PDFWAC 182-507-0125
State-funded long-term care services.
(1) Caseload limits.
(a) The state-funded long-term care services program is subject to caseload limits determined by legislative funding.
(b) The aging and long-term support administration (ALTSA) or the developmental disabilities administration (DDA) must preauthorize state-funded long-term care service before payments begin.
(c) ALTSA or DDA cannot authorize a service, under chapter 388-106 WAC or under chapter 388-825 WAC, if doing so would exceed statutory caseload limits.
(2) Location of services. State-funded long-term care services may be provided in:
(a) The person's own home, defined in WAC 388-106-0010;
(b) An adult family home, defined in WAC 182-513-1100;
(c) An assisted living facility, defined in WAC 182-513-1100;
(d) An enhanced adult residential care facility, defined in WAC 182-513-1100;
(e) An adult residential care facility, defined in WAC 182-513-1100;
(f) A nursing facility, defined in WAC 182-500-0050, but only if nursing facility care is necessary to sustain life; or
(g) A residential habilitation center, defined in WAC 388-835-0010, that is an intermediate care facility for individuals with intellectual disabilities (ICF/IID), defined in WAC 182-500-0050.
(3) Client eligibility. To be eligible for the state-funded long-term care services program, a person must meet all of the following conditions:
(a) General eligibility requirements for medical programs under WAC 182-503-0505, except (c) and (d) of this subsection;
(b) Be age 19 or older;
(c) Reside in one of the locations under subsection (2) of this section;
(d) Attain institutional status under WAC 182-513-1320;
(e) Meet the functional eligibility requirements under WAC 388-106-0355 for nursing facility level of care or under WAC 388-845-0030 for ICF/IID level of care;
(f) Not have a penalty period due to a transfer of assets under WAC 182-513-1363;
(g) Not have equity interest in a primary residence more than the amount under WAC 182-513-1350; and
(h) Meet the requirements under chapter 182-516 WAC for annuities owned by the person or the person's spouse.
(4) General limitations.
(a) If a person entered Washington only to obtain medical care, the person is ineligible for state-funded long-term care services.
(b) The certification period for state-funded long-term care services may not exceed 12 months.
(c) People who qualify for state-funded long-term care services receive categorically needy (CN) medical coverage under WAC 182-501-0060.
(5) Supplemental security income (SSI)-related program limitations.
(a) A person who is related to the SSI program under WAC 182-512-0050 (1), (2), and (3) must meet the financial requirements under WAC 182-513-1315 to be eligible for state-funded long-term care services.
(b) An SSI-related person who is not eligible for the state-funded long-term care services program under CN rules may qualify under medically needy (MN) rules under WAC 182-513-1395.
(c) The agency determines how much an SSI-related person is required to pay toward the cost of care, using:
(i) WAC 182-513-1380, if the person resides in a nursing facility or residential habilitation center.
(ii) WAC 182-515-1505 or 182-515-1510, if the person resides in one of the locations listed in subsection (2)(a) through (e) of this section.
(6) Modified adjusted gross income (MAGI)-based program limitations.
(a) A person who is related to the MAGI-based program may be eligible for state-funded long-term care services under this section and chapter 182-514 WAC if the person resides in a nursing facility.
(b) A MAGI-related person is not eligible for residential or in-home care state-funded long-term care services unless the person also meets the SSI-related eligibility criteria under subsection (5)(a) of this section.
(c) A MAGI-based person does not pay toward the cost of care in a nursing facility.
(7) Current resource, income, PNA, and room and board standards are found at www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 24-16-023, § 182-507-0125, filed 7/26/24, effective 8/26/24; WSR 23-04-034, § 182-507-0125, filed 1/25/23, effective 2/25/23. 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, § 182-507-0125, filed 1/17/17, effective 2/17/17. WSR 12-13-056, recodified as § 182-507-0125, filed 6/15/12, effective 7/1/12. Statutory Authority: 2011 c 5, RCW 74.04.057, 74.08.090, and 74.09.510. WSR 11-19-070, § 388-438-0125, filed 9/15/11, effective 10/16/11. Statutory Authority: RCW 74.04.050, 74.08.090, and 2009 c 564 §§ 1109, 201, 209. WSR 10-19-085, § 388-438-0125, filed 9/17/10, effective 10/18/10.]