WAC 182-513-1317 Income and resource criteria for an institutionalized person.

Effective February 20, 2017

  1. This section provides an overview of the income and resource eligibility rules for a person who lives in an institutional setting.
  2. To determine income eligibility for an SSI-related long-term care (LTC) applicant under the categorically needy (CN) program, the agency or its designee:
    1. Determines available income under WAC 182-513-1325 and 182-513-1330;
    2. Excludes income under WAC 182-513-1340; and
    3. Compares remaining available income to the special income level (SIL) defined under WAC 182-513-1100. A person's available income must be equal to or less than the SIL to be eligible for CN coverage.
  3. To determine income eligibility for an SSI-related LTC client under the medically needy (MN) program, the agency or its designee follows the income standards and eligibility rules under WAC 182-513-1395.
  4. To be resource eligible under the SSI-related LTC CN or MN program, the person must:
    1. Meet the resource eligibility requirements under WAC 182-513-1350;
    2. Not have a penalty period of ineligibility due to a transfer of assets under WAC 182-513-1363;
    3. Disclose to the state any interest the person or the person's spouse has in an annuity, which must meet the annuity requirements under chapter 182-516 WAC.
  5. A resident of eastern or western state hospital is eligible for medicaid if the person:
    1. Has attained institutional status under WAC 182-513-1320; and
    2. Is under age twenty-one; or
    3. Applies for or receives inpatient psychiatric treatment in the month of the person's twenty-first birthday that will likely continue through the person's twenty-first birthday, and can receive coverage until:
      1. The facility discharges the person; or
      2. The end of the month in which the person turns age twenty-two, whichever occurs first; or(d) Is at least age sixty-five.
  6. To determine long-term care CN or MN income eligibility for a person eligible under a MAGI-based program, the agency or its designee follows the rules under chapter 182-514 WAC.
  7. There is no asset test for MAGI-based LTC programs under WAC 182-514-0245.
  8. The agency or its designee determines a person's total responsibility to pay toward the cost of care for LTC services as follows:
    1. For an SSI-related person residing in a medical institution, see WAC 182-513-1380;
    2. For an SSI-related person on a home and community based waiver, see chapter 182-515 WAC.

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.