State-funded long-term care for noncitizens

Revised date
Purpose statement

There are 2 state-funded LTSS programs:

  1. WAC 182-507-0125 describes the state-funded long-term services and supports program for those needing LTSS outside of a hospital
    1. A slot for this program requires a pre-approval by Emily Watts, Residential Program Manager at Home and Community Services (HCS) headquarters.
    2. This program has limited funding by the legislature and is only for those not eligible for the state-funded Medical Care Services (MCS) program.
    3. The ACES program for nursing facility coverage is L04. The case will trickle to a L95 if income is over the special income level (SIL).
    4. The ACES program LTSS at home or in an alternate living facility is L24.
  2. WAC 182-508-0005 State-funded medical care services (MCS) program for those eligible for ABD cash and HEN eligibility described in 388-400-0060.
    1. Most individuals on MCS are legally admitted and in their 5-year bar for federal medicaid.
    2. This program only covers state-funded residential and nursing facility services. MCS does not require pre-approval for nursing facility or ALF admissions. There is no in-home services without an approved ETR by HCS HQ.
    3. The ACES code is A01, A05 and A24.

WAC 182-507-0125 State-funded long-term care services.

WAC 182-507-0125 State-funded long-term care services.

Effective August 26, 2024

  1. Caseload limits.
    1. The state-funded long-term care services program is subject to caseload limits determined by legislative funding.
    2. 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.
    3. 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:
    1. The person's own home, defined in WAC 388-106-0010;
    2. An adult family home, defined in WAC 182-513-1100;
    3. An assisted living facility, defined in WAC 182-513-1100;
    4. An enhanced adult residential care facility, defined in WAC 182-513-1100;
    5. An adult residential care facility, defined in WAC 182-513-1100; or
    6. A nursing facility, defined in WAC 182-500-0050, but only if nursing facility care is necessary to sustain life; or
    7. 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:
    1. General eligibility requirements for medical programs under WAC 182-503-0505, except (c) and (d) of this subsection;
    2. Be age 19 or older;
    3. Reside in one of the locations under subsection (2) of this section;
    4. Attain institutional status under WAC 182-513-1320;
    5. Meet the functional eligibility requirements under WAC 388-106-0355 for nursing facility level of care or under WAC 388-845-0030 for ICF/IDD level of care;
    6. Not have a penalty period due to a transfer of assets under WAC 182-513-1363;
    7. Not have equity interest in a primary residence more than the amount under WAC 182-513-1350; and
    8. Meet the requirements under chapter 182-516 WAC for annuities owned by the person or the person's spouse.
  4. General limitations.
    1. If a person entered Washington only to obtain medical care, the person is ineligible for state-funded long-term care services.
    2. The certification period for state-funded long-term care services may not exceed 12 months.
    3. 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.
    1. 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.
    2. 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.
    3. The agency determines how much an SSI-related person is required to pay toward the cost of care, using:
      1. WAC 182-513-1380, if the person resides in a nursing facility or residential habilitation center.
      2. 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.
    1. 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.
    2. 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.
    3. A MAGI-based person does not pay toward the cost of care in a nursing facility.
  7. Current resource, income, PNA, and room and board standards 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.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

ALTSA/HCS headquarters must track each case using the state funds to pay for long-term care services under this program.

The following must be reported to Residential Policy Program Manager, Emily Watts.

  • New admits. Include the date and facility.
  • Discharges. Include the date and circumstances.

Any closures. Include the date and circumstances.

Specialty hospital unit for AEM coverage

Most admissions into the state-funded long-term care program start out in a hospital. Hospital applications are completed by a specialty hospital unit at CSD for a determination of AEM for those 65 and older and not eligible for the MAGI AEM program.

The HBE determines the eligibility for individuals receiving Health Care Coverage under the Modified Adjusted Gross Income (MAGI) method.

This unit refers to HCA medical consultant for possible AEM coverage in the hospital.

Prior to admission into a NF, a prior approval by the HCS residential program manager is needed. Even if there is an approval of AEM in the hospital, AEM does not cover NF admissions.

Once an AEM Hospital case has been approved a NF slot by HCS HQ, HCS financial staff will transfer the case into HCS for maintenance and tracking.

Example #1: Joe Smith is approved through 10/31/2009 under the federal AEM program. The federal AEM program for nursing home ended on 10/31/2009. Effective 11/1/2009, this client was grandfathered into the state-funded nursing facility program as Mr. Smith is still in need of nursing home care. The medical coverage group in ACES is an L04.

Example #2: Jane Smith has been in a hospital for six months. All options for alternative settings has been explored by the hospital. She must either remain in the hospital indefinitely or be placed in a nursing home.

She is assessed by the HCS social worker and meets NFLOC. The HCS office handling the assessment contacts HCS headquarters for an available slot under the state-funded long-term care program. Once headquarters approves a slot and the client is financially and resource eligible, an L04 is opened in ACES. The nursing home will be able to admit Jane and bill under the state-funded nursing facility program.

Example #3: Jayna Smith is a legally admitted noncitizen in the 5-year bar.

Jayna is over 65, has been hospitalized, and needs nursing facility care due to a stroke. She has been assessed by the HCS SW and meets NFLOC.

Jayna can be opened on ABD cash and state funded MCS medical. There is no need to refer for the state-funded funded nursing facility program.

MCS placements do not need a preapproval by HCS HQ.

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