Long-term care Personal Needs Allowance (PNA) Chart
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Long-term care Personal Needs Allowance (PNA) Chart


Revised August 29, 2014



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

  • The PNA is based on living arrangement/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 HCS or DDA Waiver in home to NF on the 1st day of the month is allowed the full Waiver PNA based on the service authorized 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 Waiver ALF on the 1st day of the month is allowed the  ALF PNA.
  • A client converting private pay ALF to HCB Waiver (COPES) ALF any day of the month other than the first day is allowed the full MNIL as we cannot backdate HCB Waiver (COPES) in that month.
  • A client is in a medical institution such as a hospital or hospice care center on the first of the month and discharges to a NF is allowed the NF PNA. 
  • 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. 
  • 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 disability lifeline (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, assisted living and DDA group homes must pay room and board to the facility from their income for their food and shelter.   ADS clients have a room and board standard.  The formula is indicated in the standard chart below. 
  • Clients receiving MPC under the G03 program  pay a higher amount to the provider than the ADS room and board standard.  See MPC and G03 sections for further instructions.

 

Medical Standards Chart

Personal Needs Allowance and ADSA room and board

 Medical Institutions WAC 182-513-1380  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 or discharge to home from NF during the month no Waiver services (MNIL) 

721  effective 1/1/2014

ABD state cash assistance (G01, G02)  and MCS payment standard in a medical institution. WAC 182-513-1300  41.62

 Home and Community Service Waivers WAC 182-515-1505 HCS

WAC 182-515-1514 DDD
 
Home setting.  Single person (COPES, New Freedom, PACE, WMIP, RCL, )  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 182-515-1509

973 Effective 4/1/2014

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

721 effective 1/1/2014

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 $62.79 PNA and pays the remainder to the ALF as room and board. FBR  increases annually January 1. 

721 effective 1/1/2014

 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.  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 with the exception of MPC under the G03 program.   It is the maximum amount paid for room and board in a contracted/licensed ALF. 

$658.21 effective 1/1/2014

Division of Disability Services (DDD) Waivers WAC 182-515-1510
DDD Waiver at home (SIL) 300% of the FBR 

2163 effective 1/1/2014

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 as incorporated in the PNA.  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.   
State Funded ABD cash and MCS medical standards  
Living in a medical institution  ABD cash/MCS medical standard WAC 182-513-1300  41.62
 ABD cash:  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 payment standard.  The remainder goes to the AFH for room and board.  

197

ABD cash Hen/MCS medical standard:   Living in a boarding home  (assisted living, ARC, EARC, DDD group home) receive a PNA check for $38.84. WAC 182-515-1500 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 182-513-1305   
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 182-513-1305  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 182-513-1305.  G03 standard is based on daily rate x 31 days plus $38.84 state funded cash PNA.    
Modification Date: August 29, 2014