Note:

Personal Needs Allowance (PNA) chart

Program standard for income and resources (WAC references and historical standards charts)

Long-Term Care Resource Standards

Resource standards WAC 182-513-1350 Defining the resource standard and determining resource eligibility for long-term care (LTC) services.

Standards can be found on the Program standard for income and resources page.

Excess Home Equity Standards

Excess home equity limits. Applies to institutional Medicaid programs per WAC 182-513-1350. These limits may change on January 1 based on the consumer price index-Urban (CPIU).

Long-Term Care Income Standards

Income standards Used to determine income and resource eligibility in long-term care. Standards can be found on the Program standard for income and resources page.

Medicaid special income level (SIL) 300% of the FBR. May change annually on January 1 based on consumer price index. Maximum gross income level for institutional Medicaid.

Federal Benefit Rate (FBR) The FBR is the maximum dollar amount paid to an aged, blind, or disabled person who receives Social Security Disability benefits under SSI

Medically Needy Income Level (MNIL)

Categorically Needy Income Level (CNIL)

Federal Poverty Level (FPL) may change annually on April 1

CS Maintenance Needs Allowance Maximum 150% of the 2-person FPL may change annually on July 1.

CS Maintenance Needs Allowance Maximum may change annually on January 1 based on the consumer price index. (with excess shelter costs)

Excess shelter cost standard may change annually on July 1. 30% of 150% of the 2-person

Utility standard for determining excess shelter costs for a community spouse. Food Assistance Utility Standard (SUA) for a 4-person household. May change annually on 10/1.

Nursing Facility average state rate. Used to determine income eligibility for HCS HCB Waivers when gross income is over the Medicaid SIL

Nursing Facility average state rate. This is used to determine eligibility for HCB Waivers authorized by HCS when the gross income is over the Medicaid SIL. This is described in WAC 182-515-1508.

Rate is updated annually on October 1st.

Standards can be found on the Program standard for income and resources page.

Nursing facility private rate standard. Used to determine period of ineligibility due to asset transfers

Reference WAC 182-513-1363 Transfer of an asset. This rate may change annually on October 1. It is calculated using the reported date from Medicaid cost reports and determined by ALTSA. This standard is used to determine a period of ineligibility due to a resource transfer.

Standards can be found on the Program standard for income and resources page.

Special Income Level (SIL) 300 percent of the FBR

1. The agency compares an individual's available income to the SIL to determine whether a client is eligible for LTC services under the CN program.
2. The SIL is equal to 300% of the annually adjusted SSI Federal Benefit Rate (FBR).
3. The agency does not allow income disregards when determining eligibility for CN institutional services. It reduces an individual's gross income only by the exclusions allowed by federal statute as described in WAC 182-513-1340.

Clarifying Information

1. Special Income Level (SIL): The agency compares a person's nonexcluded income to the SIL to determine whether a person is eligible for LTC services under the institutional CN program.
   1. The SIL is equal to 300% of the annually adjusted SSI Federal Benefit Rate (FBR).
   2. The agency does not allow income disregards when determining eligibility for CN services. It reduces a person's gross income only by the exclusions allowed by federal statute as described in WAC 182-513-1340.
   3. All income disregards under section 1612(b) of the Social Security Act aren't allowed before doing the SIL comparison. Examples are the $20 disregard and 65 ½ earned income deduction and Impairment Related Work Expenses (IRWE).
   4. The SIL is the maximum amount allowed by law as the CN income standard for institutional Medicaid.
2. Disabled Adult Children (DAC), Pickle/COLA, Widowers, SSI individuals and SSI individuals because of 1619(b) status. How does the SIL affect their eligibility for HCBS Waiver programs?
   1. Clients who are on SSI, or are considered eligible for SSI by Social Security Administration 1619(b) or Deemed eligible for SSI (Protected DAC, Widowers, Pickle/COLA ) have countable income under the SSI Standard. These clients may have gross income above the SIL.
   2. For an SSI client who has 1619(b) status with Social Security Administration, it is possible that a 1619(b) status individual can have gross income over the SIL because of their earnings. A 1619(b) client is treated just like an SSI client. Their eligibility is maintained by the Social Security Administration and they do not need to submit eligibility reviews to the agency for Medicaid eligibility. The SDX gives information on clients having 1619(b) status and to continue the CN Medicaid eligibility.
3. Not all clients receiving DAC are deemed SSI clients. If their SSI was lost due to receipt of DAC and their non-DAC countable income is under the SSI standard, they are deemed eligible "protected DAC". If their SSI was not lost due to receipt of DAC income, or if their other income exceeds the SSI standard, they are not deemed eligible for SSI.
4. These clients do need to meet specific eligibility criteria for LTSS such as Transfer of asset penalties under WAC 182-513-1363 and excess home equity under WAC 182-513-1350.

Codes on this page:

A01-A24 | D01-D26 | F99 | G01-G99 | K01-K99 | L01-L99 | M99 | N01-N33 | P06-P99 | R02-R03 | S01-S99 | T02

Scope legend: CNP = Categorically Needy Program MNP = Medically Needy Program ERSO = Emergency Related Services Only (AEM) MSP = Medicare Savings ABP = Alternative Benefit Plan

A01-A24

D01-D26

F99

G01-G99

K01-K99

L01-L99

M99

N01-N33

P06-P99

R02-R03

S01-S99

T02

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

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

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

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

For further information, see the Department of Health website.

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

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

Medical Care Services (A01)

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

Refugee (R02, R03)

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

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

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