Waiver Services - HCS MNP - Medically Needy Residential Waiver Program (MNRW) - B

Waiver Services - HCS MNP - Medically Needy Residential Waiver Program (MNRW) - B - Resources

Revised September 8, 2008

Purpose:

Medically needy residential waiver (MNRW) program.

WAC 388-515-1540

Clarifying information: MNRW Resources

Resource Standards

The resource standard for a single person is $2,000.00.
The resource standard for a married client living with his or her spouse is $3,000.00. The community spouse resource rules do not apply.
Allow the resource standard of $2,000.00 for a married client who is living apart from his or her spouse. Count only those resources in the client’s name and ½ of those held jointly with his or her spouse.
To determine whether or not we consider a client as living apart from his or her spouse, see the information under MNRW - A. - Financial and Functional Processes - Financial Responsibility of a Client's Spouse.

We can disregard excess resources up to the amount of incurred medical expenses that are still owed and not subject to reimbursement.
However, a client cannot “participate,” or contribute excess resources toward their cost of care.
If after disregarding incurred medical expenses the client still has excess resources, then the client is not resource eligible and is not eligible for the MNRW program.

Asset Transfers

The transfer rules are the same for the Medically Needy Residential Waiver program as they are for nursing home or COPES care.
Refer to Long Term Care - Transfers - WAC 388-515-1363, WAC 388-513-1364, WAC 388-513-1365, and WAC 388-513-1366 for rules regarding asset transfers.

EXAMPLE

Single Client with Excess Resources and Sufficient Medical Expenses:

A single MNRW applicant has $2,500 in countable resources. The applicant has a $500 hospital bill. The bill is unpaid, it is not reimbursable, and is not subject to a 3rd party payment. In addition, it has never been used to meet a spenddown or participation. We can disregard the $500 excess resources by the $500 hospital bill. The client is resource eligible for MNRW.

EXAMPLE

Single Client with Excess Resources and Sufficient Medical Expenses:

A single client has $2,500 in resource. In addition, the client has an unpaid hospital bill of $700. The bill is not reimbursable nor will a 3rd party pay it. In addition, it has never been used to meet a spenddown or participation.

We can disregard the $500 in excess resources. By disregarding $500, the countable resources are $2,000. Therefore, the client is resource eligible. The remaining $200 of the medical bill can be used to reduce client responsibility.

If the client believes he or she may go over resources again in the near future, the client can opt to not use the remaining $200 as a deduction from his or her responsibility in the cost of care. However, if the $200 is left unused as a deduction now and is used in the future to offset future excess resources, then it must still be unpaid and owing at the time is used to offset the excess resources.

EXAMPLE

Single Client with Excess Resources and Insufficient Medical Expenses:

A single MNRW applicant has $3,000 in countable resources. The applicant has a $700 unpaid doctor’s bill. The bill is unpaid, it is not reimbursable, and is not subject to a 3rd party payment. In addition, it has never been used to meet a spend down or participation. Although we can disregard $700 of the excess resources, after doing so the client will still have $2,300 in countable resources. Therefore, the client is over the resource limit and not resource eligible for MNRW.

EXAMPLE

Married Client with Resources Below the Standard:

A married client applies for the MNRW program and lives with his spouse. The only countable resource is a joint checking account with a balance of $3,000.00. The client is resource eligible for MNRW because the resource standard for a married couple is $3,000.00 while they live together. The client will continue to be resource eligible if he moves into an alternate living facility without his spouse because ½ of the value of the jointly held resources ($1,500) is less than the resource standard for a single person.

EXAMPLE

Married Client, Living Together, Resources Below Standard:

A married person living at home with her spouse applies for the MNRW program on 4/1/03. The applicant is seeking placement into a residential facility. The spouse is not receiving Medicaid. The applicant has a separate checking account with $2,500. The applicant’s spouse has a separate savings account with $400. These are the only countable resources they own. The applicant is resource eligible for MNRW in April because the total amount of resources for this married couple is $2,900 and the standard for a married couple living together is $3,000.

On 4/15/03 the client is authorized MNRW services and moves into an adult family home (AFH) by herself. Her husband remains at home. If the client still has $2,500 in resources on 5/1/03, then she will no longer be eligible for MNRW services. This is because we count their resources separately beginning the first of the month after the month they stop living together. In this scenario, the first full month apart is 5/03. On 5/1/03 the client’s resource standard becomes $2,000.

To remain MNRW eligible in 5/03, she will need to reduce her excess resources. She can do this by transferring the excess to her spouse before 5/1/03, spending the excess on personal items for herself, such as clothing, before 5/1/03, or by providing an outstanding medical bill of at least $500. If she does not reduce her excess resources by 5/1/03 and does not have a medical bill, then she will not be resources eligible beginning in 5/03 and must be terminated.

EXAMPLE

Married Client Relocating from Nursing Home with a Spouse Living at Home:

A married nursing home client with a spouse living in their home is identified as a potential MNRW client. The client has $2,000 in countable resources in his name only. The spouse has $23,000 in resources in her name only.

As long as they do not live together (share a room in the residential facility) after he discharges from the nursing home then we can consider him as a separate individual. His resources are below the standard. We will not count her separate resources when making his eligibility determination. Therefore, he is resource eligible.

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