WAC 182-513-1305

Effective January 1, 2014

WAC 182-513-1305 Determining eligibility for non-institutional medical assistance in an alternate living facility (ALF)

Emergency WAC effective 1-1-2014

This section describes how the department defines the monthly income standard and uses it to determine eligibility for non-institutional medical assistance for a client who lives in a department-contracted ALF. Refer to WAC 182-515-1500 for the personal needs allowance (PNA) amount that applies in this rule.

  1. The eligibility criteria for non-institutional medical assistance in an ALF follows SSI-related medical rule described in chapter 182-512 WAC with the exception of the higher medical standard based on the daily rate described in subsection (3) of this section..
  2. Alternate living facilities (ALF) include the following:
    1. An adult family home (AFH), a licensed family home that provides its residents with personal care and board and room for two to six adults unrelated to the person (s) provider the care. Licensed as an adult family home under chapter 70.128 RCW and chapter 388-76 WAC;
    2. An adult residential care facility (ARC) (formally known as a CCF) is a licensed facility that provides its residents with shelter, food household maintenance, personal care and supervision. Licensed as a boarding home under chapter 18.20 RCW and chapter 388-78A WAC;
    3. An adult residential rehabilitation center (ARRC) described in WAC 388-865-0235 or adult residential treatment facility (ARTF) described in WAC 388-865-0465. These are licensed facilities that provide its residents with twenty-four hour residential care for impairments related to mental illness;
    4. Assisted living facility (AL), a licensed facility for aged and disabled low-income persons with functional disabilities. COPES eligible clients are often placed in assisted living. Licensed as a boarding home under chapter 18.20 RCW and chapter 388-78A WAC;
    5. Developmentally disabilities administration (DDA) group home (GH), a licensed facility that provides its residents with twenty-four hour supervision. Depending on the size of a DDA group home may be licensed as an adult family home under chapter 70.128 RCW or a boarding home under chapter 18.20 RCW. Group home means a residence that is licensed as either a boarding home or an adult family home by the department under chapters 388-78A or 388-76 WAC. Group homes provide community residential instruction, supports and services to two or more clients who are unrelated to the provider; and
    6. Enhanced adult residential care facility (EARC), a licensed facility that provides its residents with those services provided in an ARC, in addition to those required because of the client's special needs. Licensed as a boarding home under chapter 18.20 RCW.
  3. The monthly income standard for non-institutional medical assistance under the categorically needy (CN) program has two steps:
    1. The gross non-excluded monthly income cannot exceed the special income level (SIL) which is three hundred percent of the federal benefit rate (FBR); and
    2. The countable income cannot be greater than the department contracted daily rate times thirty one days, plus the PNA/CPI described in WAC 182-513-1300.
  4. The monthly income standard for non-institutional medical assistance under the medically needy (MN) program equals the private facility daily rate times thirty one days, plus the thirty-eight dollars and eighty- four cents PNA/CPI described in WAC 182-513-1300. Follow MN rules described in chapter 182-519 WAC.
  5. The department approves CN non-institutional medical assistance for a period of up to twelve months for a client who is SSI- related as described in WAC 182-512-0050, if:
    1. The client’s non-excluded resources do not exceed the standard described in WAC 182-513-1350 (1); and
    2. The client’s non-excluded income does not exceed the CN standard described in chapter 182-512 WAC.
  6. The department approves MN non-institutional medical assistance for a period of months described in chapter 182-504 WAC  for an SSI- related client, if:
    1. The client’s non-excluded resources do not exceed the standard described in WAC 182-513-1350 (1); and
    2. The client satisfies any spenddown liability as described in chapter 182-519 WAC.
  7. A client  residing in an adult family home (AFH) receiving a grant based on a payment standard in WAC 388-478-0033 due to an obligation to pay shelter costs to the adult family home. The client keeps a CPI in the amount of thirty-eight dollars and eighty-four cents described in WAC 182-515-1500 and pays the remainder of the grant to the adult family home as room and board.
  8. The client described in subsection  (3) of this section and receiving medicaid personal care (MPC) from the department keeps sixty-two dollars and seventy-nine cents as a PNA and pays the remainder of their income to the ALF for room and board and personal care.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.