WAC 182-513-1317

Effective January 1, 2014

WAC 182-513-1317 Income and resource criteria for an institutionalized client

Emergency WAC effective 1-1-2014

  1. This section provides an overview of the income and resource eligibility rules for a client who lives in an institutional setting.  The term "institution" is defined in WAC 182-500-0050. To determine income eligibility for an SSI-related WAH long-term care (LTC) client under the categorically needy (CN) program, the medicaid agency or its designee:
    1. Considers income available as described in WAC 182-513-1325 and 182-513-1330;
    2. Excludes income as described in WAC 182-513-1340;
    3. Compares remaining gross nonexcluded income to the special income level (SIL) (three hundred percent of the federal benefit rate (FBR)). A client's gross income must be equal to or less than the SIL to be eligible for CN coverage.
  2. To determine income eligibility for an SSI-related WAH LTC client under the medically needy (MN) program, the agency or its designee:
    1. Considers income available as described in WAC 182-513-1325 and 182-513-1330;
    2. Excludes income as described in WAC 182-513-1340;
    3. Disregards income as described in WAC 182-513-1345; and
    4. Follows the income standards and eligibility rules described in WAC 182-513-1395
  3. To be resource eligible under the SSI-related WAH LTC CN or MN program, the client must::
    1. Meet the resource eligibility requirements and standards described in WAC 182-513-1350;
    2. Not have a penalty period of ineligibility due to a transfer of asset as described in WAC 182-513-1363 or 182-513-1364;
    3. Disclose to the state any interest the client or the client's spouse has in an annuity and meet the annuity requirements described in chapter 182-516 WAC.
  4. the agency or its designee allows an institutionalized client to reduce countable resources in excess of the standard.  This is described in WAC 182-513-1350.
  5. A client is eligible for medicaid as a resident in a psychiatric facility, if the client:
    1. Has attained institutional status as described in WAC 182-513-1320; and
    2. Is under the age of twenty-one at the time of application; or
    3. Is receiving active psychiatric treatment just prior to their twenty-first birthday and the services extend beyond this date and that client has not yet reached age twenty-two; or
    4. Is at least sixty-five years old.
  6. To determine CN or MN income eligibility for a MAGI-based WAH LTC client, the medicaid agency or its designee follows the rules described in WAC 182-514-0230 through 182-514-0265.
  7. There is no asset test for MAGI-based WAH LTC programs as described in WAC 182-514-0245.
  8. The agency or its designee determines a client's total responsibility to pay toward the cost of care for LTC services as follows:
    1. For SSI-related WAH clients residing in a medical institution see WAC 182-513-1380;
    2. For MAGI-based WAH clients residing in a medical institution see WAC 182-514-0265.  Clients who are eligible for the MAGI-based WAH adult medical program described in WAC 182-505-0250  are not required to contribute toward the cost of care.  Nursing home care is included scope of care for these clients.

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.