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Revised October 22, 2013

Long-term care

Purpose: Many individuals receiving services through Home and Community Services (HCS) and Developmental Disability Administration (DDA) or Mental Health Division (RSN) have court ordered guardianships. This section gives information on who to send the court documents if received by the DDA financial LTC specialty unit or HCS financial worker and information on guardianships.

Chapter 388-79 WAC

Guardianship fees for clients of the department

These rules implement RCW 11.92.180 and 43.20B.460  to the extent that those statutes require the department to establish by rule the maximum amount of guardianship fees and additional compensation for administrative costs that may be allowed by the court for a guardian or limited guardian of an incapacitated person who is a Medicaid client of the department and is thus required by federal law to contribute to the cost of the client's long-term care.

Clarifying Information

Guardianship fees described in chapter 388-79 WAC are allowed as a post eligibility deduction when determining participation for long-term care Medicaid programs.  These are DDA and HCS Waivers and individuals who are receiving LTC Medicaid in a Medical institution.  Financial workers receive a copy of the final order describing the guardian/attorney fees allowed by the court.

WAC 182-515-1509  Describes the determination of participation for HCS Waivers. 

WAC 182-515-1510  Describes the determination of participation for DDAWaivers

WAC 182-513-1380  Describes the determination of participation for those in medical institutions.

Once the department has a court order, the department must allow the expense in the post eligibility process for the K and L track Institutional programs.

The combination of PNA, mandatory taxes, wages, guardianship fees and administrative costs cannot exceed the MNIL for clients in a medical institution.  (WAC 182-513-1380 (4) ).  There are times when the guardianship and/or administrative fees are over the amount allowed in a month (MNIL).  It may take 2 or more months to allow for the administrative cost and guardianship fee. 

For Waivers in an alternate living facility (ALF), an ETR to is needed to allow administrative costs or guardianship fees out of room and board.   Room and Board is not participation, therefore an approval through the Regional Designee is needed. 

For HCS cases, the ETR request is sent to the Regional HCS Financial Program Manager. (see list below for regional designee).

For DDA cases, the ETR request goes to the DDA case manager.  The deduction from service participation must always come first before allowing a deduction from room and board.   

Guardianship fees is not an allowable deduction when determining eligibility for SSI related medical programs such as S-series or G03.

Guardianship fees are coded on the LTCX, LTC expense screen in ACES for the K, C and L track programs.  More information regarding guardianships and ACES is located below. 

Guardianship training packet for Financial Workers

The HCS training packet with examples explains how Guardianship deductions work in determining the client's contribution toward the cost of care for institutional (medical institutions) and institutional Waivers (DDD and HCS Waiver programs).

HCS Guardianship Training

Chapter 11.92 RCW Guardianship-powers and duties of guardian or limited guardian

Worker Responsibilities


Chapter 388-79 WAC states the guardian must notify the Regional office of the agency authorizing services prior to a court date to authorize guardianship fees.  The guardians should be notifying the Regional Office of the agency authorizing services directly of the court notification.  This would be either the HCS or DDD Regional Designee. For Mental Health, this would be the RSN.

The department is entitled to be notified by the guardian/attorney of the court proceedings as described in RCW 11.92.150.  If the department decides to contest the proposed fees and costs, it is the responsibility of the HCS, DDD Regional designee to start that process. 

For clients receiving services with HCS, each HCS regional office has a designee who is notified by the guardian.   The HCS regional designee will notify of the HCS financial worker of the court order.  For HCS Waiver clients in an ALF, approved guardianship fees must be deducted from personal care participation first.  An ETR must be submitted to the Regional designee for approval before a deduction from room and board is allowed.  Guardianship fees are coded on the LTCX screen, any approved ETR from room and board is coded as an ETR on the LTCX screen. 

For CN Waiver programs, see WAC 182-515-1509 for HCS (COPES)Waiver, WAC 182-515-1514 for DDA Waivers.

The financial worker allows guardianship fees and administrative fees as a deduction in determining participation for waivers and institutional medicaid once there is an approved court order as described in WAC 182-513-1380 (4) and WAC 388-79.

If the court order indicates in excess of the amount allowed by WAC 388-79, contact the Regional Designee indicated indicated below. 

Find local HCS offices by county 

For clients receiving services through HCS the court notices and documents regarding guardianships must go to the following HCS Regional Designee. 

DSHS has 3 Regions.  Click on the Map  to determine what region your county is in.

HCS Regional Designee Contacts:

Region 1 North -Stevens, Pend Oreille, Grant, Adams, Lincoln, Okanogan, Ferry, Douglas, Whitman, Spokane.   

Spokane HCS Attn:  Terry Brauner FAX (509) 329-3642
1330 N. Washington Street, Suite 3000
Spokane WA 99201
(509) 323-9400 or 1-800-459-0421
FAX# (509) 458-3558
TTY# (509) 456-2827

Region 1 South- Klickitat, Yakima, Walla Walla, Franklin, Benton, Garfield, Columbia, Asotin, Kittitas.

Yakima Office  Attn:  Annie Vasquez (509) 575-2286
1002 N. 16th Ave (Office)
Yakima WA 98902
(509) 225-4400 or 1-800-822-2097
Fax: (509) 575-2286

Region 2 South-King County  Attn: Jerald Ulrich for Greg Heartburg Fax (206) 341-7607
1737 Airport Way S, Suite 130 (Office)
Seattle, WA 98134
P. O. Box 24847 (Mail)
Seattle, WA 98124-0847
206-341-7750 or 1-800-346-9257
TTY: 1-800-833-6384

Region 2 North-Snohomish, Whatcom, Skagit, Island Attn: Wendy Healey for Greg Heartburg, FAX (425)339-4859

Everett HCS
840 N. Broadway, Building A, Ste. 330
Everett, WA 98201-1262  (425) 339-1958

Region 3 HCS Pierce, Kitsap, Clallam, Jefferson, Mason, Thurston, Lewis, Pacific, Grays Harbor, Cowlitz, Clark Counties   Attn:  Ian Horlor FAX (253) 476-7158

Tacoma HCS
1949 S. State St.,
Tacoma, WA. 98405-2850
(253) 476-7200 or 1-800-442-5129  TTY: 253-593-5471

For clients receiving services through DDA the financial worker needs to fax or mail the guardianship court notices and documents to the following DDA Regional Designee:

DSHS has 3 Regions.  Click on the Map  to determine what region your county is in.

DDA Regional and Facility Contacts

Region 1 North DDA:

Attn:  Kim Abe-Gunter

Fax 509-568-3037

611 West Indiana Ave

Spokane WA  99205-4221

Region 1 South DDA:

Attn:  Tory Fiedler

Fax 509-574-5607

PO Box 12500 Yakima WA  98909-2500

Region 2 DDA:

Attn:  Martha Gluck

Fax 206-720-3334

1700 East Cherry St

Seattle WA  98122

Region 3 DDA (and Frances Haddon Morgan Center RHC)

Attn:  Anna Facio

6860 Capitol Blvd SE

Point Plaza East

Olympia WA  98504

Fax:  360-586-6502


DDA Facilities   Guardianship paperwork is sent or faxed to: 

Lakeland Village RHC

Attn:  Laura Ryan

Fax 509-299-1070

PO Box 200 Medical Lake WA 99022-0220

Yakima Valley School

Attn:  Martin Brown

Fax 509-698-1323


609 Speyers Rd

Selah WA  98942

Fircrest School

Attn:  Lura Dunn

Fax 206-361-3035

15230 15th NE

Shoreline WA  98155-7196

Rainier School

Attn:  Alan McLaughlin

PO Box 600

Buckley WA  98321-0600

Guardianship notices for Eastern and Western State Hospital residents: 

Indicate attention Guardianship-Administrator

Eastern State Hospital:

PO Box 800
Maple Street
Mail Stop B 32-23
Medical Lake, WA 99022-0800
Phone: (509) 565-4000
Fax: (509) 565-4705

Western State Hospital

Western State Hospital: Public Information Officer
9601 Steilacoom Blvd S.W. Building 18
Tacoma, Washington 98498-7213
Phone: (253) 582-8900
Fax (253) 756-2879

Guardianships and ACES

Guardianships in a Medical Institution

7//2008 an ACES fix was promoted to match the policy per WAC 182-513-1380 (4)   regarding the guardian deduction.

The combination of PNA, mandatory taxes, wages from approved employment and guardianship/attorney fees cannot exceed the MNIL in a month.  The correct order of deductions that cannot exceed the MNIL are:

  • PNA
  • Mandatory Taxes
  • Wages from approved employment
  • Guardianship/Attorney fees

Note:  65 and 1/2 deduction is not allowed for earnings in a Medical institution, however a wage deduction is allowed dollar for dollar up to the MNIL after allowing the PNA and mandatory tax deduction. Approved wages need to be coded as RH.

Modification Date: October 22, 2013