SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
[Filed December 23, 1998, 10:45 a.m., effective January 1, 1999]
Date of Adoption: December 23, 1998.
Purpose: This rules adopts changes in the federal standards for increases under spousal impoverishment in resource and income amounts for community spouses; it also adopts changes for the community spouse needs allowance and family needs allowance. Under section 1924(g) of the Social Security Act the new amounts that become effective January 1, 1999, are adopted in this emergency rule.
Citation of Existing Rules Affected by this Order: Amending WAC 388-513-1380.
Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, section 1924(g) of the Social Security Act.
Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.
Reasons for this Finding: Federal regulations require this increase in standards to be effective January 1, 1999, in order to continue receiving federal funds.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 1, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, amended 0, repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 0, repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 1, repealed 0.
Effective Date of Rule: January 1, 1999.
December 23, 1998
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit
AMENDATORY SECTION (Amending WSR 98-08-077, filed 3/31/98, effective 4/1/98)
WAC 388-513-1380 Institutional--Participation--Client share of monthly institutional payments. This section describes the allocations which can be deducted from the institutional client's income and excess resources in order to determine the amount available for the client's participation in the cost of care.
(1) The client's excess resources are available to meet the cost of care after the following deductions in this order:
(a) Health insurance and Medicare premiums, deductions, and co-insurance not paid by a third party; and
(b) Noncovered medical bills which are the liability of the client and not paid by a third party.
(2) The allocations used to reduce excess resources under subsection (1) of this section cannot be used to reduce income under subsection (3) of this section.
(3) The client's nonexempt income is available to meet the cost of care after the following deductions in this order:
(a) Deductions described in subsection (3)(a) may not total more than the one-person medically needy income level (MNIL):
(i) A personal needs allowance (PNA) as follows:
(A) One hundred sixty dollars for a veteran living in a Medicaid-certified state veteran's home nursing facility;
(B) Ninety dollars for a single veteran, or widow or widower of a veteran receiving an improved veteran's pension; or
(C) Forty-one dollars and sixty-two cents for all other clients in a medical facility.
(ii) Federal, state, or local income taxes:
(A) Mandatorily withheld from earned or unearned income for income tax purposes before receipt by the client; or
(B) Not covered by withholding, but are owed or have been paid by the client.
(iii) Wages for a client who:
(A) Is SSI-related; and
(B) Receives the wages as part of a department-approved training or rehabilitative program designed to prepare the client for a less restrictive placement. When determining this deduction employment expenses are not deducted.
(iv) Guardianship fees and administrative costs including any attorney fees paid by the guardian, after June 15, 1998, only as allowed by chapter 388-79 WAC.
(b) A monthly needs allowance for the community spouse not
to exceed, effective January 1, ((
1998)) 1999, two thousand
(( nineteen)) forty-nine dollars, unless specified in subsection
(5) of this section. The monthly needs allowance is:
(i) An amount added to the community spouse's gross income
to provide a total of one thousand three hundred fifty-((
(ii) Excess shelter expenses as specified under subsection (4) of this section; and
(iii) Allowed only to the extent the client's income is made available to the community spouse.
(c) A monthly maintenance needs amount for each dependent or minor child, dependent parent or dependent sibling:
(i) Residing with the community spouse, equal to one-third
of the amount that one thousand three hundred fifty-((
seven dollars exceeds the family member's income. Child support
received from an absent parent is the child's income.
(ii) Not residing with the community spouse, equal to the MNIL for the number of family members in the home less the income of the family members.
(d) Incurred medical expenses, not subject to third-party payment, which are the current liability of the client including:
(i) Health insurance premiums, deductions, and coinsurance amounts; and
(ii) Necessary medical care recognized under state law, but not covered under Medicaid.
(e) Maintenance of the home of a single person or institutionalized couple:
(i) Up to one hundred percent of the one-person federal poverty level per month;
(ii) Limited to a six-month period;
(iii) When a physician has certified that the client is likely to return to the home within the six-month period; and
(iv) When social service staff documents initial need for the income exemption and reviews the person's circumstances after ninety days.
(4) For the purposes of this section, "excess shelter expenses" equal the actual expenses under subsection (4)(a) of this section less the standard shelter allocation under subsection (4)(b) of this section:
(a) Shelter expenses are the actual required maintenance expenses for the community spouse's principal residence for:
(iii) Taxes and insurance;
(iv) Any maintenance care for a condominium or cooperative; and
(v) The food stamp standard utility allowance, provided the utilities are not included in the maintenance charges for a condominium or cooperative.
(b) The standard shelter allocation is four hundred
eight)) seven dollars, effective April 1, (( 1997)) 1998.
(5) The amount the institutional spouse may allocate to the community spouse may be greater than the amount in subsection (3)(b) of this section only when:
(a) A court enters an order against the institutionalized client for the support of the community spouse; or
(b) A hearings officer determines a greater amount is needed because of exceptional circumstances resulting in extreme financial duress.
(6) SSI clients shall continue to receive total payment under 1611 (b)(1) of the Social Security Act for the first three full calendar months of institutionalization in a public or Medicaid-approved medical institution or facility when the:
(a) Stay in the institution or facility is not expected to exceed three months; and
(b) The client plans to return to former living arrangements.
[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, 43.20B.460, 11.92.180, and Section 1924 (42 USC 396r-5). 98-08-077, § 388-513-1380, filed 3/31/98, effective 4/1/98. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530 and Social Security Act, Federal Register, March 10, 1997, pgs. 10856 - 10859, 42 U.S.C. 1396 (a)(l)(m). 97-16-008, § 388-513-1380, filed 7/24/97, effective 7/24/97. Statutory Authority: RCW 74.08.090 and Title XIX State Agency Letter 95-44. 96-09-033 (Order 3963), § 388-513-1380, filed 4/10/96, effective 5/11/96. Statutory Authority: RCW 74.08.090. 95-11-045 (Order 3848), § 388-513-1380, filed 5/10/95, effective 6/10/95. Statutory Authority: RCW 74.08.090 and Title XIX State Agency Letter 94-49, notice of increase in SSI level. 95-05-022 (Order 3832), § 388-513-1380, filed 2/8/95, effective 3/11/95. Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), § 388-513-1380, filed 5/3/94, effective 6/3/94. Formerly WAC 388-95-360.]