DDA Home and Community Based (HCB) waivers

WAC 182-515-1510 Home and community based (HCB) waiver services authorized by the developmental disabilities administration (DDA).

Effective February 20, 2017

This chapter describes the general and financial eligibility requirements for categorically needy (CN) home and community based (HCB) waivers authorized by the developmental disabilities administration (DDA). The definitions in WAC 182-513-1100 and chapter 182-500 WAC apply throughout this chapter.

1. The DDA waiver programs are:
   1. Basic Plus;
   2. Core;
   3. Community protection;
   4. Children's intensive in-home behavioral support (CIIBS); and
   5. Individual and family services (IFS).
2. WAC 182-515-1511 describes the general eligibility requirements for HCB waiver services authorized by DDA.
3. WAC 182-515-1512 describes the financial requirements for eligibility for HCB waiver services authorized by DDA if a person is eligible for a noninstitutional SSI-related CN program.
4. WAC 182-515-1513 describes the financial eligibility requirements for HCB waiver services authorized by DDA when a person is not eligible for an SSI-related noninstitutional CN program under WAC 182-515-1512.
5. WAC 182-515-1514 describes the rules used to determine a person's responsibility in the cost of care and room and board for HCB waiver services authorized by DDA if the person is eligible under WAC 182-515-1512.

WAC 182-515-1511 Home and community based (HCB) waiver services authorized by the developmental disabilities administration (DDA) - General eligibility.

Effective February 20, 2017

1.  To be eligible for home and community based (HCB) waiver services authorized by the developmental disabilities administration (DDA), a person must:
   1. Meet specific program requirements under chapter 388-845 WAC;
   2. Be an eligible client of the DDA;
   3. Meet the disability criteria for the supplemental security income (SSI) program under WAC 182-512-0050;
   4. Need the level of care provided in an intermediate care facility for the intellectually disabled (ICF/ID);
   5. Have attained institutional status under WAC 182-513-1320;
   6. Be able to reside in the community and choose to do so as an alternative to living in an ICF/ID;
   7. Be assessed for HCB waiver services, be approved for a plan of care, and receive HCB waiver services under (a) of this subsection, and:
      1. Be able to live at home with HCB waiver services; or
      2. Live in a department-contracted facility with HCB waiver services, such as:
         1. A group home;
         2. A group training home;
         3. A child foster home, group home, or staffed residential facility;
         4. An adult family home (AFH); or
         5.  An adult residential care (ARC) facility.
      3.  Live in the person's own home with supported living services from a certified residential provider; or
      4. Live in the home of a contracted companion home provider.
2.  A person is not eligible for home and community based (HCB) waiver services if the person:
   1. Is subject to a penalty period of ineligibility for the transfer of an asset under WAC 182-513-1363; or
   2.  Has a home with equity in excess of the requirements under WAC 182-513-1350.
3. See WAC 182-513-1315 for rules used to determine countable resources, income, and eligibility standards for long-term care (LTC) services.
4. Current income and resource standard charts are found at http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/program-standard-income-and-resources.

WAC 182-515-1512 Home and community based (HCB) waiver services authorized by the developmental disabilities administration (DDA)- Financial eligibility if a client is eligible for a noninstitutional SSI-related categorically needy (CN) program.

Effective January 1, 2018

1. A client is financially eligible for home and community based (HCB) waiver services authorized by the developmental disabilities administration (DDA) if:
   1. The client is receiving coverage under one of the following categorically needy (CN) medicaid programs:
      1. Supplemental security income (SSI) program under WAC 182-510-0001. This includes SSI clients under 1619(b) status; or
      2. Health care for workers with disabilities (HWD) under chapter 182-511 WAC; or
      3.  SSI-related noninstitutional (CN) program under chapter 182-512 WAC; or
      4. The foster care program under WAC 182-505-0211 and the client meets disability requirements under WAC 182-512-0050.
   2.  The client does not have a penalty period of ineligibility for the transfer of an asset as under WAC 182-513-1363; and
   3.  The client does not own a home with equity in excess of the requirements under WAC 182-513-1350.
2.  A client eligible under this section does not pay toward the cost of care, but must pay room and board if living in an alternate living facility (ALF) under WAC 182-513-1100.
3.  A client eligible under this section who lives in a department-contracted ALF described under WAC 182-513-1100:
   1.  Keeps a personal needs allowance (PNA) under WAC 182-513-1105; and
   2.  Pays towards room and board up to the room and board standard under WAC 182-513-1105.
4.  A client who is eligible under the HWD program must pay the HWD premium under WAC 182-511-1250, in addition to room and board if residing in an ALF.
5.  Current resource, income, PNA and room and board standards are found at www.hca.wa.gov/free-or-low-cost-health-care/program-administration/program-standard-income-and-resources.

WAC 182-515-1513 Home and community based (HCB) waiver services authorized by the developmental disabilities administration (DDA)—Financial eligibility using SSI-related institutional rules.

Effective February 20, 2017

1. If a person is not eligible for a categorically needy (CN) program under WAC 182-515-1512, the agency determines eligibility for home and community based (HCB) waiver services authorized by the developmental disabilities administration (DDA) using institutional medicaid rules. This section explains how a person may qualify using institutional rules.
2. A person must meet:
   1. General eligibility requirements under WAC 182-513-1315 and 182-515-1511;
   2. Resource requirements under WAC 182-513-1350; and
   3. Have available income at or below the special income level (SIL) defined under WAC 182-513-1100.
3. The agency determines available income and income exclusions according to WAC 182-513-1325, 182-513-1330, and 182-513-1340.
4. A person eligible under this section is responsible to pay income toward the cost of care and room and board, as described under WAC 182-515-1514.
5. Current resource, income standards are found at http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/program-standard-income-and-resources.

WAC 182-515-1514 Home and community based (HCB) services authorized by the developmental disabilities administration (DDA)- Client financial responsibility

Effective January 1, 2018

1. A client eligible for home and community based (HCB) waiver services authorized by the developmental disabilities administration (DDA) under WAC 182-515-1513 must pay toward the cost of care and room and board under this section.
   1. Post-eligibility treatment of income, participation, and participate are all terms that refer to a client's responsibility towards cost of care.
   2. Room and board is a term that refers to a client's responsibility toward food and shelter in an alternate living facility (ALF).
2. The agency determines how much a client must pay toward the cost of care for home and community based (HCB) waiver services authorized by the DDA when the client is living at home, as follows:
   1. A single client who lives at home (as defined in WAC 388-106-0010) keeps a personal needs allowance (PNA) of up to the special income level (SIL) defined under WAC 182-513-1100.
   2. A single client who lives at home on the roads to community living program authorized by DDA keeps a PNA up to the SIL but must pay any remaining available income toward cost of care after allowable deductions described in subsection (4) of this section.
   3. A married client who lives with the client's spouse at home (as defined in WAC 388-106-0010) keeps a PNA of up to the SIL but must pay any remaining available income toward cost of care after allowable deductions under subsection (4) of this section.
   4. A married couple living at home where each client receives HCB waiver services, one authorized by DDA and the other authorized by home and community services (HCS) is allowed the following:
      1. The client authorized by DDA keeps a PNA of up to the SIL but must pay any remaining available income toward the client's cost of care after allowable deductions in subsection (4) of this section; and
      2. The client authorized by HCS pays toward the cost of care under WAC 182-515-1507 or 182-515-1509.
3. The agency determines how much a client must pay toward the cost of care for HCB wavier services authorized by DDA and room and board when the client is living in a department-contracted ALF defined under WAC 182-513-1100. A client:
   1. Keeps a PNA under WAC 182-513-1105;
   2. Pays room and board up to the room and board standard under WAC 182-513-1105; and
   3. Pays the remainder of available income toward the cost of care after allowable deductions under subsection (4) of this section.
4. If income remains after the PNA and room and board liability under subsection (2) or (3) of this section, the remaining available income must be paid toward the cost of care after it is reduced by allowable deductions in the following order:
   1. An earned income deduction of the first $65, plus one-half of the remaining earned income;
   2. Guardianship fees and administrative costs including any attorney fees paid by the guardian only as allowed under WAC 182-513-1505 through 182-513-1525;
   3. Current or back child support garnished or withheld from the client's income according to a child support order in the month of the garnishment if it is for the current month. If the agency allows this as a deduction from income, the agency does not count it as the child's income when determining the family allocation amount in WAC 182-513-1385;
   4. A monthly maintenance-needs allowance for the community spouse under WAC 182-513-1385. If the community spouse is on long-term care services, the allocation is limited to an amount that brings the community spouse's income to the community spouse's PNA;
   5. A monthly maintenance-needs allowance for each dependent of the institutionalized client, or the client's spouse, as calculated under WAC 182-513-1385; and
   6. Incurred medical expenses which have not been used to reduce excess resources. Allowable medical expenses are under WAC 182-513-1350.
5. The total of the following deductions cannot exceed the SIL defined under WAC 182-513-1100:
   1. The PNA described in subsection (2) or (3) of this section, including room and board;
   2. The earned income deduction in subsection (4)(a) of this section; and
   3. The guardianship fees and administrative costs in subsection (4)(b) of this section.
6. A client may have to pay third-party resources defined under WAC 182-513-1100 in addition to the room and board and participation.
7. A client must pay the client's provider the sum of the room and board amount, the cost of care after all allowable deductions, and any third-party resources defined under WAC 182-513-1100.
8. A client on HCB waiver services does not pay more than the state rate for cost of care.
9. When a client lives in multiple living arrangements in a month, the agency allows the highest PNA available based on all the living arrangements and services the client has received in a month.
10. Standards described in this section are found at www.hca.wa.gov/free-or-low-cost-health-care/program-administration/program-standard-income-and-resources.