Section 182-513-1317 - Income and resource criteria for an institutionalized person(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 its designee: (a) Determines available income under WAC 182-513-1325 and 182-513-1330;(b) Excludes income under WAC 182-513-1340; and(c) Compares remaining available income to the special income level (SIL) defined under WAC 182-513-1100. A person's available income must be equal to or less than the SIL to be eligible for CN coverage.(3) To determine income eligibility for an SSI-related LTC client under the medically needy (MN) program, the agency or its designee follows the income standards and eligibility rules under WAC 182-513-1395.(4) To be resource eligible under the SSI-related LTC CN or MN program, the person must: (a) Meet the resource eligibility requirements under WAC 182-513-1350;(b) Not have a penalty period of ineligibility due to a transfer of assets under WAC 182-513-1363;(c) Disclose to the state any interest the person or the person's spouse has in an annuity, which must meet the annuity requirements under chapter 182-516 WAC.(5) A resident of eastern or western state hospital is eligible for medicaid if the person: (a) Has attained institutional status under WAC 182-513-1320; and(b) Is under age twenty-one; or(c) Applies for or receives inpatient psychiatric treatment in the month of the person's twenty-first birthday that will likely continue through the person's twenty-first birthday, and can receive coverage until: (i) The facility discharges the person; or (ii) The end of the month in which the person turns age twenty-two, whichever occurs first; or(d) Is at least age sixty-five.(6) To determine long-term care CN or MN income eligibility for a person eligible under a MAGI-based program, the agency or its designee follows the rules under chapter 182-514 WAC.(7) There is no asset test for MAGI-based LTC programs under WAC 182-514-0245.(8) The agency or its designee determines a person's total responsibility to pay toward the cost of care for LTC services as follows:(a) For an SSI-related person residing in a medical institution, see WAC 182-513-1380;(b) For an SSI-related person on a home and community based waiver, see chapter 182-515 WAC.Wash. Admin. Code § 182-513-1317
Adopted by WSR 17-03-116, Filed 1/17/2017, effective 2/17/2017