Wash. Admin. Code § 182-515-1509 - Home and community based (HCB) waiver services authorized by home and community services (HCS)-Client financial responsibility
(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, conservatorship fees,
and administrative costs including any attorney fees paid by the guardian or
conservator 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, conservatorship
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.
(10) Standards
described in this section are found at
www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.
Notes
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.
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