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

Emergency WAC effective 11-1-2011

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 department determines a client's nonexcluded resources for noninstitutional medical assistance under the SSI related program as described in chapter 388-475 WAC.
5. The department determines a client's nonexcluded income for noninstitutional medical assistance under the SSI related program as described in chapter 388-475 WAC.
6. The department approves CN noninstitutional 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 388-475-0050, 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). 
7. 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.
8. The client described in subsections (7) and (9) keeps the PNA amount and pays remaining income to the facility for board and room.