What are the financial requirements for home and community based (HCB) services when you are eligible for a noninstitutional categorically needy (CN) medicaid program?
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What are the financial requirements for home and community based (HCB) services when you are eligible for a noninstitutional categorically needy (CN) medicaid program?

Revised December 8, 2008

Purpose: This section describes those who are eligible for a non institutional program (such as S02 or S01) and live outside a medical institution. Institutional waiver rules are not needed to determine eligibility for Medicaid.
WAC 388-515-1507What are the financial requirements for home and community based (HCB) services when you are eligible for a non institutional categorically needy (CN) medicaid program?

WAC 388-515-1507

WAC 388-515-1507

Effective July 24, 2009

WAC 388-515-1507 What are the financial requirements for home and community based (HCB) services when you are eligible for a non institutional categorically needy (CN) medicaid program?

  1. You are eligible for medicaid under one of the following programs:
    1. Supplemental security income (SSI) eligibility described in WAC 388-474-0001. This includes SSI clients under 1619B status;
    2. SSI-related CN medicaid described in WAC 388-475-0100 (2)(a) and (b);
    3. SSI-related healthcare for workers with disabilities program (HWD) described in WAC 388-475-1000.  If you are receiving HWD you are responsible to pay your HWD premium as described in WAC 388-475-1250.  This change is effective 4/1/2009;
    4. General assistance expedited medicaid disability (GAX) or general assistance based on aged/blind/disabled criteria described in WAC 388-505-0110(6) and are receiving CN medicaid.
  2. You do not have a penalty period of ineligibility for the transfer of an asset as described in WAC 388-513-1363 through 388-513-1366. This does not apply to PACE or hospice services.
  3. You do not have a home with equity in excess of the requirements described in WAC 388-513-1350.
  4. You do not have to meet the initial eligibility income test of having gross income at or below the special income level  (SIL).
  5. You do not pay (participate) toward the cost of your personal care services.
  6. If you live in a department contracted facility listed in WAC 388-515-1506 (1)(g), you pay room and board up to the ADSA room and board standard. The ADSA room and board standard is based on the federal benefit rate (FBR) minus the current personal needs allowance (PNA) for HCS CN waivers in an alternate living facility.
    1. If you live in an assisted living (AL) facility, enhanced adult residential center (EARC), or adult family home (AFH) you keep a PNA of sixty-two dollars and seventy-nine cents and use your income to pay up to the room and board standard.
    2. If subsection (6) (a) applies and you are receiving HWD described in WAC 388-475-1000 you are responsible to pay your HWD premium as described in WAC 388-475-1250  in addition to the room and board standard. 
  7. If you are eligible for general assistance expedited medicaid disability (GAX) or general assistance based on aged/blind/disabled criteria described in WAC 388-505-0110(6), you do not participate in the cost of personal care and you may keep the following:
    1. When you live at home, you keep the cash grant amount  authorized under the general assistance program;
    2. When you live in an AFH, you keep a PNA of thirty-eight dollars and eighty-four cents, and pay any remaining income and general assistance grant to the facility for the cost of room and board up to the ADSA room and board  standard;
    3. When you live in an assisted living facility or enhanced adult residential center, you are only eligible to receive a cash grant of thirty-eight dollars and eighty-four cents, which you keep for your PNA.
  8. Current resource and income standards are located at: http://www.dshs.wa.gov/manuals/eaz/sections/LongTermCare/LTCstandardspna.shtml.
  9. Current PNA and ADSA room and board standards are located at: http://www.dshs.wa.gov/manuals/eaz/sections/LongTermCare/ltcstandardsPNAchartsubfile.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.

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Modification Date: December 8, 2008
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