Long Term Care Income & Resource Standards-Personal Needs Allowance (PNA) Charts
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Long Term Care Income & Resource Standards-Personal Needs Allowance (PNA) Charts


Revised August 29, 2014



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

WAC 182-513-1300Payment standard for persons in medical institutions.
WAC 182-513-1500Payment standard for persons in certain group living facilities.

NOTE: 

Personal Needs Allowance (PNA) chart. Includes the ADSA room and board rate

Definitions used in Long-term care and Medical programs

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. 

Current Health Care Authority (HCA) Medical income and resource standards

Washington State Medical income and resource standards.    Medical income and resource standards chart issued by Health Care Authority (HCA).  This chart includes LTC standards.  Standards charts from 2006 to the present are stored at this link. 

Internal DSHS ACES Standards chart. Includes all ACES standards (Medical, Cash, Food Assistance and history of standards)

Standards-Medical Assistance Programs (WAC references)


Long-term care resource standards



Resource standards   WAC 182-513-1350  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
Federal maximum spousal resource standard-community spouse resource allowance (CSRA) changes January 1 based on the consumer price index.

1/1/2014-12/31/2014

117,240

State spousal resource standard-community spouse resource allowance(minimum) Updates on July 1 every odd year based on RCW 74.09.575.   182-513-1350  (9)(b)(ii)  (note due to decrease in CPI during the 2009/2011 biennium standard remained the same)

    7/1/2013     53,016

 


Payment Standard for individuals in medical institutions

WAC 182-513-1300

WAC 182-513-1300

Effective January 1, 2013

WAC 182-513-1300 Payment standard for persons in medical institutions.

  1. "Medical institutions" include skilled nursing homes, public nursing homes, general hospitals, tuberculosis hospitals, intermediate care facilities, and psychiatric hospitals approved by the joint commission on accreditation of hospitals (JCAH). 
  2. The monthly payment standard for eligible persons in medical institutions is forty-one dollars and sixty-two cents.  The payment covers the person's need for clothing, personal maintenance, and necessary incidentals (CPI).

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.

Payment Standard for individuals in certain group living facilities

WAC 182-513-1500

WAC 182-515-1500

Effective January 1, 2013

WAC 182-515-1500 Payment standard for persons in certain group living facilities.

  1. A monthly grant payment of thirty-eight dollars and eighty-four cents will be made to eligible persons in the following facilities:
    1. Congregate care facilities (CCF);
    2. Adult residential rehabilitation centers/adult residential treatment facilities (AARC/ARTF); and
    3. Developmental Disabilities Administration (DDA) group home facilities. 
  2. The payment covers the person's need for clothing, personal maintenance, and necessary incidentals (CPI).

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.

Excess Home Equity Limits

Under section 6014 of the Deficit Reduction Act of 2005 (DRA), Medicaid will not pay for long-term care services for individuals whose equity interest in their home exceeds $500,000.  This provision applies to institutional and Waiver programs.  This rule also applies to Hospice when using institutional rules for eligibility. 

WAC 182-513-1350  implemented this change effective 5/1/2006.

Effective 1/1/2011 these limits are to be increased each year by the percentage increase in the consumer price index -Urban (CPIU).


Excess Home Equity Standards

Excess home equity limits. Applies to institutional Medicaid programs per WAC 182-513-1350 5/1/2006 -12/31/2010  500,000
Excess home equity limits. Applies to institutional Medicaid programs per WAC 182-513-1350   1/1/2011 - 12/31/2011  506,000
Excess home equity limits. Applies to institutional Medicaid programs per WAC 182-513-1350    1/1/2012 -12/31/2012  525,000
Excess home equity limits. Applies to institutional Medicaid programs per WAC 182-513-1350    1/1/2013-12/31/2013  536,000
Excess home equity limits. Applies to institutional Medicaid programs per WAC 182-513-1350   These limits may change on January 1 based on the consumer price index-Urban  (CPIU)  1/1/2014-12/31/2014  543,000

Long-term care Income Standards

 

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

1/1/2014-12/31/2014

2163

Federal Benefit Rate (FBR) 

Medically Needy Income Level (MNIL)  

Categorically Needy Income Level (CNIL)  

HCA Medical Standards chart

1/1/2014-12/31/2014

721

Federal Poverty Level   (FPL) Increases annually on April 1      4/1/2014     973
Basic community spouse maintenance and family allocation.  150% of the 2-person FPL increases annually on July 1. 182-513-1380  (5)(c) (i)(A) for spouse and 388-513-1380 (5)(d) dependent. 

7/1/2014

1967

Maximum community spouse maintenance allowance.  Increases annually on January 1 based on the consumer price index.  ( with excess shelter costs) 182-513-1380  (5)(b) 

1/1/2014-12/31/2014

2931

Excess shelter cost standard.  Increases annually on July 1. 30% of 150% of the 2-personFPL.  182-513-1380  (6)      7/1/2014

590

Utility standard for determining excess shelter costs for a community spouse.  Food Assistance Utility Standard (SUA) for a 4-person household. 182-513-1380  (6)(b)(v) Increases annually on 10/1

10/1/2013

10/1/2014

409

415


Nursing Facility average state rate. Used to determine eligibility for HCS HCB Waivers when gross income is over the Medicaid SIL

Nursing Facility average state rate. This standard is used to determine eligibility for HCB Waivers when the gross income is over the Medicaid SIL.  This is described in WAC 182-515-1508.

Rate is updated annually on October 1st. 

Monthly state average nursing facility rate 04/1/2012-09/30/2012 $5,626.00
Monthly state average nursing facility rate 10/1/2012-09/30/2013 $5,588.00
Monthly state average nursing facility rate 10/1/2013-09/30/2014  $5,542.00 
 Monthly state average nursing facility rate 10/1/2014-09/30/2015  $5,648.00

Nursing facility private rate standard. Used to determine period of ineligibility due to asset transfer

Reference WAC 182-513-1363, 182-513-1364, 182-513-1365 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. This standard is used to determine a period of ineligibility due to a resource transfer.

Rate effective 10/1/2014 through 9/30/2015

 Daily private nursing facility rate 10/1/2014  276
 Monthly private nursing facility rate  10/1/2014 8396

Rate effective 10/1/2013 through 9/30/2014

 Daily private nursing facility rate 10/1/2013  267 
 Monthly private nursing facility rate  10/1/2013 7994

Rate effective 10/1/2012 through 9/30/2013

 Daily private nursing facility rate  10/1/2012  258
 Monthly private nursing facility rate  10/1/2012  7844

Rate effective 10/1/2011 through 9/30/2012

 Daily private nursing facility rate  10/1/2011  246
 Monthly private nursing facility rate  10/1/2011  7474

Rate effective 10/1/2010 through 9/30/2011

 Daily private nursing facility rate  10/1/2010  238
 Monthly private nursing facility rate  10/1/2010  7219

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
     
   

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.

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.  (Under download 1998-2011 SSI FBR, Resource limits).


Special Income Level (SIL) 300% of the FBR


  1. The department compares a client’s non-excluded income to the SIL  to determine whether a client is eligible for LTC services under the CN program.
  2. The SIL  is equal to 300% of the annually adjusted SSI Federal Benefit Rate (FBR).
  3. The department does not allow income disregards when determining eligibility for CN institutional services. It reduces a client’s gross income only by the exclusions allowed by federal statute as described in WAC 182-513-1340

Federal Language regarding using gross income (before deductions) when comparing to the Medicaid SIL:

LIMITATIONS ON FFP.  Title 42: Public Health
PART 435—ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA
Subpart K—Federal Financial Participation
Limitations on FFP

 

§ 435.1005   Recipients in institutions eligible under a special income standard.

For recipients in institutions whose Medicaid eligibility is based on a special income standard established under §435.236, FFP is available in expenditures for services provided to those individuals only if their income before deductions, as determined by SSI budget methodology, does not exceed 300 percent of the SSI benefit amount payable under section 1611(b)(1) of the Act to an individual in his own home who has no income or resources.

[58 FR 4933, Jan. 19, 1993]

 


CLARIFYING INFORMATION


  1. 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.
    1. The SIL is equal to 300% of the annually adjusted SSI Federal Benefit Rate (FBR).
    2. The 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 182-513-1340
    3. Income disregards not allowed before doing the SIL comparison are the $20 disregard and 65 ½ earned income deduction and Impairment Related Work Expenses (IRWE). 
    4. The SIL is the maximum amount allowed by law as the CN income standard for institutional Medicaid.
  2. 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.   
    1. 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. 
    2. 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. 
    3. 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. 
    4. 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. 
    5. 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. 
    6. 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. 
    7. These clients do need to meet specific eligibility criteria for long-term care services.  Transfer of asset penalties and excess home equity (WAC 182-513-1350 (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. 
    8. For more information on SSI related exclusions including DAC, Pickle/COLA and Widowers:
Modification Date: August 29, 2014