WSR 18-06-031 PERMANENT RULES HEALTH CARE AUTHORITY [Filed February 28, 2018, 2:10 p.m., effective March 31, 2018] Effective Date of Rule: Thirty-one days after filing. Purpose: Section 2404 of the Affordable Care Act amended Section 1924 of the Social Security Act, for the five-year period beginning January 1, 2014, to require states to apply the spousal impoverishment rules to additional individuals receiving long-term services and supports under 1915(k). The agency is amending this section to end the time-limited spousal impoverishment provisions for the community first choice program. Citation of Rules Affected by this Order: Amending WAC 182-513-1215 and 182-513-1220. Other Authority: Section 2404 of the Affordable Care Act amending Section 1924 of the Social Security Act. Adopted under notice filed as WSR 18-03-078 on January 12, 2018. Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 2, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0. Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0. Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0. Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0. Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0. Date Adopted: February 28, 2018. Wendy Barcus Rules Coordinator
AMENDATORY SECTION (Amending WSR 17-23-039, filed 11/8/17, effective 1/1/18)
WAC 182-513-1215 Community first choice (CFC)—Eligibility.
(1) A client who is determined functionally eligible for community first choice (CFC) services under WAC 388-106-0270 through 388-106-0295 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; or
(c) Determined eligible for a home and community based (HCB) waiver program under chapter 182-515 WAC.
(2) A client whose only coverage is through one of the following programs is not eligible for CFC:
(a) Medically needy program under WAC 182-519-0100;
(b) Premium-based children's program under WAC 182-505-0215;
(c) Medicare savings programs under WAC 182-517-0300;
(d) Family planning program under WAC 182-505-0115;
(e) Take charge program under WAC 182-532-0720;
(f) Medical care services program under WAC 182-508-0005;
(g) Pregnant minor program under WAC 182-505-0117;
(h) Alien emergency medical program under WAC 182-507-0110 through 182-507-0120;
(i) State-funded long-term care (LTC) for noncitizens program under WAC 182-507-0125; or
(j) Kidney disease program under chapter 182-540 WAC.
(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 WAC.
(4) Home equity limits under WAC 182-513-1350 do apply.
(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; and
(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.
AMENDATORY SECTION (Amending WSR 17-03-116, filed 1/17/17, effective 2/17/17)
WAC 182-513-1220 Community first choice (CFC)—Spousal impoverishment protections for noninstitutional Washington apple health clients.
(1) This section is effective through December 31, 2018.
(2) The agency or its designee determines eligibility for community first choice (CFC) using spousal impoverishment protections under this section, when an applicant:
(a) Is married to, or marries, a person not in a medical institution;
(b) Meets institutional level of care and eligibility for CFC services under WAC 388-106-0270 through 388-106-0295;
(c) Is ineligible for a noninstitutional categorically needy (CN) SSI-related program:
(i) Due to spousal deeming rules under WAC 182-512-0920, or due to exceeding the resource limit in WAC 182-512-0010, or both; or
(ii) In an ALF due to combined spousal resources exceeding the resource limit in WAC 182-512-0010; and
(d) Meets the aged, blindness, or disability criteria under WAC 182-512-0050.
(((2))) (3) The agency or its designee determines countable income using the SSI-related income rules under chapter 182-512 WAC but uses only the applicant's or recipient's separate income and not the income of the applicant's or recipient's spouse.
(((3))) (4) The agency or its designee determines countable resources using the SSI-related resource rules under chapter 182-512 WAC, except pension funds owned by the spousal impoverishment protections community (SIPC) spouse are not excluded as described under WAC 182-512-0550:
(a) For the applicant or recipient, the resource standard is $2000.
(b) Before determining countable resources used to establish eligibility for the applicant, the agency allocates the state spousal resource standard to the SIPC spouse.
(c) The resources of the SIPC spouse are unavailable to the spousal impoverishment protections institutionalized (SIPI) spouse the month after eligibility for CFC services is established unless subsection (((8))) (9) of this section applies.
(((4))) (5) The SIPI spouse has until the end of the month of the first regularly scheduled eligibility review to transfer countable resources in excess of $2000 to the SIPC spouse.
(((5))) (6) A redetermination of the couple's resources under subsection (((3))) (4) of this section is required if:
(a) The SIPI spouse has a break in CFC services of at least thirty consecutive days;
(b) The SIPI spouse's countable resources exceed the standard under subsection (((3))) (4)(a) of this section; or
(c) The SIPI spouse does not transfer the amount under subsection (((4))) (5) of this section to the SIPC spouse by the end of the month of the first regularly scheduled eligibility review.
(((6))) (7) If the applicant lives at home and the applicant's separate countable income is at or below the SSI categorically needy income level (CNIL) and the applicant is resource eligible, the applicant is a SIPI spouse and is financially eligible for noninstitutional CN coverage and CFC services.
(((7))) (8) If the applicant lives in an ALF, has separate countable income at or below the standard under WAC 182-513-1205(2), and is resource eligible, the applicant is a SIPI spouse and is financially eligible for noninstitutional CN coverage and CFC services.
(((8))) (9) If the applicant is employed and has separate countable income at or below the standard under WAC 182-511-1060, the applicant is a SIPI spouse and is financially eligible for noninstitutional CN coverage and CFC services.
(((9))) (10) Once a person no longer receives CFC services for thirty consecutive days, the agency redetermines eligibility without using spousal impoverishment protection, under WAC 182-504-0125.
(((10))) (11) If the applicant's separate countable income is above the standards under subsections (((6), (7), and (8))) (7), (8), and (9) of this section, the applicant is not eligible for CFC services under this section.
(((11))) (12) The spousal impoverishment protections under this section expire on December 31, 2018.
(((12))) (13) Standards are found at http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/program-standard-income-and-resources.
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