Waiver Services - HCS MNP - Medically Needy Residential Waiver Program (MNRW) - A- Financial and Functional Processes
DSHS Home Page

EAZ
Search     for:
DSHS HomeACES ManualEAZ ManualSocial Services ManualWork First Manual
Acronyms  Revisions  WAC Number Index  Site Map  WCCC  DSHS Home

Waiver Services - HCS MNP - Medically Needy Residential Waiver Program (MNRW) - A- Financial and Functional Processes

Revised September 8, 2008

Purpose:

Medically needy residential waiver (MNRW) program.

WAC 355-515-1540 Medically needy residential waiver (MNRW)

 

Clarifying Information: Financial and Functional Processes

Concurrent Financial and Functional Determinations

  1. In order to be eligible for MNRW, a client must be functionally eligible based on a functional assessment completed by the social services worker, per WAC 388-71-0203  as well as financially eligible based on the financial determination completed by the financial services worker. The functional and financial determinations are completed concurrently. The social service worker makes a functional determination and the financial worker makes a financial determination.

  2. Once the functional eligibility and the financial eligibility are approved, MNRW services can be authorized, provided there is an active slot available.


NOTE: MNRW services and MNRW medical assistance cannot be authorized until both determinations are completed.

No Fast Track Service Component

  1. Fast Track is a process that allows the authorization of services prior to the completion of a formal financial eligibility determination. For more information, refer to the Intranet ADSA Long-Term Care Manual,Chapter 7.

  2. Unlike COPES or MPC, social service workers cannot authorize Fast Track (expedited) services while the financial eligibility is pending. Eligibility is dependent on the financial determination.

No Spousal Impoverishment Rules

  1. Married MNRW clients cannot receive a community spouse maintenance allocation like the nursing home and COPES programs allow.

  2. The spouse of an MNRW client does not get the community spouse resource standard like the nursing home and COPES programs allow.

No Dependent Allocations

When calculating client responsibility, MNRW clients cannot receive the dependent maintenance allocation like the nursing home and COPES programs allow. However, court-ordered child support can be allowed with an approved Exception to Rule (ETR)  WAC 388-440-0001

Medicare Savings Programs: WAC 388-517-0300

  1. MNRW clients are not eligible for QMB (S03) or SLMB (S05) like nursing home and COPES clients. However, they are eligible for state-pay buy-in.

  2. For active clients who are changing to the MNRW program, do nothing. If they were active on medical coverage group S03 in ACES, when the program change occurs the S03 will terminate. However, state buy-in will continue to pay the Medicare premiums, as long as there is not a break in the MN certification.

Financial Responsibility of a Client's Spouse: WAC 388-506-0620 (2) & (5)

  1. Income: Count only the client’s income when determining eligibility and calculating the client’s responsibility toward cost of care.

  2. Resources: The resources of a married client are considered available to each spouse through the end of the month the couple stop living together.

    When a client and spouse stop living together, consider their resources separately. If they continue to own joint resources, consider ½ of the value as owned by the client.

    1. When do we consider spouses as living together?

      1. When they live at the same home address, or

      2. When they reside in the same room in an alternate living facility.

    2. When do we consider spouses as living apart?

      1. Beginning the first of the month after they no longer live at the same home address, or

      2. Beginning the first of the month after they stop sharing the same room in an alternate living facility.

MNRW Web Calculator

  1. The ACES system does not currently support the eligibility and client responsibility calculation for MNRW. A website was created to track MNRW clients and to calculate eligibility. The MNRW website includes a calculator to determine:

    1. Initial eligibility

    2. Client responsibility

    3. Trial calculations prior to service authorization

  2. Financial staff will use the results to manually complete ACES award letters.

  3. There are two versions of the eligibility calculator on the web:

    1. The first version is a trial eligibility calculator:  http://adsaweb/mnwaiver/TCalc.htm

      1. It will provide the same calculations as the permanent calculator contained within the client data fields; however, the data entered in the trial eligibility calculator will not be saved to the database.

      2. Staff can use this calculator during the eligibility determination process when advising the social service worker of a potential MNRW client’s eligibility.

    2. The second version of the calculator is a permanent version.  Select DSHS staff have access to the website at:  http://adsaweb/mnwaiver/default2.htm

It will calculate and save up to 3 months of data and is part of the client data entry fields for the database. Staff will use this calculator to update active or wait list MNRW client eligibility and client responsibility information.

Back to top

Modification Date: September 8, 2008
Have comments on the manual? Please e-mail us. You can also use this link to report broken links or content problems.