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Long-term care Personal Needs Allowance (PNA) Chart

Revised October 16, 2009

Purpose: Use the PNA for the client’s circumstances based on the chart below.

LTC PNA Chart includes ADSA room and board rate    The PNA is based on living arrangment/setting and service throughout the month. If the client has lived in multiple settings or been on multiple services, choose the highest PNA available based on all the settings or services for the month, including the short-stay setting. A client going from ALF to NF in one month and back to an ALF the following month is allowed to keep the PNA for an ALF setting. A client going from COPES in home to NF on the 1st day of the month is allowed the full COPES PNA because they were in a home setting at least one moment in the the month. A client converting private pay to NF is allowed the NF PNA. A client converting private pay ALF to COPES ALF on the 1st day of the month is allowed the COPES ALF PNA. A client converting private pay ALF to COPES ALF any day of the month other than the first day is allowed the full MNIL as we cannot backdate COPES in that month. Private pay nursing home case to Medicaid: The PNA for private pay NF to medicaid is the medical institution PNA.   We do not allow the MNIL for private pay to Medicaid in the month of conversion UNLESS the client was residing outside a medical institution at any time during that month.  If the individual was in a medical institution the entire month, use the medical institution PNA in the conversion month.  When to use the MNIL as the PNA:   When a client admits or discharges home at any time during a month, their PNA is at least the MNIL, regardless of marital status. If a client is eligible for a PNA that is higher than the MNIL, use the higher PNA. Single HCS clients on Waiver services admitting to a facility get the higher HCS Waiver PNA when admitting from a home setting to a facility in a month.  (FPL ). Private pay ALF clients converting to medicaid on the first day of the month get the ALF PNA. (Waiver eligibility starts on the first day of the month) Private pay ALF clients converting to medicaid after the first day of the month get the MNIL. (Waiver eligibility starts on a day after the first of the month) This allows a case not converted on the first day of the month due to the inability to backdate waiver eligibility the full benefit of the MNIL. When do PNA standards change? See effective on the Medicaid standard chart when PNA amounts are based on the FPL, MNIL and SIL.  Links to the WAC are highlighted. PNA amounts in a medical institution or ALF  for SSI related change periodically due to legislature budget funding.  New Change.Effective 1/1/2009 PNA amounts for clients receiving MPC  or Waiver services from ADSA in an ALF  will be $62.79.  This amount matches the HCS (COPES) Waiver PNA in residential.  DDD Waiver and MPC clients were receiving $41.44 plus a $20 disregard from non SSI income.  This new PNA for all ADSA services in residential (ALF ) settings will match regardless of the service or whether a client is straight SSI or not.  PNA amounts for general assistance (state cash assistance programs), $90 VA improved pension and state veteran's home have not changed in several years. What is the ADSA room and board standard?  Clients living in alternate living facilities (ALF) such as adult family homes, boarding homes and DDD group homes must pay room and board to the facility from their income for their food and shelter.   ADSA clients have a room and board standard.  The formula is indicated in the standard chart below.   Medical Institutions WAC 388-513-1380  PNA Amount  Medical Institutions  (nursing home, hospice care center, RHC) out of home full month Effective 7/1/2008 and ongoing 57.28  State Veterans Home 160  Admit from home to NF during the month no Waiver services (MNIL)  674  Discharge to home from NF during the month no Waiver services (MNIL) 674  General Assistance (GA-U, GA-X, GA-D, GA-A) payment standard in a medical institution 41.62  Home and Community Service Waivers WAC 388-515-1505 (CN-P), 388-515-1540 (MN-P), 388-515-1550 (MN-P)   Home setting.  Single person (COPES, New Freedom, PACE, WMIP, RCL, MNIW)  FPL  increases annually April 1 (4/1/2009)  Married person on CN Waiver living at home and apart from the community spouse.  See note in WAC 388-515-1509 903 Home setting.  Married with a community spouse.(COPES, New Freedom, PACE, WMIP, RCL)  MNIL  increases annually January 1 674 ALF/residential settings  (COPES, New Freedom, PACE, MNRW, WMIP, RCL ) .  Effective 7/1/2008 and ongoing 62.79 Maintenance in an ALF /residential settings.  From this amount a client keeps $60.78 PNA and pays the remainder to the ALF as room and board. FBR  increases annually January 1.  Effective 1/1/2009 674  Aging & Disability Services Administration (ADSA)  Room and Board Standard     ADSA room and board standard is based on the FBR  rate minus the current CN/COPES Waiver in ALF PNA.  ($674 - $62.79) Room and board is considered the non personal care cost of the ALF  (meals and shelter).  This standard is used for DDD and HCS services authorized in an ALF.  It is the maximum amount paid for room and board in a contracted/licensed ALF.  Effective 1/1/2009 611.21 Division of Disability Services (DDD) Waivers WAC 388-515-1510 DDD Waiver at home (SIL) 300% of the FBR  effective 1/1/2009 2022 DDD Waiver in ALF  Effective 1/1/2009 will match HCS Waiver in ALF.  No $20 disregard from non SSI income 62.79 Medicaid Personal Care (MPC) Home setting.  No cost to client, No PNA for MPC  at home ALF/Residential setting.  Effective 1/1/2009 will match HCS Waiver in ALF.  No $20 disregard from non SSI income 62.79  Hospice services outside a medical institution    If using HCS CN (COPES) Waiver rules for eligibility use the same PNA as you would for the HCS CN Waiver program.  If client is on Hospice  and Waiver services at the same time, the Waiver program is the priority program.     General Assistance living in an ALF or Medical Institution (GA-X, GA-D, GA-A and GA-U)   Living in a medical institution 41.62 Living in an adult family home  (AFH) An adult family home is considered a non facility setting.  Clients are allowed to keep a PNA of $38.84 from the $339 standard.  The remainder goes to the AFH for room and board 339  Living in a boarding home  (assisted living, ARC, EARC, DDD group home) receive a PNA check for $38.84 38.84 SSI client living in a Medical Institution  SSI clients living in a medical institution  receiving $30 federal PNA will receive a state supplement to bring their PNA amount up to the $57.28 PNA standard. Effective 7/1/2008 57.28 G03 program-Non institutional in an alternate living facility WAC 388-513-1305   If on MPC  service, it is the same MPC PNA that is effective 1/1/2009 for ADSA clients.  The rest of the income goes to the ALF  provider.  See WAC 388-513-1305  for detailed instructions.  This is the only MPC group that pays over the ADSA room and board standard to the provider. G03 clients on MPC pay their countable income minus $62.79 to the provider.    Effective 1/1/2009 62.79 Private pay clients on G03 are responsible to pay the provider.  See WAC 388-513-1305.  G03 standard is based on daily rate x 31 days plus $38.84 General Assistance PNA.

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Modification Date: October 16, 2009

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