Apple Health for Refugees

Revised date

June 27, 2024

Purpose statement

To describe the program rules for the Refugee Medical Program (RMA).

WAC 182-507-0130 Refugee medical assistance (RMA).

WAC 182-507-0130 Refugee medical assistance (RMA)

Effective May 5, 2025

You are eligible for refugee medical assistance (RMA) if all the following conditions are met. You:
1. Meet immigration status requirements of WAC 182-507-0135;
2. Have countable resources below $2,000 on the date of application;
3. Have countable income equal to or below 200 percent of the federal poverty level (FPL) on the date of application. The following income is not considered when determining eligibility for RMA:
  1. Resettlement cash payments made by the voluntary agency (VOLAG);
  2. Income of a sponsor is not counted unless the sponsor is also part of your assistance unit; and
  3. Income received after the date of application.
4. Provide the name of the VOLAG which helped bring you to the United States so that the department of social and health services (DSHS) can promptly notify the VOLAG (or sponsor) about the medical application.
If you receive refugee cash assistance (RCA) you are eligible for RMA if you have countable resources below $2,000 on the date of application and you are not otherwise eligible for another medicaid or a children's health care program as described in WAC 182-505-0210. You do not have to apply for or receive RCA in order to qualify for RMA.
You are not eligible to receive RMA if you are:
1. Already eligible for another medicaid or a children's health care program as described in WAC 182-505-0210;
2. A full-time student in an institution of higher education unless the educational activity is part of a DSHS-approved individual responsibility plan (IRP); or
3. A nonrefugee spouse of a refugee.
If approved for RMA, the agency or its designee issue an approval letter in both English and your primary language. The agency or its designee also sends a notice every time there are any changes or actions taken which affect your eligibility for RMA.
You may be eligible for RMA coverage of medical expenses incurred during the three months prior to the first day of the month of the application. Eligibility determination will be made according to medicaid rules.
If you are a victim of human trafficking you must provide the following documentation and meet the eligibility requirements in subsections (1) and (2) of this section to be eligible for RMA:
1. Adults, 18 years of age or older, must provide the original certification letter from the United States Department of Health and Human Services (DHHS). No other documentation is needed. The eligibility period will be determined based on the entry date on your certification letter;
2. A child victim under the age of 18 does not need to be certified. DHHS issues a special letter for children. Children also have to meet income eligibility requirements;
3. A family member of a certified victim of human trafficking must have a T-2, T-3, T-4, or T-5 visa (derivative T-Visas), and the family member must meet eligibility requirements in subsections (1) and (2) of this section.
The entry date for an asylee is the date that asylum status is granted. For example, you entered the United States on December 1, 1999, as a tourist, then applied for asylum on April 1, 2000, interviewed with the asylum office on July 1, 2000, and were granted asylum on September 1, 2000. The date of entry is September 1, 2000, and that is the date used to establish eligibility for RMA.
RMA certification period.
1. (a) RMA ends on either:
  1. The last day of the eighth month from the month the person entered the United States if they entered the United States on or before September 30, 2021. For example, if they entered the United States on September 30, 2021, they are eligible through April 30, 2022;
  2. The last day of the 12th month from the month the person entered the United States if they entered the United States on or after October 1, 2021, through May 4, 2025. For example, if they entered the United States on October 25, 2021, they are eligible through September 30, 2022; or
  3. The last day of the fourth month from the month the person entered the United States if they entered the United States on or after May 5, 2025. For example, if they entered the United States on June 20, 2025, they are eligible through September 30, 2025.
2. You may receive RMA benefits for more months if you are in a category of persons for whom the federal Office of Refugee Resettlement has extended the eligibility period.
If you are approved for RMA you are continuously eligible through the end of the initial RMA certification period, regardless of an increase in income.
The agency, or its designee, determines eligibility for medicaid and other medical programs for your spouse when the spouse arrives in the United States. If the spouse is not eligible for medicaid due to your countable income, the spouse is still eligible for RMA under subsection (8) of this section.
If you disagree with a decision or action taken on the case by the agency, or its designee, you have the right to request a review of the case action(s) or request an administrative hearing (see chapter 182-526 WAC). The request must be received by the agency, or its designee, within 90 days of the date of the decision or action.

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 182-507-0135 Immigration status requirement for refugee medical assistance (RMA).

WAC 182-507-0135 Immigration status requirement for refugee medical assistance (RMA).

Effective November 24, 2024

An individual is eligible for refugee medical assistance (RMA) if the individual provides documentation issued by the United States Citizenship and Immigration Services (USCIS) to show that the individual is:
1. Admitted as a refugee under section 207 of the Immigration and Nationalities Act (INA);
2. Paroled into the United States as a refugee or asylee under section 212 (d)(5) of the INA;
3. Granted conditional entry under section 203 (a)(7) of the INA;
4. Granted asylum under section 208 of the INA;
5. Admitted as an Amerasian immigrant from Vietnam through the orderly departure program, under section 584 of the Foreign Operations Appropriations Act, incorporated in the FY88 continuing resolution P.L. 100-212;
6. A Cuban-Haitian entrant who was admitted as a public interest parolee under section 212 (d)(5) of the INA;
7. Certified as a victim of human trafficking by the federal Office of Refugee Resettlement (ORR);
8. An eligible family member of a victim of human trafficking certified by ORR who has a T-2, T-3, T-4, or T-5 visa;
9. Admitted as special immigrant from Iraq or Afghanistan under one of the following:
  1. Special immigrant status under section 101 (a) (27) of the INA;
  2. Special immigrant conditional permanent resident; or
  3. Parole under section 602 (b) (1) of the Afghan Allies Protection Act of 2009 or section 1059 (a) of the National Defense Authorization Act of 2006;
10. An Afghan granted humanitarian parole between July 31, 2021, and September 30, 2023, their spouse or child, or a parent or guardian of an unaccompanied minor who is granted parole after September 30, 2022 under section 2502 of the Extending Government Funding and Delivering Emergency Assistance Act of 2021; or
11. A citizen or national of Ukraine (or a person who last habitually resided in Ukraine) who, under section 401 of the Additional Ukrainian Supplemental Appropriations Act, 2022 (AUSAA) and the Ukraine Security Supplemental Appropriations Act, 2024 (USSAA), is evaluated as a qualified alien when:
  1. Granted parole into the United States between February 24, 2022, and September 30, 2024; or
  2. Granted parole into the United States after September 30, 2024, and is:
    1. The spouse or child of a person described in (k)(i) of this subsection; or
    2. The parent, legal guardian or primary caregiver of a person described in (k)(i) of this subsection who is determined to be an unaccompanied child under section 462 (g) (2) of the Homeland Security Act of 2002 or section 412 (d) (2) (B) of the Immigration and Nationality Act.
A permanent resident alien meets the immigration status requirements for RCA and RMA if the individual was previously in one of the statuses described in subsection (1) of this section.

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

Refugees and other humanitarian immigrants as described in WAC 182-507-0135 may be eligible for RMA if they are not eligible for Apple Health (Medicaid).
RMA eligibility is established based on an applicant's income and resources on the date of the application, rather than averaging income over the application processing period.

a. Income received after the date of application for RMA is not considered when determining eligibility for RMA.

3. A student enrolled in an institution of higher education and carrying a full-time academic workload is considered a full-time student. A full-time student is eligible for RMA only if educational activity is a part of their WorkFirst personal employment plan.

For an overview of citizenship and immigration status eligibility rules, see the Citizenship and Immigration Status Guide.

Worker responsibilities

For applicants as described in WAC 182-507-0135 who are under age 65, HCA determines eligibility for modified adjusted gross income (MAGI)-based Apple Health programs first.

Applications for medical assistance should be submitted through Healthplanfinder. If you experience an issue when submitting the application, complete a paper application and email it to HCA WAHRMA apps and include:

Primary applicant name
Healthplanfinder app ID
Managed care organization (MCO) plan selection (optional)
Error code (if any)

a. If an applicant is not eligible for MAGI-based Apple Health, or they become ineligible during the certification period, HCA will determine eligibility for Refugee medical assistance.

b. DSHS determines eligibility for medical assistance for clients over age 65 who are refugees or have other eligible immigration statuses.

2. Applicants age 65 or older, with blindness or disability, as described in WAC 182-507-0135, complete applications:

In person at a local DSHS CSO,
Online at Washington Connection,
Faxed to CSD at 1-888-338-7410, or
Mailed to DSHS - CSD Customer Service Center, PO Box 11699, Tacoma WA 98411-6699

List of Refugee Resettlement Agencies in Washington State.

Please report broken links or content problems.

SSI deemed eligible

Revised date

November 8, 2023

Note: 1619b clients are considered the same as an individual receiving SSI. Eligibility for Medicaid is continued based on SDX information to continue Medicaid due to 1619b status.

Deemed SSI eligible clients are usually under the S02 medical coverage group. They would have continued to be eligible for SSI except their SSI was closed by disabled adult child (DAC), Cost of living adjustment (COLA aka Pickle) or Widowers benefits.

1619B and "Deemed SSI eligible" clients

SSI deemed eligible clients (countable income is under the SSI standard after DAC, Pickle/COLA exclusion AND SSI was closed due to the receipt of DAC, benefits, widowers benefits, or COLA) do not pay service participation. They DO pay for room and board in an assisted living facility (ALF).
1619b clients are considered the same as an "SSI client" SSI payments have stopped due to earnings. SDX coding indicates to continue Medicaid on SDX 1 in the Med Elig field. 1619b clients do not pay service participation. They DO pay room and board in an ALF.

Deemed SSI eligible clients. What does that mean?

Clients who have countable income under the SSI standard after subtracting:

Disabled Adult Child (DAC) benefits;
Pickle/COLA;
Widow/Widowers; AND
their SSI was closed because of the receipt of the DAC/COLA/Widow(er) income.

These exclusions are described in WAC 182-512-0880. Clients continue to receive CN Medicaid as long as they meet resource criteria.

Not every client receiving DAC or Widower income is eligible for this exclusion.
DAC clients with countable income under the SSI standards are often called "Protected DAC" individuals.
DAC clients with countable income over the SSI standard are not "protected DAC".
Deemed SSI eligible clients do NOT pay HCB Waiver service participation, but they do pay room and board if living in an ALF.
Deemed SSI eligible clients DO participate toward the cost of care when living in a medical institution.
If countable income is over the SSI standard after the exclusion, then all income is counted in post eligibility in determining participation including DAC income.

In other words, an individual who would be eligible for CN/S02 in ACES

A client who would otherwise qualify for S02/CN SSI-related Medicaid because their countable income is at or below the SSI standard does not participate towards personal care under the Waiver program, but they are responsible to pay room and board when living in an ALF.

These clients do need to meet the same criteria for long-term care services as other Waiver clients and may be subject to transfer of an asset penalty or excess home equity described in WAC 182-513-1350

Let the SW/Case manager know if client would be eligible for a non institutional CN program so Medicaid Personal Care (MPC) can be considered. MPC is considered a priority over the HCB Waiver program.

1619b status, what does it mean?

SSI clients whose earnings put them over the SSI cash benefit standard, but Social Security continues their SSI eligibility. They are considered an SSI recipient and continue to send in reviews to Social Security. The SDX indicates continued Medicaid when a client is 1619b. 1619b clients do not pay service participation because they are considered to be an SSI client. Clients would pay the ALTSA room and board amount if residing in an ALF. Clients can have GROSS income over the special income level (SIL) and continue to receive HCB Waiver as long as Social Security maintains their 1619b status.

What happens if a client loses their protected DAC status?

ACES is programmed to do the COLA, DAC, Widower disregard correctly as long as the SSI end date and the correct coding is indicated on the unearned income screen.
If a client on MPC loses protected DAC status and it is because of earnings, refer to the HWD specialist for a determination. Active HWD recipients can receive either MPC or HCB Waiver services if functionally eligible. The case-manager makes the decision as to the type of services the client will receive.
If a client on MPC at home loses protected DAC status and it is not due to earnings, send a referral to the client case-manager to see if the client is functionally eligible for a HCB Waiver as the client is no longer eligible to receive a noninstitutional CN program. If the client is in a residential setting, consider eligibility for G03.
If a client on MPC loses protected DAC status and is no longer eligible for non institutional CN Medicaid and is on DDA MPC services, request that the DDA case-manager coordinate a referral to HCS intake to look at the COPES waiver. (DDA may not have an available slot on the DDA Waiver). It is the responsibility of the DDA case-manager to coordinate with HCS in this scenario.
If a client on HCB Waiver loses protected DAC status, they may be responsible to pay participation toward the cost of care. Once a client loses protected DAC status, all the income including the DAC income is counted in determining if there is a client responsibility toward the cost of care.

Example #1

S02/MPC client. Receives $850 SSDI under their own claim. Receives $600 DAC benefit. Per WAC 182-512-0880, client fits the criteria for the DAC exclusion.

$1450 total income
- $600 DAC exclusion
- $20 disregard
= $830 countable income.

Countable income is under the CNIL standard, so they are considered a protected DAC.

This client is not responsible to pay participation toward the cost of personal care even if switched over to a HCB Waiver service. The client is responsible to pay the ALTSA room and board rate if living in an alternate living facility (ALF).

Example #2

S02/MPC client receives $600 SSDI under their own claim. Receives $600 DAC benefit. Per WAC 182-512-0880, client fits the criteria for the DAC exclusion. The countable income after the DAC exclusion is under the CNIL standard. Client is considered a protected DAC.

Client starts working and has $1000 earnings.

$2,200 total income
- $600 DAC exclusion
- 20 disregard
- $465.50 (65 and 1/2 earned income deduction)
= $1,114.50 countable income. Income is over the CNIL income standard. No longer eligible for CN non institutional.

Redetermination of Medicaid needed. All the income, including the DAC income will be used in eligibility and post eligibility if on a L22 medical coverage group as client is no longer considered a "Protected DAC". This client is no longer a protected DAC because the countable income is over the CNIL standard.

Refer to the HWD specialist for a determination of HWD. The HWD premium is no more than 7.5% of the total monthly income. All income including the DAC income is used in eligibility and premium determination.
HWD is preferable over HCS HCB Waiver as the premium cost is less than projected participation.
If a DDA client, the gross income is over the Medicaid SIL, therefore HWD is the only option for services.
Continue Medicaid until the HWD specialist has made the determination.
Notify the case manager that client appears HWD-eligible and has been referred to the HWD specialist.
Notify the case manager they can be considered for either MPC or HCB Waiver.
If the client is in a residential setting, they will be responsible to pay the ADSA room and board rate to the provider.

Example #3

Client receives $1000 DAC income and is on DDA Waiver in a residential setting. Client is eligible to receive the DAC exclusion described in WAC 182-512-0880 and does not pay participation toward the cost of care because the countable income (-0-) is under the CNIL. The client is responsible to pay the ALTSA room and board rate to the residential provider.

Client starts receiving a $800 monthly pension benefit from a deceased parent's retirement annuity. The countable income is now over the CNIL. No longer a protected DAC. This client will now be responsible to pay Waiver participation plus the ALTSA room and board rate to the residential provider. The client will be allowed to keep $62.79 Personal Needs Allowance (PNA).

Example #4

Same scenario as example #3 except the client is on MPC services rather than DDA Waiver.

Consider G03 described in WAC 182-513-1205 when doing the redetermination as client is no longer eligible for a S02 and is living in a residential setting.

Example #5

Same scenario as example #3 except the client is on MPC services authorized by DDA and living at home.

In this scenario, the client no longer qualifies for MPC because the client is no longer eligible for non institutional CN Medicaid.

Send a referral to the DDA case manager indicating the client is no longer eligible for MPC and a HCB Waiver needs to be considered if the client is need of services. This may take coordination by the DDA case manager and HCS intake for COPES if DDA Waiver cannot be considered.

Continue the Medicaid while a determination is being considered and set a barcode tickler to check status in 30 days.

Example #6

Client receives $1200 DAC benefit and is on HCS COPES Waiver. Client was never on SSI in the past, so does not qualify for DAC exclusion per WAC 182-512-0880, Client is not considered a protected DAC.

All the DAC income is counted in initial and post eligibility.

Please report broken links or content problems.

LEP services

Revised date

December 11, 2023

Purpose statement

To describe worker responsibilities (where applicable) in identifying the need for and providing services to Limited-English proficient (LEP) individuals.

WAC 182-503-0110 Washington apple health -- Limited-English proficient (LEP) services

WAC 182-503-0110 Washington apple health -- Limited-English proficient (LEP) services.

Effective March 31, 2014.

We provide interpreter and translation services (limited-English proficient or LEP services) free of charge to you if you have limited ability to read, write, and/or speak English. Interpreter services are those used for oral communication between two parties who do not speak the same language. Translation services are those used for written communication.
We provide LEP services in your primary language.
1. A primary language is the language you tell us that you wish to use when communicating with us. You may designate at least one primary language for oral communications and at least one primary language for written communications, and you may designate a different primary language for oral and for written communications.
2. We note your primary languages in a record available to the agency, its designee, and health benefit exchange employees.
We can provide LEP services through bilingual workers and/or contracted interpreters and translators who are expected to be competent. We consider a bilingual worker or a contracted interpreter or translator to be competent if he or she is:
1. Certified for interpreting and/or translating in the language by the language testing and certification program of the department of social and health services;
2. Certified or otherwise determined to be competent for interpreting and/or translating in the language by an association or organization with a regional or national reputation for certifying or determining the competence of interpreters and/or translators; or
3. Determined competent for interpreting and/or translating in the language by us, taking into account his or her:
  1. Demonstrated proficiency in both English and the other language;
  2. Orientation and training that includes the skills and ethics of interpreting;
  3. Fundamental knowledge in both languages of any specialized terms or concepts peculiar to Washington apple health;
  4. Sensitivity to cultural differences; and
  5. Demonstrated ability to convey information accurately in both languages.
We provide notice of the availability of LEP services on printed applications and notices, in the Washington Healthplanfinder website, and during contact with persons who appear to need LEP services.
LEP services include:
1. Spoken language interpreter (oral) services in person, over the telephone, or through other simultaneous audio or visual transmission (if available); and
2. Translation of our forms, letters, and other text-based materials, whether printed in hard-copy or stored and presented by computer. These include, but are not limited to:
  1. Our pamphlets, brochures, and other informational material that describe our services and your health care rights and responsibilities;
  2. Our applications and other forms you need to complete and/or sign; and
  3. Notices of our actions affecting your eligibility for health care coverage.
3. Direct provision of services by our bilingual employees.
We provide interpreter services and translated documents in a prompt manner that allows the timely processing of your eligibility for health care coverage within time frames defined in WAC 182-503-0060, 182-503-0035, and 182-504-0125.
If you believe that we have discriminated against you on the basis of race, color, national origin, birthplace, or another protected status, you may file a complaint with the U.S. Department of Health and Human Services or Regional Manager, Office of Civil Rights, U.S. Department of Health and Human Services, 2201 Sixth Ave. – M/S: RX-11, Seattle, WA 98121-1831 (voice phone 800-368-1019, fax 206-615-2297, TDD 800-537-7697).

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

Limited-English proficient (LEP) services are intended to ensure that persons limited in their ability to read, write and/or speak English have equal access to Apple Health programs and services.
The provision of qualified interpreters and fully translated letters to LEP individuals is required by state (RCW 74.04.025) and federal laws (Title VI of the Civil Rights Act and implementing regulations at 45 CFR Part 80).

Interpreter services

If the individual needs assistance in communicating verbally with staff, the individual's case will be assigned to an authorized bilingual employee who speaks the individual's language or an interpreter will be scheduled to facilitate communication with the individual. These services are provided at no cost to the individual and without significant delay.
Family members, friends and children should not be used as interpreters.
HCA and DSHS have contracts with brokers who assign interpreters to DSHS appointments. These services are charged at a minimum hourly rate for the first hour of services and in fifteen minute increments thereafter. Contact your CSO Interpreter Services Coordinator to request an interpreter through the interpreter brokerage contract. Spoken language interpreter brokerage information is available at the following website:
On-demand telephone interpreter services are also available by contract. Telephone interpreter contractor information is available at the following website:
1. Services are paid for at a per-minute rate;
2. On-demand telephone interpreter services are used as a backup to the brokered interpreter service contract that supplies in-person interpreters. It is also used for interpreting needs that are emergent and / or short in duration. As such, on-demand telephone interpreter services may be required for emergency applications and walk-ins.
3. When calling an individual on the telephone or receiving an incoming individuals call, you can use conference call capabilities to get an interpreter on the line.
4. Ensure that both the individual and the interpreter are aware that such phone calls are covered by DSHS confidentiality rules.
The department has contracts with sign language interpreter providers who assign interpreters for appointments with persons who are deaf, deaf-blind, or hard of hearing. Contact your CSO Interpreter Services Coordinator to request the services of a sign language interpreter. Sign language interpreter contractor information is available through DSHS.

Assistance in communicating by phone with persons who are deaf, deaf-blind or hard of hearing is available through the Washington Relay Service.

Written translation services

Letters must be sent to LEP individuals in their primary language and in English. These letters, including all worker fill-ins, must be fully translated for individuals whose primary language is anything other than English.
For these individuals, if an English letter is sent or if the individual has signed an English form that must be fully translated, the Department must reissue the translated letter and give the individual time to respond. As a result, actions taken based on the previously released English letter must be rescinded.

Translated ACES correspondence

The following letters are generated by ACES and mailed from State Office:
1. All Automated Case Maintenance (ACM) letters in supported languages. These letters cannot be added to or changed.
2. Letters that are the result of the worker taking an action on a case when the Primary Language Code is a "supported" language.
The following ACES letters must be printed locally and translated by an authorized bilingual employee or sent to an authorized contracted translation agency for translation:
1. Letters that are the result of the worker taking an action on a case when the individual's primary language is a "nonsupported" language.
2. Letters that have free-form text.
ACES supported languages include the following:
- Cambodian
- Chinese
- Korean
- Laotian
- Russian
- Spanish
- Vietnamese
- Somali

Worker responsibility

To ensure LEP individuals receive adequate services:
1. Identify the individual’s primary language at first contact.
2. Enter the correct Primary Language Code (PLC) into the Primary Language field in ACES. Primary language should be periodically discussed with the individual, and the PLC should be reviewed and updated as necessary. Care should be taken to not inadvertently change the PLC. Incorrect PLCs result in untimely and inadequate notice to individuals, as well as increased translation costs.
3. Inform LEP individuals of their right to interpreter (verbal) and translation (written) services and that these services are available to them without charge or significant delay. This includes informing walk-in individuals.
  Note: Use the services of an interpreter if you feel you are unable to communicate with the individual well enough to provide quality services, even if the individual tells you they do not need an interpreter.
4. Provide interpreter and translation services in a timely manner so that LEP cases can be processed timely.
5. Indicate any language needs on all referrals of LEP individuals to other divisions, administrations, or agencies.
6. Provide LEP individuals with the same safeguards of confidentiality as provided to English proficient individuals.
7. Provide assistance to LEP individuals in understanding and completing forms. Remember that LEP individuals may have learning disabilities, cognitive problems and/or may not be literate in their native language. Include screening for Equal Access -- See Equal Access Chapter.
8. In the event that there are no available employee or contractor resources to serve an LEP individual in their primary language, an exception to policy may be made. This may include contacting refugee service providers, client advocates, member’s of the individual’s community (e.g., church or community center), and as a last resort, friends or family members (children should never be used as interpreters) to ask for their assistance in facilitating communication with the individual. Any exception to policy must be documented in the ACES narrative.
Provide fully translated forms in the primary language of the LEP individual whenever appropriate:
1. Many forms are available in non-English languages on the HCA website.
2. If the form is not available online, and has not been translated into the language needed for the individual, make a request for the form to be translated through your the agency or office Translation Coordinator (for example, the CSO Translation Coordinator (CSO TC)). The Translation Coordinator will submit a translation request. Translation work is usually completed in 1-2 weeks.
Provide fully translated publications in the primary language of the individual whenever appropriate.
1. Some translated publications are on the HCA website.
2. Publications needed in languages not available online can be ordered.
Provide locally generated/individual specific documents in the primary language of the individual whenever appropriate.
1. Translation of locally generated, specific documents are provided by authorized bilingual employees or requested directly from an authorized translation services contractor.
Upon receiving completed translation work:
1. Make a copy of the English and translated documents.
2. Mail the originals of both documents to the individual.
3. Send copies of the English and translated documents to DMS to be imaged into the electronic case record. If an exact duplicate of the English document is already in the ECR, do not send another copy to DMS.
Continue benefits through the advance notice period if the action requires advance notice and the fully translated letter is mailed within the 10-day advance notice period.

ACES documentation

On the Address (ADDR) screen (mainframe) or ACES.Online screening Applicant Page:
1. Enter the individual's PLC for the language the individual reads and understands. For individuals that do not read any language, the PLC should be "EN" for English. The PLCs are listed in alphabetical order by language on F1 Help from the PLC field. If the individual's language is not listed, enter "OT" (for other language) and enter the name of the language in REMARKS behind the ADDR screen.
2. If the individual needs assistance with communicating verbally, indicate that an interpreter is needed in the Interpreter Needed field and enter the name of the language in REMARKS behind the ADDR screen if it is different than the language identified in the Primary Language field.
For ACES Narrative information, visit the ACES Information Center in ACES online and document the following in the ACES narrative:
1. All efforts to secure LEP services, including when efforts are unsuccessful. Document how the client was served if an exception to policy was made.
2. The date a translation request was given to the CSO translation coordinator.
3. The date a translated letter, form or publication was mailed or given to the individual.
4. The name a the interpreter who provided services for an interview with an LEP individual.

Please report broken links or content problems.

Long-term care partnership information for consumers

Revised date

July 7, 2022

Purpose statement

This section gives an overview of the long-term care partnership insurance program. This program is a collaboration between the Department of Social and Health Services (DSHS), Health Care Authority (HCA) and the Office of the Insurance Commissioner (OIC).

WAC 182-513-1400 Long-term care (LTC) partnership program (index).

WAC 182-513-1400 Long-term care (LTC) partnership program (index).

Effective February 20, 2017

Under the long-term care (LTC) partnership program, people who purchase qualified long-term care partnership insurance policies can apply for long-term care medicaid under special rules for determining financial eligibility. These special rules generally allow the person to protect assets up to the insurance benefits received from a partnership policy so that such assets will not be taken into account in determining financial eligibility for long-term care medicaid and will not subsequently be subject to estate recovery for medicaid and long-term care services paid. The Washington long term care partnership program is effective on December 1, 2011.

The following rules govern long-term care eligibility under the long-term care partnership program:

WAC 182-513-1405 Definitions
WAC 182-513-1410 LTC Partnership policy qualifications.
WAC 182-513-1415 Assets that can't be protected under the LTC partnership provisions.
WAC 182-513-1420 Eligibility for asset protection under a partnership policy.
WAC 182-513-1425 Not qualifying for LTC medicaid if an LTC partnership policy is in pay status.
WAC 182-513-1430 Change of circumstances that must be reported when there is an LTC partnership policy paying a portion of my care.
WAC 182-513-1435 When Washington recognizes an LTC partnership policy purchased in another state.
WAC 182-513-1440 Determining how many assets can be protected.
WAC 182-513-1445 Designating a protected asset and required proof.
WAC 182-513-1450 How the transfer of assets affects LTC partnership and medicaid eligibility.
WAC 182-513-1455 Protected assets under an LTC partnership policy after death.

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.

Definitions used in long-term care (LTC)

What is long-term care?

For the purposes of Medicaid eligibility, long-term care is for individuals residing in a medical institution (primarily a nursing home) for 30 days or more or on a Home and Community based Waiver (HCB Waiver).

"Institutionalized individual" means an individual who has attained institutional status as described in WAC 182-513-1320

"Institutional Services" means services paid for by Medicaid or state funds and provided in a medical institution, through a Home and Community Based (HCB) Waiver or Program of All-Inclusive Care for the Elderly (PACE).

"Home and Community Based Services" (HCBS) means services provided in the home or a residential setting to individuals assessed by the department.

"Home and Community Based (HCB) Waiver programs" means Section 1915 (c) of the Social Security Act enables states to request a waiver of applicable federal Medicaid requirements to provide enhanced community support services to those Medicaid beneficiaries who would otherwise require institutional care.

Additional definitions used in long-term care eligibility

How do I apply for long-term care Medicaid

How to apply for Medicaid

Eligibility requirements for long-term care Medicaid

Eligibility requirements for long-term care are found in WAC 182-513-1315. Some of the key requirements are:

Identity and citizenship requirements
Furnish a valid social security number
Be a Washington State resident
Meet aged, blind, or disabled criteria
Income and resource guidelines
Institutional Medicaid is subject to penalties for resource transfers described in WAC 182-513-1363
Home equity cannot exceed $955,000 as described in WAC 182-513-1350.
Declaration of interest in an annuity and naming the State of Washington as a remainder beneficiary as described in WAC 182-516-0201

Income and resource standards for long-term care

Resources

WAC 182-513-1350 describes resource eligibility for long-term care

$2,000 for the applicant
$3,000 for a couple, both applying
$59,890 State spousal resource standard
$137,400 Federal spousal resource standard (1/1/2022)

Income

Countable income is compared to 300% of the Federal Benefit Rate (FBR). The 2022 rate is $2,523 and may also be called the Special Income Level (SIL).
Individuals with income at or below are eligible for categorically needy (CN) medical coverage.
Individuals with countable income over 300% of the FBR may be eligible for medically needy (MN) coverage based on the projected monthly cost of care in the facility or at home.
Individuals must contribute income after allowable deductions towards the cost of their care. This contribution is sometimes called participation.

Income and Resource standard charts used in long-term care eligibility

Frequently asked questions about the partnership program

Frequently Asked Questions

Washington State Long-Term Care Partnership Program Main Page

Washington State Long-term care partnership program main page (Long-Term care Medicaid manual, includes the Washington Administrative Code (WAC) rule on eligibility)

How do I designate the assets I want to protect?

Individuals with LTC partnership policy must submit a DSHS 10-438 LTCP Asset Designation form to Washington State Medicaid at the time of application and at each annual review in order to designate assets as protected based on the dollar amount paid for services by the LTC Partnership Policy. This will track protected assets for both LTC Medicaid eligibility and Estate Recovery purposes.

DSHS 10-438 Long-Term Care Partnership Asset Designation Form

More information on long-term care eligibility in Washington State

Long-term care eligibility manual includes the Washington Administrative Code

Questions and Answers on the COPES Program by Columbia Legal Services (COPES is the main home and community based waiver used in Washington State)

Questions and Answers on Medicaid for nursing home residents by Columbia Legal Services

Aging & Disability Services Administration

How to apply for Medicaid

Please report broken links or content problems.

Date of entry

Revised date

August 11, 2021

Purpose statement

To explain how to determine a lawfully present immigrant’s "date of entry" into the United States.

WAC 182-503-0535 Washington apple health -- Citizenship and immigration status.

WAC 182-503-0535 Washington apple health -- Citizenship and immigration status.

Effective June 11, 2025

Definitions.
1. Nonqualified alien means someone who is lawfully present in the United States (U.S.) but who is not a qualified alien, a U.S. citizen, a U.S. national, or a qualifying American Indian born abroad.
2. Qualified alien means someone who is lawfully present in the United States and who is one or more of the following:
  1. A person lawfully admitted for permanent residence (LPR).
  2. An abused spouse or child, a parent of an abused child, or a child of an abused spouse who no longer resides with the person who committed the abuse, and who has one of the following:
    1. A pending or approved I-130 petition or application to immigrate as an immediate relative of a U.S. citizen or as the spouse of an unmarried LPR younger than 21 years of age.
    2. Proof of a pending application for suspension of deportation or cancellation of removal under the Violence Against Women Act (VAWA).
    3. A notice of prima facie approval of a pending self-petition under VAWA. An abused spouse's petition covers his or her child if the child is younger than 21 years of age. In that case, the child retains qualified alien status even after he or she turns 21 years of age.
  3. A person who has been granted parole into the U.S. for one year or more, under the Immigration and Nationality Act (INA) Section 212 (d)(5), including public interest parolees.
  4. A member of a Hmong or Highland Laotian tribe that rendered military assistance to the U.S. between August 5, 1964, and May 7, 1975, including the spouse, unremarried widow or widower, and unmarried dependent child of the tribal member.
  5. A person who was admitted into the U.S. as a conditional entrant under INA Section 203 (a)(7) before April 1, 1980.
  6. A person admitted to the U.S. as a refugee under INA Section 207.
  7. A person who has been granted asylum under INA Section 208.
  8. A person granted withholding of deportation or removal under INA Section 243(h) or 241 (b)(3).
  9. A Cuban or Haitian national who was paroled into the U.S. or given other special status.
  10. An Amerasian child of a U.S. citizen under 8 C.F.R. Section 204.4(a).
  11. A person from Iraq or Afghanistan who has been granted one of the following:
    1. Special immigrant status under INA Section 101 (a) (27);
    2. Special immigrant conditional permanent resident; or
    3. Parole under Section 602 (b) (1) of the Afghan Allies Protection Act of 2009 or Section 1059(a) of the National Defense Authorization Act of 2006.
  12. An Afghan granted humanitarian parole between July 31, 2021, and September 30, 2023, their spouse or child, or a parent or guardian of an unaccompanied minor who is granted parole after September 30, 2022, under Section 2502 of the Extending Government Funding and Delivering Emergency Assistance Act of 2021.
  13. A citizen or national of Ukraine (or a person who last habitually resided in Ukraine) who, under section 401 of the Additional Ukrainian Supplemental Appropriations Act, 2022 (AUSAA) and the Ukraine Security Supplemental Appropriations Act, 2024 (USSAA), is evaluated as a qualified alien until the end of their parole term when:
    1. Granted parole into the United States between February 24, 2022, and September 30, 2024; or
    2. Granted parole into the United States after September 30, 2024, and is:
      1. The spouse or child of a person described in (b)(xiii)(A) of this subsection; or
      2. The parent or guardian of a person described in (b)(xiii)(A) of this subsection who is an unaccompanied minor.
  14. A person who has been certified or approved as a victim of trafficking by the federal office of refugee resettlement, or who is:
    1. The spouse or child of a trafficking victim of any age; or
    2. The parent or minor sibling of a trafficking victim who is younger than 21 years of age.
  15. A person from the Federated States of Micronesia, the Republic of Palau, or the Republic of the Marshall Islands living in the United States in accordance with the Compacts of Free Association.
3. U.S. citizen means someone who is a United States citizen under federal law.
4. U.S. national means someone who is a United States national under federal law.
5. Undocumented person means someone who is not lawfully present in the U.S.
6. Qualifying American Indian born abroad means someone who:
  1. Was born in Canada and has at least 50 percent American Indian blood, regardless of tribal membership; or
  2. Was born outside of the United States and is a member of a federally recognized tribe or an Alaska Native enrolled by the Secretary of the Interior under the Alaska Native Claims Settlement Act.
Eligibility.
1. A U.S. citizen, U.S. national or qualifying American Indian born abroad may be eligible for:
  1. Apple health for adults;
  2. Apple health for kids;
  3. Apple health for pregnant women; or
  4. Classic medicaid.
2. A qualified alien who meets or is exempt from the five-year bar may be eligible for:
  1. Apple health for adults;
  2. Apple health for kids;
  3. Apple health for pregnant women; or
  4. Classic medicaid.
3. A qualified alien who neither meets nor is exempt from the five-year bar may be eligible for:
  1. Alien medical programs;
  2. Apple health for kids;
  3. Apple health for pregnant women; or
  4. Medical care services.
4. A nonqualified alien may be eligible for:
  1. Alien medical programs;
  2. Apple health for kids;
  3. Apple health for pregnant women; or
  4. Medical care services.
5. An undocumented person may be eligible for:
  1. Alien medical programs;
  2. State-only funded apple health for kids;
  3. State-only funded apple health for pregnant women; or
  4. State-only funded apple health expansion.
The five-year bar.
1. A qualified alien meets the five-year bar if he or she:
  1. Continuously resided in the U.S. for five years or more from the date he or she became a qualified alien; or
  2. Entered the U.S. before August 22, 1996, and:
    1. Became a qualified alien before August 22, 1996; or
    2. Became a qualified alien on or after August 22, 1996, and has continuously resided in the U.S. between the date of entry into the U.S. and the date he or she became a qualified alien.
2. A qualified alien is exempt from the five-year bar if he or she is:
  1. A qualified alien as defined in subsections (1)(b)(vi) through (xv) of this section;
  2. An LPR, parolee, or abused person, who is also an armed services member or veteran, or a family member of an armed services member or veteran, as described below:
    1. An active-duty member of the U.S. military, other than active-duty for training;
    2. An honorably discharged U.S. veteran;
    3. A veteran of the military forces of the Philippines who served before July 1, 1946, as described in Title 38 U.S.C. Section 107; or
    4. The spouse, unremarried widow or widower, or unmarried dependent child of an honorably discharged U.S. veteran or active-duty member of the U.S. military.

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

"Qualified Aliens" with Entry Date before August 22, 1996

Individuals are not subject to the 5-year bar for health care coverage if they entered the U.S. before August 22, 1996 even if they did not obtain “qualified alien” status until sometime after they entered as long as they continuously resided in the U.S. from the earlier date. “Continuously residing” means the individual only left the U.S. for brief visits.

Example: An individual came to the U.S. in 1992 as undocumented and resided in the U.S. since that time, making annual trips to her country of origin to visit parents. In July 1999 she self-petitioned under the Violence Against Women Act (VAWA) and received a notice that she and her children have a "prima facie case" (as described in WAC 388-424-0001). She is a "qualified alien" and not subject to the five- year bar because her entry date is before August 22, 1996. She and her children are eligible for federally-funded Apple Health.

Example: An individual came to the U.S. in 1992 as a visitor for three months. The individual returned in 1994 as a student and returned to his country of origin in 1995. He returned to the U.S. again after he obtained lawful permanent resident status on October 10, 2011. Since he did not continuously reside in the U.S. prior to August 22, 1996, his date of entry is October 10, 2011. He is not a veteran or on active duty in the U.S. military (or the spouse or dependent child of such a person). As a result, he is not eligible for federally-funded Apple Health until October 10, 2016. He may be eligible for state-funded programs, such as Medical Care Services or the Apple Health AEM program.

"Qualified Aliens" with Entry Date on or after August 22, 1996

For individuals with immigration status of parolee, refugee, and asylee, the date that they become a “Qualified Alien” is on their I-94 card or, more recently, on their lawful permanent resident (green) card. This date is when their 5-year bar begins.

For individuals with battered alien status, the date they became a “Qualified Alien” is often before the date on their green card, such as:

The date of the approval (or notice of prima facie case) of a Violence Against Women Act (VAWA) petition; or
The date that the U.S. citizen or lawful permanent resident spouse petitioned for the family visa application.

Example: An individual came to the U.S. in 1997 as an undocumented immigrant. She married a lawful permanent resident who petitioned for a family visa on March 1, 1998. She left her husband on May 30, 1999 due to domestic violence and obtained a notice of VAWA prima facie status shortly afterward. She has not yet become a lawful permanent residence and does not have her green card. The date she became a "Qualified Alien" is March 1, 1998 because that is the date of her ex-husband’s family visa petition. Her 5-year bar will be over on February 28, 2003. In comparison, the date on her green card will be the date of her adjustment interview, which could be years after the date her 5-year bar begins.

"Qualified Aliens" who are Exempt from the 5-Year Bar

Some categories of “Qualified Aliens” are exempt from the 5-year bar, including:

Refugees,
Asylees,
Individuals with Withholding of Deportation/Removal,
Cuban/Haitian entrants,
Special Immigrants from Iraq and Afghanistan, and
Amerasian lawful permanent residents.
A person from the Federated States of Micronesia, the Republic of Palau, or the Republic of the Marshall Islands living in the United States in accordance with the Compacts of Free Association.

“Qualified Aliens” who are exempt from the 5-year bar remain exempt after they have adjusted to lawful permanent residence and have received a green card. The code on their green card will indicate what provision of law they came to the U.S. under.

Example: A refugee came to the U.S. on September 1, 2011. One year after coming to the U.S., he adjusted to lawful permanent residence. His green card will be dated September 1, 2011 and have code “RE-6” to indicate that he was admitted as a refugee (see the NILC Guide in Appendix II). He is exempt from the 5-year bar.

Immigration Status and State-Funded Apple Health Programs

“Qualified Aliens” who have not met their 5-year bar and “Nonqualified Aliens” are potentially eligible for state-funded Apple Health programs, such as Apple Health for Pregnant Women, Apple Health for Kids, Apple Health for Kids with Premiums, and Medical Care Services. They are also potentially eligible for Apple Health AEM, which is a federally funded program.

Undocumented immigrants are potentially eligible for Apple Health for Pregnant Women, Apple Health for Kids, and Apple Health for Kids with Premiums. They are also potentially eligible for Apple Health AEM, which is a federally-funded program.

Please report broken links or content problems.

Verification requirements

Revised date

September 12, 2014

WAC 182-503-0050 Verification of eligibility factors.

WAC 182-503-0050 Verification of eligibility factors.

Effective November 3, 2019

General rules.
1. We may verify the information we use to determine, redetermine, or terminate your apple health eligibility.
2. We verify the eligibility factors listed in WAC 182-503-0505(3).
3. Before we ask you to provide records to verify an eligibility factor, we use information available from state databases, including data from the department of social and health services and the department of employment security, federal databases, or commercially available databases to verify the eligibility factor.
4. We may require information from third parties, such as employers, landlords, and insurance companies, to verify an eligibility factor if the information we received:
  1. Cannot be verified through available data sources;
  2. Did not verify an eligibility factor; or
  3. Is contradictory, confusing, or outdated.
5. We do not require you to submit a record unless it is necessary to determine or redetermine your eligibility.
6. If you can obtain verification within three business days and we determine the verification is sufficient to confirm an eligibility factor, we base our initial eligibility decision upon that record.
7. If we are unable to verify eligibility as described in (f) of this subsection, then we may consider third-party sources.
8. If a fee is required to obtain a necessary record, we pay the fee directly to the holder of the record.
9. We do not deny or delay your application if you failed to provide information to verify an eligibility factor in a particular type or form.
10. Except for eligibility factors listed in WAC 182-503-0505 (3)(c) and (d), we accept alternative forms of verification. If you give us a reasonable explanation that confirms your eligibility, we may not require additional documentation.
11. Once we verify an eligibility factor that will not change, we may not require additional verification. Examples include:
  1. U.S. citizenship;
  2. Family relationships by birth;
  3. Social Security numbers; and
  4. Dates of birth, death, marriage, dissolution of marriage, or legal separation.
12. If we cannot verify your immigration status and you are otherwise eligible for Washington apple health, we approve coverage and give additional time as needed to verify your immigration status.
Submission timelines.
1. We allow at least ten calendar days for you to submit requested information.
2. If you request more time to provide information, we allow the time requested.
3. If the tenth day falls on a weekend or a legal holiday as described in RCW 1.16.050, the due date is the next business day.
4. We do not deny or terminate your eligibility when we give you more time to provide information.
5. If we do not receive your information by the due date, we make a determination based on all the information available.
Notice requirements.
1. When we need more information from you to determine your eligibility for apple health coverage, we send all notices according to the requirements of WAC 182-518-0015.
2. If we cannot determine you are eligible, we send you a denial or termination notice including information on when we reconsider a denied application under WAC 182-503-0080.
Equal access and limited-English proficiency services. If you are eligible for equal access services under WAC 182-503-0120 or limited-English proficiency services under WAC 182-503-0110, we provide legally sufficient support services.
Eligibility factors for nonmodified adjusted gross income (MAGI)-based programs. If you apply for a non-MAGI program under WAC 182-503-0510(3), we verify the factors in WAC 182-503-0505(3). In addition, we verify:
1. Household composition, if spousal or dependent deeming under chapter 182-512 WAC or spousal or dependent allowance under chapters 182-513 and 182-515 WAC applies;
2. Income and income deductions;
3. Resources, including:
  1. Trusts, annuities, life estates and promissory notes under chapter 182-516 WAC;
  2. Real property transactions; and
  3. Financial records, as defined in WAC 182-503-0055, held by financial institutions.
4. Medical expenses required to meet any spenddown liability under WAC 182-519-0110;
5. All post-eligibility deductions used to determine cost of care for clients eligible for long-term services and supports under chapters 182-513 and 182-515 WAC;
6. Transfers of assets under chapter 182-513 WAC and WAC 182-503-0055 when the program is subject to transfer of assets limitations;
7. Shelter costs for long-term care cases where spousal and dependent allowances apply;
8. Blindness or disability, if you claim either; and
9. Social Security number for a community spouse if needed when you apply for long-term care.
Verification for MAGI-based programs.
1. After we approve your coverage based on your self-attestation, we may conduct a post-eligibility review to verify your self-attested information.
2. When conducting a post-eligibility review, we attempt to verify eligibility factors using your self-attested information available to us through state, federal, and commercially available data sources, or other third parties, before requiring you to provide information.
3. You may be required to provide additional information if:
  1. We cannot verify an eligibility factor through other data sources listed in subsection (b) of this section; or
  2. The information received from the data source is not reasonably compatible with your self-attestation.
Reapplication following post-eligibility review. If your eligibility for MAGI-based apple health terminates because of a post-eligibility review and you reapply, we may request verification of eligibility factors prior to determining eligibility.

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.

Long-term Services and Supports (LTSS) verification requirements

For long-term service and support programs, follow WAC 182-503-0050. Verification of gross income, post eligibility deductions, and transfer of assets during the 5 year look back is required.

At application and renewal, financial institution balances are requested through the Asset Verification System (AVS). For applications, if no authorization is given the case will be denied. At renewal, a new authorization is not needed, however, if authorization has never been given, a client must authorize AVS or their services will be terminated. Authorizations for AVS remain in effect until revoked in writing by the applicant, spouse, or financially responsible person, the client is no longer eligible for coverage, or the application is withdrawn or denied. For more information regarding Asset Verification please see WAC 182-503-0055.

Use equal access policies and procedures if there is no response to the written request verification needed to determine eligibility or maintain eligibility for LTSS.

Applications for long-term care

Renewals for long-term care

Equal Access - Necessary Supplemental Accommodation and long-term services and supports

Please report broken links or content problems.

Long-term care partnerships

Revised date

June 17, 2024

Purpose statement

The Washington State Long-term care partnership (LTCP) program is administered in collaboration between Washington State Health Care Authority (HCA), Washington State Office of Insurance Commissioner (OIC) and the Department of Social and Health Services (DSHS). It is a unique program combining private LTC insurance and special access to Medicaid. The partnership helps individuals financially prepare for the possibility of needing nursing home care, home-based care, or assisted living/adult family home services sometime in the future. The program allows individuals to protect some or all of their assets and still qualify for Medicaid if their LTC needs extend beyond what is covered by their private insurance policy. Section 6021 of the Deficit Reduction Act of 2005 allows for qualified state long-term care partnerships.

WAC 182-513-1400 Long-term care (LTC) partnership program (index).

WAC 182-513-1400 Long-term care (LTC) partnership program (index).

Effective February 20, 2017

The following rules govern long-term care eligibility under the long-term care partnership program:

WAC 182-513-1405 Definitions
WAC 182-513-1410 LTC Partnership policy qualifications.
WAC 182-513-1415 Assets that can't be protected under the LTC partnership provisions.
WAC 182-513-1420 Eligibility for asset protection under a partnership policy.
WAC 182-513-1425 Not qualifying for LTC medicaid if an LTC partnership policy is in pay status.
WAC 182-513-1430 Change of circumstances that must be reported when there is an LTC partnership policy paying a portion of my care.
WAC 182-513-1435 When Washington recognizes an LTC partnership policy purchased in another state.
WAC 182-513-1440 Determining how many assets can be protected.
WAC 182-513-1445 Designating a protected asset and required proof.
WAC 182-513-1450 How the transfer of assets affects LTC partnership and medicaid eligibility.
WAC 182-513-1455 Protected assets under an LTC partnership policy after death.

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 182-513-1405 Definitions.: WAC 182-513-1405 Definitions.

Effective February 20, 2017

For purposes of WAC 182-513-1400 through 182-513-1455, the following terms have the meanings stated. See chapter 182-500 WAC and WAC 182-513-1100 for additional definitions.

"Issuer" means any entity that delivers, issues for delivery, or provides coverage to, a resident of Washington, any policy that claims to provide asset protection under the Washington long-term care partnership act, chapter 48.85 RCW. As used in this chapter, issuer specifically includes insurance companies, fraternal benefit societies, health care service contractors, and health maintenance organizations.

"Long-term care (LTC) insurance" means a policy under chapter 284-83 WAC.

"Protected assets" means assets that are designated as excluded or not taken into account upon determination of long-term care medicaid eligibility under WAC 182-513-1315. The protected or excluded amount is up to the dollar amount of benefits that have been paid for long-term care services by the qualifying long-term care partnership policy on the medicaid applicant's or client's behalf. The assets are also protected or excluded for the purposes of estate recovery under chapter 182-527 WAC, up to the amount of benefits paid by the qualifying policy for medical and long-term care services.

"Qualified long-term care insurance partnership" means an agreement between the Centers for Medicare and Medicaid Services (CMS), and the health care authority (HCA) which allows for the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of a person who is a beneficiary under a long-term care insurance policy that has been determined by the Washington state insurance commission to meet the requirements of section 1917 (b)(1)(c)(iii) of the act. These policies are described in chapter 284-83 WAC.

"Reciprocity Agreement" means an agreement between states approved under section 6021(b) of the Deficit Reduction Act of 2005, Public Law 109-171 (DRA) under which the states agree to provide the same asset protections for qualified partnership policies purchased by a person while residing in another state and that state has a reciprocity agreement with the state of Washington.

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 182-513-1410 LTC partnership policy qualifications.: WAC 182-513-1410 LTC partnership policy qualifications.

Effective February 20, 2017

A LTC partnership policy is a LTC policy that has been approved by the office of insurance commissioner as a LTC partnership policy described in chapter 284-83 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.

WAC 182-513-1415 Assets that can't be protected under the LTC partnership provisions.

WAC 182-513-1415 Assets that can't be protected under the LTC partnership provisions.

Effective February 20, 2017

The following assets cannot be protected under a LTC partnership policy.

Resources in a trust under WAC 182-516-0100 (6) and (7).
Annuity interests in which Washington must be named as a preferred remainder beneficiary as under WAC 182-516-0201.
Home equity in excess of the standard under WAC 182-513-1350. Individuals who have excess home equity interest are not eligible for long-term care medicaid services.
Any portion of the value of an asset that exceeds the dollar amount paid out by the LTC partnership policy.
The unprotected value of any partially protected asset is subject to estate recovery described in chapter 182-527 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.

WAC 182-513-1420 Eligibility for asset protection under a partnership policy.

WAC 182-513-1420 Eligibility for asset protection under a partnership policy.

Effective February 20, 2017

The LTC partnership policy must meet all the requirements in chapter 284-83 WAC. For existing LTC policies which are converted to a LTC partnership policy via an exchange or through the addition of a policy rider or endorsement, the conversion must take place on or after December 1, 2011 unless the policy is paying out benefits at the time the policy is exchanged.
You meet all applicable eligible requirements for LTC medicaid and:
1. Your LTC partnership policy benefits have been exhausted and you are in need of LTC services.
2. Your LTC partnership policy is not exhausted and is:
  1. Covering all costs in a medical institution and you are still in need for medicaid; or
  2. Covering a portion of the LTC costs under your LTC partnership policy but does not meet all of your LTC needs.
3. At the time of your LTC partnership policy has paid out more benefits than you have designated as protected. In this situation your estate can designate additional assets to be excluded from the estate recovery process up to the dollar amount the LTC partnership policy has paid out.

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 182-513-1425 When would I not qualify for LTC medicaid if I have a LTC partnership policy in pay status?

WAC 182-513-1425 Not qualifying for LTC medicaid if an LTC partnership policy is in pay status.

Effective February 20, 2017

You are not eligible for long-term care (LTC) medicaid when the following applies:

The income you have available to pay toward your cost of care under WAC 182-513-1380, combined with the amount paid under the qualifying LTC partnership policy, exceeds the monthly private rate at the institution.
The income you have available to pay toward your cost of care on a home and community based (HCB) waiver under chapter 182-515 WAC, combined with the amount paid under the qualifying LTC partnership policy, exceeds the monthly private rate in a home or residential setting.
You fail to meet another applicable eligibility requirement for LTC medicaid.

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 182-513-1430 Change of circumstances that must be reported when there is an LTC partnership policy paying a portion of my care.

WAC 182-513-1430 Change of circumstances that must be reported when there is an LTC partnership policy paying a portion of care.

Effective February 20, 2017

You must report changes described in WAC 182-504-0105 plus the following:

You must report and verify the value of the benefits that your issuer has paid on your behalf under the long-term care (LTC) partnership policy upon request by the agency, and at each annual eligibility review.
You must provide proof when you have exhausted the benefits under your LTC partnership policy.
You must provide proof if you have given away or transferred assets that you have previously designated as protected. Although, there is no penalty for the transfer of protected assets once you have been approved for LTC medicaid, the value of transferred assets reduces the total dollar amount that is designated as protected and must be verified.
You must provide proof if you have sold an asset or converted a protected asset into cash or another type of asset. You will need to make changes in the asset designation and verify the type of transaction and new value of the asset.

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 182-513-1435 When Washington recognizes an LTC partnership policy purchased in another state.: WAC 182-513-1435 When Washington recognizes an LTC partnership policy purchased in another state.

Effective February 20, 2017

The Washington long term care partnership program provides reciprocity with respect to qualifying long-term care insurance policies covered under other state long-term care insurance partnerships. This allows you to purchase a partnership policy in one state and move to Washington without losing your asset protection. If your LTC policy is in pay status at the time you move to Washington and you are otherwise eligible for LTC medicaid, Washington will recognize the amount of protection you accumulated in the other state.

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 182-513-1440 Determining how many of my assets can be protected.: WAC 182-513-1440 Determining how many of my assets can be protected.

Effective February 20, 2017

You can protect assets based on the amount paid by your LTC partnership policy. Assets are protected in both LTC eligibility and estate recovery. If the partnership for long-term care program is discontinued, an individual who purchased an approved plan before the date the program is discontinued remains eligible to receive dollar-for-dollar asset disregard and asset protection under the long-term care (LTC) medicaid 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.

WAC 182-513-1445 Designating a protected asset and required proof.

WAC 182-513-1445 Designating a protected asset and required proof.

Effective February 20, 2017

Complete a department of social and health services (DSHS) 10-438 long-term care partnership (LTCP) asset designation form listing assets and the full fair market value that are earmarked as protected at the time of initial application for long-term services and supports under medicaid.
1. The full fair market value (FMV) of real property or interests in real property will be based on the current assessed value for property tax purposes for real property. A professional appraisal by a licensed appraiser can establish the current value if the assessed value is disputed.
2. The value of a life estate in real property is determined using the life estate tables found at https://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/determining-value-life-estates.
3. If you own an asset with others, you can designate the value of your pro rata equity share.
4. If the dollar amount of the benefits paid under a LTCP policy is greater than the fair market value of all assets protected at the time of the application for long-term care medicaid, you may designate additional assets for protection under this section. The DSHS LTCP asset designation form must be submitted with the updated assets indicated along with proof of the current value of designated assets.
5. The value of your assets protected for you under your LTC partnership policy do not carry over to your spouse should the spouse need medicaid LTC services during or after your lifetime. If your surviving spouse has an LTC partnership policy the spouse may designate assets based on the dollar amount paid under the spouse's own policy.
6. Assets designated as protected under this subsection will not be subject to transfer penalties under WAC 182-513-1363.
Proof of the current fair market value of all protected assets is required at the initial application and each annual review.
Submit current verification from the issuer of the LTCP policy of the current dollar value paid toward LTC benefits. This verification is required at application and each annual eligibility review.
Any person or the personal representative of the person's estate who asserts that an asset is protected has the initial burden of:
1. Documenting and proving by convincing evidence that the asset or source of funds for the asset in question was designated as protected;
2. Demonstrating the value of the asset and the proceeds of the asset beginning from the time period the LTC partnership has paid out benefits to the present; and
3. Documenting that the asset or proceeds of the asset remained protected at all times.

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 182-513-1450 How the transfer of assets affects LTC partnership and medicaid eligibility.

WAC 182-513-1450 How the transfer of assets affect LTC partnership and medicaid eligibility?

Effective February 20, 2017

If you transfer an asset within the sixty months prior to the medicaid application or after medicaid eligibility has been established, the agency will evaluate the transfer based on WAC 182-513-1363 and determine if a penalty period applies unless:
1. You have already been receiving institutional services;
2. Your LTC partnership policy has paid toward institutional services for you; and
3. The value of the transferred assets has been protected under the LTC partnership policy.
The value of the transferred assets that exceed your LTC partnership protection will be evaluated for a transfer penalty.
If you transfer assets ((whose)) with values that are protected, you lose that value as future protection unless all the transferred assets are returned.
The value of your protected assets less the value of transferred assets equals the adjusted value of the assets you are able to protect.

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 182-513-1455 What happens to protected assets under a LTC partnership policy after death.

WAC 182-513-1455 What happens to protected assets under a LTC partnership policy after death.

Effective February 20, 2017

Assets designated as protected prior to death are not subject to estate recovery for medical or long-term care (LTC) services paid on your behalf under chapter 182-527 WAC as long as the following requirements are met:

A personal representative who asserts an asset is protected under this section has the initial burden of providing proof under chapter 182-527 WAC.
A personal representative must provide verification from the LTC insurance company of the dollar amount paid out by the LTC partnership policy.
If the LTC partnership policy paid out more than was previously designated, the personal representative has the right to assert that additional assets should be protected based on the increased protection. The personal representative must use the DSHS LTCP asset designation form and send it to the office of financial recovery.
The amount of protection available to you at death through the estate recovery process is decreased by the FMV of any protected assets that were transferred prior to death.

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

Background information

Section 6021 of the 2005 Deficit Reduction Act (DRA) expands LTC opportunities for States by permitting individuals who purchase a qualified long-term care partnership policy to protect assets during both the individual’s lifetime and after death in the Estate Recovery process.

The DRA provides for a unique Medicaid/private insurance model designed to attract consumers who might not otherwise purchase LTC insurance by allowing them to protect a specified level of assets. This helps both the consumer and the State by helping shift rising LTC costs from Medicaid to private insurance. It also enables consumers to do estate and inheritance planning on assets they have protected under the qualified policy, since transfer of asset penalties do not apply on designated protected assets.

In Washington State, each dollar of coverage paid out by the qualified LTC partnership policy protects one dollar of assets. Insurance companies who sell long-term care policies must have the policy approved as a qualifying partnership policy by the Office of the Insurance Commissioner and must include information to that effect in the insurance documents provided to the client.

An applicant for long-term care Medicaid coverage would still need to meet all other Medicaid eligibility rules but are able to bank additional resources based on the amount the LTC policy has paid out. A client with a qualifying LTC partnership policy does not need to have exhausted their benefits under the policy in order to apply for Medicaid, but the amount of their resources based on what the policy has paid up to the application date must be below the Medicaid standard at that time.

Example
Joe resides at home and has a qualified LTCP policy with a face value of $150,000 which covers in-home care. To date the policy has paid out $40,000 in benefits. Joe has a paid for home worth $150,000 which he wants to leave to his daughter. He also has $30,000 in investment accounts and $1500 in his bank account. Joe may keep $2000 in resources and be Medicaid eligible. He could choose to protect the remaining $29,500 in his investment accounts and the remainder toward his home equity. Since the policy has already paid out $40,000, Joe would be Medicaid eligible before the policy benefits are exhausted. As the policy continues to pay, the amount he could protect of his home would increase each year.

How do I designate the assets I want to protect?

Individuals with a LTC Partnership Policy must submit a DSHS 10-438 LTCP Asset Designation form to Washington State Medicaid at the time of application and at each annual review in order to designate assets as protected based on the dollar amount paid for services by the LTC Partnership Policy. This will track protected assets for both LTC Medicaid eligibility and Estate Recovery purposes

Reciprocity with other states

Health and Human Services (HHS) published the reciprocity standards in the Federal Register. These are effective 1/1/2009. Provisions require:

Benefits paid under a LTCP policy will be treated the same by all states.
- All States will be subject to the standards unless the State notifies the Secretary in writing of the desire to opt out.
- All states will implement a dollar-for-dollar disregard
- Policies will be treated uniformly regardless of where purchased
- Exempt protected assets from Estate Recovery.

Washington accepts approved LTC partnership policies purchased in other states with the exception of states that originally implemented the long-term care partnership program under OBRA legislation in 1993 who did not choose the dollar-for-dollar asset protection model. For example, New York chose to implement a total asset protection model so policies purchased in New York since 1993 would not meet Washington State’s requirements.

Estate Recovery

Resources banked due to a qualified LTC partnership policy are not subject to Estate Recovery. This includes all or part of the value of a primary residence that is excluded for Medicaid eligibility but would not be excluded from estate recovery at the time of a Medicaid recipient’s death.

Applicants who need more information regarding estate recovery in Washington State may contact the Office of Financial Recovery at:

Office of Financial Recovery,
PO Box 9501,
Olympia, WA 98507-9501
1-800-562-6114.

Example #1
Mr. Jones purchased a qualified LTC partnership policy in January 2012 with a value of $200,000 as he wanted to ensure his primary residence would be passed encumbrance free to his only son. Upon application for Medicaid assistance in 2014, his other countable resources were below the $2000 limit.

The only asset he chose to protect on the DSHS 10-438 Asset Designation form was his home valued at $197,000. Over the course of the next year and a half, his LTC partnership paid out $200,000, exhausting the benefits under this policy.

Upon his death in 2016, his personal representative provided the department with an updated DSHS 10-438 Asset Designation form showing the current market value of Mr. Jones house had decreased to $175,000. This value was confirmed via the Assessor’s office. In this situation, Mr. Jones personal representative would be permitted an additional asset disregard of $25,000 of any additional assets remaining in the estate.

For estate recovery purposes, the first $200,000 of medical services provided would be exempt from estate recovery.

Example #2
Same scenario as above but shortly prior to his death, Mr. Jones took out a loan on his home encumbering the primary residence for $50,000 to give to his son to buy a house. At the time of the loan, the house appraised at $175,000 with net equity of $125,000 due to the encumbrance.

At death, although the client only has $125,000 in equity, the department would add back in the value of the $50,000 loan to determine the amount of assets protected from estate recovery. The personal representative would still only be allowed an additional $25,000 in potential asset protection and not $75,000.

Example #3
In this scenario, Mr. Jones passes away earlier than in the prior examples and his policy is still in pay status. At the time of his death, his policy has only paid out $125,000 in benefits. Although Mr. Jones designated the full value of his home as protected, at death the market value is $185,000 but since the policy only paid out $125,000, that is the amount exempt from estate recovery The State would recover on the remaining $60,000.

Worker responsibilities

Financial staff will:

Request a copy of the long-term care partnership policy
Request a completed DSHS 10-438 Long-term care partnership asset designation form
1. Part A is completed by the insurance company that has issued the policy.
2. Part B is completed by the Medicaid applicant/recipient. This section identifies which assets the individual is requesting to designate as protected.
Determine the amount of resources the client is able to designate as protected based on the dollar amount paid out by the long-term care partnership insurance.
Code the protected assets on the ACES RES1 screen using code SC. Add remarks behind the RES1 screen:
- SC = assets that are excluded based on the dollar amount paid out by a LTCP policy.
- Total amount paid out by LTCP as of this date: ________________________
- LTCP asset designation form in DMS dated: 
At each annual review, determine if additional assets can be protected based on the dollar amount paid out by a LTCP policy.
A Medicaid client may transfer protected assets, but this will reduce the total amount of assets they are able to protect based on the dollar amount of the transfer.

More examples

Example

Single applicant with equity interest in a home worth $200,000 and $50,000 in resources applies for long term care services Medicaid.

Applicant has a LTCP policy that has paid out $100,000. The applicant is able to designate up to $100,000 in resources as protected.

Applicant is allowed to have $2,000 in resources. The home is excluded because the applicant is living in a nursing home but intends to return home.

Applicant wants to designate $48,000 of the liquid assets as protected. The applicant wants to designate $52,000 of home equity as protected.

On RES1 screen code SC $48,000 liquid assets LTCP

On RES1 screen code SC $52,000 home equity LTCP

Remarks behind RES1:

Total amount paid by LTCP as of this date: $100,000

LTCP asset form in DMS dated xx/xx/2012

Designating $48,000 in Bank of Trust Savings Account

Designating $52,000 of $200,000 home equity

RES2 screen, code the $200,000 home and indicate PR. Add remarks behind RES2 $52,000 of $200,000 is protected due to LTCP asset designation.

Example

Same example as #1 except it is one year later at the annual review.

The LTCP policy has paid out an additional $60,000 in benefits.

The recipient of Medicaid has designated $112,000 of the $200,000 home equity as protected and $48,000 in the savings account as protected. The recipient of Medicaid has $2,000 in resources in a checking account.

On RES1 screen update SC code to $112,000 of the home equity LTCP. Add remarks behind the RES1 screen and RES2 screen with the updating information.

Long-term care Partnership information for consumers

An overview of LTC Medicaid and the LTC Partnership for consumers

Long-term care Partnership, Frequently Asked Questions

10-438 Long-Term Care Partnership (LTCP) asset designation form

Medical Coverage Information form and third-party resource

14-194 Medical Coverage Information form

This form is completed when any other medical coverage exists including LTC insurance. Once completed and returned to DSHS, the system will automatically assign to the Health Care Authority Coordination of Benefits Section.

See Long-term care insurance and third party resources for additional information

Office of the Insurance Commissioner

Chapter 284-83 WAC Long-term Care insurance rules

Office of the Insurance Commissioner Long Term Care Partnership Program

Office of the Insurance Commissioner Long-term care insurance

Please report broken links or content problems.

Short stays

Revised date

March 26, 2018

Purpose statement

To define and clarify a short stay.

What is a short stay?

A short stay is when a client enters a medical facility or elects institutional Hospice services for under 30 days and the client is active on an Apple Health program.
Financial workers usually learn about short stays after they have ended and the clients have returned to their regular living situation.

Who does the short stay?

For clients that are not on services with HCS or DDA, the nursing facility short stay letter is done by whatever agency has the active Medicaid program. The overview chart indicates what agency is responsible for the eligibility of the different medical programs.
- CSD does the short stay letters for active CN and MN classic Medicaid programs maintained by CSD
- HCA does the short stay letters for active CN and MN cases maintained by HCA
- WASHCAP short stay letters are done as a courtesy by the HCS financial worker

How long can a short stay be?

Up to 29 days for:

Clients who meet institutional criteria (L-track and K-track).
Clients who are eligible for noninstitutional Medicaid under CN, MN, ABP or MCS

When is it appropriate to enter a short stay?

Short stay data can only be entered for:

Active medical recipients.
After the short stay has ended.
In a historical month.
Stays in a medical institution or for hospice services.
Clients who return to their original setting when the short stay ends.
NFLOC authorization has been received by an HCS social worker.

Example: Client resides in an Adult Family Home (AFH) and is admitted to a nursing home for two weeks. The client returns back to the same AFH. This situation should be coded on the Institutional Care page as a short stay.

Example: Client resides at home and is active on an S02 AU. Client admits to a nursing home for three weeks. The client returns home. This situation should be coded on Institutional Care page as a short stay.

Example: Client resides in a nursing facility, and has a medical condition requiring hospitalization. The client discharges from the nursing facility and enters the hospital. After two weeks, the client enters a new nursing facility. This situation should be coded on the Institutional Care page as a change in facilities for the hospital and new nursing facility because the client entered a different nursing facility.

Example: Client resides in an assisted living facility (ALF), and has a medical condition that requires a stay in a nursing facility or hospital for over 29 consecutive days. Client then returns to the same ALF. This situation should be coded on the Institutional Care page as a change in facilities for the nursing facility and new start of services in the ALF.

Example: If a DDA or HCS client in an ALF admits to a nursing facility and had elected hospice, be aware that the bed hold procedure is still applicable. When a bed hold for medical leave is selected the financial worker will take no action until the bed hold expires. The maximum length of stay is 20 days. Set a tickler for 30 days from the date of admission and follow the procedure for hospice in a NF.

Clarifying Information

Here are some new guidelines on how to code short stays: When HCS/DDA receive notice that a client has admitted to a nursing facility (NF), Residential Habilitation Center (RHC), Hospice Care Center (HCC) or hospital, we need to wait 30 days before coding the change, so we can determine if it is a short stay or not (even if a 14-443 or 15-345 reports that the stay is likely to exceed 30 days).

If the stay is less than 30 days and an ALF client admits to a NF or hospital, then discharges to a different setting or (ALF) provider, code the changes on the Institutional Care page as a change in facilities and HCB Services. Short stay coding shouldn't be used.
If the stay is less than 30 days and an ALF client admits to a NF or hospital, then goes back to the same setting, code the changes on the Institutional Care page as a short stay.
If the stay is less than 30 days and NF client admits to a hospital, then discharges to a different setting or different NF, code the changes on the Institutional Care page as a facilities change. Short stay coding shouldn't be used.

Review the change letters and look at the Eligibility Results page and the Institutional Care page under Short Stays to review how the cost of care is split between providers and be sure the information is conveyed on the award letters.

What if the short stay spans multiple months?

When a short stay spans multiple months, the stay must be entered in the month in which the stay begins.
The short stay data doesn't have to be reentered in the following months, but the eligibility must be manually recalculated (using the Calculate Eligibility link on the Eligibility page) in order to determine participation for each month impacted by the stay.

How is participation assigned to a short stay provider?

ACES calculates client cost-of-care responsibility based on data entered on the STAY screen and the clients circumstances.
Participation is only assigned to short stays with a Payment Authorization Date entry.
Participation is assigned first to the initial provider coded on the Institutional Care page and if there is any remaining participation, it is assigned to the short stay providers.

Please report broken links or content problems.

HCS state-funded residential program through the Medical Care Service (MCS) program

Revised date

May 31, 2024

State-funded residential

Home and Community Services (HCS) has a state-funded residential program for those eligible for Medical Care Services (MCS). The functional requirements are the same as for Medical Personal Care (MPC).

Note:

MCS does cover nursing facility claims as long as the client meets nursing facility level of care (NFLOC). The NF claim process for MCS is automated and no NF award letter is needed. The social service process is described in the HCS LTC manual.

ACES medical coverage group is A01, A05, or A24. The state-funded LTSS program is described in WAC 388-106-0905.

What services may I receive under state funded residential care? WAC 388-106-0900

Clarifying Information

A01 is used for clients who meet aged, blind or disabled criteria.
A05 is used for clients meeting ABD incapacity, but not disability criteria.
A24 is used for victims of human trafficking. Public Benefit Eligibility for Survivors of Certain Crimes | DSHS (wa.gov)
To be eligible for A01, A05, or A24, the client must be eligible for the HEN referral program or the ABD cash assistance program.
Room and Board calculations for clients in an alternate living facility (ALF) are not calculated in ACES and notices to clients will need to be sent by social services.

Am I eligible to receive state-funded residential care services? WAC 388-106-0905

Lawfully present clients, not subject to the 5-year bar, who permanently reside in the US under color of law (PRUCOL) (NQ).
Must be eligible for ABD cash or HEN referral program.
One applicant/recipient per AU.
Scope of care is state-funded Medical Care Services (MCS).
Covers the state-funded residential program and state-funded nursing facility program.
Undocumented individuals are not eligible for A01/A05 coverage.

How do I approve a new A01/A05/A24 case?

Applications: The client must apply for ABD cash assistance to be able to look at the MCS eligibility.
Screening: 'A' track AU's will not auto populate in screening; however the medical coverage group will be allowed as a selection in the dropdown list.
Default will be MA/D/A01 and will switch to the correct coverage type when finalizing the AU.
- Determine if the client is an eligible noncitizen who needs LTC residential or nursing home services.
- Did the client apply for cash assistance?
- Is the client functionally eligible for LTC services?
- If the answer is yes to 1, 2, and 3 screen in a HEN AU and an A01 AU. (Clients who are eligible for LTC services meet the incapacity criteria for HEN).
- Process the HEN AU first then finalize the A01/A05 AU.
- Determine 'durational' requirements for ABD/HEN program for clients under 65, not blind or disabled.
  - Regions 1 and 3: Using Barcode, complete a 14-084 referral to the CSD incapacity worker.
  - Region 2: Complete a referral to the Region 2 HCS social worker for a disability determination.
  - Indicate on the 14-084 the following;
    - "Per approved ETR to WAC 388-400-0070, HCS has approved HEN/MCS case. Client meets LTSS functional requirements-disability determination is needed".
- Notify the HCS social worker that client has been opened on HEN/MCS medical coverage so they can issue a notice to the client regarding the room and board calculation.
  - Indicate the client's current income to the social worker.
- Set a reminder to check on disability/duration with the CSD incapacity worker if applicable.
WAC 182-508-0005 for the state funded MCS program.
WAC 388-400-0060 for the ABD cash program.
WAC 388-513-1315 (11) which describes the ABD cash and MCS program as it applies to ALTSA services.

Disability instructions for ABD cash are found in the EAZ social service manual.

State-Funded Long Term Care Program for Noncitizens

State-funded LTC for noncitizens not eligible under ABD cash or MCS. This program is limited to 45 slots due to legislative funding limitations and requires a preapproval by ALTSA HQ. The state-funded LTC program can be used in a nursing facility, residential or home setting.

Please report broken links or content problems.

Reverse mortgage and loans

Revised date

February 13, 2019

Purpose statement

To explain how reverse mortgages and loans or mortgages affect SSI related Medicaid and Long-term care programs.

Reverse mortgages and loans

Reverse mortgage monthly payments are not considered income. If the client retains the payment from the reverse mortgage it would be considered a resource the month following the month of receipt and would affect eligibility if the client’s resources are over the standard. The client can’t give the funds away without receiving adequate consideration without imposing a penalty.

Home equity conversions and reverse mortgages HEC

Home equity conversion plans are designed to allow elderly homeowners to convert the value of their homes into cash without being forced to leave their homes. Under these plans, the home is either mortgaged or sold to a financial institution or other buyer in exchange for a regular cash payment or line of credit. The most common HEC is the reverse mortgage. They allow the homeowner to borrow equity out of their home with no repayment as long as they live in the home. The notes are due when the house ceases to be the borrower’s main residence. Proceeds from a reverse mortgage are loan proceeds, which do not meet the definition of income per SI 00815.350. (SI 00815.350 is the SSA Policy Manual)

Reverse mortgages and lines of credit

We do not count a line of credit as an available resource beyond the idea that it comprises home equity. It is not a resource all by itself. A line of credit is simply one method someone can access their home’s equity in a reverse mortgage. The equity is still in the home until the credit line is used. Once the client takes a cash advance payment from the line of credit, the cash they take could become an available resource if they still have it on the first of the month after receiving the payment. A client takes out a reverse mortgage of $150,000 (principle before fees) and took the proceeds as a $150,000 line of credit. Until the client actually uses the line of credit, it is still part of the home’s equity. In that sense, it is a resource, but the client does not have a separate available resource of $150,000. If on March 2 they take a cash advance of $50,000 on their line of credit the home’s equity has been reduced by $50,000. The remaining $100,000 in the line of credit is still part of the home’s equity until it is accessed. If they put that $50,000 from the line of credit into a bank account, whatever is still in the account on April 1 is an available resource. If a client has $555,000 equity in their home, had taken out a reverse mortgage line of credit of $150,000 but had not accessed the credit, the client still had $555,000 equity (less any loan fees). If the client did not have a spouse, minor child, or dependent child residing in the home, then the client would not be eligible. The client still has equity in excess of $552,000. However, if the client had accessed their line of credit and had used $60,000 on debts, the home’s equity is reduced by $60,000 by the time they request LTC, then the client’s equity is less than $555,000 and is potentially eligible.

Reverse mortgages and cash proceeds

If they took the option of a cash payment as proceeds from the reverse mortgage, any portion of the cash they received that is still available on the first of the month following the receipt can be considered an available resource. Same client as above but instead of taking the proceeds as a line of credit they took it as a $150,000 lump sum. On March 2 they client received the $150,000 proceeds from the loan. They have now reduced their home’s equity to $405,000. However, you need to determine what happened to the cash proceeds. If on April 1 all $150,000 was still in the checking account then it is an available resource on April 1.

Transfer of certain notes and loans

The term "assets" includes funds used to purchase a loan or mortgage unless the note, loan or mortgage:

Has a repayment term that is actuarially sounds (as determined in accordance with actuarial publications of the Office of Chief Actuary of the Social Security Administration);
Provides for payments to be made in equal amounts during the term of the loan, with no deferral and no balloon payments made; and
prohibits the cancellation of the balance upon the death of the lender.

If the loan, or mortgage does not meet the criteria above, the value of the note, loan or mortgage as of the date of the LTC medicaid application is counted as a resource.

Federal guidance on reverse mortgages and loans

Social Security Procedural manual (POMS)

Please report broken links or content problems.

Subscribe to

Apple Health for Refugees

WAC 182-507-0130 Refugee medical assistance (RMA).

WAC 182-507-0130 Refugee medical assistance (RMA)

WAC 182-507-0135 Immigration status requirement for refugee medical assistance (RMA).

WAC 182-507-0135 Immigration status requirement for refugee medical assistance (RMA).

Clarifying information

Worker responsibilities

SSI deemed eligible

1619B and "Deemed SSI eligible" clients

Deemed SSI eligible clients. What does that mean?

In other words, an individual who would be eligible for CN/S02 in ACES

1619b status, what does it mean?

What happens if a client loses their protected DAC status?

LEP services

WAC 182-503-0110 Washington apple health -- Limited-English proficient (LEP) services

WAC 182-503-0110 Washington apple health -- Limited-English proficient (LEP) services.

Clarifying information

Interpreter services

Written translation services

Translated ACES correspondence

Worker responsibility

ACES documentation

Long-term care partnership information for consumers

WAC 182-513-1400 Long-term care (LTC) partnership program (index).

WAC 182-513-1400 Long-term care (LTC) partnership program (index).

Definitions used in long-term care (LTC)

What is long-term care?

How do I apply for long-term care Medicaid

Eligibility requirements for long-term care Medicaid

Income and resource standards for long-term care

Resources

Income

Frequently asked questions about the partnership program

Washington State Long-Term Care Partnership Program Main Page

How do I designate the assets I want to protect?

More information on long-term care eligibility in Washington State

Date of entry

WAC 182-503-0535 Washington apple health -- Citizenship and immigration status.

WAC 182-503-0535 Washington apple health -- Citizenship and immigration status.

Clarifying Information

Verification requirements

WAC 182-503-0050 Verification of eligibility factors.

WAC 182-503-0050 Verification of eligibility factors.

Long-term Services and Supports (LTSS) verification requirements

Long-term care partnerships

WAC 182-513-1400 Long-term care (LTC) partnership program (index).

WAC 182-513-1400 Long-term care (LTC) partnership program (index).

WAC 182-513-1405 Definitions.

WAC 182-513-1405 Definitions.

WAC 182-513-1410 LTC partnership policy qualifications.

WAC 182-513-1410 LTC partnership policy qualifications.

WAC 182-513-1415 Assets that can't be protected under the LTC partnership provisions.

WAC 182-513-1415 Assets that can't be protected under the LTC partnership provisions.

WAC 182-513-1420 Eligibility for asset protection under a partnership policy.

WAC 182-513-1420 Eligibility for asset protection under a partnership policy.

WAC 182-513-1425 When would I not qualify for LTC medicaid if I have a LTC partnership policy in pay status?

WAC 182-513-1425 Not qualifying for LTC medicaid if an LTC partnership policy is in pay status.

WAC 182-513-1430 Change of circumstances that must be reported when there is an LTC partnership policy paying a portion of my care.

WAC 182-513-1430 Change of circumstances that must be reported when there is an LTC partnership policy paying a portion of care.

WAC 182-513-1435 When Washington recognizes an LTC partnership policy purchased in another state.

WAC 182-513-1435 When Washington recognizes an LTC partnership policy purchased in another state.

WAC 182-513-1440 Determining how many of my assets can be protected.

WAC 182-513-1440 Determining how many of my assets can be protected.

WAC 182-513-1445 Designating a protected asset and required proof.

WAC 182-513-1445 Designating a protected asset and required proof.

WAC 182-513-1450 How the transfer of assets affects LTC partnership and medicaid eligibility.

WAC 182-513-1450 How the transfer of assets affect LTC partnership and medicaid eligibility?

WAC 182-513-1455 What happens to protected assets under a LTC partnership policy after death.

WAC 182-513-1455 What happens to protected assets under a LTC partnership policy after death.

Clarifying information

Background information

How do I designate the assets I want to protect?

Reciprocity with other states

Estate Recovery

Worker responsibilities

More examples

Long-term care Partnership information for consumers

Medical Coverage Information form and third-party resource

Office of the Insurance Commissioner

Short stays