Long-term care Personal Needs Allowance (PNA) Chart

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Long-term care Personal Needs Allowance (PNA) Chart

Revised June 19, 2008

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.

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.

PNA amounts for general assistance (state cash assistance programs), $90 VA improved pension and state veteran's home have not changed in several years.

Medical Institutions WAC 388-513-1380 PNA Amount

Medical Institutions (nursing home, hospice care center, hospice services in a nursing home, RHC) out of home full month Effective 7/1/2007 to 6/30/2008 55.45

Medical Institutions (nursing home, hospice care center, RHC) out of home full month Effective 7/1/2008 and ongoing 57.28

Medical Institution with single veteran or widow receiving a $90 VA improved pension. 90

State Veterans Home 160

Admit from home to NF during the month no Waiver services (MNIL) 637

Discharge to home from NF during the month no Waiver services (MNIL) 637

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 1 867

Home setting. Married with a community spouse.(COPES, New Freedom, PACE, WMIP, RCL)  MNIL increases annually January 1 637

ALF/residential settings (COPES, New Freedom, PACE, MNRW, WMIP, RCL )   Effective 7/1/2007 to 6/30/2008 60.78

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. 637

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. ($637 - $60.78) 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. Effective 1/1/2008 to 6/30/2008 576.22

ADSA room and board standard -Effective 7/1/2008 574.21

Division of Disability Services (DDD) Waivers WAC 388-515-1510

DDD Waiver at home (SIL) 300% of the FBR 1911

DDD Waiver in ALF (plus a $20 disregard from non SSI income)* Effective July 1, 2007 to June 20, 2008 40.12

DDD Waiver in ALF (plus a $20 disregard from non SSI income)* Effective July 1, 2008 41.44

Medicaid Personal Care (MPC)

Home setting. No cost to client, No PNA for MPC at home

ALF/Residential setting Plus a $20 disregard from non SSI income* Eff. July 1, 2007 to June 30, 2008. 40.12

ALF/Residential setting. Plus a $20 disregard from non SSI income* Eff. July 1, 2008 and ongoing 41.44

* Clients with only SSI income do not have a $20 disregard from their income

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 55.45 PNA standard. Effective 7/1/2007 to 6/30/2008 55.45

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 plus $20 disregard, the rest of the income goes to the ALF provider. See WAC 388-513-1303 for detailed instructions. This is the only MPC group that pays over the ADSA room and board standard to the provider Effective 7/1/2007 to 6/30/2008 40.12

If on MPC service, it is the same MPC PNA plus $20 disregard, the rest of the income goes to the ALF provider. See WAC 388-513-1303 for detailed instructions. This is the only MPC group that pays over the ADSA room and board standard to the provider. Effective 7/1/2008 41.44

Private pay clients on G03 pay all available income over the standard to the ALF. 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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