Current through Register Vol. 24-18, September 15, 2024
(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.
12-13-056, recodified as WAC 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. 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. 10-19-085, § 388-438-0125, filed 9/17/10,
effective 10/18/10.
