WAC 182-513-1318

Effective January 1, 2014

WAC 182-513-1318 Income and resource criteria for home and community based (HCB) waiver programs and hospice clients

Emergency WAC effective 1-1-2014

  1. This section provides an overview of the income and resource eligibility rules for a client to be eligible for a home and community based (HCB) waiver program or the Washington apple health (WAH) hospice program.
  2. To determine income eligibility for an SSI-related WAH long-term care (LTC) waiver 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 non excluded income to:
      1. The special income level (SIL) (three hundred percent of the federal benefit rate (FBR)); or
      2. For home and community based (HCB) service programs authorized by aging and long-term supports administration (ALTSA), a higher standard is determined following the rules described in WAC 182-515-1508  if a client's income is above the SIL but net income is below the medically needy income level (MNIL).
  3. A client who receives MAGI-based WAH is not eligible for HCB waiver services unless found eligible based on program rules in chapter 182-515  WAC.
  4. There is not WAH HCB Waiver medically needy program.
  5. To be resource eligible under the SSI-related WAH LTC CN waiver programs, 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 182-513-1363182-513-1364, or 182-513-1365;
    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
  6. The agency or its designee allows an HCB waiver client to use verified unpaid medical expenses to reduce countable resources in excess of the standard.  This is described in WAC 182-513-1350.
  7. 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 clients receiving HCS CN waiver services see WAC 182-515-1509;
    2. For clients receiving DDA CN waiver services see WAC 182-515-1514.
  8. HCB waiver clients who are "deemed eligible" for SSI benefits as described in WAC 182-512-0880 do not pay service participation toward their cost of personal care.  Clients living in a residential setting do pay room and board as described in WAC 182-515-1505 through 182-515-1509 or 182-515-1514.
  9. To be eligible for hospice services under the CN program, a client must:
    1. Meet the program requirements described in chapter 182-551 WAC  governing client eligibility for hospice care; and
    2. Be eligible for a noninstitutional CN program if not residing in a medical institution thirty days or more.
  10. A client who is not eligible for a noninstitutional CN program who needs hospice care is eligible for the WAH hospice program if they meet the following criteria:
    1. Meet the hospice program requirements described in chapter 182-551 WAC; and
    2. Reside at home and would be eligible for coverage by using home and community services waiver rules described in WAC 182-515-1505 through 182-515-1509  (SSI related clients with income over the effective one-person MNIL and gross income at or below the three hundred percent of the FBR or clients with a community spouse); or
    3. Receive WAH HCB waivers services in addition to hospice services.  The client's responsibility to pay toward the cost of care (participation) is applied to the waiver service provider first; or
    4. Be eligible for institutional CN if residing in a medical institution (including a hospice care center) for thirty days or more.
  11. To be eligible for hospice services under the MN program, a client must be:
    1. Eligible for the MN SSI-related program described in WAC 182-512-0150  for hospice clients residing in a home setting; or
    2. Eligible for the MN SSI-related program described in WAC 182-513-1305  for hospice clients not receiving HCB waiver services who reside in an alternate living facility.
    3. Be eligible for institutional MN if residing in a medical institution thirty days or more described in WAC 182-513-1395.  

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.