WAC 182-514-0265 How the department determines how much of an institutionalized individual's income must be paid towards the cost of care.

1.  Individuals who reside in a medical institution, inpatient psychiatric facility or an institution for mental diseases (IMD) may be required to pay a portion of their income towards the cost of care.  This section explains how the department calculates how much an individual is required to pay to the facility.  This process is known as the post-eligibility process.  If an individual does not have income, he or she does not have to pay.

2.  The department determines available income by considering an individual's total gross income before any mandatory deductions from earnings.  Income that was not counted in the initial eligibility process is counted for the post-eligibility process unless the income is excluded under federal or state law.  See WAC 388-450-0015  for examples of excluded income types. 

3.  The following income allocations and exemptions are deducted from an individual's total gross income to determine his or her available income.  The department uses the rules described in WAC 388-513-1380  to calculate the amount of these allocations and exemptions, with the exception that under the family institutional medical program, there is no deduction for earned income in the post-eligibility process.

a.  Personal needs allowance (PNA) and maintenance allocation.  The combined totals of all of the following deductions cannot exceed the medically needy income level (MNIL):

i.  PNA as allowed under WAC 388-478-0040;

ii.  Mandatory federal, state, or local taxes owed by the client; and

iii.  Court ordered guardianship fees and administrative costs, including attorney fees, as described in chapter 388-79 WAC.

b.  Income garnished to comply with a court order for child support.

c.  Community spouse allocation.

d.  Family maintenance allocation if married with dependents.

e.  Legal dependent allocation for an unmarried client with dependents.  The maximum allocation is based upon the MNIL standard for the number of dependents minus the dependent's income.

f.  Medical expenses allocation.  The department allows a deduction for unpaid medical expenses for which the individual is still liable.  Medical expenses allowed for this allocation are described in WAC 388-513-1350. 

g.  Housing maintenance exemption:

i.  For an individual who is financially responsible for the costs of maintaining a home while he or she is in an institution, the department allows a deduction, limited to a six-month period, of up to one hundred percent of the one-person poverty level per month, when a physician has certified that the individual is likely to return to the home within the six-month period.

ii.  An individual eighteen years of age or younger is not eligible for the housing maintenance exemption unless the housing expense is the individual's financial responsibility.  Children are not financially responsible for the housing expenses incurred by their parents.

4.  Individuals may keep a personal needs allowance of up to the one person temporary assistance for needy families (TANF) payment standard (based upon the requirement to pay shelter costs) in the month they are admitted and in the month they are discharged from the facility. 

5.  Any income which remains must be paid to the facility towards the cost of care.

6.  Individuals nineteen years of age or older who qualify for categorically needy (CN) or medically needy (MN) coverage but have countable resources in excess of the resource limits as described in WAC 388-505-0245  must pay an amount equal to the excess amount to the facility towards the cost of their care in the month of application.  This amount is in addition to the amount calculated under subsections (2) through (4) of this section (if any).