WAC 388-505-0235 Definitions.

The following terms are used in WAC 388-505-0230 through 388-505-0270:

"Categorically needy income level (CNIL)" - The standard used by the department to determine eligibility under a categorically needy medicaid program.

"Categorically needy (CN) medical" - Full scope of care medical benefits.  CN medical may be either federally-funded under Title XIX of the social security act or state-funded.

"Categorically needy (CN) medicaid" - Federally-funded full scope of care medical benefits under Title XIX of the social security act.

"Federal benefit rate (FBR)" - The payment standard set by the social security administration for recipients of supplemental security income (SSI).  This standard is adjusted annually in January.

"Federal poverty level" - The income standards published annually by the federal government in the Federal Register found at http://aspe.hhs.gov/poverty/index.shtml.  The income standards change on April first every year.

"Institution for mental diseases (IMD)" - A hospital, nursing facility, or other institution of more than sixteen beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.  Inpatient chemical dependency facilities of  more than sixteen beds which provide residential treatment for alcohol and substance abuse are also considered an IMD.

"Institutional status" - An individual meets institutional status when he or she is admitted to a medical institution, inpatient psychiatric facility, or IMD for a period of thirty days or longer.  The time period is ninety days or longer for individuals seventeen years of age and younger who are admitted to an inpatient psychiatric facility or institution for mental diseases.  Institutional status is described in WAC 388-513-1320.

"Legal dependent" - A minor child, seventeen years of age and younger, and an individual eighteen years of age and older claimed as a dependent for income tax purposes; or a parent of either the applicant or the applicant's spouse claimed as a dependent for income tax purposes; or the brother or sister (including half and adoptive siblings) claimed by either the applicant or the applicant's spouse as a dependent for income tax purposes. 

"Medical institution" - A medical facility that provides twenty-four hour supervision and skilled nursing care.  Facilities which meet this definition include:

(1) Hospitals;

(2) Nursing homes or the nursing home section of a state veteran's facility;

(3) Hospice care centers;

(4) An intermediate care facility for the mentally retarded (ICF/MR); or

(5) A residential habilitation center (RHC).

"Medically needy income level (MNIL)" - The standard used by the department to determine eligibility under the medically needy medicaid program.  The MNIL standards are described in WAC 388-478-0070. 

"Medically needy (MN) medicaid" - Federally-funded medical coverage under title XIX of the social security act.  MN coverage has a more limited scope of care than CN coverage.

"Personal needs allowance (PNA)" - An amount designated to cover the expenses of an individual's clothing and personal incidentals while living in a medical institution, inpatient psychiatric facility, or institution for mental diseases.

"Psychiatric facility" - Designated long term inpatient psychiatric residential treatment facilities, state psychiatric hospitals, designated distinct psychiatric units, and medicare-certified distinct units in acute care hospitals. 

"Spenddown" - The amount of medical expenses an individual is required to incur prior to medical benefits being authorized.  Spenddown is described in WAC 388-519-0100  and 388-519-0110. 

"Title XIX" - The portion of the federal social security act, 42 U.S.C. 1396, that authorizes grants to states for medical assistance programs.  Title XIX is also called medicaid.