WAC 182-527-2742  Estate recovery-Service-related limitations.

Effective July 1, 2017

For the purposes of this section, the term "agency" includes the agency's designee.

The agency's payment for the following services is subject to recovery:

  1. State-only funded services, except:
    1. Adult protective services;
    2. Offender reentry community safety program services;
    3. Supplemental security payments (SSP) authorized by the developmental disabilities administration (DDA); and
    4. Volunteer chore services.
  2. For dates of service on or after January 1, 2014:
    1. Basic Plus waiver services;
    2. Community first choice (CFC) services;
    3. Community option program entry system (COPES) services;
    4. Community protection waiver services;
    5. Core waiver services;
    6. Hospice services;
    7. Intermediate care facility for individuals with intellectual disabilities services provided in either a private community setting or in a rural health clinic;
    8. Individual and family services;
    9. Medicaid personal care services;
    10. New Freedom consumer directed services;
    11. Nursing facility services;
    12. Personal care services funded under Title XIX or XXI;
    13. Private duty nursing administered by aging and long-term support administration (ALTSA) or the DDA;
    14. Residential habilitation center services;
    15. Residential support waiver services;
    16. Roads to community living demonstration project services;
    17. The portion of the managed care premium used to pay for ALTSA-authorized long-term care services under the program of all-inclusive care for the elderly (PACE); and
    18.  The hospital and prescription drug services provided to a client while the client was receiving services listed in this subsection.
  3. For dates of service beginning January 1, 2010, through December 31, 2013:
    1. Medicaid services;
    2. Premium payments to managed care organizations (MCOs); and
    3. The client's proportional share of the state's monthly contribution to the Centers for Medicare and Medicaid Services to defray the costs for outpatient prescription drug coverage provided to a person who is eligible for medicare Part D and medicaid.
  4. For dates of service beginning June 1, 2004, through December 31, 2009:
    1. Medicaid services;
    2. Medicare premiums for individuals also receiving medicaid;
    3. Medicare savings programs (MSPs) services for people also receiving medicaid; and
    4.  Premium payments to MCOs. 
  5. For dates of service beginning July 1, 1995, through May 31, 2004:
    1. Adult day health services;
    2. Home and community-based services;
    3. Medicaid personal care services;
    4. Nursing facility services;
    5. Private duty nursing services; and
    6. The hospital and prescription drug services provided to a client while the client was receiving services listed in this subsection. 
  6. For dates of service beginning July 1, 1994, through June 30, 1995:
    1. Home and community-based services;
    2. Nursing facility services; and 
    3. Hospital and prescription drug services provided to a client while the client was receiving services listed in this subsection.
  7. For dates of service beginning July 26, 1987, through June 30, 1994: Medicaid services.
  8. For dates of service through December 31, 2009.  If a client was eligible for the MSP, but not otherwise medicaid eligible, the client's estate is liable only for any sum paid to cover medicare premiums and cost-sharing benefits.
  9. For dates of service beginning January 1, 2010.  If a client was eligible for medicaid and the MSP, the client's estate is not liable for any sum paid to cover medical assistance cost-sharing benefits.
  10. For dates of service beginning July 1, 2017, long-term services and supports authorized under the medicaid transformation project are exempt from estate recovery. Exempted services include those provided under:
    1. Medicaid alternative care under WAC 182-513-1600;
    2. Tailored supports for older adults under WAC 182-513-1610;
    3. Supportive housing under WAC 388-106-1700 through 388-106-1765; or
    4. Supported employment under WAC 388-106-1800 through 388-106-1865.

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.