WAC 388-505-0260 Eligibility for family institutional medical for children eighteen years of age or younger.

(1) Individuals eighteen years of age or younger must meet the requirements in WAC 388-505-0240  to qualify for family institutional medical coverage.

(2) When an individual eighteen years of age or younger is eligible for premium-based categorically needy (CN) coverage under apple health for kids as described in WAC 388-505-0210  (4), the department re-determines his or her eligibility using the provisions of this section so that the individual is not required to pay the premium.

(3) The department does not restrict or limit the resources available to individuals eighteen years of age or younger when determining eligibility for family institutional medical coverage.  The department does not consider, or count towards eligibility any resources owned by the individual in this age category, or any resources owned by the individual's parent(s), spouse, or child(ren), if applicable.

(4) The categorically needy income level (CNIL) for individuals who qualify for family institutional medical coverage under this section is two hundred percent of the federal poverty level income standard.  Once the department determines an individual meets institutional status, it does not count the income of a parent(s), spouse, or dependent children (if applicable) when determining the individual's countable income.

(5) The department approves CN medical coverage under this section for twelve calendar months.  If an individual is discharged from the facility before the end of his or her certification period, he or she remains continuously eligible for CN medical coverage through the end of the original certification date, unless he or she ages out of the program, moves out of state, is incarcerated, or dies.

(6) If an individual is not eligible for CN medical coverage under this section, the department determines his or her eligibility for coverage under the medically needy (MN) program.

(a) MN coverage is only available for an individual who meets the citizenship requirements under WAC 388-424-0010  (1) or (2).

(b) Individuals with countable income below the state monthly cost of care in the facility are eligible for MN without spenddown.

(c) If the individual's countable income exceeds the state monthly cost of care, but is under the private monthly cost of care plus the amount of any recurring medical expenses for institutional services, the department may require the individual to spend down his or her income as described in WAC 388-519-0110.

(d) If the individual's countable income exceeds the private monthly cost of care plus the amount of any recurring medical expenses for institutional services, he or she is not eligible for family institutional medical coverage.

(7) The facility where the individual resides may submit an application on the individual's behalf and may act as an authorized representative for the individual if the individual is:

(a) In a court ordered, out-of-home placement under chapter 13.34 RCW;

(b) Involuntarily committed to an inpatient treatment program by a court order under chapter 71.34 RCW.

(8) Individuals eligible for family institutional medical coverage under the provisions of this section may be required to contribute a portion of their income towards the cost of care as described in WAC 388-505-0265.