Definitions used in Long-Term Care (LTC)
What is long-term care?
For the purposes of Medicaid eligibility, long-term care is for individuals residing in a Medical institution (primarily a nursing home) for 30 days or more or on a Home and Community based Waiver (HCB Waiver).
"Institutionalized individual" means an individual who has attained institutional status as described in WAC 182-513-1320
"Institutional Services" means services paid for by Medicaid or state funds and provided in a medical institution, through a Home and Community Based (HCB) Waiver or Program of All-Inclusive Care for the Elderly (PACE).
"Home and Community Based Services" (HCBS) means services provided in the home or a residential setting to individuals assessed by the department.
"Home and Community Based (HCB) Waiver programs" means Section 1915 (c) of the Social Security Act enables states to request a waiver of applicable federal Medicaid requirements to provide enhanced community support services to those Medicaid beneficiaries who would otherwise require institutional care.
Additional definitions used in long-term care eligibility
How Do I apply for Long Term Care Medicaid
How to apply for Medicaid
Eligibility requirements for Long-term Care Medicaid
Eligibility requirements for long-term care are found in WAC 182-513-1315. Some of the key requirements are:
- Identity and citizenship requirements
- Furnish a valid social security number
- Be a Washington State resident
- Meet aged, blind or disabled criteria
- Income and resource guidelines
- Institutional Medicaid is subject to penalties for resource transfers described in WAC 182-513-1363
- Home equity cannot exceed $506,000 as described in WAC 182-513-1350. Effective 1/1/2015 this standard increases to $552,000
- Declaration of interest in an annuity and naming the State of Washington as a remainder beneficiary as described in WAC 182-516-0201
Income and Resource standards for long-term care
WAC 182-513-1350 describes resource eligibility for long-term care
- $2,000 for the applicant
- $3,000 for a couple, both applying
- $53,016 State spousal resource standard
- $119,220 Federal spousal resource standard (1/1/2015)
- Countable income is compared to 300% of the Federal Benefit Rate (FBR). The 2014 rate is $2,163 and may also be called the Special Income Level (SIL).
- Individuals with income at or below are eligible for categorically needy (CN) medical coverage.
- Individuals with countable income over 300% of the FBR may be eligible for medically needy (MN) coverage based on the projected monthly cost of care in the facility or at home.
- Individuals must contribute income after allowable deductions towards the cost of their care. This contribution is sometimes called participation.
Income and Resource standard charts used in long-term care eligibility
Frequently Asked Questions About the Partnership Program
Frequently Asked Questions
Washington State Long-Term Care Partnership Program Main Page
Washington State Long-term care partnership program main page (Long-Term care Medicaid manual, includes the Washington Administrative Code (WAC) rule on eligibility)
How do I designate the assets I want to protect?
Individuals with LTC partnership policy must submit a DSHS 10-438 LTCP Asset Designation form to Washington State Medicaid at the time of application and at each annual review in order to designate assets as protected based on the dollar amount paid for services by the LTC Partnership Policy. This will track protected assets for both LTC Medicaid eligibility and Estate Recovery purposes.
More information on Long-term Care eligibility in Washington State
Long-term care eligibility manual includes the Washington Administrative Code
Questions and Answers on the COPES Program by Columbia Legal Services (COPES is the main home and community based waiver used in Washington State)
Questions and Answers on Medicaid for nursing home residents by Columbia Legal Services
Aging & Disability Services Administration Internet Site
How to apply for Medicaid