WAC 388-513-1305 Determining eligibility for non-institutional medical assistance in an alternate living facility (ALF)

This section describes how the department defines the monthly income standard and uses it to determine eligibility for non-institutional medical assistance for a client who lives in a department-contracted ALF. Refer to WAC 388-478-0045 for the personal needs allowance (PNA) amount that applies in this rule.   

1. Alternate living facilities  include the following: 

   1. An adult family home (AFH);

   2. An adult residential care facility (ARC);

   3. An adult residential rehabilitation center (ARRC);

   4. An adult residential treatment facility (ARTF);

   5. An assisted living facility (AL);

   6. A division of developmental disabilities (DDD) group home (GH); and

   7. An enhanced adult residential care facility (EARC).

2. The monthly income standard for non-institutional medical assistance under the categorically needy (CN) program that cannot exceed the special income level  (SIL) equals the following amounts. For a client who lives in:

   1. An ARC, an ARRC, an ARTF, an AL, a DDD GH, or an EARC, the department-contracted rate based on a thirty-one day month plus the PNA.

   2. An AFH, the department-contracted rate based on a thirty-one day month plus the PNA  plus the cost of any add-on hours authorized by the department; or

3. The monthly income standard for non-institutional medical assistance under the medically needy (MN) program equals the private facility rate based on a thirty-one-day month plus the PNA  .

4. The monthly income standard for non-institutional medical assistance under the general assistance (GA) program equals the GA grant standard described in WAC 388-478-0030.

5. The department determines a client’s non-excluded resources as described in chapter 388-470 WAC and WAC 388-505-0595.

6. The department determines a client's nonexcluded income for noninstitutional medical assistance as described in:

   1. Chapter 388-450 WAC for GA and TANF programs; and

   2. Chapter 388-475 WAC and WAC 388-506-0620 for SSI-related medical programs.

7. The department approves CN non-institutional medical assistance for a period of up to twelve months for a client who receives Supplemental Security Income (SSI) or who is SSI-related as described in WAC 388-503-0510 (1), if:

   1. The client’s non-excluded resources described in subsection (5) do not exceed the standard described in WAC 388-513-1350 (1); and

   2. The client’s non-excluded income described in subsection (6) does not exceed the CN standard described in subsection (2).

8. The department approves MN non-institutional medical assistance for a period of months described in chapter 388-416 WAC for an SSI-related client, if:

   1. The client’s non-excluded resources described in subsection (5) do not exceed the standard described in WAC 388-513-1350 (1); and

   2. The client satisfies any spenddown liability as described in chapter 388-519 WAC.

9. The department approves GA non-institutional medical assistance for a period of months described in chapter 388-416  WAC for a client determined eligible for the program as described in WAC 388-400-0025.

10. The client described in subsections (7) and (9) keeps the PNA amount and pays remaining income to the facility for board and room.