(1) A client who is determined functionally eligible for community first choice (CFC) services under WAC 388-106-0270
is financially eligible to receive CFC services if the client is:
(a) Eligible for a noninstitutional Washington apple health (medicaid) program which provides categorically needy (CN) or alternative benefits plan (ABP) scope of care;
(b) Through December 31, 2018, a spousal impoverishment protections institutional (SIPI) spouse under WAC 182-513-1220
(c) Determined eligible for a home and community based (HCB) waiver program under chapter 182-515
(2) A client whose only coverage is through one of the following programs is not eligible for CFC:
(b) Premium-based children's program under WAC 182-505-0215
(i) State-funded long-term care (LTC) for noncitizens program under WAC 182-507-0125
(j) Kidney disease program under chapter 182-540
(3) Transfer of asset penalties under WAC 182-513-1363
do not apply to CFC applicants, unless the client is applying for long-term services and supports (LTSS) that are available only through one of the HCB waivers under chapter 182-515
(5) Post-eligibility treatment of income rules do not apply if the client is eligible under subsection (1)(a) or (b) of this section.
(6) Clients eligible under subsection (1)(a) or (b) of this section, who reside in an alternate living facility (ALF):
(a) Keep a personal needs allowance (PNA) under WAC 182-513-1105
(b) Pay up to the room and board standard under WAC 182-513-1105
except when CN eligibility is based on the rules under WAC 182-513-1205
(7) A client who receives CFC services under the health care for workers with disabilities (HWD) program under chapter 182-511
WAC must pay the HWD premium in addition to room and board under WAC 182-513-1105
, if residing in an ALF.
(8) Post-eligibility treatment of income rules do apply if a client is eligible under subsection (1)(c) of this section.
(9) A client may have to pay third-party resources as defined under WAC 182-513-1100
in addition to the room and board and participation.
(10) PNA, MNIL, and room and board standards are found at www.hca.wa.gov/free-or-low-cost-health-care/program-administration/program-standard-income-and-resources.
[Statutory Authority: RCW 41.05.021
and P.L. 111–148, Title II, § 2404. WSR 18-06-031, § 182-513-1215, filed 2/28/18, effective 3/31/18. Statutory Authority: RCW 41.05.021
, 2017 c 270. WSR 17-23-039, § 182-513-1215, 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, § 182-513-1215, filed 1/17/17, effective 2/17/17.]