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

Revised October 22, 2009

Purpose: The long-term care medical chart includes standards for income and resource eligibility The personal needs allowance (PNA) chart defines the amount of money a client is allowed to keep for their personal use

NOTE: Definitions and Acronyms  used in the long-term care standards and Personal Needs Allowance (PNA) chart. Defines a medical institution and an Alternate Living Facility (ALF)/residential setting.  Additional definitions used in Medicaid and long-term care Current and past history of Washington State Medical income and resource standards.    2nd bullet on this site stores the Medical income and resource standards chart issued by Health & Recovery Services Administration (HRSA).  This chart includes LTC standards.  Standards charts from 2006 to the present are stored at this link.

Long Term Care Medical Standards Resource standards  WAC 388-513-1350  Defining the resource standard and determining resource eligibility for long-term care (LTC) services  Description  Effective  Amount  Resource standard for SSI related  applicant 1/1/1989  2,000  Resource standard for SSI related  couple, both applying in same month 1/1/1989  3,000 State spousal resource standard-community spouse resource allowance(minimum) Increases on July 1 every odd year based on RCW 74.09.575.   388-513-1350  (9)(b)(ii) Federal Spousal Impoverishment information 7/1/2009 48,639 Maximum spousal resource standard-community spouse resource allowance (federal) Increases on January 1 based on the consumer price index.       388-513-1350  (9)(a) Federal Spousal Impoverishment information 1/1/2009  109,560 Income standards Used to determine income eligibility and financial participation in long-term care  Description  Effective  Amount Medicaid special income level (SIL) 300% of the FBR.  Increases annually on January 1. Maximum gross income level for CN-P institutional Medicaid 1/1/2009  2022 Federal Benefit Rate (FBR)  (based on SSI Federal Payment Amounts) Medically Needy Income Level (MNIL)   Categorically Needy Income Level (CNIL)   Note:  There will be no increase in these standards 1/1/2010. 1/1/2009  674 Federal Poverty Level (FPL) Increases annually on April 1  4/1/2009  903 Basic community spouse maintenance and family allocation.  150% of the 2-person FPL increases annually on July 1. 388-513-1380  (5)(c) (i)(A) for spouse and 388-513-1380 (5)(d) dependent. Federal link 7/1/2009  1822 Maximum community spouse maintenance allowance.  Increases annually on January 1 based on the consumer price index.  ( with excess shelter costs) 388-513-1380  (5)(b)  Federal link 1/1/2009  2739  Excess shelter cost standard.  Increases annually on July 1. 30% of 150% of the 2-person FPL.  388-513-1380  (6) Federal link 7/1/2009  547 Utility standard for determining excess shelter costs for a community spouse.  Food Assistance Utility Standard (SUA) for a 4-person household. 388-513-1380  (6)(b)(v) Increases annually on 10/1.  Note:  There is no increase 10/1/2009. 10/1/2008  384  Adult Day Health (eligibility for a CN Medicaid program plus income at or below 150% of the FPL) 1/1/2010  1355

PERSONAL NEEDS ALLOWANCE (PNA) and ADSA room and board standard LTC personal needs allowance chart

Nursing facility private rate standard. Used to determine period of ineligibility due to asset transfer    Reference WAC 388-513-1363, 388-513-1364, 388-513-1365 Transfer of an asset.  This rate increases annually on October 1.  It is calculated using the reported date from Medicaid cost reports and determined by ADSA.   It is used to determine a period of ineligibility due to a resource transfer.  Rate effective 10/1/2009 through 9/30/2010  Daily private nursing facility rate  10/1/2009  227  Monthly private nursing facility rate  10/1/2009  6916 Rate effective 10/1/2008 through 9/30/2009  Daily private nursing facility rate  10/1/2008 217   Monthly private nursing facility rate  10/1/2008 6589 Rates Prior to 09/30/2008   Daily private nursing facility rate 10/1/2007 through 9/30/2008 206 Monthly private nursing facility rate 10/1/2007 through 9/30/2008 6250  Daily private nursing facility rate  10/1/2006 to 9/30/2007  199  Monthly private nursing facility rate  10/1/2006 to 9/30/3007  6028    10/2005 change    Daily private nursing facility rate  10/1/2005 to 9/30/2006  190  Monthly private nursing facility rate  10/1/2005 to 9/30/2006  5763  10/2004 change  Daily private nursing facility rate  10/1/2004 to 9/30/2005 181  Monthly private nursing facility rate  10/1/2004 to 9/30/2005  5485    10/2003 change    Daily private nursing facility rate  10/1/2003 to 9/30/2004  172  Monthly private nursing facility rate  10/1/2003 to 9/30/2004  5204

Other Standards  Standards-Medical Assistance Programs Medical Income and Resource Standards Second bullet is the standard chart by HRSA.  Includes all medical standards including long term care.  Medical standards chart from 2006 to the present are stored on this site. Internal DSHS ACES Standards chart. Includes all ACES standards (Medical, Cash, Food Assistance and history of standards). Key Medicaid Standards from Washington Law Help site

Links to Federal Medicaid Standards Standards used for long-term care Medicaid eligibility are based on federal income and resource standards.  SSI Federal Payment Amounts Poverty Guidelines United States Department of Health & Human Services.  Includes a link with current and past HHS poverty guidelines. Poverty Guidelines  (link from Centers for Medicare & Medicaid Services) U.S. Department of Labor Consumer Price Index SSI and Spousal Impoverishment standards (Centers for Medicare & Medicaid Services) Link includes current substantial gainful activity (SGA) limit. Centers for Medicare & Medicaid Services Income and Resource standards (includes past standards)

CLARIFYING INFORMATION Special income level (SIL): The department compares a client’s non-excluded income to the SIL to determine whether a client is eligible for LTC services under the institutional CN program. The SIL is equal to 300% of the annually adjusted SSI Federal Benefit Rate (FBR). he department does not allow income disregards when determining eligibility for CN services. It reduces a client’s gross income only by the exclusions allowed by federal statute as described in WAC 388-513-1340.  Income disregards not allowed before doing the SIL comparison are the $20 disregard and 65 ½ earned income deduction. The SIL is the maximum amount allowed by law as the CN income standard for institutional Medicaid. Disabled Adult Children (DAC), Pickle/COLA, Widowers, SSI clients and SSI clients because of 1619B status.  How does the SIL affect their eligibility for HCBS Waiver programs.    Clients who are on SSI and are considered eligible for SSI by Social Security Administration (1619B) or Deemed eligible for SSI (Protected DAC, Widowers, Pickle/COLA ) who have countable income under the SSI Standard.  These clients may have gross income above the SIL.  Clients who are eligible to receive non-institutional CN-P Medicaid based on countable income below the SSI standard do not need to meet the SIL criteria for institutional Waiver Medicaid.  These clients are already eligible for CN-P Medicaid because their countable income is under the SSI standard.  They are receiving SSI or considered a SSI client due to 1619B status with Social Security Administration.  It is possible that a 1619B status client can have gross income over the SIL because of their earnings.  A 1619B client is treated just like a SSI client.  Their eligibility is maintained by the Social Security Administration and they do not need to submit eligibility reviews to DSHS for Medicaid eligibility.  The SDX gives information on clients having 1619B status and to continue the CN-P Medicaid eligibility.  Client’s deemed “SSI eligible” such as the disabled adult child (DAC), Pickle/COLA and Widowers group because their countable income after the allowable exclusion    is under the SSI standard can have gross income over the SIL, but as long as this group is eligible for CN-P under the S02 program, they are financial eligible for the HCS or DDD Waiver and do not participate toward their personal care.  Not all clients receiving DAC are considered deemed SSI clients if their non DAC countable income is over the SSI standard.  Clients receiving DAC benefits who have other countable income (after the DAC and other SSI related exclusions) UNDER the SSI standard are called “protected DAC” clients.  These clients are eligible for non institutional CN-P medicaid (S02 in ACES).  Clients receiving DAC benefits who have countable income after SSI related exclusions OVER the SSI standard are not considered protected DAC, they are not automatically eligible for a CN-P program and their countable income is considered in determining Medicaid eligibility.  These clients do need to meet specific eligibility criteria for long-term care services.  Transfer of asset penalties and excess home equity (WAC 388-513-1350 (7)) apply to Waiver and institutional long-term care services.  Transfer of asset penalties and excess home equity criteria does not apply to MPC services.  For more information on SSI related exclusions including DAC, Pickle/COLA and Widowers:

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Modification Date: October 22, 2009

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