Washington Administrative Code

(1) This section describes the state-funded programs available to a person who does not meet the citizenship and immigration status criteria under WAC 182-513-1316 for federally funded coverage.(2) If a person meets the eligibility and incapacity criteria of the medical care serv…

(1) To attain institutional status outside a medical institution, a person must be approved for and receive:(a) Home and community based (HCB) waiver services under chapter 182-515 WAC;(b) Roads to community living (RCL) services under WAC 182-513-1235;(c) Program of all-inclusiv…

This section describes income the agency or its designee determines available when evaluating an SSI-related single client's eligibility for long-term care (LTC) services.(1) See WAC 182-513-1330 for rules related to available income for legally married couples.(2) The agency or …

This section describes income the agency or its designee determines available when evaluating a legally married person's eligibility for long-term care (LTC) services.(1) The agency or the agency's designee applies the following rules when determining income eligibility for LTC s…

This section describes income the agency or its designee excludes when determining a client's eligibility and participation in the cost of care for long-term care (LTC) services.(1) When determining a client's eligibility and participation in the cost of care for LTC services, th…

This section describes income the agency or its designee disregards when determining a person's eligibility for institutional or hospice services under the medically needy (MN) program. Disregarded income is available when determining a person's participation in the cost of care.…

(1) General information.(a) This section describes how the agency or the agency's designee defines the resource standard and countable or excluded resources when determining a person's eligibility for SSI-related long-term care (LTC) services. (b) "Resource standard" means the ma…

(1) The agency or its designee uses this section to calculate the resource allocation from the institutionalized spouse to the community spouse for the determination of the institutionalized spouse's resource eligibility under WAC 182-513-1350 (2)(a)(ii).(2) If the institutionali…

(1) When determining a client's eligibility for long-term care (LTC) services, the medicaid agency or the agency's designee evaluates the effect of an asset transfer made within the sixty-month period before the month that the client:(a) Attained institutional status, or would ha…

(1) This section defines undue hardship for long-term services and supports (LTSS) and specifies the request, approval, denial, and other processes for hardship waivers.(2) Undue hardship.(a) Undue hardship exists when, without LTSS benefits, the client is unable to obtain:(i) Me…

This rule describes how the agency or the agency's designee allocates income and excess resources when determining participation in the cost of care in a medical institution.(1) The agency or the agency's designee defines which income and resources must be used in this process un…

(1) This section describes how to calculate the monthly maintenance needs allowance (MMNA) in post-eligibility treatment of income for long-term care (LTC) programs for a community spouse or dependent of the institutionalized individual.(2) The community spouse MMNA standards are…

(1) For the purposes of this section only, "remaining income" means all gross nonexcluded income remaining after the post-eligibility calculation under WAC 182-513-1380.(2) General information. To be eligible for institutional services when living in a medical institution under t…

(1) The agency or its designee determines apple health coverage under noninstitutional rules for a person who meets all other eligibility requirements and lives in a licensed, but nonmedicaid-contracted facility operated by a fraternal, religious, or benevolent organization.(2) N…

(1) A person's entrance fee in a continuing care retirement community or life care community is an available resource to the person, to the extent that:(a) The person has the ability to use the entrance fee, or the contract provides that the entrance fee may be used, to pay for c…

Under the long-term care (LTC) partnership program, people who purchase qualified long-term care partnership insurance policies can apply for long-term care medicaid under special rules for determining financial eligibility. These special rules generally allow the person to prote…

For purposes of WAC 182-513-1400 through 182-513-1455, the following terms have the meanings stated. See chapter 182-500 WAC and WAC 182-513-1100 for additional definitions."Issuer" means any entity that delivers, issues for delivery, or provides coverage to, a resident of Washin…

A LTC partnership policy is a LTC policy that has been approved by the office of insurance commissioner as a LTC partnership policy described in chapter 284-83 or 284-212 WAC.[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 26-09-114, s 182-513-1410, filed 4/21/26, effectiv…

The following assets cannot be protected under a LTC partnership policy.(1) Resources in a trust under WAC 182-516-0100 (6) and (7).(2) Annuity interests in which Washington must be named as a preferred remainder beneficiary as under WAC 182-516-0201.(3) Home equity in excess of …

(1) The LTC partnership policy must meet all the requirements in chapter 284-83 or 284-212 WAC. For existing LTC policies which are converted to a LTC partnership policy via an exchange or through the addition of a policy rider or endorsement, the conversion must take place on or…

You are not eligible for long-term care (LTC) medicaid when the following applies:(1) The income you have available to pay toward your cost of care under WAC 182-513-1380, combined with the amount paid under the qualifying LTC partnership policy, exceeds the monthly private rate …

You must report changes described in WAC 182-504-0105 plus the following:(1) You must report and verify the value of the benefits that your issuer has paid on your behalf under the long-term care (LTC) partnership policy upon request by the agency, and at each annual eligibility …

The Washington long-term care partnership program provides reciprocity with respect to qualifying long-term care insurance policies covered under other state long-term care insurance partnerships. This allows you to purchase a partnership policy in one state and move to Washingto…

You can protect assets based on the amount paid by your LTC partnership policy. Assets are protected in both LTC eligibility and estate recovery. If the partnership for long-term care program is discontinued, an individual who purchased an approved plan before the date the progra…

(1) Complete a department of social and health services (DSHS) 10-438 long-term care partnership (LTCP) asset designation form listing assets and the full fair market value that are earmarked as protected at the time of initial application for long-term services and supports unde…

(1) If you transfer an asset within the sixty months prior to the medicaid application or after medicaid eligibility has been established, the agency will evaluate the transfer based on WAC 182-513-1363 and determine if a penalty period applies unless:(a) You have already been re…

Assets designated as protected prior to death are not subject to estate recovery for medical or long-term care (LTC) services paid on your behalf under chapter 182-527 WAC as long as the following requirements are met:(1) A personal representative who asserts an asset is protecte…

(1) General information.(a) This section sets the maximum guardianship or conservatorship fee and related cost deductions when:(i) A court order was entered on or after June 1, 2018; or(ii) The client under guardianship or conservatorship began receiving medicaid-funded long-term…

Medicaid alternative care (MAC) is a Washington apple health benefit authorized under section 1115 of the Social Security Act. It enables the medicaid agency and the agency's designees to deliver an array of person-centered long-term services and supports (LTSS) to unpaid caregiv…

(1) The person receiving care must meet the financial eligibility criteria for medicaid alternative care (MAC).(2) To be eligible for MAC services, the person receiving care must:(a) Be age 55 or older;(b) Be assessed as meeting nursing facility level of care under WAC 388-106-03…

(1) The tailored supports for older adults (TSOA) program is a federally funded program approved under section 1115 of the Social Security Act. It enables the medicaid agency and the agency's designees to deliver person-centered long-term services and supports (LTSS) to a person …

(1) The person receiving care must meet the financial eligibility criteria for tailored supports for older adults (TSOA).(2) To be eligible for the TSOA program, the person receiving care must:(a) Be age 55 or older;(b) Be assessed as meeting nursing facility level of care under …

(1) A person may be determined presumptively eligible for tailored supports for older adults (TSOA) services upon completion of a prescreening interview.(2) The prescreening interview may be conducted by either:(a) The area agency on aging (AAA); or(b) A home and community servic…

(1) Applications for tailored supports for older adults (TSOA) are submitted:(a) Online at Washington Connection at www.washingtonconnection.org;(b) By sending a completed HCA 18-005 application for TSOA form to P.O. Box 45826, Olympia, WA 98605;(c) By faxing a completed HCA 18-0…

(1) A person applying for or receiving tailored supports for older adults (TSOA) has the right to:(a) Have TSOA rights and responsibilities explained and provided in writing;(b) Be treated politely and fairly without regard to race, color, political beliefs, national origin, reli…

(1) To determine income eligibility for the tailored supports for older adults (TSOA) program, the medicaid agency or the agency's designee uses the following rules depending on whether the person is single or married.(2) If the TSOA applicant is single, the agency or the agency'…

(1) The resource standard for a single applicant for tailored supports for older adults (TSOA) is six times the Washington state average monthly private nursing facility rate, as determined by the department of social and health services under chapter 74.46 RCW.(2) The resource s…

(1) A certification period is the period of time a person is determined eligible for the tailored supports for older adults (TSOA) program. It begins on the first day of the month that the medicaid agency or the agency's designee determines the person is eligible for TSOA service…

(1) Changes in tailored supports for older adults (TSOA) household and family circumstances described in subsection (2) of this section must be reported to the medicaid agency or the agency's designee within thirty days of the date of the change.(2) The following changes must be …

(1) A person who receives tailored supports for older adults (TSOA) services must complete a renewal of all eligibility factors for the program at least every twelve months.(2) Forty-five days prior to the end of the certification period, notice is sent to the recipient with the …

(1) The medicaid agency or the agency's designee determines financial eligibility for medicaid alternative care (MAC) or tailored supports for older adults (TSOA) using spousal impoverishment protections under this section, when an applicant or recipient:(a) Is married to, or mar…

(1) This chapter describes eligibility requirements for the Washington apple health (WAH) modified adjusted gross income (MAGI)-based long-term care program (LTC) for children and adults who have been admitted to an institution as defined in WAC 182-500-0050 for at least 30 days.…

(1) To be eligible for modified adjusted gross income (MAGI)-based long-term care (LTC) coverage under this section, a person must:(a) Meet institutional status under WAC 182-513-1320;(b) Meet the general eligibility requirements under WAC 182-503-0505, unless the applicant is a …

Applicants for and recipients of the modified adjusted gross income (MAGI)-based long-term care program are exempt from the transfer-of-asset evaluation under WAC 182-513-1363, and there is no resource test.[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 16-04-087, § 182-5…

(1) To qualify for coverage under the modified adjusted gross income (MAGI)-based long-term care (LTC) program under this section, a person age nineteen or older must be eligible for one of the following Washington apple health (WAH) programs:(a) WAC 182-505-0240 Washington apple…

(1) To qualify for the modified adjusted gross income (MAGI)-based long-term care (LTC) program under this section, you (a child under age nineteen) must meet:(a) The general eligibility requirements in WAC 182-514-0240; and(b) Program requirements under WAC 182-505-0210 or 182-5…

(1) Medically needy (MN) coverage under this section is only available for people age 20 and younger or pregnant people. The medicaid agency determines a client who meets SSI-related criteria under WAC 182-512-0050 eligible for institutional MN coverage under WAC 182-513-1395. If…

(1) A person who is involuntarily committed to Eastern or Western State Hospital under chapter 71.34 RCW is eligible for categorically needy (CN) coverage if the person:(a) Is under age twenty-one;(b) Meets institutional status under WAC 182-513-1320; and(c) Has countable income …

This chapter describes the general and financial eligibility requirements for categorically needy (CN) home and community based (HCB) waiver services authorized by home and community services (HCS). The definitions in WAC 182-513-1100 and chapter 182-500 WAC apply throughout this…

(1) To be eligible for home and community based (HCB) waiver services a person must:(a) Meet the program and age requirements for the specific program:(i) Community options program entry system (COPES), under WAC 388-106-0310;(ii) Residential support waiver (RSW), under WAC 388-1…