Clarifying Information
DDA Waivers
- DDA Waivers are categorically needy (CN) waiver programs that provide clients described in WAC 182-515-1510 through 182-515-1514 with alternatives to placement in an Intermediate Care Facility for the Mentally Retarded (ICF/MR). These alternatives include remaining in their home or placement in an alternate living facility (ALF) approved by the Developmental Disabilities Administration (DDA). The goal of these programs is to provide a safe level of care with maximum independence.
- In addition to the income allocations described in WAC 182-515-1514 the case manager (CM) can request an exception to rule to reduce the client's participation in the cost of care when the client requires the services of a guardian.
- If the client lives in an alternate living facility (ALF), the DDA case manager determines the amount the client keeps for personal needs and the amount the client pays for room and board.
- The department determines financial eligibility for these services according to WAC 182-513-1315. A client must have non excluded income at or below the special income level (SIL), but can reduce excess resources in the initial or review months as described in WAC 182-513-1350.
- Guardianship fees can be deducted in the post eligibility (participation determination) process if approved by court order for DDA Waivers in an ALF. See guardianship fee for clarifying information and a training module regarding guardianships. Since in home DDA Waiver clients keep the Medicaid SIL as a PNA, there is no guardianship deduction available.
- DDA Waiver clients at home do not pay toward personal care costs as they keep up to the Medicaid SIL. (300% of the FBR). DDA Waiver clients can pay up to the ALTSA room and board standard if living in an alternative living facility (ALF) such as a DDA group home or adult family home.
- Clients who are eligible to receive Apple Health for Workers with Disabilities (HWD) can receive DDA Waiver services if approved by DDA. HWD/S08 is the priority program in ACES if the client is better off with HWD/S08 over the L22 program. See HWD for more instructions on HWD for DDA Waiver clients. HWD clients on a DDA Waiver pay a premium and have no participation toward personal care. These clients do pay the ALTSA room and board rate if living in a DDA group home or Adult Family Home (these are also called Alternate living facilities (ALF)) See Working clients and long-term care programs (Waiver, Residing in a medical institution, or MPC).
1619B and "Deemed SSI eligible" clients
SSI deemed eligible clients (countable income is under the SSI standard after DAC, Pickle/COLA exclusion and SSI closed due to the receipt of DAC, COLA) do not pay toward the cost of personal care. They DO pay room and board if residing in an adult family home, boarding home or DDA group home. These facilities are also referred to as alternate living facilities or ALFs. ALFs are not medical institutions.
1619(b) clients are considered the same as an "SSI client". SSI payments have stopped due to earnings. SDX indicates continue Medicaid on SDX 1 in the Med Elig field. 1619(b) clients do not pay toward the cost of personal care. (also called participation). They DO pay room and board in an ALF.
"Deemed SSI clients" and 1619(b) status clients can have gross income over the Medicaid SIL (300% of the FBR) and still be eligible for the Waiver. 1619(b) is described in WAC 182-508-0001 (2).
Deemed SSI eligible clients. What does that mean?
Clients who have countable income under the SSI standard after allowing the exclusion for Disabled Adult Child (DAC), Pickle/COLA, Widow/Widowers and their SSI was closed because of the receipt of the DAC/COLA/Widow(er) income. These exclusions are described in the Overview chapter. Clients continue to receive CN Medicaid as long as they meet resource criteria. Not every client receiving DAC income is eligible for this exclusion. These are the requirements:
- Lost cash payment of SSI after 7/1/88 due to receipt of DAC benefits from SSA or a COLA to those benefits.
- Disability onset date prior to age 22
Deemed SSI eligible clients do not pay Waiver service participation, they do pay room and board if living in an adult family home, DDA group home or boarding home (ALFs).
If countable income is over the SSI standard after the exclusion then all income is counted in post eligibility in determining service participation for DDA Waiver clients living in an ALF. This includes DAC income.
Individuals who qualify for the DAC exclusion and countable income after the exclusion is under the SSI standard are referred to as "Protected DAC" cases.
Instructions are found in WAC 182-512-0880 Special income disregards for SSI-related medical programs.
In other words, an individual who would be eligible for CN-P/S02 in ACES
A client who would otherwise qualify for S02/CN SSI related medicaid because their countable income is at or below the SSI standard does not participate towards personal care under the Waiver program. (but they are responsible to pay room and board when living in an ALF).
These clients do need to meet the same criteria for long-term care services as other Waiver clients and may be subject to Asset transfers or excess home equity described in WAC 182-513-1350
The room and board amount ALTSA uses is based on the FBR minus the current HCS CN Waiver personal needs allowance (PNA) for individuals residing in an ALF.
See Standards - Long-term care (LTC) Long Term Services and Supports (LTSS) and PNA amounts.
1619(b) status, what does it mean?
SSI clients whose earnings put them over the SSI cash benefit standard but Social Security continues their SSI eligibility. They are considered an SSI recipient and continue to send in reviews to Social Security. The SDX indicates continued Medicaid when a client is 1619(b). 1619(b) clients don’t pay toward the cost of personal care because they are considered to be an SSI client. Follow the same instructions as SSI clients on a waiver for 1619(b) clients. Code SI on UNER to prevent an eligibility review from being generated for the L22. Clients would pay the ALTSA room and board amount if residing in an ALF. Clients can have GROSS income over the SIL and continue to receive a DDA Waiver as long as Social Security maintains their 1619(b) status.
How is this different if the client enters a Medical Institution?
Individuals entering a Medical institution and are "institutionalized" 30 days or more do participate toward the cost of care. This includes "deemed SSI eligible" clients. Institutional rules do apply once a client has entered a Medical institution. (WAC 182-513-1380) This means most of these individuals would participate in a medical institution. This is called the post eligibility process.
In crisis?
