WAC 182-513-1316

Effective January 1, 2014

WAC 182-513-1316 General Eligibility requirements for WAH long-term care programs

Emergency WAC effective 1-1-2014

  1. To be eligible for long-term care (LTC) services, a client must:
    1. Meet the general eligibility requirements for medical programs described in WAC 182-503-0505;
    2. Attain institutional status as described in WAC 182-513-1320;
    3. Meet the functional eligibility described in:
      1. Chapter 388-106 WAC  for a home and community services (HCS) waiver or nursing facility coverage; or
      2. Chapter 388-828  WAC for DDA waiver or institutional services; and
    4. Meet either:
      1. SSI-related WAH criteria as described in WAC 182-512-0050; or
      2. MAGI-based WAH criteria as described in WAC 182-503-0510  (2).  A client who is eligible for MAGI-based WAH is not subject to the provisions described in subsection (2) of this section. 
  2. An SSI-related client, including supplemental security income (SSI) recipients, who needs LTC services must also:
    1. Not have a penalty period of ineligibility as described in WAC 182-513-1363, 182-513-1364, or 182-513-1365;
    2. Not have equity interest in their primary residence great than the home equity standard described in WAC 182-513-1350;
    3. Disclose to the state any interest the applicant or spouse has in an annuity and meet annuity requirements described in chapter 182-516 WAC.
  3. An SSI recipient must submit a signed health care coverage application form attesting to the provisions described in subsection (2) of this section.  A signed and completed eligibility review for long-term care benefits can be accepted for SSI clients applying for long-term care services. 
  4. To be eligible for WAH LTC waiver services, a client must also meet program requirements described in:
    1. WAC 182-515-1505 through 182-515-1509  for COPES, New Freedom, PACE and WMIP services; or
    2. WAC 182-515-1510 through 182-515-1514  for DDA Waivers
  5. A client who is eligible for categorically needy WAH coverage is certified for twelve months.
  6. A client who is eligible for medically needy WAH coverage is approved for a period of months described in WAC 182-513-1395  (6) for:
    1. Institutional services in a medical institution; or
    2. Hospice services in a medical institution.
  7. The medicaid agency or its designee determines a client's eligibility as it does for a single person when the client's spouse has already been determined eligible for LTC services.

 

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.