182-513-1200  <<  182-513-1205 >>   182-513-1210

WAC 182-513-1205

Determining eligibility for noninstitutional coverage in an alternate living facility (ALF).

(1) This section describes the eligibility determination for noninstitutional coverage for a client who lives in a department-contracted alternate living facility (ALF) defined under WAC 182-513-1100.
(2) The eligibility criteria for noninstitutional Washington apple health (medicaid) coverage in an ALF follows SSI-related rules under WAC 182-512-0050 through 182-512-0960, with the exception of the higher income standard under subsection (3) of this section.
(3) A client is eligible for noninstitutional coverage under the categorically needy (CN) program if the client's monthly income after allowable exclusions under chapter 182-512 WAC:
(a) Does not exceed the special income level (SIL) defined under WAC 182-513-1100; and
(b) Is less than or equal to the client's assessed state rate at a department-contracted facility. To determine the CN standard: ((y × 31) + $38.84), where "y" is the state daily rate. $38.84 is based on the cash payment standard for a client living in an ALF setting under WAC 388-478-0006.
(4) A client is eligible for noninstitutional coverage under the medically needy (MN) program if the client's monthly income after allowable exclusions under chapter 182-512 WAC is less than or equal to the client's private rate at a department-contracted facility. To determine the MN standard: ((z × 31) + $38.84), where "z" is the facility's private daily rate. To determine MN spenddown liability, see chapter 182-519 WAC.
(5) For both CN and MN coverage, a client's countable resources cannot exceed the standard under WAC 182-512-0010.
(6) The agency or the agency's designee approves CN noninstitutional coverage for twelve months.
(7) The agency or the agency's designee approves MN noninstitutional coverage for a period of months described in WAC 182-504-0020 for an SSI-related client, provided the client satisfies any spenddown liability under chapter 182-519 WAC.
(8) Clients who receive medicaid personal care (MPC) or community first choice (CFC) pay all of their income to the ALF except a personal needs allowance under WAC 182-513-1105.
(9) A client may have to pay third-party resources as defined under WAC 182-513-1100 in addition to the payment under this subsection.
[Statutory Authority: RCW 41.05.021, 41.05.160, 2017 c 270. WSR 17-23-039, § 182-513-1205, filed 11/8/17, effective 1/1/18. 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, § 182-513-1205, filed 1/17/17, effective 2/17/17.]
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