WAC 182-514-0263 Non-SSI-related institutional medically needy coverage for pregnant women and people age twenty and younger.
Effective February 29, 2016
- Medically needy (MN) coverage under this section is only available for people age twenty and younger or pregnant women. The medicaid agency determines a person who meets SSI-related criteria under WAC 182-512-0050 eligible for institutional MN coverage under WAC 182-513-1395. If a person meets requirements in both this section and WAC 182-513-1395, the person may choose which program to enroll in for coverage.
- A person whose income exceeds the categorically needy (CN) standards under WAC 182-514-0250 and 182-514-0260 is:
- Eligible for MN coverage with no spenddown if the person's countable income (CI) is equal to or less than the department-contracted daily rate times the number of days in the institution;
- Eligible for MN coverage after a spenddown under WAC 182-519-0110 is met if the person's CI is above the department-contracted daily rate times the number of days in the institution but less than the institution's private rate;
- Not eligible for payment of long-term care services provided by the institution if the person's CI exceeds the institution's private rate;
- Responsible for paying up to the monthly state rate for the facility as participation in the cost of care; and
- Allowed to keep a monthly personal needs allowance (PNA) of at least $57.28. Current PNA and long-term care standards can be found at https://www.hca.wa.gov/health-care-services-and-supports/program-standards-income-and-resources.
- If a person's CI exceeds the institution's private rate, the agency determines eligibility for medical coverage under chapter 182-519 WAC.