WAC 182-513-1395 Determining eligibility for institutional services for people living in a medical institution under the SSI-related medically needy program.

Effective February 20, 2017

  1. For the purposes of this section only, "remaining income" means all gross nonexcluded income remaining after the post-eligibility calculation under WAC 182-513-1380.
  2. General information. To be eligible for institutional services when living in a medical institution under the SSI-related medically needy (MN) program, a person must:
    1. Meet program requirements under WAC 182-513-1315;
    2. Have gross nonexcluded income in excess of the special income level (SIL) defined under WAC 182-513-1100; and
    3. Meet the financial requirements of subsection (3) or (4) of this section.
  3. Financial eligibility.
    1. The agency or its designee determines a person's resource eligibility, excess resources, and medical expense deductions using WAC 182-513-1350.
    2. The agency or its designee determines a person's countable income by:
      1. Excluding income under WAC 182-513-1340;
      2. Determining available income under WAC 182-513-1325 or 182-513-1330;
      3. Disregarding income under WAC 182-513-1345; and
      4. Deducting medical expenses that were not used to reduce excess resources under WAC 182-513-1350.
  4. Eligibility for agency payment to the facility for institutional services and the MN program.
    1. If a person's remaining income plus excess resources is less than, or equal to, the state-contracted daily rate times the number of days the person has resided in the facility, the person:
      1. Is eligible for agency payment to the facility for institutional services and the MN program; and
      2. Is approved for a twelve-month certification period.
    2. The person must pay income and excess resources towards the cost of care under WAC 182-513-1380.
  5. Eligibility for agency payment to the facility for institutional services and MN spenddown. If a person's remaining income is more than the state-contracted daily rate times the number of days the person has resided in the facility, but less than the private nursing facility rate for the same period, the person:
    1. Is eligible to receive institutional services at the state-contracted rate; and
      1. Is approved for a three-month or six-month base period;
      2. Pays income and excess resources towards the state-contracted cost of care under WAC 182-513-1380; and
    2. Is eligible for the MN program for the same three-month or six-month base period when the total of additional medical expenses incurred during the base period exceeds:
      1. The total remaining income for all months of the base period;
      2. Minus the total state-contracted rate for all months of the base period.
  6. If a person has excess resources and the person's remaining income is more than the state-contracted daily rate times the number of days the person has resided in the facility, the person is not eligible to receive institutional services and the MN program.

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.