WAC 182-509-0305 MAGI income -- Persons subject to the modified adjusted gross income (MAGI) methodology.

Effective November 1, 2024.

1. Eligibility for Washington apple health for the following people is determined using the modified adjusted gross income (MAGI) methodology described in WAC 182-509-0300:
   1. Parents or caretaker relatives with an eligible dependent child (described in WAC 182-503-0565) whose net countable income is below 54 percent of the federal poverty level (FPL) as described in WAC 182-505-0240.
   2. Parents or caretaker relatives with an eligible dependent child whose net countable income exceeds the standard described in (a) of this subsection but is at or below 133 percent FPL as described in WAC 182-505-0250 and 182-507-0110.
   3. Adults with no eligible dependent child with net countable income at or below 133 percent FPL as described in WAC 182-505-0250 and 182-507-0110.
   4. Pregnant people whose net countable income, based on a household size that includes any unborn children, is equal to or below 210 percent FPL at the time of application, as described in WAC 182-505-0115.
   5. People within the 12-month postpartum period beginning the month after the pregnancy ends whose net countable income is equal to or below 210 percent FPL at the time of application, as described in WAC 182-505-0115.
   6. Children age 18 or younger in households with net countable income which is equal to or below 210 percent FPL as described in WAC 182-505-0210.
   7. Children age 18 or younger in households with net countable income that is greater than 210 percent but equal to or below 312 percent FPL, as described in WAC 182-505-0215. Children who are eligible under this section are subject to premiums as described in WAC 182-505-0225.
2. Household size for a person who is subject to MAGI income methodologies is determined according to WAC 182-506-0010.

WAC 182-509-0300 Modified adjusted gross income (MAGI).

Effective September 18, 2020.

1. The agency uses the modified adjusted gross income (MAGI) methodology to determine eligibility for MAGI-based Washington apple health programs described in WAC 182-509-0305.
2. MAGI methodology is described in WAC 182-509-0300 through 182-509-0375. Generally, MAGI includes adjusted gross income (as determined by the Internal Revenue Code (IRC)) increased by:
   1. Any amount excluded from gross income under Section 911 of the IRC;
   2. Any amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax; and
   3. Any amount of Title II Social Security income or Tier 1 Railroad Retirement income which is excluded from gross income under Section 86 of the IRC.
3. When calculating a person's eligibility for the programs listed in WAC 182-509-0305, the agency uses the person's MAGI income with the following exceptions:
   1. Scholarships or fellowship grants described in WAC 182-509-0335 used for education purposes are excluded from income;
   2. Income received by American Indian/Alaskan Native individuals described in WAC 182-509-0340 is excluded from income; and
   3. Any income received as a lump sum as described in WAC 182-509-0375 is counted as income only in the month in which it is received; and
   4. Income received by a child are eighteen or younger or a tax dependent as described in WAC 182-509-0360 is excluded from income.
4. Countable MAGI income is reduced by an amount equal to five percentage points of the federal poverty level (FPL) based on household size to determine net income except that there is no such reduction of countable MAGI income for parents or caretaker relatives with an eligible dependent child whose net countable income is below fifty-four percent of the FPL (as described in WAC 182-509-0305(1)). Net income is compared to the applicable standard described in WAC 182-505-0100.
5. When calculating a person's eligibility for MAGI-based programs listed in WAC 182-509-0305, the agency determines the medical assistance unit for each person according to WAC 182-506-0010.

WAC 182-509-0220 Washington apple health -- How resources are considered.

Effective October 3, 2025.

1. A resource is any cash, other personal property, or real property that a person:
   1. Owns;
   2. Has the right, authority, or power to convert to cash (if not already cash); and
   3. Has the legal right to use for their support and maintenance.
2. There is no resource limit for an applicant or recipient of the following Washington apple health (medicaid) programs:
   1. Apple Health for workers with disabilities (HWD) program, as described in chapter 182-511 WAC;
   2. Apple Health foster care program (see WAC 182-505-0211);
   3. Medicare savings programs (see WAC 182-517-0100);
   4. All programs that are based on modified adjusted gross income (MAGI) methodologies, as described in WAC 182-503-0510. This includes the following:
      1. Apple Health for parents and caretaker relatives (see WAC 182-505-0240);
      2. Apple health pregnancy coverage (see WAC 182-505-0115);
      3. Apple health for kids (see WAC 182-505-0210);
      4. Premium-based apple health for kids (see WAC 182-505-0215);
      5. Apple health long-term care for children and adults (see WAC 182-514-0230);
      6. Apple health for MAGI-based adult coverage (see WAC 182-505-0250); 
      7. Apple health MAGI-based adult alien emergency medical (see WAC 182-507-0110); and 
      8. Apple health expansion coverage.
3. For all other apple health programs, the resource limits and exclusions can be found in the following chapters:
   1. Apple health SSI-related medical (see chapter 182-512 WAC);
   2. Apple health long-term care (see chapters 182-513 and 182-515 WAC);
   3. SSI-related apple health alien medical program (see chapter 182-507 WAC);
   4. Apple health for refugees (see WAC 182-507-0130); and
   5. Medical care services (see WAC 182-508-0005).
4. The agency or its designee determines how trusts, annuities and life estates affect eligibility for apple health coverage for the programs listed in subsection (3)(a) through (e) of this section by following the rules described in chapter 182-516 WAC.
5. Receipt of money by a member of a federally recognized tribe from exercising federally protected rights or extraction of protected resources, such as fishing, shell-fishing, or selling timber, is considered conversion of an exempt resource during the month of receipt. Any amounts remaining from the conversion of this exempt resource on the first of the month after the month of receipt will remain exempt if the funds were used to purchase another exempt resource. Any amounts remaining in the form of countable resources (such as in checking or savings accounts) on the first of the month after receipt, will be added to other countable resources for eligibility determinations when a resource determination is required by the specific apple health program. If no resource determination is required by the specific apple health program, eligibility is not affected.

WAC 182-509-0001 Countable income for Washington apple health programs.

Effective December 27, 2024.

1. For purposes of Washington apple health program eligibility, a person's countable income is income which remains when:
   1. The income cannot be specifically excluded; and
   2. All appropriate deductions and disregards allowed by a specific program have been applied.
2. A person's countable income may not exceed the income standard for the specific Washington apple health program, unless the program allows for those limits to be exceeded. Specific program standards are described below:
   1. For modified adjusted gross income (MAGI)-based programs described in WAC 182-503-0510, see WAC 182-505-0100 for the applicable program standard based on a percentage of the federal poverty level (FPL);
   2. For Washington apple health SSI-related CN coverage, see WAC 182-512-0010;
   3. For Washington apple health MN coverage, see WAC 182-519-0050;
   4. For Washington apple health medicare savings programs, see WAC 182-517-0100;
   5. For Washington apple health noninstitutional medical in an alternative living facility, see WAC 182-513-1205; and
   6. For Washington apple health long-term care programs, see WAC 182-513-1315 and 182-513-1395.
3. For the MAGI-based programs listed below, the agency or its designee determines eligibility based on the countable MAGI income of the members of the person's medical assistance unit as determined per WAC 182-506-0010:
   1. Washington apple health for parents and caretaker relatives program as described in WAC 182-505-0240;
   2. Washington apple health pregnancy program as described in WAC 182-505-0115;
   3. Washington apple health for kids programs as described in WAC 182-505-0210 with the following exceptions:
      1. Newborn children born to a person who is eligible for WAH on the date of the newborn's birth, including a retroactive eligibility determination;
      2. Children who are receiving SSI;
      3. Children who are in foster care or receiving subsidized adoption services.
   4. Washington apple health MAGI-based adult medical as described in WAC 182-505-0250; and
   5. Washington apple health MAGI-based alien emergency medical as described in WAC 182-507-0110.
4. For the following SSI-related Washington apple health programs, unless the state has adopted more liberal rules, income rules for the SSI program are used to determine a person's countable income:
   1. Washington apple health noninstitutional SSI-related CN or medically needy (MN) coverage described in chapters 182-511 and 182-512 WAC;
   2. Washington apple health institutional SSI-related CN or MN long-term care or hospice coverage described in chapters 182-513 and 182-515 WAC;
   3. Washington apple health alien emergency medical programs based on age 65 or older or disability described in chapter 182-507 WAC; and
   4. Washington apple health medicare savings programs described in chapter 182-517 WAC.
5. Anticipated nonrecurring lump sum payments received by an applicant or recipient of a Washington apple health SSI-related medical program are counted as income in the month of receipt, subject to reporting requirements, with the exception of retroactive supplemental security income (SSI)/Social Security disability lump sum payments. See WAC 182-512-0300(4) and 182-512-0700 for more information.
6. Countable income for the Washington apple health refugee medical (RMA) program and Washington apple health MN program for pregnant people and children is determined as follows:
   1. The agency or its designee allows the following deductions from a household's gross earnings:
      1. The first $500 of earnings and 50 percent of the remaining earnings;
      2. Actual work-related child and dependent care expenses, which are the person's responsibility; and
      3. Court or administratively ordered current or back support paid to meet the needs of legal dependents.
   2. Only income actually contributed to a person from the person's sponsor is countable unless the sponsor signs the affidavit of support I-864 or I-864A.
   3. Nonrecurring lump sum payments are counted as income in the month of receipt and as a resource if the person retains the payment after the month of receipt (resource limits do not apply to MN coverage for pregnant people and children). For RMA, nonrecurring lump sum payments are counted as income if received in the month of application and not considered if received thereafter per WAC 182-507-0130.
7. Countable income rules for other Washington apple health programs that are not MAGI-based or SSI-related are described in the specific program rules listed in WAC 182-503-0510 (3)(c).
8. Some Washington apple health programs are not based on a person's or household's countable income but are based on a specific status or entitlement in federal rule. The rules for these deemed eligible Washington apple health programs are described in WAC 182-503-0510(4).

WAC 182-508-0150 Enrollment cap for medical care services (MCS).

Effective February 1, 2022 

1. Enrollment in medical care services (MCS) coverage is subject to available funds.
2. The medicaid agency may limit enrollment into MCS coverage by implementing an enrollment cap and wait list.
3. If a person is denied MCS coverage due to an enrollment cap:
   1. The person is added to the MCS wait list based on the date the person applied.
   2. Applicants with the oldest application date will be the first to receive an opportunity for enrollment when MCS coverage is available as long as the person remains on the MCS wait list.
4. A person is exempted from the enrollment cap and wait list rules when:
   1. MCS was terminated due to agency error;
   2. The person is in the 30-day reconsideration period for incapacity reviews under WAC 388-447-0110(4);
   3. The person is being terminated from a categorically needy (CN) medical program and was receiving and eligible for CN coverage prior to the date a wait list was implemented and at the time their CN coverage ended, the person met eligibility criteria to receive benefits under either the aged, blind, or disabled program as described in WAC 388-400-0060 or the housing and essential needs referral program as described in WAC 388-400-0070; or
   4. The person applied for a determination by the department of social and health services (DSHS) to be eligible for benefits under one of the following programs, but the determination was not completed before the enrollment cap effective date:
      1.  The aged, blind, or disabled program as described in WAC 388-400-0060 ; 
      2. The housing and essential needs referral program as described in WAC 388-400-0070; or
      3. The survivors of certain crimes (SCC) program, as described in WAC 388-424-0035, which includes victims of human trafficking as described in RCW 74.04.005.
5. The person is removed from the MCS wait list if the person:
   1. Is not a Washington resident;
   2. Is deceased;
   3. Requests removal from the wait list;
   4. Is found eligible for categorically or medically needy coverage; or
   5. Is no longer determined by DSHS to be eligible for benefits under:
      1. The aged, blind, or disabled program as described in WAC 388-400-0060;
      2. The housing and essential needs referral program as described in WAC 388-400-0070; or
      3. The SCC program as described in WAC 388-424-0035.

WAC 182-508-0005 Washington apple health medical care services - eligibility and scope of coverage.

Effective February 12, 2023

1. A person is eligible for state-funded Washington apple health medical care services (MCS) coverage to the extent of available funds if the person is:
   1. Determined by the department of social and health services to be eligible for benefits under:
      1. The aged, blind, or disabled program as described in WAC 388-400-0060;
      2. The housing and essential needs referral program as described in WAC 388-400-0070; or
      3. The survivors of certain crimes (SCC) program, as described in WAC 388-424-0035, which includes victims of human trafficking as described in RCW 74.04.005;
   2. Not eligible for another federally funded categorically needy (CN) (as defined in WAC 182-500-0020) or alternative benefits plan (ABP) (as defined in WAC 182-500-0010) Washington apple health program and
   3. Not residing in a public institution as defined in WAC 182-500-0050.
2. If an enrollment cap exists under WAC 182-508-0150, a waiting list of people may be established.
3. A person's period of eligibility for MCS is the same as the person's period of eligibility for:
   1. The aged, blind, or disabled program as described in WAC 388-449-0150;
   2. The person's incapacity authorization period for the housing and essential needs referral program as described in WAC 388-447-0110;
   3. The person's period of eligibility for the SCC program as described in WAC 388-424-0035.
4. The MCS program covers only the medically necessary services defined in WAC 182-501-0060.
5. The MCS program does not cover medical services received outside the state of Washington unless the medical services are provided in a border city listed in WAC 182-501-0175.

WAC 182-508-0001 Washington apple health – Coverage options for adults not eligible under MAGI methodologies.

April 1, 2024

1. This chapter provides information on eligibility determinations for adults who:
   1. Need a determination of eligibility on the basis of being aged, blind, or disabled;
   2. Need a determination of eligibility based on the need for long-term institutional care or home and community-based services;
   3. Are excluded from coverage under a modified adjusted gross income (MAGI)-based program as referenced in WAC 182-503-0510 on the basis of medicare entitlement;
   4. Are not eligible for health care coverage under chapter 182-505 WAC due to citizenship or immigration requirements; or
   5. Are not eligible for health care coverage under chapter 182-505 WAC due to income which exceeds the applicable standard for coverage.
2. The agency determines eligibility for Washington apple health (WAH) noninstitutional categorically needy (CN) coverage under chapter 182-512 WAC for an adult who is age 65 or older, or who meets the federal blind or disabled criteria of the federal SSI program, and:
   1. Meets citizenship/immigration, residency, and Social Security number requirements as described in chapter 182-503 WAC; and
   2. Has CN countable income and resources that do not exceed the income and resource standards in WAC 182-512-0010.
3. The agency determines eligibility for WAH health care for workers with disabilities (HWD) CN coverage for adults who meet the requirements described in WAC 182-511-1050, as follows:
   1. Are age 16 or older;
   2. Meet citizenship/immigration, residency, and Social Security number requirements as described in chapter 182-503 WAC;
   3. Meet the federal disability requirements described in WAC 182-511-1150;
   4. Are employed full or part-time (including self-employment) as described in WAC 182-511-1200.
4. The agency determines eligibility for WAH long-term care CN coverage for adults who meet the institutional status requirements defined in WAC 182-513-1320 under the following rules:
   1. When the person receives coverage under a MAGI-based program and needs long-term care services in an institution, the agency follows rules described in chapter 182-514 WAC;
   2. When the person meets aged, blind, or disabled criteria as defined in WAC 182-512-0050 and needs long-term care services, the agency follows rules described in:
      1. Chapter 182-513 WAC, for an adult who resides in an institution; and
      2. Chapter 182-515 WAC, for an adult who is determined eligible for WAH home and community-based waiver services.
5. The agency determines eligibility for WAH noninstitutional CN or medically needy (MN) health care coverage for an adult who resides in an alternate living facility under rules described in WAC 182-513-1205.
6. The agency determines eligibility for WAH-CN coverage under institutional rules described in chapters 182-513 and 182-515 WAC for an adult who:
   1. Has made a voluntary election of hospice services;
   2. Is not otherwise eligible for noninstitutional CN or MN health care coverage or for whom hospice is not included in the benefit service package available to the person; and
   3. Meets the aged, blind, or disabled criteria described in WAC 182-512-0050.
7. The agency uses the following rules to determine eligibility for an adult under the WAH-MN program:
   1. Noninstitutional WAH-MN is determined under chapter 182-519 WAC for an adult with countable income that exceeds the applicable CN standard; and
   2. Non-SSI-related institutional WAH-MN long-term care coverage is determined under WAC 182-514-0263 for pregnant people and people age 20 and younger:
      1. Meets institutional status requirements described in WAC 182-513-1320;
      2. Do not meet blind or disabled criteria described in WAC 182-512-0050; and
      3. Have countable income that exceeds the applicable CN standard.
   3. WAH-MN long-term care coverage is determined under WAC 182-513-1395 for an aged, blind, or disabled adult who resides in an institution and has countable income that exceeds the special income level (SIL).
8. An adult is eligible for WAH-MN coverage when he or she:
   1. Meets citizenship/immigration, residency, and Social Security number requirements as described in WAC 182-503-0505;
   2. Has MN countable income that does not exceed the effective MN income standards in WAC 182-519-0050, or meets the excess income spenddown requirements in WAC 182-519-0110;
   3. Meets the countable resource standards in WAC 182-519-0050; and
   4. Is 65 years of age or older or meets the blind or disabled criteria of the federal SSI program.
9. WAH-MN coverage is available for an aged, blind, or disabled ineligible spouse of an SSI recipient. See WAC 182-519-0100 for additional information.
10. An adult who does not meet citizenship or alien status requirements described in WAC 182-503-0535 may be eligible for the WAH alien emergency medical program as described in WAC 182-507-0110.
11. An adult is eligible for the state-funded medical care services (MCS) program when he or she meets the requirements under WAC 182-508-0005.
12. A person who is entitled to medicare is eligible for coverage under a medicare savings program or the state-funded buy-in program when he or she meets the requirements described in chapter 182-517 WAC.

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

Effective November 24, 2024

1. 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. 
2. 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.

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

Effective September 6, 2025

1. 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 a resettlement agency;
      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 resettlement agency which helped bring you to the United States so that the department of social and health services (DSHS) can promptly notify the resettlement agency (or sponsor) about the medical application.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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, T-5 or T-6 visa (derivative T-Visas), and the family member must meet eligibility requirements in subsections (1) and (2) of this section.
7. 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.
8. 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. The number of months you may receive RMA benefits could change if the federal Office of Refugee Resettlement changes the eligibility period.
9. 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.
10. 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.
11. 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.

WAC 182-507-0125 State-funded long-term care services.

Effective October 11, 2025

1. Caseload limits.
   1. The state-funded long-term care services program is subject to caseload limits determined by legislative funding.
   2. The home and community living administration (HCLA) must preauthorize state-funded long-term care service before payments begin.
   3. HCLA cannot authorize a service, under chapter 388-106 WAC or under chapter 388-825 WAC, if doing so would exceed statutory caseload limits.
2. Location of services. State-funded long-term care services may be provided in:
   1. The person's own home, defined in WAC 388-106-0010;
   2. An adult family home, defined in WAC 182-513-1100;
   3. An assisted living facility, defined in WAC 182-513-1100;
   4. An enhanced adult residential care facility, defined in WAC 182-513-1100;
   5. An adult residential care facility, defined in WAC 182-513-1100; or
   6. A nursing facility, defined in WAC 182-500-0050, but only if nursing facility care is necessary to sustain life; or
   7. A residential habilitation center, defined in WAC 388-835-0010, that is an intermediate care facility for individuals with intellectual disabilities (ICF/IID), defined in WAC 182-500-0050.
3. Client eligibility. To be eligible for the state-funded long-term care services program, a person must meet all of the following conditions:
   1. General eligibility requirements for medical programs under WAC 182-503-0505, except (c) and (d) of this subsection;
   2. Reside in one of the locations under subsection (2) of this section;
   3. Attain institutional status under WAC 182-513-1320;
   4. Meet the functional eligibility requirements under WAC 388-106-0355 for nursing facility level of care or under WAC 388-845-0030 for ICF/IDD level of care;
   5. Meet the financial eligibility requirements under WAC 182-513-1315;
   6. Not have a penalty period due to a transfer of assets under WAC 182-513-1363;
   7. Not have equity interest in a primary residence more than the amount under WAC 182-513-1350; and
   8. Meet the requirements under chapter 182-516 WAC for annuities owned by the person or the person's spouse.
4. General limitations.
   1. If a person entered Washington only to obtain medical care, the person is ineligible for state-funded long-term care services.
   2. Disability requirements under WAC 182-512-0050 do not apply to state-funded long-term care services.
   3. The certification period for state-funded long-term care services may not exceed 12 months.
   4. People who qualify for state-funded long-term care services receive categorically needy (CN) medical coverage under WAC 182-501-0060.
5. A person who is not eligible for the state-funded long-term care services program under CN rules may qualify under medically needy (MN) rules under WAC 182-513-1395.
   1. The agency determines how much a person is required to pay toward the cost of care, using:
      1. WAC 182-513-1380, if the person resides in a nursing facility or residential habilitation center.
      2. WAC 182-515-1505 or 182-515-1510, if the person resides in one of the locations listed in subsection (2)(a) through (e) of this section.
6. 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.