WAC 182-515-1509 Home and community based (HCB) waiver services authorized by home and community services (HCS) – Client financial responsibility

WAC 182-515-1509 Home and community based (HCB) waiver services authorized by home and community services (HCS) – Client financial responsibility.

Effective February 25, 2023

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.
   1. Post-eligibility treatment of income, participation, and participate are all terms that refer to a client's responsibility towards cost of care.
   2. 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:
   1. 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).
   2. 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.
   3. 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.
   4. 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.
   5. 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:
      1. The client authorized by DDA pays toward the cost of care under WAC 182-515-1512 or 182-515-1514; and
      2. 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:
   1. Keeps a PNA of under WAC 182-513-1105;
   2. Pays room and board up to the room and board standard under WAC 182-513-1105; and
   3. 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:
   1. An earned income deduction of the first $65 plus one-half of the remaining earned income;
   2. Guardianship fees and administrative costs including any attorney fees paid by the guardian only as allowed under chapter 388-79A WAC;
   3. 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;
   4. 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;
   5. A monthly maintenance-needs allowance for each dependent of the institutionalized client, or the client's spouse, as calculated under WAC 182-513-1385;
   6. 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:
   1. The PNA allowed in subsection (2) or (3) of this section, including room and board;
   2. The earned income deduction in subsection (4)(a) of this section; and
   3. 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.
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.