) services

Current through Register Vol. 24-14, July 15, 2024
This section describes income the agency or its designee
				  determines available when evaluating an SSI-related single client's eligibility
				  for long-term care (LTC) services .
(1) See WAC
				182-513-1330 for rules related to
				available income for legally married couples.
(2) The agency or its designee applies the
				following rules when determining income eligibility for SSI-related LTC
				services:
(a) WAC
				182-512-0600 SSI-related
				medical-Definition of income;
(b)
				WAC 182-512-0650 SSI-related
				medical-Available income;
(c) WAC
				182-512-0700 SSI-related
				medical-Income eligibility;
(d) WAC
				182-512-0750 SSI-related
				medical-Countable unearned income;
(e) WAC
				182-512-0840(3)
				self-employment income-allowable expenses; and
(f) WAC
				182-512-0785,
				182-512-0790, and
				182-512-0795 for sponsored
				immigrants and how to determine if sponsors' income counts in determining
				benefits.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1330 - Determining available income for legally married couples for long-term care (LTC) services

Current through Register Vol. 24-14, July 15, 2024
This section describes income the agency or its designee
				  determines available when evaluating a legally married person's eligibility for
				  long-term care (LTC) services.
(1) The
				agency or the agency's designee applies the following rules when determining
				income eligibility for LTC services:
(a) WAC
				182-512-0600
				SSI-related medical-Definition of income;
(b)WAC
				182-512-0650
				SSI-related medical-Available income;
(c) WAC
				182-512-0700
				SSI-related medical-Income eligibility;
(d) WAC
				182-512-0750
				SSI-related medical-Countable unearned income;
(e) WAC
				182-512-0840(3),
				self-employment income-allowance expenses;
(f) WAC
				182-512-0960
				SSI-related medical-Allocating income-Determining eligibility for a spouse when
				the other spouse receives long-term services and supports (LTSS);
(g) WAC
				182-512-0785,
				182-512-0790,
				and
				182-512-0795
				for sponsored immigrants and how to determine if the sponsors' income counts in
				determining benefits.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1345 - Determining disregarded income for institutional or hospice services under the medically needy (MN) program

Current through Register Vol. 24-14, July 15, 2024
This section describes income the agency or its designee
				  disregards when determining a person's eligibility for institutional or hospice
				  services under the medically needy (MN) program. Disregarded income is
				  available when determining a person's participation in the cost of care.
(1) The agency or its designee disregards the
				following income amounts in the following order:
(a) Income that is not reasonably
				anticipated, or is received infrequently or irregularly, when such income does
				not exceed:
(i) Twenty dollars per month if
				unearned; or
(ii) Ten dollars per
				month if earned.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1350 - Defining the resource standard and determining resource eligibility for SSI-related long-term care (LTC) services

Current through Register Vol. 24-14, July 15, 2024
(1) General
				information.
(a) This section describes how
				the agency or the agency's designee defines the resource standard and countable
				or excluded resources when determining a person's eligibility for SSI-related
				long-term care (LTC) services.
(b)
				"Resource standard" means the maximum amount of resources a person can have and
				still be resource eligible for program benefits.
(c) For a person not SSI-related, the agency
				applies program specific resource rules to determine eligibility.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1355 - Allocating resources to a community spouse when determining resource eligibility for SSI-related long-term care services

Current through Register Vol. 24-14, July 15, 2024
(1) The agency or
				its designee uses this section to calculate the resource allocation from the
				institutionalized spouse to the community spouse for the determination of the
				institutionalized spouse's resource eligibility under WAC
				182-513-1350(2)(a)(ii).
(2) If the institutionalized spouse's most
				recent continuous period of institutionalization (MRCPI) began:
(a) Before October 1, 1989, the agency adds
				together one-half the total amount of countable resources, as determined under
				WAC 182-513-1350(4),
				held in the name of:
(i) The institutionalized
				spouse; and
(ii) Both
				spouses.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1363 - Evaluating an asset transfer for clients applying for or receiving long-term care (LTC) services

Current through Register Vol. 24-14, July 15, 2024
(1) When
				determining a client's eligibility for long-term care (LTC) services, the
				medicaid agency or the agency's designee evaluates the effect of an asset
				transfer made within the sixty-month period before the month that the client:
(a) Attained institutional status, or would
				have attained institutional status but for a period of ineligibility;
				and
(b) Applied for LTC
				services.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1364

Current through Register Vol. 24-14, July 15, 2024
WSR 13-01-017, recodified as §
											182-513-1364, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005 (DRA), and 2010 1st sp.s. c 37§ 209(1). WSR
					 12-21-091, § 388-513-1364, filed 10/22/12, effective 11/22/12. Statutory
					 Authority:
					 RCW
					 34.05.353(2)(d),
					 74.08.090, and chapters 74.09,
					 74.04 RCW. WSR 08-11-047, §
					 388-513-1364, filed 5/15/08, effective 6/15/08. Statutory Authority:
					 RCW
					 74.08.090. WSR 03-20-059, §
					 388-513-1364, filed 9/26/03, effective 10/27/03. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090, and
					 74.09.575. WSR 03-06-048, §
					 388-513-1364, filed 2/28/03, effective
					 4/1/03.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1365

Current through Register Vol. 24-14, July 15, 2024
WSR 13-01-017, recodified as §
											182-513-1365, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.530, section 6014 of the
					 Deficit Reduction Act of 2005 (DRA), and 2010 1st sp.s. c 37§ 209(1). WSR
					 12-21-091, § 388-513-1365, filed 10/22/12, effective 11/22/12. Statutory
					 Authority:
					 RCW
					 34.05.353(2)(d),
					 74.08.090, and chapters 74.09,
					 74.04 RCW. WSR 08-11-047, §
					 388-513-1365, filed 5/15/08, effective 6/15/08. Statutory Authority:
					 RCW
					 74.04.050,
					 74.04.057,
					 74.08.090, and
					 74.09.575. WSR 03-14-038, §
					 388-513-1365, filed 6/23/03, effective 8/1/03. Statutory Authority:
					 RCW
					 74.08.090. WSR 01-02-076, §
					 388-513-1365, filed 12/29/00, effective 1/29/01. Statutory Authority:
					 RCW
					 11.92.180,
					 43.20B.460,
					 48.85.020,
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.530, 74.[09.]575, 74.09.585;
					 20 C.F.R. 416.1110-1112, 1123 and 1160;
					 42 C.F.R.
					 435.403(j)(2) and 1005; and
					 Sections 17, 1915(c), and 1924 (
					 42 U.S.C.
					 1396 ) of the Social Security Act. WSR
					 00-01-051, § 388-513-1365, filed 12/8/99, effective 1/8/00. Statutory
					 Authority:
					 RCW
					 74.08.090 and
					 74.09.500. WSR 99-06-045, §
					 388-513-1365, filed 2/26/99, effective 3/29/99. Statutory Authority:
					 RCW
					 74.08.090,
					 74.04.050,
					 74.04.057,
					 74.09.585 and § 17 of the
					 Social Security Act. WSR 97-05-040, § 388-513-1365, filed 2/14/97,
					 effective 3/17/97. Statutory Authority:
					 RCW
					 74.08.090. WSR 95-02-027 (Order 3818), §
					 388-513-1365, filed 12/28/94, effective 1/28/95; WSR 94-10-065 (Order 3732),
					 § 388-513-1365, filed 5/3/94, effective 6/3/94. Formerly WAC
					 388-95-395.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1366

Current through Register Vol. 24-14, July 15, 2024
WSR 13-01-017, recodified as §
											182-513-1366, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 11.92.180,
					 43.20B.460,
					 48.85.020,
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.530, 74.[09.]575, 74.09.585;
					 20 C.F.R. 416.1110-1112, 1123 and 1160;
					 42 C.F.R.
					 435.403(j)(2) and 1005; and
					 Sections 17, 1915(c), and 1924 (
					 42 U.S.C.
					 1396 ) of the Social Security Act. WSR
					 00-01-051, § 388-513-1366, filed 12/8/99, effective
					 1/8/00.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1367 - Hardship waivers

Current through Register Vol. 24-14, July 15, 2024
(1) This section
				defines undue hardship for long-term services and supports (LTSS) and specifies
				the request, approval, denial, and other processes for hardship
				waivers.
(2) Undue hardship.
(a) Undue hardship exists when, without LTSS
				benefits, the client is unable to obtain:
(i)
				Medical care to the extent that health or life is endangered; or
(ii) Food, clothing, shelter or other basic
				necessities of life.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1380 - Determining a client's financial participation in the cost of care for long-term care in a medical institution

Current through Register Vol. 24-14, July 15, 2024
This rule describes how the agency or the agency's designee
				  allocates income and excess resources when determining participation in the
				  cost of care in a medical institution.
(1) The agency or the agency's designee
				defines which income and resources must be used in this process under WAC
				182-513-1315.
(2) The agency or the agency's designee
				allocates nonexcluded income in the following order, and the combined total of
				(a), (b), (c), and (d) of this subsection cannot exceed the effective
				one-person medically needy income level (MNIL):
(a) A personal needs allowance (PNA) under
				WAC 182-513-1105.
(b) Mandatory federal, state, or local income
				taxes owed by the client.
(c) Wages
				for a client who:
(i) Is related to the
				supplemental security income (SSI) program under WAC
				182-512-0050(1);
				and
(ii) Receives the wages as part
				of an agency-approved or department-approved training or rehabilitative program
				designed to prepare the client for a less restrictive placement. When
				determining this deduction, employment expenses are not deducted.
(d) Guardianship fees and
				administrative costs, including any attorney fees paid by the guardian, as
				allowed under chapter 388-79A WAC.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1385 - Determining the community spouse monthly maintenance needs allowance and dependent allowance in post-eligibility treatment of income for long-term care (LTC) programs

Current through Register Vol. 24-14, July 15, 2024
(1) This section
				describes how to calculate the monthly maintenance needs allowance (MMNA) in
				post-eligibility treatment of income for long-term care (LTC) programs for a
				community spouse or dependent of the institutionalized individual.
(2) The community spouse MMNA standards are
				found at
www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources
,
				unless a greater amount is calculated under subsection (5) of this section. The
				MMNA standards may change each January and July based on the consumer price
				index.
(3) The community spouse
				MMNA is allowed only to the extent that the institutionalized spouse's income
				is made available to the community spouse, and is calculated as follows:
(a) The minimum MMNA as calculated in
				subsection (4)(a) of this section plus excess shelter expenses as calculated in
				subsection (4)(b) of this section;
(i) The
				total under (a) of this subsection cannot be less than the minimum MMNA;
				and
(ii) If the total under
				subsection (4)(a) of this section exceeds the maximum MMNA, the maximum MMNA is
				the result under subsection (4)(a) of this section; and
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1395 - Determining eligibility for institutional services for people living in a medical institution under the SSI-related medically needy program

Current through Register Vol. 24-14, July 15, 2024
(1) For the
				purposes of this section only, "remaining income" means all gross non-excluded
				income remaining after the post-eligibility calculation under WAC
				182-513-1380.
(2) General information. To be eligible for
				institutional services when living in a medical institution under the
				SSI-related medically needy (MN) program, a person must:
(a) Meet program requirements under WAC
				182-513-1315;
(b) Have gross nonexcluded income in excess
				of the special income level (SIL) defined under WAC 182-513-1100; and
(c) Meet the financial requirements of
				subsection (3) or (4) of this section.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1396 - People living in a fraternal, religious, or benevolent nursing facility

Current through Register Vol. 24-14, July 15, 2024
(1) The agency or
				its designee determines apple health coverage under noninstitu-tional rules for
				a person who meets all other eligibility requirements and lives in a licensed,
				but nonmedicaid-con-tracted facility operated by a fraternal, religious, or
				benevolent organization.
(2)
				Nothing in subsection (1) of this section prevents the agency or its designee
				from evaluating contracts with facilities not described in subsection (1) of
				this section.
WSR 13-01-017, recodified as §
											182-513-1396, filed 12/7/12,
					 effective 1/1/13. Statutory Authority:
					 RCW
					 11.92.180,
					 43.20B.460,
					 48.85.020,
					 74.04.050,
					 74.04.057,
					 74.08.090,
					 74.09.500,
					 74.09.530, 74.[09.]575, 74.09.585;
					 20 C.F.R. 416.1110-1112, 1123 and 1160;
					 42 C.F.R.
					 435.403(j)(2) and 1005; and
					 Sections 17, 1915(c), and 1924 (
					 42 U.S.C.
					 1396 ) of the Social Security Act. WSR
					 00-01-051, § 388-513-1396, filed 12/8/99, effective 1/8/00. Statutory
					 Authority:
					 RCW
					 74.08.090. WSR 94-10-065 (Order 3732), §
					 388-513-1396, filed 5/3/94, effective 6/3/94. Formerly WAC
					 388-95-310.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1397 - Treatment of entrance fees for people residing in a continuing care retirement community or a life care community

Current through Register Vol. 24-14, July 15, 2024
(1)
				A person's entrance fee in a continuing care retirement community or life care
				community is an available resource to the person, to the extent that:
(a) The person has the ability to use the
				entrance fee, or the contract provides that the entrance fee may be used, to
				pay for care should other resources or income of the person be insufficient to
				pay for care;
(b) The person is
				eligible for a refund of any remaining entrance fee when the person dies or
				when the person terminates the continuing care retirement community or life
				care community contract and leaves the community; and
(c) The entrance fee does not confer an
				ownership interest in the continuing care retirement community or life care
				community.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-513 - Client not in own home-Institutional medical › Section 182-513-1400 - Long-term care (LTC) partnership program (index)

Current through Register Vol. 24-14, July 15, 2024
Under the long-term care (LTC) partnership program, people
				  who purchase qualified long-term care partnership insurance policies can apply
				  for long-term care medicaid under special rules for determining financial
				  eligibility. These special rules generally allow the person to protect assets
				  up to the insurance benefits received from a partnership policy so that such
				  assets will not be taken into account in determining financial eligibility for
				  long-term care medicaid and will not subsequently be subject to estate recovery
				  for medicaid and long-term care services paid. The Washington long-term care
				  partnership program is effective on December 1, 2011.
The following rules govern long-term care eligibility under
				  the long-term care partnership program:
(1) WAC
				182-513-1405
				Definitions.
(2) WAC
				182-513-1410 LTC partnership
				policy qualifications.
(3) WAC
				182-513-1415 Assets that can't be
				protected under the LTC partnership provi-sions.
(4) WAC
				182-513-1420 Eligibility for
				asset protection under a partnership policy.
(5) WAC
				182-513-1425 Not qualifying for
				LTC medicaid if an LTC partnership policy is in pay status.
(6) WAC
				182-513-1430 Change of
				circumstances that must be reported when there is an LTC partnership policy
				paying a portion of care.
(7) WAC
				182-513-1435 When Washington
				recognizes an LTC partnership policy purchased in another state.
(8) WAC
				182-513-1440 Determining how many
				assets can be protected.
(9) WAC
				182-513-1445 Designating a
				protected asset and required proof .
(10) WAC
				182-513-1450 How the transfer of
				assets affects LTC partnership and medicaid eligibility.
(11) WAC
				182-513-1455 Protected assets
				under an LTC partnership policy after death.
WSR 13-01-017, recodified as §
											182-513-1400, 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, § 388-513-1400, 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 182-513-1405 - Definitions

Current through Register Vol. 24-14, July 15, 2024
For purposes of WAC
				  182-513-1400 through
				  182-513-1455, the following terms
				  have the meanings stated. See chapter 182-500 WAC and WAC 182-513-1100 for
				  additional definitions.
"Issuer"
means any entity that delivers, issues
				  for delivery, or provides coverage to, a resident of Washington, any policy
				  that claims to provide asset protection under the Washington long-term care
				  partnership act, chapter 48.85 RCW. As used in this chapter, issuer
				  specifically includes insurance companies, fraternal benefit societies, health
				  care service contractors, and health maintenance organizations.
"Long-term care (LTC) insurance"
means a policy
				  under chapter 284-83 WAC.
"Protected assets"
means assets that are
				  designated as excluded or not taken into account upon determination of
				  long-term care medicaid eligibility under WAC
				  182-513-1315. The protected or
				  excluded amount is up to the dollar amount of benefits that have been paid for
				  long-term care services by the qualifying long-term care partnership policy on
				  the medicaid applicant's or client's behalf. The assets are also protected or
				  excluded for the purposes of estate recovery under chapter 182-527 WAC, up to
				  the amount of benefits paid by the qualifying policy for medical and long-term
				  care services.
"Qualified long-term care insurance partnership"
means an agreement between the Centers for Medicare and Medicaid Services
				  (CMS), and the health care authority (HCA) which allows for the disregard of
				  any assets or resources in an amount equal to the insurance benefit payments
				  that are made to or on behalf of a person who is a beneficiary under a
				  long-term care insurance policy that has been determined by the Washington
				  state insurance commission to meet the requirements of section 1917
				  (b)(1)(c)(iii) of the act. These policies are described in chapter 284-83
				  WAC.
"Reciprocity Agreement"
means an agreement
				  between states approved under section 6021(b) of the Deficit Reduction Act of
				  2005, Public Law
				  109-171 (DRA) under which the states agree to
				  provide the same asset protections for qualified partnership policies purchased
				  by a person while residing in another state and that state has a reciprocity
				  agreement with the state of Washington.
WSR 13-01-017, recodified as §
											182-513-1405, 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, § 388-513-1405, filed 11/18/11, effective
					 12/19/11.