WSR 98-04-003

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Medical Assistance Administration)

[Filed January 22, 1998, 4:00 p.m.]

Date of Adoption: January 22, 1998.

Purpose: To change eligibility requirements for institutional care to comply with 42 CFR 435.1005. The department will base eligibility on "gross nonexempt" income rather than "countable" income. Editorial changes to improve readability do not change intent of this WAC.

Citation of Existing Rules Affected by this Order: Amending WAC 388-513-1315.

Statutory Authority for Adoption: RCW 74.04.050 and 74.08.090.

Other Authority: 42 CFR 435.1005.

Adopted under notice filed as WSR 97-23-083 on November 19, 1997.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, amended 1, repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 0, repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 1, repealed 0.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: Thirty-one days after filing.

January 22, 1998

Edith M. Rice, Chief

Office of Legal Affairs

AMENDATORY SECTION (Amending Order 3980, filed 5/10/96, effective 6/10/96 WAC 388-513-1315 Eligibility determination--Institutional.(1) ((The department shall find)) A person ((meeting the requirements of WAC 388-513-1320)) is eligible for institutional care under the categorically needy program, if the person:

(a) ((Is SSI-related with countable)) Has achieved institutional status as described under WAC 388-513-1320; and

(b) Has gross nonexempt income:

(i) ((Equal to or less)) For an SSI-related person, no greater than three hundred percent of the SSI Federal Benefit Amount((. The department shall determine a person's eligibility under the categorically needy program)); ((and)) or

(ii) ((Greater than three hundred percent of SSI federal benefit amount. The department shall determine a person's eligibility under the limited casualty--medically needy program as determined under WAC 388-513-1395.

(b) Is AFDC-related with countable income:

(i) Equal to or less)) For an AFDC or TANF-related person, no greater than the one-person program standard as described under WAC 388-505-0590, 388-508-0805, or 388-509-0960. ((The department shall determine a person's eligibility under the categorically needy program; and

(ii) Greater than the program standards as described under subsection (1)(b)(i) of this section. The department shall determine a person's eligibility under the limited casualty--medically needy program as determined under WAC 388-513-1395.))

(c) ((Does not have nonexcluded)) Has resources((,)) which are:

(i) Not exempt under WAC 388-513-1360 and 388-513-1365, ((greater)) and

(ii) Less than ((limitations)) the standards under WAC 388-513-1310 and 388-513-1395(((2))); and

(d) Is not subject to a period of ineligibility for transferring of resources under WAC 388-513-1365.

(2) ((The department shall determine nursing facility residents)) A person is eligible for institutional care ((when the amount of the resources in excess of the amount in WAC 388-513-1310 plus countable income are less than the nursing facility private rate plus recurring medical expenses)) under the limited casualty program--medically needy, if the person meets the requirements in WAC 388-513-1395.

(3) ((The department shall allocate a client's income and resources as described under WAC 388-513-1380.

(4) When both spouses are institutionalized, the department shall determine the eligibility of each spouse individually.

(5) The department shall determine eligibility for a person residing or expected to reside in a Medicaid-approved medical facility less than the amount of time needed to achieve institutional status in WAC 388-513-1320 as for a noninstitutionalized person.

(6) The department shall determine eligibility)) For an AFDC- or TANF-related child under eighteen years of age residing or expected to reside in inpatient chemical dependency treatment or inpatient mental health treatment ((as described under)) refer to WAC 388-506-0610 (1)(f).

(((7))) (4) For other institutionalized persons twenty years of age or younger, ((the department shall not consider)) the income and resources of the parents are not considered available unless the income and resources are actually contributed.

(((8) The department shall determine as))

(5) A person is eligible for Medicaid ((a person)) who:

(a) Meets institutional status as a psychiatric facility resident; and

(b) Is twenty years of age or younger or is sixty-five years of age or older.

(((9) The department shall not consider))

(6) A client's income and resources are allocated as described under WAC 388-513-1380.

(7) When both spouses are institutionalized, the department shall determine the eligibility of each spouse individually.

(8) A person's transfer between medical institutions ((as)) is not a change in ((institutionalized)) institutional status((.

(10) For the effect of a social absence from an institutional living arrangement, see WAC 388-88-115)).

[Statutory Authority: RCW 74.08.090. 96-11-072 (Order 3980), 388-513-1315, filed 5/10/96, effective 6/10/96. Statutory Authority: RCW 74.08.090 and 1995 c 312 48. 95-19-007 (Order 3895), 388-513-1315, filed 9/6/95, effective 10/7/95. Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-513-1315, filed 5/3/94, effective 6/3/94.]