WAC 182-515-1514

Effective January 1, 2013

WAC 182-515-1514 How does the department determine how much of my income I must pay towards the cost of my DDA waiver services if I am not eligible for Medicaid under a categorically needy program (CN) listed in WAC 182-515-1512 (1)?

Emergency WAC effective 1-1-2014

If you are not eligible for Medicaid under a categorically need program (CN) listed in WAC 182-515-1512(1), the department determines how much you must pay based upon the following:

  1. If you are an SSI-related client living at home as defined in WAC 388-106-0010, you keep all your income up to the SIL (three hundred percent of the FBR) for your personal needs allowance (PNA ).
  2. If you are an SSI-related client and you live in an ARCAFH or DDA group home, you:
    1. Keep a personal needs allowance (PNA ) from your gross non-excluded income. Effective January 1, 2009 the PNA is sixty-two dollars and seventy-nine cents; and  
    2. Pay for your room and board up to the ADS room and board  rate described in http://www.hca.wa.gov/medicaid/Eligibility/Pages/index.aspx
  3. In addition to paying room and board, you may also have to pay toward the cost of personal care. This is called your participation. Income that remains after the PNA and any room and board deduction described in subsection (2) of this section, is reduced by allowable deductions in the following order:
    1. If you are working, we allow an earned income deduction of the first sixty-five dollars plus one-half of the remaining earned income;
    2. Guardianship fees and administrative costs including any attorney fees paid by the guardian only as allowed by chapter 388-79 WAC;
    3. Current or back child support garnished or withheld from your income according to a child support order in the month of the garnishment if it is for the current month.  If we allow this as a deduction from your income, we will not count it as your child's income when determining the family allocation amount;
    4. A monthly maintenance needs allowance for your community spouse not to exceed that in WAC 182-513-1380  (5)(b) unless a greater amount is allocated as described in  (e) of this subsection.  This amount:
      1. Is allowed only to the extent that your income is made available to your community spouse; and
      2. Consists of a combined total of both:
        1. One hundred fifty percent of the two person federal poverty level (FPL ). This standard may change annually on July 1st and can be found at http://www.hca.wa.gov/medicaid/Eligibility/Pages/index.aspx
        2. Excess shelter expenses.  For the purposes of this section, excess shelter expenses are the actual required maintenance expenses for your community spouse's principal residence.  These expenses are determined in the following manner:
          1. Rent, including space rent for mobile homes, plus;
          2. Mortgage, plus;
          3. Taxes and insurance, plus;
          4. Any required payments for maintenance care for a condominium or cooperative minus;
          5. The food assistance standard utility  allowance (SUA) provided the utilities are not included in the maintenance charges for a condominium or cooperative, minus;
          6. The standard shelter allocation.  This standard is based on thirty percent of one hundred fifty percent of the two person federal poverty level.  This standard may change annually on July 1st and can be found at http://www.hca.wa.gov/medicaid/Eligibility/Pages/index.aspx
          7. Is reduced by your community spouse's gross countable income.
          8. May be greater than the amount in (d)(ii) of this subsection only when:
        3. There is a court order approving a higher amount for the support of your community spouse; or
        4. A hearings officer determines a greater amount is needed because of exceptional circumstances resulting in extreme financial duress.
    5. A monthly maintenance needs amount for each minor or dependent child, dependent parent or dependent sibling of your community or institutionalized spouse. The amount we allow is based on the living arrangement of the dependent.  If the dependent:
      1. Resides with your community spouse, for each child, one hundred fifty percent of the two-person FPL minus that child's income and divided by three (child support received from a noncustodial parent is considered the child's income);
      2. Does not reside with the community spouse, the amount is equal to the effective one-person MNIL  based on the number of dependent family members in the home less their separate income (child support received from a noncustodial parent is considered the child's income).
    6. Your unpaid medical expenses which have not been used to reduce excess resources.  Allowable medical expenses are described in WAC 182-513-1350.
    7. The total of the following deductions cannot exceed the SIL  (three hundred percent of the FBR):
      1. Personal needs allowances (PNA ) in subsection (1) of this section for in home or subsection (2) (a) of this section in a residential setting; and
      2. Earned income deduction of the first sixty-five dollars plus one-half of the remaining earned income in (a) of this subsection; and
      3. Guardianship fees  and administrative costs in (b) of this subsection.
  4. If you are eligible for aged, blind, or disabled (ABD) cash assistance described in WAC 388-400-0060 and CN medicaid based on ABD criteria, you do not participate in the cost of personal care and you may keep the following:
    1. When you live at home, you keep the cash grant amount  authorized under the ABD cash program;
    2. When you live in an AFH, you keep a PNA  of thirty-eight dollars and eighty-four cents, and pay any remaining income and ABD cash grant to the facility for the cost of room and board  up to the ADS room and board standard described in http://www.hca.wa.gov/medicaid/Eligibility/Pages/index.aspx;or
    3. When you live in an ARC or DDA group home, you are only eligible to receive a cash grant of thirty-eight dollars and eighty-four cents which you keep for your PNA.
  5. You may have to pay third party resources (TPR) described in WAC 182-501-0200 in addition to room and board and the cost of personal care and/or habilitation services (participation) after all allowable deductions have been considered is called your total responsibility.  You pay this amount to the ARC, AFH or DDA group home provider.

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.