WAC 182-513-1205  Determining eligibility for noninstitutional coverage in an alternate living facility (ALF).

Effective January 1, 2018

  1. This section describes the eligibility determination for noninstitutional coverage for a client who lives in a department-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:
    1. Does not exceed the special income level (SIL) defined under WAC 182-513-1100; and
    2. Is less than or equal to the client's assessed state rate at a department-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.
  4. A person is eligible for noninstitutional coverage under the medically needy (MN) program if the person's monthly income after allowable exclusions under chapter 182-512 WAC is less than or equal to the person's private rate at a department-contracted facility. To determine the MN standard: ((z × 31) + $38.84), where "z" is the facility's private daily rate. To determine MN spenddown liability, see chapter 182-519 WAC.
  5. For both CN and MN coverage, a client's countable resources cannot exceed the standard under WAC 182-512-0010.
  6. The agency or the agency's designee approves CN noninstitutional coverage for twelve months.
  7. The agency or the agency's designee approves MN noninstitutional coverage for a period of months described in WAC 182-504-0020 for an SSI-related client, provided the client satisfies any spenddown liability under chapter 182-519 WAC.
  8. Clients who receive medicaid personal care (MPC) or community first choice (CFC) pay all of their income to the ALF except a personal needs allowance under WAC 182-513-1105.
  9. A client may have to pay third-party resources as defined under WAC 182-513-1100 in addition to the payment under this subsection.

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.