(1) This section describes the eligibility determination for noninstitutional coverage for a client who lives in an agency-contracted alternate living facility (ALF) defined under WAC 182-513-1100
(2) The eligibility criteria for noninstitutional Washington apple health (medicaid) coverage in an ALF follows SSI-related rules under WAC 182-512-0050
, with the exception of the higher income standard under subsection (3) of this section.
(3) A client is eligible for noninstitutional coverage under the categorically needy (CN) program if the client's monthly income after allowable exclusions under chapter 182-512
(a) Does not exceed the special income level (SIL) defined under WAC 182-513-1100
(b) Is less than or equal to the client's assessed state rate at an agency-contracted facility. To determine the CN standard: ((y × 31) + $38.84), where "y" is the state daily rate. $38.84 is based on the cash payment standard for a client living in an ALF setting under WAC 388-478-0006
(4) A client is eligible for noninstitutional coverage under the medically needy (MN) program if the client's monthly income after allowable exclusions under chapter 182-512
WAC is less than or equal to the client's private rate at an agency-contracted facility. To determine the MN standard: ((z × 31) + $38.84), where "z" is the facility's private daily rate. To determine MN spenddown liability, see chapter 182-519
(5) For both CN and MN coverage, a client's countable resources cannot exceed the standard under WAC 182-512-0010
(6) The agency or the agency's designee approves CN noninstitutional coverage for twelve months.
(7) The agency or the agency's designee approves MN noninstitutional coverage for a period of months described in WAC 182-504-0020
for an SSI-related client, provided the client satisfies any spenddown liability under chapter 182-519
(8) Clients who receive medicaid personal care (MPC) or community first choice (CFC) pay all of their income to the ALF except a personal needs allowance under WAC 182-513-1105
(9) A client may have to pay third-party resources as defined under WAC 182-513-1100 in addition to the payment under this subsection.
[Statutory Authority: RCW 41.05.021
. WSR 20-03-040, § 182-513-1205, filed 1/8/20, effective 2/8/20. Statutory Authority: RCW 41.05.021
, 2017 c 270. WSR 17-23-039, § 182-513-1205, filed 11/8/17, effective 1/1/18. Statutory Authority: RCW 41.05.021
, P.L. 111-148, 42 C.F.R. §§ 431, 435, and 457, and 45 C.F.R. § 155. WSR 17-03-116, § 182-513-1205, filed 1/17/17, effective 2/17/17.]