WAC 182-516-0300 Life estates

Effective March 2, 2018

1. "Life estate" means an ownership interest in real property only during the lifetime of a specified person.
2. Subject to subsection (3) of this section, a life estate is an available resource, unless it is either excluded or unavailable un­der chapter 182-512 WAC.
3. For someone applying for or receiving long-term services and supports, a life estate interest is subject to the home equity limits under:
   1. WAC 182-513-1350 for institutional and home and community- based (HCB) waiver programs; and
   2. WAC 182-513-1215 for community first choice.
4. For clients of institutional or HCB waiver services:
   1. If the remainder interest was transferred for less than fair market value, the medicaid agency or the agency's designee will evalu­ate the transaction as an asset transfer under WAC 182-513-1363. "Re­mainder interest" is the fair market value of the property at the time the client transferred it and retained a life estate, minus the value of the life estate at the time of that transfer.
   2. If a client purchased a life estate but has not lived in the property for at least one year after the purchase, the purchase price of the life estate is an uncompensated asset transfer under WAC 182-513-1363.
   3. If a client purchased a life estate and has lived in the property for more than one year, it is not an uncompensated transfer, unless the purchase price for the life estate exceeded the value of the life estate. Any amount paid for a life estate in excess of the value of the life estate is an uncompensated transfer under WAC 182-513-1363.
5. To calculate the value of a life estate:
   1. Identify the person whose life determines the length of the life estate;
   2. Identify whether uncompensated value or home equity is being calculated:
      1. If calculating uncompensated value under subsection (4)(a) or (c) of this section, identify that person's age on the person's last birthday before the transfer; or
      2. If determining whether home equity requirements are met un­ der subsection (3) of this section, identify that person's age on the person's most recent birthday; and
   3. Multiply the property's fair market value by the life estate factor corresponding to that person's age in the Life Estate and Re­mainder Interest Tables maintained by the Social Security Administra­tion.
6. To calculate the remainder interest, subtract the value in subsection (5) of this section from the property's fair market value at the time of the transaction that created the life estate.

WAC 182-516-0201 Annuities established on or after April 1, 2009

Effective March 2, 2018

1. The medicaid agency or the agency's designee determines how an annui­ty, purchased by or on behalf of an annuitant and established on or after April 1, 2009, affects eligibility for medicaid.
2. General information.
   1. Clients of noninstitutional medicaid must disclose to the agency or the agency's designee any interest that client, or the fi­nancially responsible members of that client's assistance unit, has in an annuity.
   2. Clients of institutional or home and community-based (HCB) waiver services must disclose to the agency or the agency's designee any interest that client, or that client's community spouse, has in an annuity.
   3. Subject to (d) of this subsection, this section applies when the annuitant is:
      1. The client of medicaid;
      2. That client's spouse, if that spouse is financially respon­sible for that client; or
      3. That client's community spouse.
   4. If this section does not apply because of (c) of this subsec­tion, but the client of institutional or HCB waiver services, or that client's community spouse, is the owner of the annuity, then the pur­chase of the annuity is evaluated as an asset transfer under WAC 182-513-1363.
   5. For the definition of "disabled," see WAC 182-512-0050 (1)(b) and (c).
   6. Actuarial life expectancy in this section is rounded up to the nearest whole year.
3. Annuities as resources.
   1. Subject to (b) of this subsection, a revocable annuity is an available resource.
   2. The following annuities are not available resources, even if revocable:
      1. An annuity described under 26 U.S.C. Sec. 408(b) or (q); or
      2. An annuity purchased with proceeds from:
         1. An account or trust described under 26 U.S.C. Sec. 408(a), (c), or (p);
         2. A simplified employee pension (within the meaning of 26 U.S.C. Sec. 408(k)); or
         3. A Roth IRA described under 26 U.S.C. Sec. 408A.
   3. An annuity not described under (b) of this subsection is an available resource unless the annuity:
      1. Is issued by an entity licensed and approved to issue annui­ties in the jurisdiction in which the annuity is established;
      2. Is immediate, irrevocable, nonassignable; and
      3. Is paid out, in equal monthly amounts with no deferral and no balloon payments, over a term:
         1. Of at least five years, if the actuarial life expectancy of the annuitant is at least five years; or
         2. Not less than the actuarial life expectancy of the annuitant, if the actuarial life expectancy of the annuitant is less than five years.
   4. If an annuity fails either the immediate requirement under (c)(ii) of this subsection or the monthly payout requirement under (c)(iii) of this subsection, the annuity is not a resource if:
      1. The annuity is fully paid out within the actuarial life ex­pectancy of the annuitant; and
      2. The annuitant:
         1. Changes the scheduled payout to equal monthly payments; or
         2. Asks the agency or the agency's designee to calculate and budget the periodic payments as equal monthly payments beginning the month of eligibility. Periodic payments made before the month of eli­gibility are not included in the calculation.
      3. Nothing under (d) of this subsection affects the deferral or balloon payment requirements under (c)(iii) of this subsection, or the payment term requirements under (c)(iii)(A) or (B) of this subsec­tion.
4. Annuities as income.
   1. If an annuity is not an available resource under subsection (3) of this section, the payments from the annuity are unearned income to the annuitant.
   2. If an annuity is an available resource under subsection (3) of this section, the payments from the annuity are not income to the annuitant.
5. An annuity as a transfer of assets.
   1. The purchase of an annuity is an uncompensated asset trans­fer, unless the annuity designates the state of Washington as remain­der beneficiary under subsection (6) of this section.
   2. The purchase of an annuity by the client of institutional or HCB waiver services is an uncompensated asset transfer, unless the an­nuity is an annuity under subsection (3)(b)(i) or (ii) of this sec­tion, or the annuity:
      1. Is issued by an entity licensed and approved to issue annui­ties in the jurisdiction in which the annuity is established;
      2. Is immediate, irrevocable, nonassignable; and
      3. Is paid out, in equal periodic amounts with no deferral and no balloon payments, over a term that is actuarially sound (i.e., a term that is not greater than the actuarial life expectancy of that client).
6. Beneficiary designation requirements.
   1. Subject to (b) of this subsection, to satisfy subsection (5)(a) of this section, when the client of institutional or HCB waiver services, or that client's community spouse, is the annuitant, the an­nuity must:
      1. Name the states as the remainder beneficiary, for at least the total amount of services covered under medicaid, paid on behalf of the client of institutional or HCB waiver services; and
      2. The remainder beneficiary must be listed in the annuity in the:
         1. First position;
         2. Next position, after the community spouse, and any minor or disabled children; or
         3. First position, if either the community spouse, or any minor or disabled children, or a representative for such children, named as beneficiary in the first position under (a)(ii)(B) of this subsection, transfers the right to receive payments from the annuity for less than fair market value.
   2. When the community spouse is the annuitant, the community spouse, or the community spouse's estate, cannot be named as remainder beneficiary under (a)(ii)(A) of this subsection.
   3. If a change of circumstance requires a change in beneficiary designation under (a) of this subsection, the agency or the agency's designee reevaluates the annuity's beneficiary designation.
7. Actuarial life expectancy is determined by tables that are published by the office of the chief actuary of the Social Security Administration.

WAC 182-516-0200 Annuities established prior to April 1, 2009

Effective March 2, 2018

1. A revocable annuity is considered an available resource.
2. An irrevocable annuity established prior to May 1, 2001, is not an available resource when issued by an individual, in­ surer, or other body licensed and approved to do business in the ju­risdiction in which the annuity is established.
3. The income from an irrevocable annuity that meets the requirements of this section is income for determining eligibility and the amount of participation in the total cost of care. The annuity itself is not a re­source.
4. Subject to subsection (5) of this section, an annuity established on or after May 1, 2001, and before April 1, 2009, is an available resource unless it:
   1. Is irrevocable;
   2. Is paid out in equal monthly amounts within the actuarial life expectancy of the annuitant;
   3. Is issued by an individual, insurer, or other body licensed and approved to do business in the jurisdiction in which the annuity is established; and
   4. Names the state of Washington as the benefi­ciary of the remaining funds up to the total of medicaid funds spent on the client during the client's lifetime. This subsection only ap­plies if the annuity is in the client's name.
5. If an irrevocable annuity is an availa­ble resource under subsection (4) of this section because it does not pay out in equal monthly amounts, it is an unavailable resource if:
   1. The full pay out is within the actuarial life expectancy of the client; and
   2. The client:
      1. Changes the scheduled pay out into equal monthly payments within the actuarial life expectancy of the annuitant; or
      2. Requests that the medicaid agency or the agency's designee calculate and budget the payments as equal monthly payments within the actuarial life expectancy of the annuitant. The income from the annuity remains unearned income to the annuitant.
6. An irrevocable annuity is unearned income when the annuitant is:
   1. The client;
   2. The spouse of the client;
   3. The blind or disabled child, as defined in WAC 182-512-0050 (1)(b) and (c), of the client; or
   4. A person designated to use the annuity for the sole benefit of the client, client's spouse, or a blind or disabled child, as de­ fined in WAC 182-512-0050 (1)(b) and (c), of the client.
7. An annuity is not an available resource when there is a joint owner, co-annuitant or an irrevocable beneficiary who will not agree to allow the annuity to be cashed, unless the joint owner or irrevocable beneficiary is the community spouse. In the case of a community spouse, the value of the annuity is an available resource and counts toward the maximum community spouse resource allowance.

WAC 182-516-0100 Trust index

Effective March 2, 2018

The medicaid agency or the agency's designee applies the following rules to determine how trusts affect eligibility for medicaid:

1. WAC 182-516-0105 General rules that apply to all trusts.
2. WAC 182-516-0110 Self-settled trusts overview.
3. WAC 182-516-0115 Revocable self-settled trusts established on or after August 11, 1993.
4. WAC 182-516-0120 Irrevocable self-settled trusts for a disabled client under age sixty-five established on or after August 11, 1993.
5. WAC 182-516-0125 Irrevocable pooled self-settled trusts for a disabled client established on or after August 11, 1993.
6. WAC 182-516-0130 Irrevocable self-settled trusts established on or after August 11, 1993.
7. WAC 182-516-0135 Self-settled trusts established before August 11, 1993.
8. WAC 182-516-0140 Third-party trusts.
9. WAC 182-516-0145 Trusts containing both assets of the beneficiary and third-party assets.

WAC 182-515-1514 Home and community based (HCB) services authorized by developmental disabilities community services (DDCS)- Client financial responsibility

Effective December 3, 2025

1. A client eligible for home and community based (HCB) waiver services authorized by developmental disabilities community services (DDCS) under WAC 182-515-1513 must pay toward the cost of care and room and board under this section.
   1. Post-eligibility treatment of income, participation, and participate are all terms that refer to a client's responsibility towards cost of care.
   2. Room and board is a term that refers to a client's responsibility toward food and shelter in an alternate living facility (ALF).
2. The agency determines how much a client must pay toward the cost of care for home and community based (HCB) waiver services authorized by the DDCS when the client is living at home, as follows:
   1. A single client who lives at home (as defined in WAC 388-106-0010) keeps a personal needs allowance (PNA) of up to the special income level (SIL) defined under WAC 182-513-1100.
   2. A single client who lives at home on the roads to community living program authorized by DDCS keeps a PNA up to the SIL but must pay any remaining available income toward cost of care after allowable deductions described in subsection (4) of this section.
   3. A married client who lives with the client's spouse at home (as defined in WAC 388-106-0010) keeps a PNA of up to the SIL but must pay any remaining available income toward cost of care after allowable deductions under subsection (4) of this section.
   4. A married couple living at home where each client receives HCB waiver services, one authorized by DDCS and the other authorized by home and community services (HCS) is allowed the following:
      1. The client authorized by DDCS keeps a PNA of up to the SIL but must pay any remaining available income toward the client's cost of care after allowable deductions in subsection (4) of this section; and
      2. The client authorized by HCS pays toward the cost of care under WAC 182-515-1507 or 182-515-1509.
3. The agency determines how much a client must pay toward the cost of care for HCB wavier services authorized by DDCS and room and board when the client is living in a department-contracted ALF defined under WAC 182-513-1100. A client:
   1. Keeps a PNA under WAC 182-513-1105;
   2. Pays room and board up to the room and board standard under WAC 182-513-1105; and
   3. Pays the remainder of available income toward the cost of care after allowable deductions under subsection (4) of this section.
4. If income remains after the PNA and room and board liability under subsection (2) or (3) of this section, the remaining available income must be paid toward the cost of care after it is reduced by allowable deductions in the following order:
   1. An earned income deduction of the first $65, plus one-half of the remaining earned income;
   2. Guardianship fees, conservatorship fees, and administrative costs including any attorney fees paid by the guardian or conservator only as allowed under chapter 388-79A WAC;
   3. Current or back child support garnished or withheld from the client's income according to a child support order in the month of the garnishment if it is for the current month. If the agency allows this as a deduction from income, the agency does not count it as the child's income when determining the family allocation amount in WAC 182-513-1385;
   4. A monthly maintenance-needs allowance for the community spouse under WAC 182-513-1385. If the community spouse is on long-term care services, the allocation is limited to an amount that brings the community spouse's income to the community spouse's PNA;
   5. A monthly maintenance-needs allowance for each dependent of the institutionalized client, or the client's spouse, as calculated under WAC 182-513-1385; and
   6. Incurred medical expenses which have not been used to reduce excess resources. Allowable medical expenses are under WAC 182-513-1350.
5. The total of the following deductions cannot exceed the SIL defined under WAC 182-513-1100:
   1. The PNA described in subsection (2) or (3) of this section, including room and board;
   2. The earned income deduction in subsection (4)(a) of this section; and
   3. The guardianship fees, conservatorship fees, and administrative costs in subsection (4)(b) of this section.
6. A client may have to pay third-party resources defined under WAC 182-513-1100 in addition to the room and board and participation.
7. A client must pay the client's provider the sum of the room and board amount, the cost of care after all allowable deductions, and any third-party resources defined under WAC 182-513-1100.
8. A client on HCB waiver services does not pay more than the state rate for cost of care.
9. When a client lives in multiple living arrangements in a month, the agency allows the highest PNA available based on all the living arrangements and services the client has received in a month.
10. Standards described in this section are found on www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.

WAC 182-515-1513 Home and community based (HCB) waiver services authorized by developmental disabilities community services (DDCS)—Financial eligibility using SSI-related institutional rules.

Effective December 3, 2025

1. If a person is not eligible for a categorically needy (CN) program under WAC 182-515-1512, the agency determines eligibility for home and community based (HCB) waiver services authorized by developmental disabilities community services (DDCS) using institutional medicaid rules. This section explains how a person may qualify using institutional rules.
2. A person must meet:
   1. General eligibility requirements under WAC 182-513-1315 and 182-515-1511;
   2. Resource requirements under WAC 182-513-1350; and
   3. Have available income at or below the special income level (SIL) defined under WAC 182-513-1100.
3. The agency determines available income and income exclusions according to WAC 182-513-1325, 182-513-1330, and 182-513-1340.
4. A person eligible under this section is responsible to pay income toward the cost of care and room and board, as described under WAC 182-515-1514.
5. Current resource, income 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 182-515-1512 Home and community based (HCB) waiver services authorized by developmental disabilities community services (DDCS)- Financial eligibility if a client is eligible for a noninstitutional SSI-related categorically needy (CN) program.

Effective December 3, 2025

1. A client is financially eligible for home and community based (HCB) waiver services authorized by developmental disabilities community services (DDCS) if:
   1. The client is receiving coverage under one of the following categorically needy (CN) medicaid programs:
      1. Supplemental security income (SSI) program under WAC 182-510-0001. This includes SSI clients under 1619(b) status; or
      2. Health care for workers with disabilities (HWD) under chapter 182-511 WAC; or
      3. SSI-related noninstitutional (CN) program under chapter 182-512 WAC; or
      4. The foster care program under WAC 182-505-0211 and the client meets disability requirements under WAC 182-512-0050.
   2. The client does not have a penalty period of ineligibility for the transfer of an asset as under WAC 182-513-1363; and
   3. The client 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 up to the room and board standard 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 182-515-1511 Home and community based (HCB) waiver services authorized by developmental disabilities community services (DDCS) - General eligibility.

Effective December 3, 2025

1. To be eligible for home and community based (HCB) waiver services authorized by developmental disabilities community services (DDCS), a person must:
   1. Meet specific program requirements under chapter 388-845 WAC;
   2. Be an eligible client of the DDCS;
   3. Meet the disability criteria for the supplemental security income (SSI) program under WAC 182-512-0050;
   4. Need the level of care provided in an intermediate care facility for the intellectually disabled (ICF/ID);
   5. Have attained institutional status under WAC 182-513-1320;
   6. Be able to reside in the community and choose to do so as an alternative to living in an ICF/ID;
   7. Be assessed for HCB waiver services, be approved for a plan of care, and receive HCB waiver services under (a) of this subsection, and:
      1. Be able to live at home with HCB waiver services; or
      2. Live in a department-contracted facility with HCB waiver services, such as:
         1. A group home;
         2. A group training home;
         3. A child foster home, group home, or staffed residential facility;
         4. An adult family home (AFH); or
         5. An adult residential care (ARC) facility.
      3. Live in the person's own home with supported living services from a certified residential provider; or
      4. Live in the home of a contracted companion home provider.
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 standard charts are found at http://www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.

WAC 182-515-1510 Home and community based (HCB) waiver services authorized by developmental disabilities community services (DDCS).

Effective December 3, 2025

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

1. The DDCS waiver programs are:
   1. Basic Plus;
   2. Core;
   3. Community protection;
   4. Children's intensive in-home behavioral support (CIIBS); and
   5. Individual and family services (IFS).
2. WAC 182-515-1511 describes the general eligibility requirements for HCB waiver services authorized by DDCS.
3. WAC 182-515-1512 describes the financial requirements for eligibility for HCB waiver services authorized by DDCS if a person is eligible for a noninstitutional SSI-related CN program.
4. WAC 182-515-1513 describes the financial eligibility requirements for HCB waiver services authorized by DDCS when a person is not eligible for an SSI-related noninstitutional CN program under WAC 182-515-1512.
5. WAC 182-515-1514 describes the rules used to determine a person's responsibility in the cost of care and room and board for HCB waiver services authorized by DDCS if the person is eligible under WAC 182-515-1512.

WAC 182-515-1509 Home and community based (HCB) waiver services authorized by home and community services (HCS) – Client financial responsibility.

Effective December 3, 2025

1. A client eligible for home and community based (HCB) waiver services authorized by home and community services (HCS) under WAC 182-515-1508 must pay toward the cost of care and room and board under this section.
   1. Post-eligibility treatment of income, participation, and participate are all terms that refer to a client's responsibility towards cost of care.
   2. Room and board is a term that refers to a client's responsibility toward food and shelter in an alternate living facility (ALF).
2. The agency determines how much a client must pay toward the cost of care for HCB waiver services authorized by HCS when living in their own home:
   1. A single client who lives in their own home (as defined in WAC 388-106-0010) keeps a personal needs allowance (PNA) of up to 300% of the federal benefit rate (FBR) for the supplemental security income (SSI) cash grant program and must pay the remaining available income toward cost of care after allowable deductions described in subsection (4) of this section. The Washington apple health income and resource standards chart identifies 300% of the FBR as the medical special income level (SIL).
   2. A married client who lives with the client's spouse in their own home (as defined in WAC 388-106-0010) keeps a PNA of up to the effective one-person medically needy income level (MNIL) and pays the remainder of the client's available income toward cost of care after allowable deductions under subsection (4) of this section.
   3. A married client who lives in their own home and apart from the client's spouse keeps a PNA of up to the SIL but must pay the remaining available income toward cost of care after allowable deductions under subsection (4) of this section.
   4. A married couple living in their own home where each client receives HCB waiver services is each allowed to keep a PNA of up to the SIL but must pay remaining available income toward cost of care after allowable deductions under subsection (4) of this section.
   5. A married couple living in their own home where each client receives HCB waiver services, one spouse authorized by developmental disabilities community services (DDCS) and the other authorized by HCS, is allowed the following:
      1. The client authorized by DDCS pays toward the cost of care under WAC 182-515-1512 or 182-515-1514; and
      2. The client authorized by HCS retains the SIL and pays the remainder of the available income toward cost of care after allowable deductions under subsection (4) of this section.
3. The agency determines how much a client must pay toward the cost of care for HCB waiver services authorized by HCS and room and board when living in a department contracted alternate living facility (ALF) defined under WAC 182-513-1100. A Client:
   1. Keeps a PNA of under WAC 182-513-1105;
   2. Pays room and board up to the room and board standard under WAC 182-513-1105; and
   3. Pays the remainder of available income toward the cost of care after allowable deductions under subsection (4) of this section.
4. If income remains after the PNA and room and board liability under subsection (2) or (3) of this section, the remaining available income must be paid toward the cost of care after it is reduced by deductions in the following order:
   1. An earned income deduction of the first $65 plus one-half of the remaining earned income;
   2. Guardianship fees, conservatorship fees, and administrative costs including any attorney fees paid by the guardian or conservator only as allowed under chapter 388-79A WAC;
   3. Current or back child support garnished or withheld from the client's income according to a child support order in the month of the garnishment if it is for the current month. If the agency allows this as a deduction from income, the agency does not count it as the child's income when determining the family allocation amount in WAC 182-513-1385;
   4. A monthly maintenance-needs allowance for the community spouse as determined under WAC 182-513-1385. If the community spouse is also receiving long-term care services, the allocation is limited to an amount that brings the community spouse's income to the community spouse's PNA, as calculated under WAC 182-513-1385;
   5. A monthly maintenance-needs allowance for each dependent of the institutionalized client, or the client's spouse, as calculated under WAC 182-513-1385;
   6. Incurred medical expenses which have not been used to reduce excess resources. Allowable medical expenses are under WAC 182-513-1350.
5. The total of the following deductions cannot exceed the special income level (SIL) defined under WAC 182-513-1100:
   1. The PNA allowed in subsection (2) or (3) of this section, including room and board;
   2. The earned income deduction in subsection (4)(a) of this section; and
   3. The guardianship fees, conservatorship fees, and administrative costs in subsection (4)(b) of this section.
6. A client may have to pay third-party resources defined under WAC 182-513-1100 in addition to the room and board and participation.
7. A client must pay the client's provider the sum of the room and board amount, and the cost of care after all allowable deductions, and any third-party resources defined under WAC 182-513-1100.
8. A client on HCB waiver services does not pay more than the state rate for cost of care.
9. When a client lives in multiple living arrangements in a month, the agency allows the highest PNA available based on all the living arrangements and services the client has received in a month.
10. Standards described in this section 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.