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WAC 182-514-0265  Washington apple health -- How the agency or its designee determines how much of an institutionalized person's income must be paid towards the cost of care for the MAGI-based long-term care program.

Effective October 1, 2013.

(1) A person who resides in a medical institution, inpatient psychiatric facility, or an institution for mental diseases (IMD) may be required to pay a portion of their income towards the cost of care. This section explains how the agency or its designee calculates how much a person pays to the facility under the Washington apple health (WAH) modified adjusted gross income (MAGI)-based long-term care program. This process is known as the post-eligibility process. If a person does not have income, he or she does not have to pay.

(2) The agency or its designee determines available income by considering a person's total gross income before any mandatory deductions from earnings. Income that was not counted in the initial eligibility process under the MAGI methodology is counted for the post-eligibility process unless the income is excluded under WAC 182-513-1340.

(3) The following income allocations and exemptions are deducted from the person's total gross income to determine his or her available income. The agency or its designee uses the rules described in WAC 182-513-1380 to calculate the amount of these allocations and exemptions, with the exception that the deduction of wages stated in WAC 182-513-1380 (4)(c) is not allowed.

                (a) A personal needs allowance (PNA) and maintenance allocation. The combined totals of all of the following deductions cannot exceed the medically needy income level (MNIL): 

                                (i) PNA as allowed under WAC 182-513-1300;

                                (ii) Mandatory federal, state, or local income taxes owed by the person; and 

                                (iii) Court ordered guardianship fees and administrative costs, including attorney fees, as described in chapter 388-79 WAC.

                (b) Income garnished to comply with a court order for child support. 

                (c) Community spouse allocation.

                (d) Family maintenance allocation if married with dependents.

                (e) Legal dependent allocation for an unmarried person with dependents. The maximum allocation is based upon the MNIL standard for the number of dependents minus the dependent's income.

                (f) Medical expense allocation. The agency or its designee allows a deduction for unpaid medical expenses for which the individual is still liable. Medical expenses allowed for this allocation are described in WAC 182-513-1350

                (g) Housing maintenance exemption: 

                                (i) A person who is financially responsible for the costs of maintaining a home while he or she is in an institution is allowed a deduction, limited to a six-month period, of up to one hundred percent of the one-person poverty level per month, when a physician has certified that the person is likely to return to the home within the six-month period.

                                (ii) A person eighteen years of age or younger is not eligible for the housing maintenance exemption unless the housing expense is the person's financial responsibility. Children are not financially responsible for the housing expenses incurred by their parents.

(4) A person may keep a personal needs allowance of up to the effective MNIL in the month he or she admitted and in the month the person discharged from the facility. See WAC 182-519-0050 for the effective MNIL standards.

(5) Any income remaining is called the person's responsibility toward the cost of care and must be paid to the facility. This amount is also called the person's participation. 


This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.