WAC 182-514-0263 Non-SSI-related institutional medically needy coverage for pregnant women and people age twenty and younger.

Effective February 29, 2016

  1. 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.
  2. A person whose income exceeds the categorically needy (CN) standards under WAC 182-514-0250 and 182-514-0260 is:
    1. 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;
    2. 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;
    3. Not eligible for payment of long-term care services provided by the institution if the person's CI exceeds the institution's private rate;
    4. Responsible for paying up to the monthly state rate for the facility as participation in the cost of care; and
    5. 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.
  3. If a person's CI exceeds the institution's private rate, the agency determines eligibility for medical coverage under chapter 182-519 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.