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Long Term Care

Revised April 20, 2009

Purpose: Long Term Care Eligibility. This section describes institutional medical programs, Home and Community based Waiver programs authorized by Division of Developmental Disabilities (DDD) and Home and Community Services (HCS), Hospice authorized by Health & Recovery Services (HRSA), Mental Health facilities, Medicaid Personal Care (MPC) and Adult Protective Services (APS). HCS has financial staff responsible for cases receiving services from HCS. CSO staff are responsible for cases with LTC services through Hospice, DDD, Mental Health and family/children related programs. See LTC Overview for detailed information on responsibilities and program administration.

Long-term Care WAC Index Long Term Care WAC Index

Overview Overview (Long Term Care)

Definitions Definitions (Long Term Care and Medical Definitions)

Long Term Care Standards and Personal Needs Allowance Charts Long Term Care Medical Standards-Personal Needs Allowance (PNA) charts

Medical Coverage Groups Chart. Institutional and Non Institutional Programs Medical Coverage Group chart for all Medical programs.

Eligibility long-term care (LTC) Eligibility Requirements                                                                               Institutional Status                                                                                     Available Income                                                                                      Income Exclusions and Disregards                                                            Available Resources Trusts, Annuities and Life Estates including definitions                                                                                  Transfer of an Asset                                           Participation                                                                                             Allowable Medical Services and Expenses used to reduce Participation and MN Spenddown Medically Needy                                                                                     Other Facilities (fraternal, religious or benevolent)                                     Hospice    Guardianships    Hardship Waivers for long-term care (LTC) services   Lump sums and long-term care Short Stays in Medical Institutions (Temporary Admissions)   Working clients and long-term care

Non-institutional SSI related clients living in an adult family home or boarding home (G03) Non-Institutional SSI related clients living in an adult family home or boarding home (G03)

Waiver Services (Authorized by HCS or DDD) LTC Home & Community based services and hospice. (COPES, New Freedom, WMIP, PACE)    (HCS CN Waiver)                                                                                                                             DDD Waivers (DDD CN Waivers) Medically needy in-home waiver (MNIW) (HCS MN In-home Waiver)                                                                                                             Medically Needy Residential Waiver Program (MNRW) (HCS MN Residential Waiver)

Long Term Care for families and children Long-term care for families and children

Citizenship and Identity Requirements for Medicaid Citizenship and Identity requirements for Medicaid SSI related/Long-term care citizenship procedures GAX Adult Citizenship Requirements Citizenship and Identify documents Tier 1-4  Chart for Medicaid Exception to rule (ETR) process for HCS cases where we are unable to verify citizenship and ID. ACES manual material Citizenship and Identity verification for Medicaid Citizenship or Alien Status for all programs.  Includes Definitions, Date of entry, work quarters, SSN requirements, Appendix with decision trees and guides. Citizenship and Identity Verification for Medicaid-ACES Instructions

Long-term care insurance and third party resources Long-term care insurance and third party resources

Medicare and long-term care Medicare and long-term care

Alien Emergent Medical (AEM) and Nursing Home eligibility AEM and nursing home eligibility

Medicaid Personal Care (MPC) Medicaid Personal Care

Roads to Community Living (RCL) Roads to Community Living (RCL) Program

Necessary Supplemental Accommodation (NSA) and HCS Services NSA and HCS Services.

Trusts, Annuities and Life Estates Medical - Trusts, Annuities and Life Estates - Definitions   How Annuities Affect Eligibility for Medical Programs   How Life Estates Affect Eligibility for Medical Programs   How Trusts Affect Eligibility for Medical  Programs

* Life Estate Values chart * Life expectancy Annuity tables * APS * Veteran Administration benefits * Estate Recovery * Managed Care * Institutional Program and Coverage Groups-Appendix 1   Determining the Value of Life Estate -Appendix 2   Summary Chart for Institutional Income Eligibility Process Appendix 3   Veteran's Administration Benefits Chart  (Including information on VA benefits) Appendix 4    Individual Life Expectancy Annuity Tables-Appendix 5  Adult Abuse and Neglect Reporting-Adult Protective Services  (APS) Managed Care Information including information on WMIP project Estate Recovery Information including Estate Recovery sheet used by ADSA & Legal Services Bulletin

SSI related Medicaid links SSI-related Medical-General SSI related Medical-Resources SSI related Medical-Income SSI related Medical-Financial responsibility  (WAC 388-506-0620) SSI and State supplemental payment SSI Facilitation and Home and Community Services

Medical Assistance Programs Links This section contains links for Medical Assistance programs including: Adult Medical Programs Alien Emergency Medical (AEM) Family Medical Programs including institutional for family and children Healthcare for Workers with Disabilities Managed Care Medical Programs-Certification Periods Medicare Program Summary Refugee Medical Scope of Care Spenddown Standards Third Party Liability

How does living in an institution affect my eligibility for Basic Food? How does living in an institution affect my eligibility for Basic Food?

Long Term Care ACES Links Long Term Care, Alternate Care, Managed Care & Waiver Services BENDEX Information SDX Information PARIS Institutions for Mental Diseases (IMD) Medical Screens in ACES ACES Alerts

Other Long-term care Procedures and links Aging & Disability Services Administration (ADSA) Internet site  The site above includes information on HCS, DDD, APS, Area Agencies on Aging (AAA) caregiver and provider resources.  It includes a link for applying for Medicaid. HCS Financial LTC Training Modules (internal link) Questions and Answers on the COPES program from Washington LawHelp Questions and Answers on Medicaid for Nursing Home Residents from Washington LawHelp Rules and Policies Assistance Unit (RPAU). Indicates filings and proposed rule changes.  LTC WACs are filed under Aging & Disability Service Administration (ADSA). ADSA is responsible for chapters 388-513 (institutional medicaid), 388-515 (institutional Waivers), 388-561 (Trust, Annuities and Life Estates).  Statewide Health Insurance Benefits Advisors (SHIBA)  Helpline (assistance with Medical insurance including Medicare D plans) Centers for Medicare & Medicaid Services (CMS) -Health & Human Services Title 388 of Washington Administrative Code (WAC) Department of Social & Health Services (DSHS) SSA's Program Operations Manual System (POMS) (Federal site for policy on SSI related programs ) Social Security Act   Social Security Online Code of Federal Regulations (CFR) Medical Assistance Customer Service Center (HRSA ) 1-800-562-3022 (phone number used by clients receiving medical assistance and providers with issues relating to Medical coverage).

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Modification Date: April 20, 2009

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