Wash. Admin. Code § 182-513-1205 - Determining eligibility for non-institutional coverage in an alternate living facility (ALF)
(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) coverage in an ALF follows
SSI-related rules under WAC
182-512-0050
through
182-512-0960,
with the exception of the higher income standard under subsection (3) of this
section.
(3) A client is eligible
for noninstitutional coverage under the categorically needy (CN) program if the
client's monthly income after allowable exclusions under chapter 182-512 WAC:
(a) Does not exceed the special income level
(SIL) defined under WAC
182-513-1100;
and
(b) Is less than or equal to
the client's assessed state rate at an agency-contracted facility. To determine
the CN standard: ((y × 31) + $38.84), where "y" is the state daily rate. $38.84
is based on the cash payment standard for a client living in an ALF setting
under WAC
388-478-0006.
(4) A client is eligible for
noninstitutional coverage under the medically needy (MN) program if the
client's monthly income after allowable exclusions under chapter 182-512 WAC is
less than or equal to the client's private rate at an agency-contracted
facility. To determine the MN standard: ((z × 31) + $38.84), where "z" is the
facility's private daily rate. To determine MN spenddown liability, see chapter
182-519 WAC.
(5) For both CN and MN
coverage, a client's countable resources cannot exceed the standard under WAC
182-512-0010.
(6) The agency or the agency's designee
approves CN noninstitutional coverage for twelve months.
(7) The agency or the agency's designee
approves MN noninstitutional coverage for a period of months described in WAC
182-504-0020
for an SSI-related client, provided the client satisfies any spenddown
liability under chapter 182-519 WAC.
(8) Clients who receive medicaid personal
care (MPC) or community first choice (CFC) pay all of their income to the ALF
except a personal needs allowance under WAC
182-513-1105.
(9) A client may have to pay third-party
resources as defined under WAC
182-513-1100
in addition to the payment under this subsection.
Notes
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