WAC 182-513-1316 General eligibility requirements for long-term care (LTC) programs.

Effective February 20, 2017

  1. To be eligible for long-term care (LTC) services, a person must:
    1. Meet the general eligibility requirements for medical programs under WAC 182-503-0505, except:
      1. An adult age nineteen or older must meet citizenship and immigration status requirements under WAC 182-503-0535 (2)(a) or (b);
      2. A person under age nineteen must meet citizenship and immigration status requirements under WAC 182-503-0535 (2)(a), (b), (c), or (d); and
      3. If a person does not meet the requirements in (a)(i) or (ii) of this subsection, the person is not eligible for medicaid and must have eligibility determined under WAC 182-513-1319.
    2. Attain institutional status under WAC 182-513-1320;
    3. Meet the functional eligibility under:
      1. Chapter 388-106 WAC for a home and community services (HCS) home and community based (HCB) waiver or nursing facility coverage; or
      2. Chapter 388-828 WAC for developmental disabilities administration (DDA) HCB waiver or institutional services; and
    4. Meet either:
      1. SSI-related criteria under WAC 182-512-0050; or
      2. MAGI-based criteria under WAC 182-503-0510(2), if residing in a medical institution. A person who is eligible for MAGI-based coverage is not subject to the provisions under subsection (2) of this section.
  2. A supplemental security income (SSI) recipient or a person meeting SSI-related criteria who needs LTC services must also:
    1. Not have a penalty period of ineligibility due to the transfer of assets under WAC 182-513-1363;
    2. Not have equity interest in a primary residence greater than the home equity standard under WAC 182-513-1350; and
    3. Disclose to the agency or its designee any interest the applicant or spouse has in an annuity, which must meet annuity requirements under chapter 182-516 WAC.
  3. A person who receives SSI must submit a signed health care coverage application form attesting to the provisions under subsection (2) of this section. A signed and completed eligibility review for LTC benefits can be accepted for people receiving SSI who are applying for long-term care services.
  4. To be eligible for HCB waiver services, a person must also meet the program requirements under:
    1. WAC 182-515-1505 through 182-515-1509 for HCS HCB waivers; or
    2. WAC 182-515-1510 through 182-515-1514 for DDA HCB waivers.

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.