Long-term services and supports (LTSS) manual

Guardianships - deductions to participation, room and board

Revised Date: 
June 13, 2018

Purpose: Describe and clarify rules regarding guardianship-related deductions to a client’s participation or room & board (R&B).

WAC 182-513-1530 Maximum guardianship fee and related cost de­ductions allowed from a client's 
participation or room and board on or after June 1, 2018.

Revised June 1, 2018

  1. General information.
    1. This section sets the maximum guardianship fee and related cost deductions when:
      1. A court order was entered on or after June 1, 2018; or
      2. The client under guardianship began receiving medicaid-fun­ded long-term services and supports on or after June 1, 2018.
    2. This section only applies to a client who is:
      1. Eligible for and receives institutional services under chap­ter 182-513 WAC or home and community-based waiver services under chapter 182-515 WAC, and who is required to pay participation under WAC 182-513-1380, 182-515-1509, or 182-515-1514; or
      2. Eligible for long-term services and supports under chapter 182-513 or 182-515 WAC, and who is required to pay only room and board.
    3. All requirements of this section remain in full force whether or not the agency appears at a guardianship proceeding.
    4. In this section, the agency does not delegate any authority in determining eligibility or post-eligibility for medicaid clients.
      1. Under the authority granted by RCW 11.92.180, the agency does not deduct more than the amounts allowed by this section from partici­pation or room and board.
      2. The eligibility rules under Title 182 WAC remain in full force and effect.
    5. The agency does not reduce a client's participation or room and board under this section for guardianship fees or related costs accumulated during any month that a client was not required to pay:
      1. Participation under WAC 182-513-1380, 182-515-1509, or 182-515-1514; or
      2. Room and board under chapter 182-513 or 182-515 WAC.
    6. If the client has another fiduciary, payee, or other princi­pal-agency relationship and the agent is allowed compensation, any monthly guardianship fee approved under this section is reduced by the agent's compensation.
  2. Maximum guardianship fee and related cost deductions.
    1. The maximum guardianship fee and related cost deductions un­der this section include all guardianship services provided to the client, regardless of the number of guardians appointed to a client during a period of time, or whether the client has multiple guardians appointed at the same time.
    2. Maximum guardianship fees and related cost deductions are as follows:
      1. The total deduction for costs directly related to establish­ing a guardianship for a client cannot exceed $1,850;
      2. The total deduction for guardianship-related costs cannot exceed $1,200 during any three-year period; and
      3. The amount of the monthly deduction for guardianship fees cannot exceed $235 per month.
  3. For people under subsection (1)(b)(i) of this section – Par­ticipation deductions.
    1. After receiving the court order, the agency or its designee adjusts the client's current participation to reflect the deductions under WAC 182-513-1380, 182-515-1509, or 182-515-1514.
    2. The amounts of the participation deductions are the amounts under subsection (2) of this section, or the court order, whichever are less.
    3. For clients who pay room and board in addition to participa­tion, if the client's amount of participation is insufficient to allow for the amounts under subsection (2) of this section, then, regardless of any provision of chapter 182-513 or 182-515 WAC, the client's room and board will be adjusted to allow the amounts under subsection (2) of this section.
  4. For people under subsection (1)(b)(ii) of this section - Room and board deductions.
    1. The agency adjusts the client's room and board after receiv­ing the court order, regardless of any provision of chapter 182-513 or 182-515 WAC.
    2. The amounts of the room and board deductions are the amounts under subsection (2) of this section, or the court order, whichever are less.

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.

Clarifying Information

On or after June 1, 2018

For court orders signed, or clients who begin receiving long-term services and supports (LTSS), on or after June 1, 2018, WAC 182-513-1530 applies. A client is allowed a deduction to their participation, R&B, or both, when that client is required to pay towards their cost of LTSS.

  • Participation deductions for guardianship-related fees and costs are allowed for clients required to pay participation under WAC 182-513-1380, WAC 182-515-1509, or WAC 182-515-1514;
  • R&B deductions are allowed for clients whose only liability for LTSS is R&B under chapter 182-513 WAC (for example, CFC-only, MPC, MCS, or Group 1 home and community-based (HCB) waivers)
  • For those clients with participation and R&B, if there is insufficient participation to deduct guardianship-related fees and costs, participation can be reduced to $0, and any remaining amounts can be deducted from R&B.

Note: R&B deductions for guardianship fees and costs are allowed per rule effective June 1, 2018. Although an exception-to-rule (ETR) is no longer required to allow the deduction, financial services specialists (FSS) must code as a “Room and Board Exception” in ACES to allow the R&B deduction. The maximum deductions allowed for fees and costs are either the amounts in the rule, or the court order, whichever is less. Any exceptions to these amounts are subject to the eligibility ETR WAC 182-503-0090.

Before June 1, 2018

WAC 388-79A-001 Definitions.

Revised June 1, 2018

The following definitions apply to this chapter:

  1. "Client" means a person who is eligible for and is receiving medicaid-funded long-term care.
  2. "Guardianship fees" or "fees" means necessary fees charged by a guardian for services rendered on behalf of a client.
  3. "Participate" or "participation" means the amount a client must pay each month toward the cost of long-term care services received each month. It is the amount remaining after the post-eligibility process under:
    1. WAC 182-513-1380 for a client residing in a medical institution, as defined under WAC 182-500-0050;
    2. WAC 182-515-1509 for a client receiving home and community services (HCS) waivered services in an alternate living facility (ALF), as defined under WAC 182-513-1100, or in an at-home setting; or
    3. WAC 182-515-1514 for a client receiving developmental disability administration (DDA) waivered services in an ALF, as defined under WAC 182-513-1100, or in an at-home setting.
  4. "Related costs" or "costs" means necessary costs paid by the guardian, including attorney fees.

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.

WAC 388-79A-005 Maximum amount of guardianship fees and related costs for a long-term care medicaid eligible client.

Revised March 8, 2019

  1. As mandated by RCW 43.20B.460 and in accordance with RCW 11.92.180, the maximum amount of guardianship fees and related costs must not exceed the limits of this section when the person under guardianship is:
    1. A medicaid eligible client, residing in:
      1. A medical institution, as defined under WAC 182-500-0050;
      2. An alternate living facility (ALF), as defined under WAC 182-513-1100; or
      3. An at-home setting; and
    2. Required under chapter 182-513 WAC or chapter 182-515 WAC to participate towards the cost of long-term care.
  2. The maximum amount of guardianship fees and related costs must not exceed the limits of WAC 388-79A-010​ when:
    1. The most recent court order establishing or continuing a guardianship was entered before June 1, 2018; and
    2. The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
  3. For all other clients not described under subsection (2) of this section, the maximum amount of guardianship fees and related costs must not exceed the limits under WAC 182-513-1530.

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.

WAC 388-79A-010 Maximum guardianship fees and related costs before June 1, 2018

Revised June 1, 2018

  1. This section sets the maximum guardianship fees and related costs when:
    1. The court order was entered before June 1, 2018; and
    2. The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
  2. For court orders entered before June 1, 2018, where the order establishes or continues a legal guardianship for a client:
    1. Guardianship fees must not exceed $175 per month;
    2. Costs directly related to establishing a guardianship for a client must not exceed $700; and
    3. Costs to maintain the guardianship must not exceed $600 during any three-year period.

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.

WAC 388-79A-015 Procedure for allowing guardianship fees and related costs from client participation before June 1, 2018.

Revised June 1, 2018

  1. This section describes the procedure for allowing guardianship fees and related costs from client participation when:
    1. A court order was entered before June 1, 2018; and
    2. The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
  2. The medicaid agency or the agency's designee, after receiving the court order, adjusts the client's current participation to reflect the amounts, as allowed under WAC 182-513-1380, 183-515-1509, or 183-515-1514.
  3. A client's participation cannot be prospectively or retrospectively reduced to pay guardianship fees and related costs incurred:
    1. Before the client's long-term care medicaid eligibility effective date;
    2. During any time when the client was not eligible for or did not receive long-term care services; or
    3. After the client has died.
  4. The fees and costs allowed by the court at the final accounting must not exceed the amounts advanced and paid to the guardian from the client's participation if:
    1. The court, at a prior accounting, allowed the guardian to receive guardianship fees and related costs from the client's participation in advance of services rendered by the guardian; and
    2. The client dies before the next accounting.

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.

For those clients who began receiving LTSS prior to June 1, 2018, and also has a court order signed before June 1, 2018, chapter 388-79A WAC applies.

Effective June 1, 2018, chapter 388-79A was amended to end the previous requirement of notification (by the guardian) to DSHS on proposed guardianship orders, and also end the procedure to exceed the maximum deductions allowed per rule. Any clients subject to chapter 388-79A will have their deductions allowed per the signed order.

Note: R&B deductions are NOT allowed per rule under this chapter. As long as a court order is subject to chapter 388-79A WAC, an ETR must be approved to reduce R&B.

Worker Responsibilities

Upon receipt of a court order: if it was signed on or after June 1, 2018, or if the client began LTSS after June 1, 2018, allow the deductions per WAC 182-513-1530 or the court order, whichever is less.

Most (if not all) clients subject to chapter 388-79A WAC have current allowed deductions. Continue to allow these deductions until a new court order is received. Ensure an ETR is approved prior to allowing or continuing to allow a deduction to R&B.

Forward any ETR requests from the guardian to your regional guardianship designee.