WAC 182-515-1507 Home and community based (HCB) waiver services authorized by home and community services (HCS) — Financial eligibility if a client is eligible for an SSI-related noninstitutional categorically needy (CN) medicaid program.

Effective February 25, 2023

1. A client is financially eligible for home and community based (HCB) waiver services if the client:
   1. Is receiving coverage under one of the following categorically needy (CN) medicaid programs:
      1. SSI program under WAC 182-510-0001. This includes SSI clients under Section 1619(b) of the Social Security Act;
      2. SSI-related noninstitutional CN program under chapter 182-512 WAC; or
      3. Health care for workers with disabilities program (HWD) under chapter 182-511 WAC.
   2. Does not have a penalty period of ineligibility for the transfer of an asset under WAC 182-513-1363; and
   3. Does not own a home with equity in excess of the requirements under WAC 182-513-1350.
2. A client eligible under this section does not pay toward the cost of care, but must pay room and board if living in an alternate living facility (ALF) under WAC 182-513-1100.
3. A client eligible under this section who lives in a department-contracted ALF described under WAC 182-513-1100 :
   1. Keeps a personal needs allowance (PNA) under WAC 182-513-1105; and
   2. Pays towards room and board under WAC 182-513-1105.
4. A client who is eligible under the HWD program must pay the HWD premium under WAC 182-511-1250, in addition to room and board, if residing in an ALF.
5. Current resource, income, PNA, and room and board standards are found at www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.

WAC 182-515-1506 Home and community based (HCB) waiver services authorized by home and community services (HCS) general eligibility.

Effective February 9, 2025

1. To be eligible for home and community based (HCB) waiver services a person must:
   1. Meet the program and age requirements for the specific program:
      1. Community options program entry system (COPES), under WAC 388-106-0310;
      2. Residential support waiver (RSW), under WAC 388-106-0310; or
      3. New Freedom, under WAC 388-106-1410.
   2. Meet the disability criteria for the supplemental security income (SSI) program under WAC 182-512-0050;
   3. Require the level of care provided in a nursing facility under WAC 388-106-0355;
   4. Reside in a medical institution as defined in WAC 182-500-0050, or be likely to be placed in one within the next 30 days without HCB waiver services provided under one of the programs listed in (a) of this subsection;
   5. Attain institutional status under WAC 182-513-1320;
   6. Assessed for HCB waiver services, be approved for a plan of care, and receiving an HCB waiver service under (a) of this subsection;
   7. Be able to live at home with community support services and choose to remain at home, or live in a department-contracted alternate living facility under WAC 182-513-1100.
2. A person is not eligible for home and community based (HCB) waiver services if the person:
   1. Is subject to a penalty period of ineligibility for the transfer of an asset under WAC 182-513-1363; or
   2. Has a home with equity in excess of the requirements under WAC 182-513-1350.
3. See WAC 182-513-1315 for rules used to determine countable resources, income, and eligibility standards for long-term care (LTC) services.
4. Current income and resource standards are found at www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.

WAC 182-515-1505 Home and community based (HCB) waiver services authorized by home and community services (HCS).

Effective February 20, 2017

This chapter describes the general and financial eligibility requirements for categorically needy (CN) home and community based (HCB) waiver services authorized by home and community services (HCS). The definitions in WAC 182-513-1100 and chapter 182-500 WAC apply throughout this chapter.

1. The HCS waivers are:
   1. Community options program entry system (COPES);
   2. New Freedom consumer-directed services (New Freedom); and
   3. Residential support waiver (RSW).
2. WAC 182-515-1506 describes the general eligibility requirements for HCB waiver services authorized by HCS.
3. WAC 182-515-1507 describes financial requirements for eligibility for HCB waiver services authorized by HCS when a person is eligible for a noninstitutional SSI-related categorically needy (CN) medicaid program.
4. WAC 182-515-1508 describes the financial eligibility requirements for HCB waiver services authorized by HCS when a person is not eligible for SSI-related noninstitutional CN medicaid under WAC 182-515-1507.
5. WAC 182-515-1509 describes the rules used to determine a person's responsibility for the cost of care and room and board for HCB waiver services if the person is eligible under WAC 182-515-1508.

WAC 182-514-0270 Involuntary commitment to Eastern or Western State Hospital.

Effective February 29, 2016.

1. A person who is involuntarily committed to Eastern or Western State Hospital under chapter 71.34 RCW is eligible for categorically needy (CN) coverage if the person:
   1. Is under age twenty-one;
   2. Meets institutional status under WAC 182-513-1320; and
   3. Has countable income below:
      1. Two hundred ten percent of the federal poverty level if under age nineteen; or
      2. One hundred thirty-three percent of the federal poverty level if age nineteen or twenty.
2. A person who is involuntarily committed or receives MAGI-based long-term care coverage at Eastern or Western State Hospital in the month of the person's twenty-first birthday and receives active inpatient psychiatric treatment that will likely continue through the person's twenty-first birthday, is eligible for CN coverage until:
   1. The facility discharges the person; or
   2. The end of the month in which the person turns twenty-two, whichever occurs first.

WAC 182-514-0260 Institutional program for children under age nineteen.

Effective July 1, 2017

1. To qualify for the modified adjusted gross income (MAGI)-based long-term care (LTC) program under this section, you (a child under age nineteen) must meet:
   1. The general eligibility requirements in WAC 182-514-0240; and
   2. Program requirements under WAC 182-505-0210 or 182-505-0117.
2. If you are eligible for the premium-based children's program under WAC 182-505-0215, we redetermine your eligibility under this section so that your family is not required to pay the premium.
3. The categorically needy (CN) income level for LTC coverage under this section is two hundred ten percent of the federal poverty level after the standard five percentage point income disregard.
4. To determine countable income for CN coverage under this section, we apply the MAGI methodology under chapter 182-509 WAC.
5. We approve CN coverage under this section for twelve calendar months (certification period). If you are discharged from the facility before the end of the certification period, the child remains continuously eligible for CN coverage through the certification period, unless you age out of the program, move out-of-state, or die.
6. If you are not eligible for CN coverage under this section, we determine your eligibility for coverage under the institutional medically needy program described in WAC 182-514-0263.
7. The institution where you reside may submit an application on your behalf and may act as your authorized representative if you are:
   1. In a court-ordered, out-of-home placement under chapter 13.34 RCW; or
   2. Involuntarily committed to an inpatient treatment program by a court order under chapter 71.34 RCW.

WAC 182-514-0245 Resource eligibility.

Effective February 29, 2016.

Applicants for and recipients of the modified adjusted gross income (MAGI)-based long-term care program are exempt from the transfer-of-asset evaluation under WAC 182-513-1363, and there is no resource test. 

WAC 182-514-0240 General eligibility.

Effective February 29, 2016.

1. To be eligible for modified adjusted gross income (MAGI) - based long-term care (LTC) coverage under this section, a person must:
   1. Meet institutional status under WAC 182-513-1320;
   2. Meet the general eligibility requirements under WAC 182-503-0505, unless the applicant is a noncitizen, in which case WAC 182-503-0505 (3) (c) and (d) do not apply;
   3. Have countable income below the applicable standard described in WAC 182-514-0250 (2) or 182-514-0260 (3), unless the applicant is eligible as medically needy;
   4. Satisfy the program requirements in WAC 182-514-0250 and 182-514-0260; and
   5. Meet the nursing facility level of care under WAC 388-106-0355 if admitted to a nursing facility for nonhospice care. Hospice patients are exempt from this requirement.
2. A person age nineteen or older who does not meet the citizenship or immigration requirements under WAC 182-503-0535 to qualify for medicaid must meet the criteria in subsection (1) of this section and:
   1. Have a qualifying emergency condition and meet the requirements under WAC 182-507-0115 and 182-507-0120; or
   2. Meet the requirements under WAC 182-507-0125 if the person needs LTC coverage in a nursing facility.
3. If a person meets institutional status, the medicaid agency counts only income received by the person or on behalf of the person when determining eligibility.
4. A person who meets the federal aged, blind, or disabled criteria may qualify for coverage under chapter 182-513 WAC.
5. A person who receives supplemental security income (SSI) is not eligible for the MAGI-based LTC program.
6. If a person does not meet institutional status, the agency determines the person's eligibility for a noninstitutional medical program.
7. A person eligible for categorically needy or medically needy coverage under a noninstitutional program who is admitted to a nursing facility for fewer than thirty days is only approved for coverage for the nursing facility room and board costs if the person meets the nursing facility level of care as described under WAC 388-106-0355.
8. A MAGI-based LTC recipient is not required to pay toward the cost of care.

WAC 182-514-0230 Purpose.

Effective February 25, 2023.

1. This chapter describes eligibility requirements for the Washington apple health (WAH) modified adjusted gross income (MAGI)-based long-term care program (LTC) for children and adults who have been admitted to an institution as defined in WAC 182-500-0050 for at least 30 days. The rules are stated in the following sections:
   1. WAC 182-514-0240 General eligibility;
   2. WAC 182-514-0245 Resource eligibility;
   3. WAC 182-514-0250 Program for adults age 19 and older;
   4. WAC 182-514-0260 Program for children under age nineteen;
   5. WAC 182-514-0263 Non-SSI-related institutional medically needy coverage for pregnant women and people age 20 and younger.
   6. WAC 182-514-0270 Involuntary commitment to Eastern or Western State Hospital.
2. A noninstitutional WAH program recipient does not need to submit a new application for LTC coverage if admitted to an institution under this section. Admission to an institution constitutes a change of circumstances. Eligibility is based on institutional status under WAC 182-513-1320.
3. In this chapter, "medicaid agency" or "agency" means the Washington state health care authority and includes the agency's designee. See chapter 182-500 WAC for additional definitions.
4. Income standards used in this chapter are listed at www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.

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:

1. A personal representative who asserts an asset is protected under this section has the initial burden of providing proof under chapter 182-527 WAC.
2. A personal representative must provide verification from the LTC insurance company of the dollar amount paid out by the LTC partnership policy.
3. 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.
4. 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.

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

Effective February 20, 2017

1. 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.
2. The value of the transferred assets that exceed your LTC partnership protection will be evaluated for a transfer penalty.
3. If you transfer assets ((whose)) with values that are protected, you lose that value as future protection unless all the transferred assets are returned.
4. The value of your protected assets less the value of transferred assets equals the adjusted value of the assets you are able to protect.