Waiver Services - CNP DDD Waivers
DSHS Home Page

EAZ
  Search   for:   
DSHS HomeACES ManualEAZ ManualSocial Services ManualWork First Manual
Acronyms  Revisions  WAC Number Index  Site Map  WCCC  DSHS Home

Waiver Services - CNP DDD Waivers

Revised July 8, 2008

Purpose: Determining Medicaid eligibility and client responsibility for cost of care for clients functionally eligible for a DDD Waiver program.
WAC 388-515-1510Division of developmental disabilities (DDD) home and community based services waivers
WAC 388-515-1511What are the general eligibility requirements for waiver services under the four division of developmental disabilities (DDD) home and community based services (HCBS) waivers?
WAC 388-515-1512What are the financial requirements if I am eligible for Medicaid under the noninstitutional categorically needy program (CN-P)
WAC 388-515-1513How does the department determine if I am financially eligible for medical coverage if I am not eligible for Medicaid under a categorically needy program (CN-P) listed in WAC 388-515-1512 (1)?
WAC 388-515-1514How does the department determine how much of my income I must pay towards the cost of my care if I am not eligible for Medicaid under a categorically needy program (CN-P) listed in WAC 388-515-1512 (1)?

WAC 388-515-1510

WAC 388-515-1510

Effective June 20, 2008

WAC 388-515-1510 Division of developmental disabilities (DDD) home and community based services waivers

The four sections that follow describe the general and financial eligibility requirements for the division of developmental disabilities (DDD) home and community based services (HCBS) waivers. 

  1. WAC 388-515-1511 describes the general eligibility requirements under the four DDD HCBS Waivers. 
  2. WAC 388-515-1512 describes the financial requirements if you are eligible for Medicaid under the noninstitutional categorically needy program (CN-P).
  3. WAC 388-515-1513 describes the initial financial requirements if you are not eligible for Medicaid under a categorically needy program (CN-P) listed in WAC 388-515-1512(1).
  4. WAC 388-515-1514 describes the post eligibility financial requirements if you are not eligible for Medicaid under a categorically needy program (CN-P) listed in WAC 388-515-1512(1).

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.
WAC 388-515-1511
WAC 388-515-1511

Effective June 20, 2008

WAC 388-515-1511 What are the general eligibility requirements for waiver services under the four division of developmental disabilities (DDD) home and community based services (HCBS) waivers?

This section describes the general eligibility requirements for waiver services under the four DDD home and community based services (HCBS) waivers.

  1. The four DDD HCBS Waivers are:
    1. Basic;
    2. Basic plus;
    3. Core; and
    4. Community Protection.
  2. The requirements for services for DDD HCBS waivers are described in chapter 388-845 WAC.  The department establishes eligibility for DDD HCBS waivers.  To be eligible, you must:
    1. Be an eligible client of the division of developmental disabilities (DDD);
    2. Meet the disability criteria for the supplemental security income (SSI) program as described in WAC 388-475-0050;
    3. Require the level of care provided in an intermediate care facility for the mentally retarded (ICF/MR);
    4. Have attained institutional status as described in WAC 388-513-1320;
    5. Be able to reside in the community and choose to do so as an alternative to living in an ICF/MR;
    6. Need waiver services as determined by your plan of care or individual support plan; and:
      1. Be able to live at home with waiver services; or
      2. Live in a department contracted facility, which includes:
        1. A group home;
        2. Group training home;
        3. Child foster home, group home or staffed residential facility;
        4. Adult family home (AFH); or
        5. Adult residential care (ARC) facility.
      3. Live in your own home with supported living services from a certified residential provider; or
      4. Live in the home of a contracted companion home provider; and
    7. Be both Medicaid eligible under the categorically needy program (CN-P) and be approved for services by the division of developmental disabilities.

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.
WAC 388-515-1512
WAC 388-515-1512

Effective June 20, 2008

WAC 388-515-1512 What are the financial requirements if I am eligible for Medicaid under the noninstitutional categorically needy program (CN-P)

  1. You automatically meet income and resource eligibility for DDD Waiver services if you are eligible for Medicaid under a categorically needy program (CN-P)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. These clients have Medicaid eligibility determined and maintained by the Social Security Administration;
    2. Healthcare for workers with disabilities (HWD) described in WAC 388-475-1000 through 388-475-1250;  
    3. SSI-related CN-P Medicaid described in WAC 388-475-0100 (2) (a) and (b) or meets the requirements in WAC 388-475-0880  and is CN-P eligible after the income disregards have been applied;
    4. CN-P Medicaid for a child as described in WAC 388-505-0210  (1), (2), (7) or (8); or
    5. General assistance expedited Medicaid disability (GA-X) or general assistance based on aged/blind/disabled criteria described in WAC 388-505-0110  (6).
  2. If you are eligible for a CN-P Medicaid program listed in subsection (1) above, you do not have to pay (participate) toward the cost of your personal care and/or habilitation services.
  3. If you are eligible for a CN-P Medicaid program listed in subsection (1) above, you do not need to meet the initial eligibility income test of gross income at or below the special income level(SIL), which is three hundred percent of the federal benefit rate (FBR).
  4. If you are eligible for a CN-P Medicaid program listed in subsection (1), you pay up to the ADSA room and board standard described in WAC 388-515-1505. Room and board and long-term care standards are located at http://www.dshs.wa.gov/manuals/eaz/sections/LongTermCare/LTCstandardspna.shtml.
    1. If you live in an ARC, AFH or DDD group home, you keep a personal needs allowance (PNA) and use your income to pay up to the ADSA room and board standard.  The PNA from July 1, 2007 through June 30, 2008 is forty dollars and twelve cents.  Effective July 1, 2008 the PNA increases to forty-one dollars and forty-four cents. 
    2. If you receive non SSI income, you may keep up to an additional twenty dollars.
    3. If you are eligible for a premium based Medicaid program such as healthcare for workers with disabilities (HWD), you must continue to pay the Medicaid premium to remain eligible for that CN-P program.

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.
WAC 388-515-1513
WAC 388-515-1513

Effective June 20, 2008

WAC 388-515-1513 How does the department determine if I am financially eligible for medical coverage if I am not eligible for Medicaid under a categorically needy program (CN-P) listed in WAC 388-515-1512 (1)?

If you are not eligible for Medicaid under a categorically needy program (CN-P) listed in WAC 388-515-1512 (1) we must determine your eligibility using institutional Medicaid rules. This section explains how you may qualify under this program. You may be required to pay towards the cost of your care if you are eligible under this program. The rules explaining how much you have to pay are listed in WAC 388-515-1514.  To qualify, you must meet both the resource and income requirements. 

  1. If you have resources which are higher than the standard allowed under WAC 388-515-1350, we may reduce the amount we are required to count if you have unpaid medical expenses.
    1. We will reduce your resources in an amount equal to the unpaid medical expenses you verify.  The anticipated cost of your waiver services cannot be used as a medical expense to qualify for this deduction.
    2. If your remaining resources, after the deduction in section (1) (a) are still over the standard, you are ineligible until your resources are below the standard.
    3. You are not subject to a transfer of asset penalty described in WAC 388-513-1363 through 388-513-1366.
    4. Equity in your home is five hundred thousand dollars or less as described in WAC 388-513-1350.
  2. Your gross non excluded income must be at or below the special income level (SIL) which is three hundred percent of the federal benefit rate (FBR). The department follows the rules in WAC 388-513-1325, 388-513-1330 and 388-513-1340  to determine available income and income exclusions.

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.
WAC 388-515-1514
WAC 388-515-1514

Effective June 20, 2008

WAC 388-515-1514 How does the department determine how much of my income I must pay towards the cost of my care if I am not eligible for Medicaid under a categorically needy program (CN-P) listed in WAC 388-515-1512 (1)?

If you are not eligible for Medicaid under a categorically need program (CN-P) listed in WAC 388-515-1512(1), the department determines how much you must pay based upon the following:

  1. If you are an SSI-related client living at home as defined in WAC 388-106-0010, you keep all your income up to the SIL (three hundred percent of the FBR) for your personal needs allowance (PNA ).
  2. If you are an SSI-related client and you live in an ARC, AFH or DDD group home, you:
    1. Keep a personal needs allowance (PNA ) from your gross non excluded income. The PNA from July 1, 2007 through July 30, 2008 is forty dollars and twelve cents.  Effective July 1, 2008 the PNA increases to Forty-one dollars and forty-four cents.
    2. May keep up to an additional twenty dollars from your non SSI income; and
    3. Pay for your room and board up to the ADSA room and board  rate described in http://www.dshs.wa.gov/manuals/eaz/sections/LongTermCare/LTCstandardspna.shtml.
  3. Income that remains after the allocation described in (2) above, is reduced by allowance deductions in the following order:
    1. If you are working, we allow an earned income deduction of the first sixty-five dollars plus one-half of the reamining earned income;
    2. Guardianship fees and administrative costs including any attorney fees paid by the guardian only as allowed by chapter 388-79 WAC;
    3. Current or back child support garnished from your income or withheld according to a child support order in the month of the garnishment if it is for the current month.  If we allow this as a deduction from your income, we will not count it as your child's income when determining the family allocation amount;
    4. A monthly maintenance needs allowance for your community spouse not to exceed that in WAC 388-513-1380  (5)(b) unless a greater amount is allocated as described in subsection (e) of this section.  This amount:
      1. Is allowed onloy to the extent that your income is made available to your community spouse; and
      2. Consists of a combined total of both:
        1. One hundred fifty percent of the two person federal poverty level (FPL ). This standard increases annually on July 1st (http://aspe.os.dhhs.gov/poverty/ ); and
        2. Excess shelter expenses.  For the purposes of this section, excess shelter expenses are the actual required maintenance expenses for your community spouse's principal residence.  These expenses are determined in the following manner:
          1. Rent, including space rent for mobile homes, plus;
          2. Mortgage, plus;
          3. Taxes and insurance, plus;
          4. Any required payments for maintenance care for a condominiuim or cooperative minus;
          5. The food assistance standard utility allowance (for long term care services this is set at the standard utility allowance  (SUA) for a four-person household), provided the utilities are not included in the maintenance charges for a condominium or cooperative, minus;
          6. The standard shelter allocation.  This standard is based on thirty percent of one hundred fifty percent of the two person federal poverty level.  This standard increases annually on July 1st (http://aspe.os.dhhs.gov/poverty ); and
          7. Is reduced by your community spouse's gross countable income.
          8. May be greater than the amount in subsection (d)(ii) only when:
        3. There is a court order approving a higher amount for the support of your community spouse; or
        4. A hearings officer determines a greater amount is needed because of exceptional circumstances resulting in extreme financial duress.
    5. A monthly maintenance needs amount for each minor or dependent child, dependent parent or dependent sibling of your community or institutionalized spouse. The amount we allow is based on the living arrangement of the dependent.  If the dependent:
      1. Resides with your community spouse, the amount is equal to one-third of the community spouse allocation as described in WAC 388-513-1380  (5) (b) (i) (A) that exceeds the dependent family member's income (child support received from a noncustodial parent is considered the child's income);
      2. Does not reside with the community spouse, the amount is equal to the MNIL  based on the number of dependent family members in the home less their separate income (child support received from a noncustodial parent is considered the child's income).
    6. Your unpaid medical expenses which have not been used to reduce excess resources.  Allowable medical expenses are described in WAC 388-513-1350.
    7. The total of the following deductions cannot exceed the SIL  (three hundred percent of the FBR):
      1. Personal needs allowances (PNA )  in subsection (1) for in home or subsection (2) (a) in a residential setting; and
      2. Earned income deduction of the first sixty-five dollars plus one-half of the remaining earned income in subsection (3) (a); and
      3. Guardianship fees  and administrative costs in subsection (3) (b).
  4. If you are eligible for general assistance expedited Medicaid disability (GA-X) or general assistance based on aged/blind/disabled criteria 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 described in http://www.dshs.wa.gov/manuals/eaz/sections/LongTermCare/LTCstandardspna.shtml;or
    3. When you live in an ARC or DDD group home, you are only eligible to receive a cash grant of thirty-eight dollars and eighty-four cents which you keep for your PNA.
  5. The combination of the room and board  amount and the cost of personal care and/or habilitation services (participation) after all allowable deductions have been considered is called your total responsibility.  You pay this amount to the ARC, AFH or DDD group home provider.

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.

Clarifying Information

DDD Waivers

  1. DDD Waivers are categorically needy (CN) waiver programs that provide clients described in WAC 388-515-1510 through 388-515-1514 with alternatives to placement in an Intermediate Care Facility for the Mentally Retarded (ICF/MR).  These alternatives include remaining in their home or placement in an alternate living facility (ALF) approved by the Division of Developmental Disabilities (DDD).  The goal of these programs is to provide a safe level of care with maximum independence.
  2. In addition to the income allocations described in WAC 388-515-1514  the case manager (CM) can request an exception to rule to reduce the client's participation in the cost of care when the client requires the services of a guardian.
  3. If the client lives in an alternate living facility (ALF), the DDD case manager determines the amount the client keeps for personal needs and the amount the client pays for room and board.
  4. The department determines financial eligibility for these services according to WAC 388-513-1315.  A client must have non excluded income at or below the special income level (SIL),  but can reduce excess resources in the initial or review months as described in WAC 388-513-1350.
  5. Guardianship fees  can be deducted in the post eligibility (participation determination) process if approved by court order. 
  6. DDD Waiver clients at home do not pay toward personal care costs as they keep up to the Medicaid SIL.  (300% of the FBR).  DDD Waiver clients can pay up to the ADSA room and board  standard if living in an alternative living facility (ALF) such as a DDD group home or adult family home. 
  7. Clients who are eligible to receive Healthcare for Workers with Disabilities (HWD) can receive DDD Waiver services if approved by DDD.  HWD/S08 is the priority program in ACES if the client is better off with HWD/S08 over the C01 program.  See HWD  for more instructions on HWD for DDD Waiver clients. 

1619B and "Deemed SSI eligible" clients

SSI deemed eligible clients (countable income is under the SSI standard after DAC, Pickle/COLA exclusion and SSI closed due to the receipt of DAC, COLA) do not pay toward the cost of personal care.  They DO pay room and board if residing in an adult family home, boarding home or DDD group home.  These facilities are also referred to as alternate living facilities or ALFs.  ALFs are not medical institutions. 

1619(b) clients are considered the same as an “SSI client”. SSI payments have stopped due to earnings. SDX indicates continue Medicaid on SDX 1 in the Med Elig field. 1619(b) clients do not pay toward the cost of personal care. They DO pay room and board in an ALF. 

 "Deemed SSI clients" and 1619(b) status clients can have gross income over the Medicaid SIL (300% of the FBR) and still be eligible for the Waiver.  1619(b) is described in WAC 388-505-0110 (2)

Deemed SSI eligible clients.  What does that mean?

Clients who have COUNTABLE income under the SSI standard after allowing the exclusion for Disabled Adult Child (DAC), Pickle/COLA,  Widow/Widowers AND their SSI was closed because of the receipt of the DAC/COLA/Widow(er) income.  These exclusions are described in the SSI related Medicaid chapter.  Clients continue to receive CN-P Medicaid as long as they meet resource criteria. Not every client receiving DAC income is eligible for this exclusion.  These are the requirements:

  • Lost cash payment of SSI after 7/1/88 due to receipt of DAC benefits from SSA or a COLA to those benefits.
  • Disability onset date prior to age 22

Deemed SSI eligible clients do not pay Waiver service participation, they do pay room and board if living in an adult family home, DDD group home or boarding home (ALFs). 

If countable income is over the SSI standard after the exclusion then all income is counted in post eligibility in determining service participation for DDD Waiver clients living in an ALF.  This includes DAC income.

Individuals who qualify for the DAC exclusion and countable income after the exclusion is under the SSI standard are referred to as "Protected DAC" cases. 

Instructions are found in WAC 388-475-0880  Special income disregards for SSI-related medical programs.

In other words, an individual who would be eligible for CN-P/S02 in ACES

A client who would otherwise qualify for S02/CN SSI related medicaid because their countable income is at or below the SSI standard does not participate towards personal care under the Waiver program.  (but they are responsible to pay room and board when living in an ALF). 

These clients do need to meet the same criteria for long-term care services as other Waiver clients and may be subject to transfer of asset penalties or excess home equity described in WAC 388-513-1350  (7)

The room and board amount ADSA uses is based on the FBR minus the current HCS CN Waiver personal needs allowance (PNA) for individuals residing in an ALF.

SeeLong-term care standards and PNA amounts. 

1619(b) status, what does it mean? 

SSI clients whose earnings put them over the SSI cash benefit standard but Social Security continues their SSI eligibility.  They are considered an SSI recipient and continue to send in reviews to Social Security.  The SDX indicates continued Medicaid when a client is 1619(b).  1619(b) clients don’t pay toward the cost of personal care because they are considered to be an SSI client.  Follow the same instructions as SSI clients on a waiver for 1619(b) clients.  Code SI on UNER to prevent an eligibility review from being generated for the C01.  Clients would pay the ADSA room and board amount if residing in an ALF.  Clients can have GROSS income over the SIL  and continue to receive a DDD Waiver as long as Social Security maintains their 1619(b) status

How is this different if the client enters a Medical Institution?

Individuals entering a Medical institution and are "institutionalized" 30 days or more do participate toward the cost of care.  This includes "deemed SSI eligible" clients.  Institutional rules do apply once a client has entered a Medical institution.  (WAC 388-513-1380) This means most of these individuals would participate in a medical institution.  This is called the post eligibility process. 

 

Worker Responsibilities

  1. Follow procedures in Section D:  ELIGIBILITY REQUIREMENTS to establish financial eligibility.
  3. Consider a client who is approved for DDD Waivers by DDD as having attained institutional status. 
  4. The DDD case manager sends a DSHS 15-345 CSO/DDD Communication to inform the financial worker of DDD Waiver eligibility and the start date of services, type of service, change of service, if in an alternate living facility  (ALF) such as an adult family home or DDD group home, the state daily rate of the facility, address of facility placement and other changes described in the instructions of the DSHS 15-345  form. 
  5. Indicate the address of the DDD office on the AREP screen of the C01 Waiver Assistance Unit.  DDD would then receive notice of termination or changes in the Medicaid case. 
  6. DDD must be informed of a C01/Waiver closure as the services authorized under the Waiver is based on eligibility for the Waiver Medicaid program.  DDD will receive a copy of all notices for the Waiver assistance unit (C01) via the AREP screen.  This informs DDD of the changes in the case including participation changes. 
  7. Eligibility for the C01 DDD Waiver is a 2 prong eligiblity program.  The individual must meet both the financial and functional eligiblity for the program.  If DDD waiver services are closed by DDD, DDD must inform the financial worker via the DSHS 15-345.  Financial would then consider a reconsideration of Medicaid for that individual.
  8. The C01 program code is used for the DDD Waivers.  There are exceptions:
    1. Eligibility for Healthcare for Workers with Disabilities (HWD), use the S08/HWD program.  Refer to the HWD specialist.
    2. DDD Foster Care Program
    3. Because of systems issues such as a SSI deemed eligible client with gross income over the SIL.  Use a S02 program
  9. Information on DDD community based waivers are in WAC 388-845
  10. Follow necessary supplemental accommondation services (NSA).  The DDD case manager will inform the CSO of any additional NSA services indicated in the CARE plan with a accomodation to access or maintaining services.

ACES Instructions

Categorically Needy Home Services (C01)

Authorized Representative Payee Chart for AREP screen

Transfer of Asset Screen

 

Back to top

Modification Date: July 8, 2008
Have comments on the manual? Please e-mail us. You can also use this link to report broken links or content problems.