Eligibility requirements for LTSS

Eligibility requirements specific to long-term care

• Application processes for long-term care eligibility
• Community First Choice (CFC)
• Eligibility requirements for long-term care (Institutional roadmap WAC)
• Eligibility for MAGI based long-term care (K track, formally known as institutional children/families)
• Exception to rule (ETR) process for HCS cases where we are unable to verify citizenship and ID
• Managed care and long-term care
• HCS Home and Community Based (HCB) waivers
• Hospice overview
• How does living in an institution affect my eligibility for Basic Food?
• Institutional Status (In ACES K track (children and families) and L track Aged/Blind/Disabled)
• Long-term care insurance and third party resources
• Medicaid Personal Care (MPC)
• Medically needy LTC programs (Specific rules are used for Medical Needy in a Medical Institution for gross income over the Medicaid SIL) (L95, L99)
• Medicare and long-term care
• NSA and HCS Services
• Program for the all-inclusive care for the elderly (PACE)
• Roads to community living (RCL)
• Short stays in medical institutions (temporary admissions)
• State funded HCS services (A01/A05 MCS in residential setting)
• State-funded LTC for noncitizens (L04/L24)
• Working clients and long-term care
• 1619B and SSI deemed eligible (after DAC, Pickle/COLA, Widower Exclusion)

Washington Apple Health (WAH) eligibility WACs Title 182 Health Care Authority (HCA)

WAH includes Modified Adjusted Gross Income (MAGI) programs AND institutional and SSI related Medicaid, also known as "Classic Medicaid".

• Chapter 182-500 WAC Definitions
• Chapter 182-501 WAC Health Care Coverage
• Chapter 182-502 WAC Billing
• Chapter 182-503 WAC General Eligibility. This chapter includes eligibility requirements for all Washington Apple Health programs:
  • Applications
  • Interview requirements
  • Verification requirements
  • Application denials and withdrawals
  • Exceptions to rule
  • Rights and responsibilities
  • Limited English proficient (LEP) services
  • Equal Access
  • General eligibility requirements
  • Program summary
  • Social Security number requirements
  • Residency requirements - including those in institutions
  • Citizenship and alien status
• Chapter 182-504 WAC (Certification/renewals/Change of Circumstances) Chapter includes:
  • Retroactive coverage
  • Certification periods
  • Renewals
  • Change of circumstances
  • Income standards based on the federal poverty level (FPL)
• Chapter 182-506 WAC Assistance units
• Chapter 182-507 WAC AEM, includes:
  • Alien medical programs (AEM)
  • Long term care for non-citizens
  • Refugee medical
• Chapter 182-508 WAC and Chapter 182-509 WAC describes state funded medical care services (MCS) criteria
• Chapter 182-510 WAC Supplemental Security Income and associated CN medical (S01)
• Chapter 182-511 WAC Health Care for Workers with Disabilities (HWD) (S08)
• Chapter 182-512 WAC SSI related medical
• Chapter 182-513 Institutional Medicaid (L01, L02, L99, L95)
• Chapter 182-514 WAC-MAGI based long institutional K01, K95, K99)
• Chapter 182-515 WAC Home and Community Based (HCB) waivers
• Chapter 182-516 WAC Trusts, annuities and life estates
• Chapter 182-517 WAC Medicare Savings Programs (MSP) S03, S05, S06
• Chapter 182-518 WAC Notice requirements
• Chapter 182-519 WAC Medically needy
• Chapter 182-520 WAC Fraud and overpayments
• Chapter 182-523 WAC Medical extensions and redeterminations
• Chapter 182-526 WAC Administrative hearings
• Chapter 182-527 WAC Estate recovery
• Chapter 182-538 WAC Managed care