PDFWAC 182-515-1508

Home and community based (HCB) waiver services authorized by home and community services (HCS)—Financial eligibility using SSI-related institutional rules.

(1) If a person is not eligible for a categorically needy (CN) program under WAC 182-515-1507, the agency determines eligibility for home and community based (HCB) waiver services authorized by home and community services (HCS) using institutional medicaid rules. This section explains how a person may qualify using institutional rules.
(2) A person must meet:
(a) General eligibility requirements under WAC 182-513-1315 and 182-515-1506;
(b) The resource requirements under WAC 182-513-1350;
(c) The following income requirements:
(i) Available income must be at or below the special income level (SIL), defined under WAC 182-513-1100; or
(ii) If available income is above the SIL, net available income is no greater than the effective one-person medically needy income level (MNIL). Net income is calculated by reducing available income by:
(A) Medically needy (MN) disregards found under WAC 182-513-1345;
(B) The average monthly nursing facility state rate;
(C) Health insurance premiums, other than medicare; and
(D) Outstanding medical bills, prorated monthly over a 12-month certification period, that meet the requirements of WAC 182-513-1350.
(3) The agency determines available income and income exclusions under WAC 182-513-1325, 182-513-1330, and 182-513-1340.
(4) A person eligible under this section is responsible to pay toward the cost of care and room and board, as described under WAC 182-515-1509.
(5) Current resource, income standards, and the average state nursing facility rate for long-term care are found at www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 23-04-034, § 182-515-1508, filed 1/25/23, effective 2/25/23. Statutory Authority: RCW 41.05.021, 41.05.160, P.L. 111-148, 42 C.F.R. §§ 431, 435, and 457, and 45 C.F.R § 155. WSR 17-03-116, § 182-515-1508, filed 1/17/17, effective 2/17/17. WSR 13-01-017, recodified as WAC 182-515-1508, filed 12/7/12, effective 1/1/13. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530, section 6014 of the Deficit Reduction Act of 2005 (DRA), and 2010 1st sp.s. c 37 § 209(1). WSR 12-21-091, § 388-515-1508, filed 10/22/12, effective 11/22/12. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 74.09.530 and Washington state 2007-09 operating budget (SHB 1128). WSR 08-22-052, § 388-515-1508, filed 11/3/08, effective 12/4/08.]