Purpose: This rule adopts recent changes in the federal standards for community spouse needs allowance, family needs allowance, and the standard shelter allocation effective July 1, 1998. This rule also adopts a state plan amendment, allowing an increase in the personal needs allowance (PNA) by the amount of income garnisheed for child support subject to the following limitations: (1) The increase applies only to garnishments made in the same period covered by the PNA; and (2) the increase does not apply to any amount of the garnishment that is deducted under another provision in the posteligibility process.

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.

Other Authority: State Plan Supplement 12 to Attachment 2.6-A Page 1.

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: This amendment must go into effect by July 1, 1998, to comply with federal regulations.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 1, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, amended 0, repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 0, repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 1, repealed 0.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: Immediately.

July 1, 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)) are deducted ((from the institutional client's income and excess resources in order to determine the amount available for the)) when determining a client's participation in the cost of care for institutional/waivered services.

(1) ((The client's)) Deductions to reduce excess resources are ((available to meet the cost of care after)) taken in the following ((deductions in this)) order:

(a) Health insurance and Medicare premiums, deductions, and co-insurance not ((paid by a)) subject to third-party payment; and

(b) Noncovered medical bills ((which are the liability of the client and not paid by a)) not subject to third-party payment for which the client is liable.

(2) ((The allocations)) Deductions 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)) Deductions to reduce income ((is available to meet the cost of care after)) not excluded in WAC 388-513-1340 are taken in 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)), if the client is a veteran living in a ((Medicaid-certified)) state veteran's home ((nursing facility));

(B) Ninety dollars ((for a single veteran, for widow or widower of a veteran receiving an improved veteran's)), if the client is a veteran not living in a state's veteran home or a veteran's surviving spouse, who receives an improved 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.

(v) Income garnished for child support.

(b) A monthly needs allowance for the community spouse not to exceed, effective January 1, 1998, two thousand nineteen 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-((eight)) six dollars;

(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-((eight))six 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((,)) for which ((are the current liability of the)) the client is liable, 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:

(i) Rent;

(ii) Mortgage;

(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)) July 1, 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.]

Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.