182-513-1315  <<  182-513-1316 >>   182-513-1317

WAC 182-513-1316

General eligibility requirements for long-term care (LTC) programs.

(1) To be eligible for long-term care (LTC) services, a person must:
(a) Meet the general eligibility requirements for medical programs under WAC 182-503-0505, except:
(i) An adult age nineteen or older must meet citizenship and immigration status requirements under WAC 182-503-0535 (2)(a) or (b);
(ii) A person under age nineteen must meet citizenship and immigration status requirements under WAC 182-503-0535 (2)(a), (b), (c), or (d); and
(iii) If a person does not meet the requirements in (a)(i) or (ii) of this subsection, the person is not eligible for medicaid and must have eligibility determined under WAC 182-513-1319.
(b) Attain institutional status under WAC 182-513-1320;
(c) Meet the functional eligibility under:
(i) Chapter 388-106 WAC for a home and community services (HCS) home and community based (HCB) waiver or nursing facility coverage; or
(ii) Chapter 388-828 WAC for developmental disabilities administration (DDA) HCB waiver or institutional services; and
(d) Meet either:
(i) SSI-related criteria under WAC 182-512-0050; or
(ii) MAGI-based criteria under WAC 182-503-0510(2), if residing in a medical institution. A person who is eligible for MAGI-based coverage is not subject to the provisions under subsection (2) of this section.
(2) A supplemental security income (SSI) recipient or a person meeting SSI-related criteria who needs LTC services must also:
(a) Not have a penalty period of ineligibility due to the transfer of assets under WAC 182-513-1363;
(b) Not have equity interest in a primary residence greater than the home equity standard under WAC 182-513-1350; and
(c) Disclose to the agency or its designee any interest the applicant or spouse has in an annuity, which must meet annuity requirements under chapter 182-516 WAC.
(3) A person who receives SSI must submit a signed health care coverage application form attesting to the provisions under subsection (2) of this section. A signed and completed eligibility review for LTC benefits can be accepted for people receiving SSI who are applying for long-term care services.
(4) To be eligible for HCB waiver services, a person must also meet the program requirements under:
(a) WAC 182-515-1505 through 182-515-1509 for HCS HCB waivers; or
(b) WAC 182-515-1510 through 182-515-1514 for DDA HCB waivers.
[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, § 182-513-1316, filed 1/17/17, effective 2/17/17.]
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