How does the department determine if you are financially eligible for home and community based (HCB) services and hospice if you are not eligible for medicaid under a categorically needy (CN) program listed in WAC 388-515-1507(1)?
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How does the department determine if you are financially eligible for home and community based (HCB) services and hospice if you are not eligible for medicaid under a categorically needy (CN) program listed in WAC 388-515-1507(1)?

Revised May 13, 2013

Purpose: If you are not eligible for medicaid under a CN program listed in WAC 182-515-1507 (1) the department must determine eligibility using institutional medicaid rules. This section explains the qualifications using institutional medicaid rules.
WAC 182-515-1508How does the department determine if you are financially eligible for home and community based (HCB) services authorized byHCS and hospice if you are not eligible for Medicaid under a categorically needy (CN) program listed in WAC 388-515-1507(1) ?

WAC 182-515-1508

WAC 182-515-1508

Effective January 1, 2013

WAC 182-515-1508 How does the department determine if you are financially eligible for home and community based (HCB) services authorized byHCS and hospice if you are not eligible for Medicaid under a categorically needy (CN) program listed in WAC 388-515-1507(1) ?

  1. If you are not eligible for medicaid under a categorically needy (CN) program listed in WAC 388-515-1507(1), the department must determine your eligibility using institutional medicaid rules. This section explains how you may qualify using institutional medicaid rules.
  2. You must meet the general eligibility requirements described in WAC 388-513-1315 and 388-515-1506.
  3. You must meet the following resource requirements:
    1. Resource limits described in WAC 388-513-1350.
    2. If you have resources over the standard allowed in WAC 388-513-1350, the department reduces resources over the standard by your unpaid medical expenses described in WAC 388-513-1350 if you verify these expenses.
  4. You must meet the following income requirements:
    1. Your gross nonexcluded income must be at or below the special income level (SIL) which is three hundred percent of the federal benefit rate (FBR); or
    2. For home and community based (HCB) service programs authorized by HCS your gross nonexcluded income is:
      1. Above the special income level (SIL) which is three hundred percent of the federal benefit rate (FBR); and
      2. Net income is no greater than themedically needy income level (MNIL).  Net income is calculated by reducing gross nonexcluded income by:
        1. Medically Needy (MN) disregards found in WAC 388-513-1345; and
        2. The average monthly nursing facility state rate  is five thousand six hundred and twenty six dollars.  This rate will be updated annually starting October 1, 2012 and each year thereafter on October 1.  This standard will be updated annually in the long-term care section of the EAZ manual  described at http://www.dshs.wa.gov/manuals/eaz/sections/LongTermCare/LTCstandardspna.shtml
  5. The department follows the rules in WAC 388-513-1325, 388-513-1330 and 388-513-1340  to determine available income exclusions.
  6. Current resource and income standards (including the SIL, MNIL  and FBR) for long-term care are found at: http://www.dshs.wa.gov/manuals/eaz/sections/LongTermCare/LTCstandardspna.shtml.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.
Modification Date: May 13, 2013