Current through Register Vol. 24-18, September 15, 2024
(1) A client
eligible for home and community based (HCB) waiver services authorized by home
and community services (HCS) under WAC
182-515-1508 must pay toward the
cost of care and room and board under this section.
(a) Post-eligibility treatment of income,
participation, and participate are all terms that refer to a client's
responsibility towards cost of care.
(b) Room and board is a term that refers to a
client's responsibility toward food and shelter in an alternate living facility
(ALF).
(2) The agency
determines how much a client must pay toward the cost of care for HCB waiver
services authorized by HCS when living in their own home:
(a) A single client who lives in their own
home (as defined in WAC
388-106-0010) keeps a personal
needs allowance (PNA) of up to 300% of the federal benefit rate (FBR) for the
supplemental security income (SSI) cash grant program and must pay the
remaining available income toward cost of care after allowable deductions
described in subsection (4) of this section. The Washington apple health income
and resource standards chart identifies 300% of the FBR as the medical special
income level (SIL).
(b) A married
client who lives with the client's spouse in their own home (as defined in WAC
388-106-0010) keeps a PNA of up
to the effective one-person medically needy income level (MNIL) and pays the
remainder of the client's available income toward cost of care after allowable
deductions under subsection (4) of this section.
(c) A married client who lives in their own
home and apart from the client's spouse keeps a PNA of up to the SIL but must
pay the remaining available income toward cost of care after allowable
deductions under subsection (4) of this section.
(d) A married couple living in their own home
where each client receives HCB waiver services is each allowed to keep a PNA of
up to the SIL but must pay remaining available income toward cost of care after
allowable deductions under subsection (4) of this section.
(e) A married couple living in their own home
where each client receives HCB waiver services, one spouse authorized by the
developmental disabilities administration (DDA) and the other authorized by
HCS, is allowed the following:
(i) The client
authorized by DDA pays toward the cost of care under WAC
182-515-1512 or
182-515-1514; and
(ii) The client authorized by HCS retains the
SIL and pays the remainder of the available income toward cost of care after
allowable deductions under subsection (4) of this section.
(3) The agency determines how much
a client must pay toward the cost of care for HCB waiver services authorized by
HCS and room and board when living in a department contracted alternate living
facility (ALF) defined under WAC
182-513-1100. A client:
(a) Keeps a PNA of under WAC
182-513-1105;
(b) Pays room and board up to the room and
board standard under WAC
182-513-1105; and
(c) Pays the remainder of available income
toward the cost of care after allowable deductions under subsection (4) of this
section.
(4) If income
remains after the PNA and room and board liability under subsection (2) or (3)
of this section, the remaining available income must be paid toward the cost of
care after it is reduced by deductions in the following order:
(a) An earned income deduction of the first
$65 plus one-half of the remaining earned income;
(b) Guardianship fees and administrative
costs including any attorney fees paid by the guardian only as allowed under
chapter 388-79A WAC;
(c) Current or
back child support garnished or withheld from the client's income according to
a child support order in the month of the garnishment if it is for the current
month. If the agency allows this as a deduction from income, the agency does
not count it as the child's income when determining the family allocation
amount in WAC
182-513-1385;
(d) A monthly maintenance-needs allowance for
the community spouse as determined under WAC
182-513-1385. If the community
spouse is also receiving long-term care services, the allocation is limited to
an amount that brings the community spouse's income to the community spouse's
PNA, as calculated under WAC
182-513-1385;
(e) A monthly maintenance-needs allowance for
each dependent of the institutionalized client, or the client's spouse, as
calculated under WAC
182-513-1385;
(f) Incurred medical expenses which have not
been used to reduce excess resources. Allowable medical expenses are under WAC
182-513-1350.
(5) The total of the following
deductions cannot exceed the special income level (SIL) defined under WAC
182-513-1100:
(a) The PNA allowed in subsection (2) or (3)
of this section, including room and board;
(b) The earned income deduction in subsection
(4)(a) of this section; and
(c) The
guardianship fees and administrative costs in subsection (4)(b) of this
section.
(6) A client
may have to pay third-party resources defined under WAC
182-513-1100 in addition to the
room and board and participation.
(7) A client must pay the client's provider
the sum of the room and board amount, and the cost of care after all allowable
deductions, and any third-party resources defined under WAC
182-513-1100.
(8) A client on HCB waiver services does not
pay more than the state rate for cost of care.
(9) When a client lives in multiple living
arrangements in a month, the agency allows the highest PNA available based on
all the living arrangements and services the client has received in a
month.
WSR 13-01-017, recodified as WAC 182-515-1509, filed
12/7/12, effective 1/1/13. Statutory Authority:
RCW
74.04.050,
74.04.057,
74.08.090,
74.09.530, section 6014 of the
Deficit Reduction Act of 2005 (DRA), and 2010 1st sp.s. c 37§ 209(1). WSR
12-21-091, § 388-515-1509, filed 10/22/12, effective 11/22/12. Statutory
Authority:
RCW
74.04.050,
74.04.057,
74.08.090,
74.09.500, and
74.09.530 and Washington state
2007-09 operating budget (SHB 1128). WSR 08-22-052, § 388-515-1509, filed
11/3/08, effective 12/4/08.
