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

Effective February 25, 2023

1. General information.
   1. This section describes how the agency or the agency's designee defines the resource standard and countable or excluded resources when determining a person's eligibility for SSI-related long-term care (LTC) services.
   2. "Resource standard" means the maximum amount of resources a person can have and still be resource eligible for program benefits.
   3. For a person not SSI-related, the agency applies program specific resource rules to determine eligibility.
2. Resource standards.
   1. The resource standard for the following people is $2000:
      1. A single person; or
      2. An institutionalized spouse.
   2. The resource standard for a legally married couple is $3000, unless subsection (3)(b)(ii) of this section applies.
   3. The resource standard for a person with a qualified long-term care partnership policy under WAC 182-513-1400 may be higher based on the dollar amount paid out by a partnership policy.
   4. Determining the amount of resources that can be allocated to the community spouse when determining resource eligibility is under WAC 182-513-1355.
3. Availability of resources.
   1. General. The agency or the agency's designee applies the following rules when determining available resources for LTC services:
      1. WAC 182-512-0300 SSI-related medical—Resources eligibility;
      2. WAC 182-512-0250 SSI-related medical—Ownership and availability of resources; and
      3. WAC 182-512-0260 SSI-related medical—How to count a sponsor's resources.
   2. Married couples.
      1. When both spouses apply for LTC services, the resources of both spouses are available to each other through the month in which the spouses stopped living together.
      2. When both spouses are institutionalized, the agency or the agency's designee determines the eligibility of each spouse as a single person the month following the month of separation.
      3. If the agency or the agency's designee has already established eligibility and authorized services for one spouse, and the community spouse needs LTC services in the same month, but after eligibility has been established and services authorized for the institutionalized spouse, then the agency applies the standard under subsection (2)(a) of this section to each spouse. If doing this would make one of the spouses ineligible, then the agency applies subsection (2)(b) of this section for the couple.
      4. The resources of the community spouse are unavailable to the institutionalized spouse the month after eligibility for LTC services is established, unless (v) or (vi) of this subsection applies.
      5. When a single institutionalized individual marries, the agency or the agency's designee redetermines eligibility applying the resource and income rules for a legally married couple.
      6. A redetermination of the couple's resources under this section is required if:
         1. The institutionalized spouse has a break of at least 30 consecutive days in a period of institutional status;
         2. The institutionalized spouse's countable resources exceed the standard under subsection (2)(a) of this section, and WAC 182-513-1355 (2)(b) applies; or
         3. The institutionalized spouse does not transfer the amount, under WAC 182-513-1355 (3) or (5), to the community spouse by either:
            1. The end of the month of the first regularly scheduled eligibility review; or
            2. A reasonable amount of time necessary to obtain a court order for the support of the community spouse.
4. Countable resources.
   1. The agency or the agency's designee determines countable resources using the following sections:
      1. WAC 182-512-0200 SSI-related medical—Definition of resources.
      2. WAC 182-512-0250 SSI-related medical—Ownership and availability of resources.
      3. WAC 182-512-0260 SSI-related medical—How to count a sponsor's resources.
      4. WAC 182-512-0300 SSI-related medical—Resources eligibility.
      5. WAC 182-512-0350 SSI-related medical—Property and contracts excluded as resources;
      6. WAC 182-512-0400 SSI-related medical—Vehicles excluded as resources;
      7. WAC 182-512-0450 SSI-related medical—Life insurance excluded as a resource; and
      8. WAC 182-512-0500 SSI-related medical—Burial funds, contracts and spaces excluded as resources.
      9. Chapter 182-516 WAC, Trusts, annuities, life estates, and promissory notes—Effect on medical programs.
   2. The agency or the agency's designee determines excluded resources based on federal law and WAC 182-512-0550, except:
      1. For institutional and HCB waiver programs, pension funds owned by a nonapplying spouse are counted toward the resource standard.
      2. For long-term services and supports (LTSS), based on the need for either nursing facility level of care or intermediate care facility for the intellectually disabled level of care, one home is excluded only if it meets the home equity limits of subsection (8) of this section. See WAC 182-512-0350 (1)(b).
   3. The agency or the agency's designee adds together the countable resources of both spouses if subsections (3)(b)(i) and (iv) apply, but not if subsection (3)(b)(ii) or (iii) apply. For a person with a community spouse, see WAC 182-513-1355.
5. Excess resources.
   1. For LTC programs, a person may reduce excess resources by deducting incurred medical expenses under subsection (6) of this section;
   2. The amount of excess resources is limited to the following amounts:
      1. For LTC services provided under the categorically needy (CN) program:
         1. In a medical institution, excess resources and available income must be under the state medicaid rate based on the number of days the person spent in the medical institution in the month.
         2. For HCB waiver eligibility, incurred medical expenses must reduce resources within allowable resource standards. The cost of care for the HCB waiver services cannot be allowed as a projected expense.
      2. For LTC services provided under the medically needy (MN) program, see:
         1. WAC 182-513-1395 for LTC programs; and
         2. WAC 182-513-1245 for hospice.
   3. Excess resources not otherwise applied to medical expenses will be applied to the projected cost of care for services in a medical institution under WAC 182-513-1380.
6. Allowable medical expenses.
   1. The following incurred medical expenses may be used to reduce excess resources:
      1. Premiums, deductibles, coinsurance, or copayment charges for health insurance and medicare;
      2. Medically necessary care defined under WAC 182-500-0070, but not covered under the state's medicaid plan. Information regarding covered services is under chapter 182-501 WAC;
      3. Medically necessary care defined under WAC 182-500-0070 incurred prior to medicaid eligibility. Expenses for nursing facility care are reduced at the state rate for the specific facility that provided the services.
   2. To be allowed, the medical expense must:
      1. Have been incurred no more than three months before the month of the medicaid application;
      2. Not be subject to third-party payment or reimbursement;
      3. Not have been used to satisfy a previous spenddown liability;
      4. Not have been previously used to reduce excess resources;
      5. Not have been used to reduce participation;
      6. Not have been incurred during a transfer of asset penalty under WAC 182-513-1363; and
      7. Be an amount for which the person remains liable.
7. ​Nonallowable expenses. The following expenses are not allowed to reduce excess resources:
   1. Unpaid adult family home (AFH) or assisted living facility expenses incurred prior to medicaid eligibility;
   2. Personal care cost in excess of approved hours determined by the CARE assessment under chapter 388-106 WAC; and
   3. Expenses excluded by federal law.
8. Excess home equity.
   1. A person with an equity interest in a primary residence in excess of the home equity limit is ineligible for long-term services and supports (LTSS) that are based on the need for either nursing facility level of care or intermediate care facility for the intellectually disabled level of care, unless one of the following persons lawfully resides in the home:
      1. That person's spouse; or
      2. That person's dependent child under age 21, blind child, or disabled child.
   2. The home equity provision applies to all applications for LTSS received on or after May 1, 2006.
   3. The excess home equity limit is the federal maximum allowed. On January 1st of each year, this standard may change by the percentage in the consumer price index for all consumers (CPI-U). The current maximum home equity limit is posted by the Centers for Medicare and Medicaid Services. (See subsection (9) of this section for institutional resource standards.)
   4. A person who is denied or terminated LTC services due to excess home equity may apply for an undue hardship waiver under WAC 182-513-1367.
9. Institutional 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 182-513-1345 Determining disregarded income for institutional or hospice services under the medically needy (MN) program.

Effective February 20, 2017

This section describes income the agency or its designee disregards when determining a person's eligibility for institutional or hospice services under the medically needy (MN) program. Disregarded income is available when determining a person's participation in the cost of care.

1. The agency or its designee disregards the following income amounts in the following order:
   1. Income that is not reasonably anticipated, or is received infrequently or irregularly, when such income does not exceed:
      1. Twenty dollars per month if unearned; or
      2. Ten dollars per month if earned.
   2. The first $20 per month of earned or unearned income, unless the sole source of income paid to a person is:
      1. Based on need; and
      2. Totally or partially funded by the federal government or a nongovernmental agency.
2. For a person who is related to the supplemental security income (SSI) program under WAC 182-512-0050(1), the first $65 per month of earned income not excluded under WAC 182-513-1340, plus one-half of the remainder.
3. Department of Veterans Affairs benefits designated for:
   1. The veteran's dependent when determining LTC eligibility for the veteran. The VA dependent allowance is considered countable income to the dependent unless it is paid due to unusual medical expenses (UME);
   2. Unusual medical expenses, aid and attendance allowance, special monthly compensation (SMC) and housebound allowance, with the exception under subsection (4) of this section.
4. Benefits under subsection (3)(b) of this section for a person who receives long-term care services are excluded when determining eligibility, but are considered available as a third-party resource (TPR) defined under WAC 182-513-1100 when determining the amount the person contributes in the cost of care.

WAC 182-513-1340 Determining excluded income for long-term care (LTC) services.

Effective June 10, 2019

This section describes income the agency or its designee excludes when determining a client's eligibility and participation in the cost of care for long-term care (LTC) services.

1. When determining a client's eligibility and participation in the cost of care for LTC services, the agency excludes:
   1. Crime victim's compensation;
   2. Earned income tax credit (EITC) for twelve months after the month of receipt;
   3. American Indian/Alaskan native benefits excluded by federal statute (refer to WAC 182-512-0770);
   4. Tax rebates or special payments excluded by other statutes;
   5. Any public agency's refund of taxes paid on real property and/or on food;
   6. Supplemental security income (SSI) and certain state public assistance based on financial need;
   7. The amount a representative payee charges to provide services when the services are a requirement for the client to receive the income;
   8. The amount of expenses necessary for a client to receive compensation, e.g., legal fees necessary to obtain settlement funds;
   9. Education benefits under WAC 182-512-0760;
   10. Self-employment income allowed as a deduction by the Internal Revenue Service (IRS);
   11. Payments to prevent fuel cut-offs and to promote energy efficiency that are excluded by federal statute;
   12. Assistance (other than wages or salary) received under the Older Americans Act;
   13. Assistance (other than wages or salary) received under the foster grandparent program;
   14. Certain cash payments a client receives from a governmental or nongovernmental medical or social service agency to pay for medical or social services;
   15. Interest earned on excluded burial funds and any appreciation in the value of an excluded burial arrangement that are left to accumulate and become part of the separately identified burial funds set aside;
   16. Tax exempt payments received by Alaska natives under the Alaska Native Settlement Act established by P.L. 100-241;
   17. Compensation provided to volunteers in ACTION programs under the Domestic Volunteer Service Act of 1973 established by P.L. 93-113;
   18. Payments made from the Agent Orange Settlement Fund or any other funds to settle Agent Orange liability claims established by P.L. 101-201;
   19. Payments made under section six of the Radiation Exposure Compensation Act established by P.L. 101-426;
   20. Payments made under the Energy Employees Occupational Illness Compensation Program Act of 2000, (EEOICPA) Pub. L. 106-398;
   21. Restitution payment, and interest earned on such payment to a civilian of Japanese or Aleut ancestry established by P.L. 100-383;
   22. Payments made under sections 500 through 506 of the Austrian General Social Insurance Act;
   23. Payments made from Susan Walker v. Bayer Corporation, et, al., 95-C-5024 (N.D. Ill.) (May 8, 1997) settlement funds;
   24. Payments made from the Ricky Ray Hemophilia Relief Fund Act of 1998 established by P.L. 105-369;
   25. Payments made under the Disaster Relief and Emergency Assistance Act established by P.L. 100-387;
   26. Payments made under the Netherlands' Act on Benefits for Victims of Persecution (WUV);
   27. Payments made to certain survivors of the Holocaust under the Federal Republic of Germany's Law for Compensation of National Socialist Persecution or German Restitution Act.
   28. Interest or dividends received by the institutionalized individual is excluded as income. Interest or dividends received by the community spouse of an institutional individual is counted as income of the community spouse. Dividends and interest are returns on capital investments such as stocks, bonds, or savings accounts. Institutional status is defined in WAC 182-513-1320.
   29. Income received by an ineligible or nonapplying spouse from a governmental agency for services provided to an eligible person, e.g., chore services.
2. The agency or its designee treats Department of Veterans Affairs (VA) benefits as follows:
   1. Any VA dependent allowance is countable income to the dependent unless it is paid due to unusual medical expenses (UME);
   2. UME, aid and attendance allowance, special monthly compensation (SMC) and housebound allowance are third-party resources;
   3. Benefits in subsection (2)(b) of this section for a client who receives long-term care services are excluded when determining eligibility, but are available as a third-party resource (TPR) as defined under WAC 182-513-1100 when determining the amount the institutionalized client contributes in the cost of care.
3. Any other income excluded by federal law is excluded.

WAC 182-513-1330 Determining available income for legally married couples for long-term care (LTC) services.

Effective August 26, 2018

This section describes income the agency or its designee determines available when evaluating a legally married person's eligibility for long-term care (LTC) services.

1. The agency or the agency's designee applies the following rules when determining income eligibility for LTC services:
   1. WAC 182-512-0600 SSI-related medical—Definition of income;
   2. WAC 182-512-0650 SSI-related medical—Available income;
   3. WAC 182-512-0700 SSI-related medical—Income eligibility;
   4. WAC 182-512-0750 SSI-related medical—Countable unearned income;
   5. WAC 182-512-0840(3), self-employment income-allowance expenses;
   6. WAC 182-512-0960 SSI-related medical —Allocating income—Determining eligibility for a spouse when the other spouse receives long-term services and supports (LTSS);
   7. WAC 182-512-0785, 182-512-0790, and 182-512-0795 for sponsored immigrants and how to determine if the sponsors' income counts in determining benefits.
2. In initial categorically needy income eligibility for LTC, the agency does not allow any deductions listed in 1612(b) of the Social Security Act, for example:
   1. Twenty dollars per month income exclusion under WAC 182-512-0800;
   2. The first $65 and the remaining one-half earned income work incentive under WAC 182-512-0840; and
   3. Impairment related work expense or blind work expense under WAC 182-512-0840.
3. The following income is available to an institutionalized spouse, unless subsections (5) and (6) apply:
   1. Income received in the institutionalized spouse's name;
   2. Income paid to a representative on the institutionalized spouse's behalf; and
   3. One-half of the income received in the names of both spouses.
4. The following income is unavailable to an institutionalized spouse:
   1. Separate income received in the name of the community spouse; and
   2. Income established as unavailable through a court order.
5. For the determination of eligibility only, if available income under subsection (3)(a) through (c) of this section, minus income exclusions under WAC 182-513-1340, exceeds the special income level (SIL), defined under WAC 182-513-1100, the agency or its designee:
   1. Follows Washington state community property law when determining ownership of income;
   2. Presumes all income received after the marriage by either spouse to be community income;
   3. Considers one-half of all community income available to the institutionalized spouse.
6. If the total of subsection (5)(c) of this section plus the institutionalized spouse's separate income is over the SIL, determine available income using subsection (3) of this section.
7. A stream of income, not generated by a transferred resource, is available to the institutionalized spouse, even if the institutionalized spouse transfers or assigns the rights to the stream of income to one of the following:
   1. The community spouse; or
   2. A trust for the benefit of the community spouse.

WAC 182-513-1325 Determining available income for an SSI-related single client for long-term care (LTC) services.

Effective February 20, 2017

This section describes income the agency or its designee determines available when evaluating an SSI-related single client's eligibility for long-term care (LTC) services.

1. See WAC 182-513-1330 for rules related to available income for legally married couples.
2. The agency or its designee applies the following rules when determining income eligibility for SSI-related LTC services:
   1. WAC 182-512-0600 SSI-related medical—Definition of income;
   2. WAC 182-512-0650 SSI-related medical—Available income;
   3. WAC 182-512-0700 SSI-related medical—Income eligibility;
   4. WAC 182-512-0750 SSI-related medical—Countable unearned income;
   5. WAC 182-512-0840 (3) self-employment income-allowable expenses
   6. WAC 182-512-0785, 182-512-0790, and 182-512-0795 for sponsored immigrants and how to determine if sponsors' income counts in determining benefits.
3. In initial categorically needy income eligibility for LTC, the agency does not allow any deductions listed in 1612(b) of the Social Security Act, for example:
   1. Twenty dollars per month income exclusion under WAC 182-512-0800;
   2. The first $65 and the remaining one-half earned income work incentive under WAC 182-512-0840; and
   3. Impairment related work expense or blind work expense under WAC 182-512-0840.

WAC 182-513-1320 Determining institutional status for long-term care (LTC) services.

Effective February 17, 2017

1. To attain institutional status outside a medical institution, a person must be approved for and receive:
   1. Home and community based (HCB) waiver services under chapter 182-515 WAC;
   2. Roads to community living (RCL) services under WAC 182-513-1235;
   3. Program of all-inclusive care for the elderly (PACE) under WAC 182-513-1230;
   4. Hospice services under WAC 182-513-1240(3); or
   5. State-funded long-term care service under WAC 182-507-0125.
2. To attain institutional status in a medical institution, a person must reside in a medical institution thirty consecutive days or more, or based on a department assessment, be likely to reside in a medical institution thirty consecutive days or more.
3. Once a person meets institutional status, the person's status is not affected if the person:
   1. Transfers between medical facilities; or
   2. Changes between any of the following programs: HCB waiver, RCL, PACE, hospice or services in a medical institution.
4. A person loses institutional status if the person is absent from a medical institution, or does not receive HCB waiver, RCL, PACE, or hospice services, for more than twenty-nine consecutive days.

WAC 182-513-1318 Income and resource criteria for home and community based (HCB) waiver programs and hospice.

Effective December 3, 2025

1. This section provides an overview of the income and resource eligibility rules for a person to be eligible for a categorically needy (CN) home and community based (HCB) waiver program under chapter 182-515 WAC or the hospice program under WAC 182-513-1240 and 182-513-1245.
2. To determine income eligibility for an SSI-related long-term care (LTC) HCB waiver, the agency or its designee:
   1. Determines income available under WAC 182-513-1325 and 182-513-1330;
   2. Excludes income under WAC 182-513-1340;
   3. Compares remaining gross nonexcluded income to:
      1. The special income level (SIL) defined under WAC 182-513-1100; or
      2. For HCB service programs authorized by the home and community living administration (HCLA), a higher standard is determined following the rules under WAC 182-515-1508 if a client's income is above the SIL but net income is below the medically needy income level (MNIL).
3. A person who receives MAGI-based coverage is not eligible for HCB waiver services unless found eligible based on program rules in chapter 182-515 WAC.
4. To be resource eligible under the HCB waiver program, the person must:
   1. Meet the resource eligibility requirements and standards under WAC 182-513-1350;
   2. Not be in a period of ineligibility due to a transfer of asset penalty under WAC 182-513-1363;
   3. Disclose to the state any interest the person or that person's spouse has in an annuity and meet the annuity requirements under chapter 182-516 WAC.
5. The agency or its designee determines a person's responsibility to pay toward the cost of care for LTC services as follows:
   1. For people receiving HCS HCB waiver services, see WAC 182-515-1509;
   2. For people receiving DDCS HCB waiver services, see WAC 182-515-1514.
6. To be eligible for the CN hospice program, see WAC 182-513-1240.
7. To be eligible for the MN hospice program in a medical institution, see WAC 182-513-1245.

WAC 182-513-1317 Income and resource criteria for an institutionalized person.

Effective February 20, 2017

1. This section provides an overview of the income and resource eligibility rules for a person who lives in an institutional setting.
2. To determine income eligibility for an SSI-related long-term care (LTC) applicant under the categorically needy (CN) program, the agency or its designee:
   1. Determines available income under WAC 182-513-1325 and 182-513-1330;
   2. Excludes income under WAC 182-513-1340; and
   3. Compares remaining available income to the special income level (SIL) defined under WAC 182-513-1100. A person's available income must be equal to or less than the SIL to be eligible for CN coverage.
3. To determine income eligibility for an SSI-related LTC client under the medically needy (MN) program, the agency or its designee follows the income standards and eligibility rules under WAC 182-513-1395.
4. To be resource eligible under the SSI-related LTC CN or MN program, the person must:
   1. Meet the resource eligibility requirements under WAC 182-513-1350;
   2. Not have a penalty period of ineligibility due to a transfer of assets under WAC 182-513-1363;
   3. Disclose to the state any interest the person or the person's spouse has in an annuity, which must meet the annuity requirements under chapter 182-516 WAC.
5. A resident of eastern or western state hospital is eligible for medicaid if the person:
   1. Has attained institutional status under WAC 182-513-1320; and
   2. Is under age twenty-one; or
   3. Applies for or receives inpatient psychiatric treatment in the month of the person's twenty-first birthday that will likely continue through the person's twenty-first birthday, and can receive coverage until:
      1. The facility discharges the person; or
      2. The end of the month in which the person turns age twenty-two, whichever occurs first; or(d) Is at least age sixty-five.
6. To determine long-term care CN or MN income eligibility for a person eligible under a MAGI-based program, the agency or its designee follows the rules under chapter 182-514 WAC.
7. There is no asset test for MAGI-based LTC programs under WAC 182-514-0245.
8. The agency or its designee determines a person's total responsibility to pay toward the cost of care for LTC services as follows:
   1. For an SSI-related person residing in a medical institution, see WAC 182-513-1380;
   2. For an SSI-related person on a home and community based waiver, see chapter 182-515 WAC.

WAC 182-513-1316 General eligibility requirements for long-term care (LTC) programs.

Effective December 3, 2025

1. To be eligible for long-term care (LTC) services, a person must:
   1. Meet the general eligibility requirements for medical programs under WAC 182-503-0505, except:
      1. An adult age 19 or older must meet citizenship and immigration status requirements under WAC 182-503-0535 (2)(a) or (b);
      2. A person under age 19 must meet citizenship and immigration status requirements under WAC 182-503-0535 (2)(a), (b), (c), or (d); and
      3. If a person does not meet the requirements in (a)(i) or (ii) of this subsection, the person is not eligible for medicaid and must have eligibility determined under WAC 182-513-1319.
   2. Attain institutional status under WAC 182-513-1320;
   3. Meet the functional eligibility under:
      1. Chapter 388-106 WAC for a home and community services (HCS) home and community based (HCB) waiver or nursing facility coverage; or
      2. Chapter 388-828 WAC for developmental disabilities community services (DDCS) HCB waiver or institutional services; and
   4. Meet either:
      1. SSI-related criteria under WAC 182-512-0050; or
      2. MAGI-based criteria under WAC 182-503-0510(2), if residing in a medical institution. A person who is eligible for MAGI-based coverage is not subject to the provisions under subsection (2) of this section.
2. A supplemental security income (SSI) recipient or a person meeting SSI-related criteria who needs LTC services must also:
   1. Not have a penalty period of ineligibility due to the transfer of assets under WAC 182-513-1363;
   2. Not have equity interest in a primary residence greater than the home equity standard under WAC 182-513-1350; and
   3. Disclose to the agency or its designee any interest the applicant or spouse has in an annuity, which must meet annuity requirements under chapter 182-516 WAC.
3. A person who receives SSI must submit a signed health care coverage application form attesting to the provisions under subsection (2) of this section. A signed and completed eligibility review for LTC benefits can be accepted for people receiving SSI who are applying for long-term care services.
4. To be eligible for HCB waiver services, a person must also meet the program requirements under:
   1. WAC 182-515-1505 through 182-515-1509 for HCS HCB waivers; or
   2. WAC 182-515-1510 through 182-515-1514 for DDCS HCB waivers.

WAC 182-513-1315 General eligibility requirements for long-term care (LTC) programs.

Effective February 20, 2017

This section lists the sections in this chapter that describe how the agency determines a person's eligibility for long-term care services. These sections are:

1. WAC 182-513-1316 General eligibility requirements for long-term care (LTC) programs.
2. WAC 182-513-1317 Income and resource criteria for an institutionalized person.
3. WAC 182-513-1318 Income and resource criteria for home and community based (HCB) waiver programs and hospice.
4. WAC 182-513-1319 State-funded programs for noncitizens who are not eligible for a federally funded program.