WAC 388-79A-015 Procedure for allowing guardianship fees and related costs from client participation before June 1, 2018.

WAC 388-79A-015 Procedure for allowing guardianship fees and related costs from client participation before June 1, 2018.

Revised June 1, 2018

  1. This section describes the procedure for allowing guardianship fees and related costs from client participation when:
    1. A court order was entered before June 1, 2018; and
    2. The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
  2. The medicaid agency or the agency's designee, after receiving the court order, adjusts the client's current participation to reflect the amounts, as allowed under WAC 182-513-1380, 183-515-1509, or 183-515-1514.
  3. A client's participation cannot be prospectively or retrospectively reduced to pay guardianship fees and related costs incurred:
    1. Before the client's long-term care medicaid eligibility effective date;
    2. During any time when the client was not eligible for or did not receive long-term care services; or
    3. After the client has died.
  4. The fees and costs allowed by the court at the final accounting must not exceed the amounts advanced and paid to the guardian from the client's participation if:
    1. The court, at a prior accounting, allowed the guardian to receive guardianship fees and related costs from the client's participation in advance of services rendered by the guardian; and
    2. The client dies before the next accounting.

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.

WAC 388-79A-010 Maximum guardianship fees and related costs before June 1, 2018.

WAC 388-79A-010 Maximum guardianship fees and related costs before June 1, 2018

Revised June 1, 2018

  1. This section sets the maximum guardianship fees and related costs when:
    1. The court order was entered before June 1, 2018; and
    2. The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
  2. For court orders entered before June 1, 2018, where the order establishes or continues a legal guardianship for a client:
    1. Guardianship fees must not exceed $175 per month;
    2. Costs directly related to establishing a guardianship for a client must not exceed $700; and
    3. Costs to maintain the guardianship must not exceed $600 during any three-year period.

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.

Other programs

Revised date

Breast and Cervical Cancer Treatment Program (BCCTP) for Women (S30):

This federally-funded program provides health care coverage for women diagnosed with breast or cervical cancer or a related precancerous condition. Eligibility is determined by the Department of Health's (DOH) Breast, Cervical, and Colon Health Program (BCCHP). DOH is responsible for screening and eligibility, while HCA administers enrollment and provider payment. Coverage continues through the full course of treatment as certified by the BCCHP.

A woman is eligible if she meets all of the following criteria:

  • Screened for breast or cervical cancer under BCCHP
  • Requires treatment for either breast or cervical cancer or for a related precancerous condition
  • Is under age 65
  • Is not covered for another CN (Categorically Needy) Apple Health program
  • Has no insurance or has insurance that is not creditable coverage
  • Meets residency requirements
  • Meets social security number requirements
  • Meets citizenship or immigration status requirements
  • Meets income limits set by the BCCHP.

For further information, see the Department of Health website.

Foster Care/Adoption Support/Former Foster Care (D01, D02, D26):

This program provides CN coverage to children receiving foster care or adoption support services. This program also provides CN coverage to individuals up to age 26 who turn 18 or age out of foster care in Washington State.

Medical Care Services (A01):

This state-funded program provides limited health care coverage to adults meeting incapacity requirements who are not eligible for Apple Health programs with CN, MN or ABP scope of care and who meet the income and resource standards for this program. Individuals over age 65 who are qualified immigrants within their 5-year bar and nonqualified immigrants are eligible for MCS if they meet income and resource requirements.

Refugee (R02, R03):

The Refugee Medical Assistance program (RMA) provides CN coverage to refugees who are not eligible for Apple Health programs with CN or ABP scope of care and who meet the income and resource standards for this program. RMA is a 100% federally funded program for persons granted asylum in the U.S. as refugees or asylees. Individuals enrolled in RMA are covered from the date they entered the U.S.

Eligibility for refugees/asylees that have been in the United States for more than twelve months is determined the same as for U.S. citizens.

Immigrants from Iraq and Afghanistan who were granted Special Immigrant status under Section 101(a)(27) of the Immigration and Nationality Act (INA) are eligible for Medicaid and Refugee Medical Assistance (RMA) the same as refugees.

Please report broken links or content problems.

WAC 388-79A-005 Maximum Amount of Guardianship Fees and Related Costs for a Long-term Care Medicaid Eligible Client.

WAC 388-79A-005 Maximum amount of guardianship fees and related costs for a long-term care medicaid eligible client.

Revised March 8, 2019

  1. As mandated by RCW 43.20B.460 and in accordance with RCW 11.92.180, the maximum amount of guardianship fees and related costs must not exceed the limits of this section when the person under guardianship is:
    1. A medicaid eligible client, residing in:
      1. A medical institution, as defined under WAC 182-500-0050;
      2. An alternate living facility (ALF), as defined under WAC 182-513-1100; or
      3. An at-home setting; and
    2. Required under chapter 182-513 WAC or chapter 182-515 WAC to participate towards the cost of long-term care.
  2. The maximum amount of guardianship fees and related costs must not exceed the limits of WAC 388-79A-010​ when:
    1. The most recent court order establishing or continuing a guardianship was entered before June 1, 2018; and
    2. The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
  3. For all other clients not described under subsection (2) of this section, the maximum amount of guardianship fees and related costs must not exceed the limits under WAC 182-513-1530.

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.

WAC 388-79A-001 Definitions.

WAC 388-79A-001 Definitions.

Revised June 1, 2018

The following definitions apply to this chapter:

  1. "Client" means a person who is eligible for and is receiving medicaid-funded long-term care.
  2. "Guardianship fees" or "fees" means necessary fees charged by a guardian for services rendered on behalf of a client.
  3. "Participate" or "participation" means the amount a client must pay each month toward the cost of long-term care services received each month. It is the amount remaining after the post-eligibility process under:
    1. WAC 182-513-1380 for a client residing in a medical institution, as defined under WAC 182-500-0050;
    2. WAC 182-515-1509 for a client receiving home and community services (HCS) waivered services in an alternate living facility (ALF), as defined under WAC 182-513-1100, or in an at-home setting; or
    3. WAC 182-515-1514 for a client receiving developmental disability administration (DDA) waivered services in an ALF, as defined under WAC 182-513-1100, or in an at-home setting.
  4. "Related costs" or "costs" means necessary costs paid by the guardian, including attorney fees.

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.

Behavioral health and recovery

Behavioral health is a term that covers the full range of mental and emotional well-being – from day-to-day challenges of life, to treating mental health and substance use disorders.

HCA integrates state-funded (Medicaid) services for substance use, mental health and problem gambling. We provide funding, training, and technical assistance to community-based providers for prevention, intervention, treatment, and recovery support services to people in need.

With our community, state, and national partners, we are committed to providing evidence-based, cost-effective services that support the health and well-being of individuals, families, and communities in Washington State.

Goals

Our goals are to prevent substance use disorders and support holistic, evidence-based, person-centered care that addresses both medical and behavioral health conditions.

Some of the ways our services are making a difference include:

  • Decreasing costs to the public for criminal justice, medical care, foster care and financial assistance;
  • Helping people achieve higher levels of education, find living-wage jobs, and access affordable and supported housing; and
  • Strengthening families so children have the care and support they need to reach their full potential.

Fact sheets

Block grants
Prenatal - 25 services

Prenatal

Children

Youth and young adults

Families

Residential stays and transitions

Grants and collaborations

Prevention services

Youth and young adults

Prescription drugs and marijuana

Mental health promotion

Partnerships and workforce development

Recovery services

Housing

Foundational Community Supports (FCS)

Employment

Peer services

Trueblood

Unsorted

Substance use disorder treatment

Jails and law enforcement diversion

Residential and treatment services

Community

Opioids

Workforce

State v. Blake behavioral health expansion

Unsorted

Treatment services

Inpatient treatment

Reentry and outpatient treatment

Community and response teams

Other

Pictogram of person with thought bubble

How do I…

WAC 182-513-1530 Maximum guardianship fee and related cost deductions allowed from a client's participation or room and board on or after June 1, 2018.

WAC 182-513-1530 Maximum guardianship fee and related cost de­ductions allowed from a client's participation or room and board on or after June 1, 2018.

Revised March 1, 2025

  1. General information.
    1. This section sets the maximum guardianship or conservatorship fee and related cost deductions when:
      1. A court order was entered on or after June 1, 2018; or
      2. The client under guardianship or conservatorship began receiving medicaid-fun­ded long-term services and supports on or after June 1, 2018.
    2. This section only applies to a client who is:
      1. Eligible for and receives institutional services under this chap­ter or home and community-based waiver services under chapter 182-515 WAC, and who is required to pay participation under WAC 182-513-1380, 182-515-1509, or 182-515-1514; or
      2. Eligible for long-term services and supports under this chapter or chapter 182-515 WAC, and who is required to pay only room and board.
    3. All requirements of this section remain in full force whether or not the agency appears at a guardianship or conservatorship proceeding.
    4. In this section, the agency does not delegate any authority in determining eligibility or post-eligibility for medicaid clients.
      1. Under the authority granted by chapter 11.130 RCW, the agency does not deduct more than the amounts allowed by this section from partici­pation or room and board.
      2. The eligibility rules under Title 182 WAC remain in full force and effect.
    5. The agency does not reduce a client's participation or room and board under this section for guardianship or conservatorship fees or related costs accumulated during any month that a client was not required to pay:
      1. Participation under WAC 182-513-1380, 182-515-1509, or 182-515-1514; or
      2. Room and board under this chapter or chapter 182-515 WAC.
    6. If the client has another fiduciary, payee, or other princi­pal-agency relationship and the agent is allowed compensation, any monthly guardianship or conservatorship fee approved under this section is reduced by the agent's compensation.
  2. Maximum guardianship fee and related cost deductions.
    1. The maximum guardianship or conservatorship fee and related cost deductions un­der this section include all guardianship or conservatorship services provided to the client, regardless of the number of guardians or conservators appointed to a client during a period of time, or whether the client has multiple guardians appointed at the same time.
    2. Maximum guardianship or conservatorship fees and related cost deductions are as follows:
      1. The total deduction for costs directly related to establish­ing a guardianship or conservatorship for a client cannot exceed $1,850;
      2. The total deduction for all guardianship and conservatorship-related costs cannot exceed $1,200 during any three-year period; and
      3. The amount of the monthly deduction for all guardianship and conservatorship fees cannot exceed $235 per month.
  3. For people under subsection (1)(b)(i) of this section – Par­ticipation deductions.
    1. After receiving the court order, the agency or its designee adjusts the client's current participation to reflect the deductions under WAC 182-513-1380, 182-515-1509, or 182-515-1514.
    2. The amounts of the participation deductions are the amounts under subsection (2) of this section, or the court order, whichever are less.
    3. For clients who pay room and board in addition to participa­tion, if the client's amount of participation is insufficient to allow for the amounts under subsection (2) of this section, then, regardless of any provision of this chapter or chapter 182-515 WAC, the client's room and board will be adjusted to allow the amounts under subsection (2) of this section.
  4. For people under subsection (1)(b)(ii) of this section - Room and board deductions.
    1. The agency adjusts the client's room and board after receiv­ing the court order, regardless of any provision of this chapter or chapter 182-515 WAC.
    2. The amounts of the room and board deductions are the amounts under subsection (2) of this section, or the court order, whichever are less.

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.

Medically needy LTC programs

Revised date

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

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.

Clarifying information

  1. Determination of eligibility for the categorically needy (CN) or medically needy (MN) programs – income only:
    1. Program policy requires the department to use only the amount of an individual's nonexcluded income when determining eligibility for institutional, waivered, or hospice services under the CN program and institutional or hospice services under the MN program.
    2. For services under the CN program, an individual's nonexcluded income cannot exceed the special income level (SIL). For services under the MN program, an individual's nonexcluded income exceeds the SIL, but cannot exceed the amount established in rule and described below. The SIL is 300% of the federal benefit rate (FBR). The current SIL is located on the Standards LTSS chart.
    3. When determining an individual's eligibility for LTC services in the initial or review month, the department allows an amount of excess resources if, when the excess resources are added together with nonexcluded income, the combined total amount does not exceed the program requirements described below.

      Note: Income standard: The income standard used to determine an individual's eligibility for CN or MN program services does not include any amount of the individual's resources. Institutional Medicaid Standards.

  2. Excess resources: Individuals who have resources in excess of the resource standard in the month of application, or in the month in which they are completing an eligibility review, can be approved for or continue to receive LTC services, if the following conditions are met:
    1. For institutional or hospice services provided under the medically needy (MN) program, the combined total of the individual's nonexcluded income and excess resources cannot exceed the private rate of the facility in which the individual receives the services plus the amount of recurring medical expenses. The department adds the excess resources when determining the individual's participation in the cost of care for that month. Medically needy (MN) with no spenddown for institutional or hospice services: When the individual's nonexcluded income exceeds the facility's department-contracted rate with the department and is less than the facility's private rate plus the amount of recurring medical expenses, the individual is locked into the department-contracted rate for facility care only. The department counts the individual's nonexcluded income in excess of the department-contracted rate plus excess resources when determining the individual's spenddown liability for noninstitutional medical. See Spenddown. The contracted rate is equal to that of the medical facility in which the individual lives, or the monthly rate based on a thirty-one day month for hospice services provided in a medical facility.
    2. The department cannot approve noninstitutional medical for the individual, until the individual incurs medical expenses that are at least equal to the amount of nonexcluded income in excess of the department-contracted rate in the base period plus any excess resources. The individual remains liable for all such medical expenses, the amount of which is referred to as the individual's spenddown amount. WAC 182-513-1350 describes what medical expenses we can allow to reduce spenddown for long term care. The medical expenses are incurred by the institutional individual.
  3. Medically needy (MN) with no spenddown for institutional or hospice services: When the individual's nonexcluded income exceeds the facility's department-contracted rate with the department and is less than the facility's private rate plus the amount of recurring medical expenses, the individual is locked into the department-contracted rate for facility care only.
    1. The department counts the individual's nonexcluded income in excess of the department-contracted rate plus excess resources when determining the individual's spenddown liability for noninstitutional medical. See Spenddown. The contracted rate is equal to that of the medical facility in which the individual lives, or the monthly rate based on a thirty-one day month for hospice services provided in a medical facility.
    2. The department cannot approve noninstitutional medical for the individual, until the individual incurs medical expenses that are at least equal to the amount of nonexcluded income in excess of the department-contracted rate in the base period plus any excess resources. The individual remains liable for all such medical expenses, the amount of which is referred to as the individual's spenddown amount.
    3. WAC 182-513-1350 (8)(d) describes what medical expenses we can allow to reduce spenddown for long term care. The medical expenses are incurred by the institutional individual.

Worker Responsibilities

  1. When determining whether an individual is CN or MN eligible, do not add any resource amount to the individual's nonexcluded income.
  2. Include any excess resource amount in the initial or review month when determining an individual's participation in the cost of care or spenddown liability for noninstitutional medical.
  3. Establish the amount of excess resources and nonexcluded income used to determine an individual's participation in the cost of care by subtracting medical expenses from excess resources in an amount equal to incurred medical expenses such as:
    1. Premiums, deductibles, and coinsurance/copayment charges for health insurance and Medicare premiums;
    2. Necessary medical care recognized under state law, but not covered under the state's Medicaid plan;
    3. Necessary medical care covered under the state's Medicaid plan incurred prior to Medicaid eligibility.
      1. As long as the incurred medical expenses:
        1. Are not subject to third-party payment or reimbursement;
        2. Have not been used to satisfy a previous spend down liability;
        3. Have not previously been used to reduce excess resources;
        4. Have not been used to reduce the individual's responsibility toward cost of care;
        5. Were not incurred during a transfer of asset penalty described in WAC 182-513-1363, and
        6. Are amounts for which the individual remains liable.
      2. Expenses not allowed to reduce excess resources or participation in personal care are:
        1. Unpaid expense(s) prior to Waiver eligibility to an adult family home (AFH) or boarding home is not a medical expense.
        2. Personal care cost in excess of approved hours determined by the CARE assessment described in 106 WAC is not a medical expense.
  4. For LTC services provided under the medically needy (MN) program when excess resources are added to nonexcluded income, the combined total is less than the:
    1. Private medical institution rate plus the amount of recurring medical expenses for institutional services; or
    2. Private hospice rate plus the amount of recurring medical expenses, for hospice services in a medical institution.
    3. For MN Waiver eligibility, incurred medical expenses must reduce resources within allowable resource limits for MN-Waiver eligibility. The cost of care for the waiver services cannot be allowed as a projected expense.
  5. Contact the medical facility or hospice provider to obtain necessary documentation or verification as appropriate, since the individual will generally be physically and/or mentally unable to provide the information. It is not necessary to interview the individual.
  6. Use the rules described in WAC 182-513-1395 (5) when approving institutional or hospice services under the MN program. See SPENDDOWN when approving noninstitutional medical.

Please report broken links or content problems.

Non-Grant Medical Assistance (NGMA) examples

Revised date
Purpose statement

To provide examples of the decision-making process for non-grant medical assistance (Apple Health).

Example: Individual is resource eligible for SSI-related Medicaid, but income exceeds the Substantial Gainful Activity (SGA) test.

Robert (53) is working and earns $1885 per month managing an apartment complex. He has no other income, and his resources are below $2000. After allowing the $20 income exclusion and the $65 plus one half earned income disregard, it appears Robert's net countable income of $900 would make him eligible under the S02 program (based on the Categorically Needy Income Level (CNIL)). However, since S02 medical does not waive the SGA test, and Robert has earned income over the current SGA limit, Robert is not considered 'disabled' under S02 program rules and is not eligible for this program.

Since Robert is working he could be eligible for the Apple Health for Workers with Disabilities (HWD) program. Since Robert has gross earned income over SGA, send his application to the HWD unit for processing who will review for a disability and request a NGMA if appropriate.

Example: Earned income gives an individual the choice between SSI-related Medicaid and HWD if program requirements are met.

Katie (45) receives L&I payments of $950 per month and she has a small self-employment business and earns approximately $100 per week. Her total gross income is $1350 per month. Also, she has recently become eligible for Medicare. If she were not eligible for Medicare, then she should first be screened for MAGI coverage under the new adult group (N05), using the Healthplanfinder.

Since Katie's earnings are below the current SGA limit, she is eligible for regular SSI-related Medicaid with a spenddown OR she can choose HWD coverage with a premium. Explain the options available to her. If she chooses HWD, the NGMA referral is initiated by the HWD worker.

Example: An individual on a DDA waiver with earnings over SGA.

Miranda (34) has been receiving state-funded employment supports through the Developmental Disabilities Administration (DDA) but has not had medical coverage. Miranda applies for Apple Health, because DDA wants to transition her to the Basic Waiver program. She is working and earns $1800 per month. Miranda has been working with a benefit analyst who has recommended that she apply for HWD. Although Miranda's income is below the Special Income Level for the Basic Waiver program, her earnings are over the SGA amount. Refer Miranda's application to the HWD unit to complete the NGMA referral and premium determination. Miranda is not eligible for SSI-related medical under the L22 coverage group because of the SGA test.

Please report broken links or content problems.

Healthplanfinder letters

Revised date
HPF Number HPF Letter Name Description Freeform Text Requirement Triggering Action/Sent When
EE001*** Additional Verification Required (conditionally approved - or pending verification) Produce a correspondence to an individual who needs to provide additional verifications to finalize their eligibility status Yes - able to add free form text

Auto generated

Status of conditionally eligible is returned for an individual for HIPTC/QHP

Status of active is returned for an individual for WAH

  • But citizenship is not verified.
  • But lawful presence is not verified
EE0034*** Complete Your Application Reminder to complete application None - unable to add free form text

Auto generated

When an individual has started an application, but has not completed it
EE005 WAH Information Request Information request for individuals with outstanding verifications for WAH Yes - able to add free form text

When an individual designates their application as "partially submitted".

When a worker manually triggers EE005 through an individual's dashboard
EE008 WAH Renewal Correspondence for automatic renewal for WAH (Medicaid/CHIP) coverage None - unable to add free form text

Auto generated

When an individual is currently enrolled in WAH and their new eligibility determination at renewal indicates a status of "approved" for WAH for the subsequent coverage period.
EE009 WAH Renewal - Action Required Correspondence notifying an individual of action required to complete a WAH renewal 60 days ahead of the end of the eligibility period. None - unable to add free form text

Auto generated

When HBE calls the Eligibility Service (ES) engine 60 days before the end of a household's WAH eligibility period and receives a status indicating that all members of the household cannot be auto renewed.
EE010 WAH Denial Correspondence notifying an individual who is denied for WAH Yes - able to add free form text

When a worker forces "denial" on an individual's application with an eligibility status of "pending".

When an individual receives the EE005 Information Request for a partially submitted application and has not responded by the due date specified in the Information Request.
EE011 WAH Termination Correspondence notifying an individual who is being terminated for WAH coverage  

When a status of "termination" is returned for an individual or household who is currently part of WAH

When a worker forces termination of WAH through the Application Review screen.

NOTE: When HBE runs an eligibility determination for a household that has a 19-year-old, HBE will receive a status of "denied" with a reason code of "failure to renew". At that point, HBE business logic will determine whether the household has a 19-year-old and will add the appropriate tag next.

Forced termination reason code text is included in this correspondence.
EE013 General Correspondence Correspondence used by staff to provide custom information to individuals Yes - able to add free form text

When a worker clicks the "next" button on the free form text screen
EE015 Eligibility Results Correspondence for determination of WAH, APTC, QHP during the initial application, at change reporting or renewal period None - unable to add free form text

Auto generated

When an individual receives their eligibility determination as part of the initial application, change reporting or renewal process

Please report broken links or content problems.

Subscribe to