(1) General information.
(a) This section describes how the agency determines household income and resources when the household contains both institutional and noninstitutional household members.
(b) A separate medical assistance unit is established for people who meet institutional status under WAC
182-513-1320. See WAC
182-506-0015 for rules on how to determine medical assistance units for households that include people related to the supplemental security income (SSI) program.
(c) Throughout this section, "home" means "own home" as defined in WAC
388-106-0010.
(d) The income and resources of each spouse are available to the other through the end of the month in which the spouses stopped living together, unless subsection (3) of this section applies.
(e) The agency determines income and resources separately starting the first day of the month following the month of separation if spouses stop living together in the same home.
(f) When one, or both members of a couple live in an alternative living facility (ALF), the agency considers the couple to be living:
(i) Apart when:
(A) Only one spouse enters the ALF;
(B) Both spouses enter the same ALF but have separate rooms; or
(C) Both spouses enter separate ALFs.
(ii) Together when both spouses share a room in an ALF.
(2) The agency counts income and resources under this chapter when both members of a couple live in the same house and the community spouse or spousal impoverishment protections community (SIPC) spouse applies for coverage and his or her spouse receives:
(a) Home and community-based (HCB) waiver;
(b) Program for all inclusive care to the elderly (PACE);
(c) Roads to community living (RCL);
(d) Hospice; or
(e) Community first choice (CFC).
(3) When one member of a couple lives apart from their spouse and the community spouse or SIPC spouse applies for coverage, and the spouse who receives long-term services and supports lives:
(a) In an institution:
(i) The agency counts income under this chapter, plus any allocation the institutionalized spouse has made available to the community spouse; and
(ii) The agency counts resources under this chapter, plus any resources allocated to the community spouse when eligibility for the institutionalized spouse was determined, that remain in the name of the institutionalized spouse and are available to the community spouse under WAC
182-512-0250.
(b) In an ALF and receives HCB waiver, PACE, RCL, or hospice:
(i) The agency counts income under this chapter, plus any allocation the institutionalized spouse has made available to the community spouse; and
(ii) The agency counts resources under this chapter, plus any resources allocated to the community spouse when eligibility for the institutionalized spouse was determined, that remain in the name of the institutionalized spouse, and are available to the community spouse under WAC
182-512-0250; and
(c) In an ALF and receives CFC:
(i) The agency counts income under this chapter; and
(ii) The agency counts resources under this chapter, plus any resources allocated to the SIPC spouse when eligibility for the spousal impoverishment protections institutionalized (SIPI) spouse was determined, that remain in the name of the SIPI spouse and are available to the community spouse under WAC
182-512-0250.
(4) Determining household income when the spouse of an HCB waiver recipient is not eligible for categorically needy (CN) coverage.
(a) When the community spouse is not eligible for categorically needy (CN) coverage under subsection (2) of this section, the agency determines eligibility under the medically needy program;
(b) The agency counts income and resources as described under subsection (2) of this section;
(c) The agency allocates income to the institutionalized spouse before comparing the community spouse's income to the medically needy income level (MNIL) if:
(i) The community spouse lives in the same household as the institutionalized spouse;
(ii) The institutionalized spouse is receiving home and community-based waiver services under WAC
182-515-1505 or institutional hospice services under WAC
182-513-1240; and
(iii) The institutionalized spouse has gross income under the MNIL.
(d) The allocation in (c) of this subsection cannot exceed the one-person effective MNIL minus the institutionalized spouse's income.
[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, § 182-512-0960, filed 1/17/17, effective 2/17/17. Statutory Authority: RCW
41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0960, filed 3/14/14, effective 4/14/14. WSR 11-24-018, recodified as § 182-512-0960, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW
74.04.050,
74.04.057,
74.08.090, and
74.09.500. WSR 11-15-023, § 388-475-0960, filed 7/8/11, effective 8/8/11.]
