Washington Administrative Code

(1) The SSI payment standards, also known as the federal benefit rate (FBR), change each January 1st.(2) See WAC 388-478-0055 for the amount of the state supplemental payments (SSP) for SSI recipients.(3) See WAC 182-513-1205 for standards of clients living in an alternate living…

(1) The agency (which includes its designee for purposes of this chapter) provides health care coverage under the Washington apple health (WAH) categorically needy (CN) and medically needy (MN) SSI-related programs for SSI-related people, meaning those who meet at least one of th…

(1) Washington apple health (WAH) categorically needy (CN) coverage is available for an SSI-related person who meets the criteria in WAC 182-512-0050, SSI-related medical—General information.(2) To be eligible for SSI-related WAH CN medical programs, a person must also have:(a) C…

(1) Washington apple health (WAH) medically needy (MN) health care coverage is available for any of the following:(a) A person who is SSI-related and not eligible for WAH categorically needy (CN) medical coverage because the person has countable income that is above the WAH CN in…

(1) A resource is any cash, other personal property, or real property that an applicant, recipient or other financially responsible person:(a) Owns;(b) Has the right, authority, or power to convert to cash (if not already cash); and(c) Has the legal right to use for his/her suppo…

(1) The agency considers personal and real property to be available to a Washington apple health applicant or recipient if the applicant or recipient:(a) Owns the property;(b) Has the authority to convert the property into cash;(c) Can expect to convert the property to cash withi…

(1) The agency counts part of a sponsor's resources as available to an applicant or recipient of Washington apple health (WAH) SSI-related health care coverage if:(a) The person is a sponsored immigrant as defined in WAC 182-512-0785; and(b) The person is not exempt from deeming …

(1) At 12:00 a.m. on the first day of the month a client's countable resources must be at or below the resource standard to be eligible for noninstitutional medical benefits for that month. If the total of the client's countable resources is above the resource standard at 12:00 a…

(1) The agency excludes the following resources when determining eligibility for SSI-related medical assistance:(a) A client's household goods and personal effects;(b) One home (which can be any shelter), including the land on which the dwelling is located, and all contiguous pro…

(1) For SSI-related medical programs, a vehicle is defined as anything used for transportation. In addition to cars and trucks, a vehicle can include boats, snowmobiles, and animal-drawn vehicles.(2) One vehicle is excluded regardless of its value, if it is used to provide transp…

(1) The agency excludes life insurance policies that do not have or cannot accrue a cash surrender value (CSV) in determining whether owned policies exceed the life insurance exclusion limits for resources and in determining burial fund exclusion limits.(2) Policies owned by each…

(1) For the purposes of this section, burial funds are funds set aside and clearly designated solely for burial and related expenses, and kept separate from all other resources not intended for burial. These include:(a) Revocable burial contracts;(b) Revocable burial trusts; or(c…

All resources described in this section are excluded resources for SSI-related medical programs. Unless otherwise stated, interest earned on the resource amount is counted as unearned income.(1) Resources necessary for a person who is blind or disabled to fulfill a self-sufficien…

(1) Income is anything a client receives in cash or in-kind that can be used to meet the client's needs for shelter. Income can be earned or unearned.(2) Some receipts are not income because they do not meet the definition of income above. Some types of receipts that are not inco…

(1) Income is considered available to a person at the earliest of when it is:(a) Received; or(b) Credited to a person's account; or(c) Set aside for the person's use; or(d) Used or can be used to meet the person's needs for shelter.(2) Anticipated nonrecurring lump sum payments a…

(1) The agency does not count income until the person begins to receive it. Income is budgeted prospectively for all Washington apple health health care programs.(2) Anticipated nonrecurring lump sum payments other than retroactive SSI/SSDI payments are considered income in the m…

The agency counts unearned income for Washington apple health (WAH) SSI-related medical programs as follows:(1) The total amount of income benefits to which a person is entitled is treated as available unearned income even when the benefits are:(a) Reduced through the withholding…

(1) The agency does not count:(a) Educational assistance in the form of grants, loans or work study, issued from Title IV of the Higher Education Amendments (Title IV – HEA) and Bureau of Indian Affairs (BIA) education assistance programs. Examples of Title IV – HEA and BIA educa…

(1) The agency excludes the following types of income from being considered when determining eligibility for Washington apple health (WAH) categorically needy (CN) and medically needy (MN) SSI-related programs for American Indians or Alaska Natives:(a) Distributions from Alaska N…

(1) The agency excludes income received from the following programs:(a) Payments issued under the Workforce Investment Act (WIA);(b) Payments issued under the National and Community Service Trust Act of 1993. This includes payments made through the AmeriCorps program;(c) Payments…

(1) The following definitions apply to this section:(a) "Sponsor" means a person who agreed to meet the needs of a sponsored immigrant by signing a United States Citizenship and Immigration Services Affidavit of Support form I-864 or I-864A. This includes a sponsor's spouse if th…

(1) A person who meets any of the following conditions is permanently exempt from deeming and the agency does not count the sponsor's income or resources when determining eligibility for Washington apple health (WAH) SSI-related coverage:(a) The Immigration and Nationality Act (I…

(1) The agency counts some of the income of a person's sponsor as unearned income to the medical assistance unit (MAU) if:(a) The sponsor signed the U.S. Citizenship and Immigration Services (USCIS) Affidavit of Support form I-864 or I-864A; and(b) The person is not exempt from t…

The agency excludes, or does not consider, the following when determining a person's eligibility for Washington apple health SSI-related medical programs:(1) The first $20 per month of unearned income. If there is less than $20 of unearned income in a month, the remainder is excl…

(1) For the purposes of Washington apple health SSI-related medical eligibility determinations under chapter 182-512 WAC, a child is defined as a person who is:(a) Unmarried;(b) Living in the household of the SSI-related applicant;(c) The natural, adopted or stepchild of the SSI-…

The agency excludes the following when determining eligibility for Washington apple health (WAH) SSI-related medical programs:(1) Work related expenses:(a) That enable an SSI-related person to work; or(b) That allows a blind or disabled person to work and that are directly relate…

The Social Security Act and other federal statutes or state laws list income that the agency excludes when determining eligibility for Washington apple health (WAH) SSI-related medical programs. These exclusions include, but are not limited to:(1) Income tax refunds;(2) Federal e…

Portions of a person's income the agency otherwise counts are disregarded when determining eligibility for Washington apple health SSI-related medical programs.(1) The agency disregards cost of living adjustments (COLAs) to Social Security benefits and provides categorically need…

The agency considers income of financially responsible persons to determine if a portion of that income must be regarded as available to other household members.(1) Deeming is the process of determining how much of another person's income is counted when determining Washington ap…

The agency considers the income of financially responsible persons to determine if a portion of that income is available to other household members.(1) A portion of the income of a nonapplying spouse is considered available to meet the needs of a Washington apple health SSI-relat…

The agency considers income of financially responsible persons to determine if a portion of that income must be regarded as available to other household members.(1) A portion of the income of a parent(s) is considered available to the SSI-related applicant child when the child is…

The agency considers resources of financially responsible people to determine if a portion of the resources must be regarded as available to other household members.(1) A portion of the resources of a parent or parents is available to the SSI-related child when the child is age s…

(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 institutiona…

This section defines the meaning of certain terms used in chapters 182-513 and 182-515 WAC. Within these chapters, institutional, home and community-based services (HCBS) waiver, program of all-inclusive care for the elderly (PACE), and hospice in a medical institution are referr…

(1) This section describes the personal needs allowance (PNA), which is an amount set aside from a client's income that is intended for personal needs, and the room and board standard.(2) The PNA in a state veteran's nursing facility:(a) Is indicated on the chart described in sub…

(1) A person may be determined presumptively eligible for long-term services and supports (LTSS) in their own home, as defined in WAC 388-106-0010:(a) Upon completion of a screening interview; and(b) When authorized by home and community services (HCS).(2) The screening interview…

(1) Long-term services and supports (LTSS) programs available to people eligible for noninstitutional Washington apple health coverage who meet the functional requirements.(a) Noninstitutional apple health coverage in an alternate living facility (ALF) under WAC 182-513-1205.(b) …

(1) This section describes the eligibility determination for noninstitutional coverage for a client who lives in an agency-contracted alternate living facility (ALF) defined under WAC 182-513-1100.(2) The eligibility criteria for noninstitutional Washington apple health (medicaid…

(1) Community first choice (CFC) is a Washington apple health state plan benefit authorized under Section 1915(k) of the Social Security Act.(2) CFC enables the agency and its contracted entities to deliver person-centered home and community based long-term services and supports …

(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) progr…

(1) This section is effective through September 30, 2027.(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 …

(1) Medicaid personal care (MPC) is a state-plan benefit available to a client who is determined:(a) Functionally eligible for MPC services under WAC 388-106-0200 through 388-106-0235; and(b) Financially eligible for a noninstitutional categorically needy (CN) or alternative bene…

(1) The program of all-inclusive care for the elderly (PACE) provides long-term services and supports (LTSS), medical, mental health, and substance use disorder (SUD) treatment through a department-contracted managed care plan using a personalized plan of care for each enrollee.(…

(1) Roads to community living (RCL) is a demonstration project authorized under Section 6071 of the Deficit Reduction Act of 2005 (P.L. 109-171) and extended through the Patient Protection and Affordable Care Act (P.L. 111-148).(2) Program rules governing functional eligibility f…

(1) General information.(a) The hospice program provides palliative care to people who elect to receive hospice services and are certified as terminally ill by their physician.(b) Program rules governing election of hospice services are under chapter 182-551 WAC.(c) A person may …

(1) General information.(a) When living in a medical institution, a person may be eligible for medically needy coverage under the hospice program. A person must:(i) Meet program requirements under WAC 182-513-1315;(ii) Have available income that exceeds the special income level (…

This section lists the sections in this chapter that describe how the agency determines a person's eligibility for long-term care services. These sections are:(1) WAC 182-513-1316 General eligibility requirements for long-term care (LTC) programs.(2) WAC 182-513-1317 Income and r…

(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 19 or older must meet citizenship and immigration status requirements under WAC 182-503-0535 (2)(…

(1) This section provides an overview of the income and resource eligibility rules for a person who lives in an institutional setting.(2) To determine income eligibility for an SSI-related long-term care (LTC) applicant under the categorically needy (CN) program, the agency or it…

(1) This section provides an overview of the income and resource eligibility rules for a person to be eligible for a categorically needy (CN) home and community based (HCB) waiver program under chapter 182-515 WAC or the hospice program under WAC 182-513-1240 and 182-513-1245.(2)…