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.