WAC 182-513-1235 Roads to Community Living (RCL).

Effective May 30, 2021

1. Roads to community living (RCL) is a demonstration project authorized under Section 6071 of the Deficit Reduction Act of 2005 (P.L. 109-171) and extended through the Patient Protection and Affordable Care Act (P.L. 111-148).
2. Program rules governing functional eligibility for RCL are described in WAC 388-106-0250 through 388-106-0265. RCL services are authorized by the department.
3. A person must have a stay of at least sixty consecutive days in a qualified institutional setting such as a hospital, nursing home, or residential habilitation center, to be eligible for RCL. The sixty-day count excludes days paid solely by medicare, must include at least one day of medicaid paid inpatient services immediately prior to discharge, and the person must be eligible to receive any categorically needy (CN), medically needy (MN), or alternate benefit plan (ABP) medicaid program on the day of discharge. In addition to meeting the sixty-day criteria, a person who is being discharged from a state psychiatric hospital must be under age twenty-two or over age sixty-four.
4. Once a person is discharged to home or to a residential setting under RCL, the person remains continuously eligible for medical coverage for three hundred sixty-five days unless the person:
   1. Returns to an institution for thirty days or longer;
   2. Is incarcerated in a public jail or prison;
   3. No longer wants RCL services;
   4. Moves out-of-state; or
   5. Dies.
5. Changes in income or resources during the continuous eligibility period do not affect eligibility for RCL services. Changes in income or deductions may affect the amount a person must pay toward the cost of care.
6. A person approved for RCL is not subject to transfer of asset provisions under WAC 182-513-1363 during the continuous eligibility period, but transfer penalties may apply if the person needs HCB waiver or institutional services once the continuous eligibility period has ended.
7. A person who is not otherwise eligible for a noninstitutional medical program must have eligibility determined using the same rules used to determine eligibility for HCB waivers. If HCB rules are used to establish eligibility, the person must pay participation toward the cost of RCL services. HCB waiver eligibility and cost of care calculations are under:
   1. WAC 182-515-1508 and 182-515-1509 for home and community services (HCS); and
   2. WAC 182-515-1513 and 182-515-1514 for development disabilities administration (DDA) services.
8. At the end of the continuous eligibility period, the agency or its designee redetermines a person's eligibility for other programs under WAC 182-504-0125.

WAC 182-507-0130 Refugee medical assistance (RMA)

Effective December 27, 2024

1. You are eligible for refugee medical assistance (RMA) if all the following conditions are met. You:
   1. Meet immigration status requirements of WAC 182-507-0135;
   2. Have countable resources below $2,000 on the date of application;
   3. Have countable income equal to or below 200 percent of the federal poverty level (FPL) on the date of application.  The following income is not considered when determining eligibility for RMA:
      1. Resettlement cash payments made by the voluntary agency (VOLAG);
      2. Income of a sponsor is not counted unless the sponsor is also part of your assistance unit; and 
      3. Income received after the date of application.
   4. Provide the name of the VOLAG which helped bring you to the United States so that the department of social and health services (DSHS) can promptly notify the VOLAG (or sponsor) about the medical application.
2. If you receive refugee cash assistance (RCA) you are eligible for RMA if you have countable resources below $2,000 on the date of application and you are not otherwise eligible for another medicaid or a children's health care program as described in WAC 182-505-0210. You do not have to apply for or receive RCA in order to qualify for RMA.
3. You are not eligible to receive RMA if you are:
   1. Already eligible for another medicaid or a children's health care program as described in WAC 182-505-0210;
   2. A full-time student in an institution of higher education unless the educational activity is part of a DSHS-approved individual responsibility plan (IRP); or
   3. A nonrefugee spouse of a refugee.
4. If approved for RMA, the agency or its designee issue an approval letter in both English and your primary language. The agency or its designee also sends a notice every time there are any changes or actions taken which affect your eligibility for RMA.
5. You may be eligible for RMA coverage of medical expenses incurred during the three months prior to the first day of the month of the application. Eligibility determination will be made according to medicaid rules.
6. If you are a victim of human trafficking you must provide the following documentation and meet the eligibility requirements in subsections (1) and (2) of this section to be eligible for RMA:
   1. Adults, 18 years of age or older, must provide the original certification letter from the United States Department of Health and Human Services (DHHS). No other documentation is needed. The eligibility period will be determined based on the entry date on your certification letter;
   2. A child victim under the age of 18 does not need to be certified. DHHS issues a special letter for children. Children also have to meet income eligibility requirements;
   3. A family member of a certified victim of human trafficking must have a T-2, T-3, T-4, or T-5 visa (derivative T-Visas), and the family member must meet eligibility requirements in subsections (1) and (2) of this section.
7. The entry date for an asylee is the date that asylum status is granted. For example, you entered the United States on December 1, 1999, as a tourist, then applied for asylum on April 1, 2000, interviewed with the asylum office on July 1, 2000, and were granted asylum on September 1, 2000. The date of entry is September 1, 2000, and that is the date used to establish eligibility for RMA.
8. RMA certification period.
   1. (a) RMA ends on either:
      1. The last day of the eighth month from the month the person entered the United States if they entered the United States on or before September 30, 2021. For example, if they entered the United States on September 30, 2021, they are eligible through April 30, 2022; or
      2. The last day of the 12th month from the month the person entered the United States if they entered the United States on or after October 1, 2021. For example, if they entered the United States on October 25, 2021, they are eligible through September 30, 2022.
   2. You may receive RMA benefits for more months if you are in a category of persons for whom the federal Office of Refugee Resettlement has extended the eligibility period.
9. If you are approved for RMA you are continuously eligible through the end of the initial RMA certification period, regardless of an increase in income.
10. The agency, or its designee, determines eligibility for medicaid and other medical programs for your spouse when the spouse arrives in the United States. If the spouse is not eligible for medicaid due to your countable income, the spouse is still eligible for RMA under subsection (8) of this section.
11. If you disagree with a decision or action taken on the case by the agency, or its designee, you have the right to request a review of the case action(s) or request an administrative hearing (see chapter 182-526 WAC). The request must be received by the agency, or its designee, within 90 days of the date of the decision or action.        

WAC 182-507-0135 Immigration status requirement for refugee medical assistance (RMA).

Effective November 24, 2024

1. An individual is eligible for refugee medical assistance (RMA) if the individual provides documentation issued by the United States Citizenship and Immigration Services (USCIS) to show that the individual is:
   1. Admitted as a refugee under section 207 of the Immigration and Nationalities Act (INA);
   2. Paroled into the United States as a refugee or asylee under section 212 (d)(5) of the INA;
   3. Granted conditional entry under section 203 (a)(7) of the INA;
   4. Granted asylum under section 208 of the INA;
   5. Admitted as an Amerasian immigrant from Vietnam through the orderly departure program, under section 584 of the Foreign Operations Appropriations Act, incorporated in the FY88 continuing resolution P.L. 100-212;
   6. A Cuban-Haitian entrant who was admitted as a public interest parolee under section 212 (d)(5) of the INA;
   7. Certified as a victim of human trafficking by the federal Office of Refugee Resettlement (ORR);
   8. An eligible family member of a victim of human trafficking certified by ORR who has a T-2, T-3, T-4, or T-5 visa; 
   9. Admitted as special immigrant from Iraq or Afghanistan under one of the following:
      1. Special immigrant status under section 101 (a) (27) of the INA;
      2. Special immigrant conditional permanent resident; or 
      3. Parole under section 602 (b) (1) of the Afghan Allies Protection Act of 2009 or section 1059 (a) of the National Defense Authorization Act of 2006;
   10. An Afghan granted humanitarian parole between July 31, 2021, and September 30, 2023, their spouse or child, or a parent or guardian of an unaccompanied minor who is granted parole after September 30, 2022 under section 2502 of the Extending Government Funding and Delivering Emergency Assistance Act of 2021; or
   11.  A citizen or national of Ukraine (or a person who last habitually resided in Ukraine) who, under section 401 of the Additional Ukrainian Supplemental Appropriations Act, 2022 (AUSAA) and the Ukraine Security Supplemental Appropriations Act, 2024 (USSAA), is evaluated as a qualified alien when:
       1. Granted parole into the United States between February 24, 2022, and September 30, 2024; or
       2. Granted parole into the United States after September 30, 2024, and is:
          1. The spouse or child of a person described in (k)(i) of this subsection; or
          2. The parent, legal guardian or primary caregiver of a person described in (k)(i) of this subsection who is determined to be an unaccompanied child under section 462 (g) (2) of the Homeland Security Act of 2002 or section 412 (d) (2) (B) of the Immigration and Nationality Act. 
2. A permanent resident alien meets the immigration status requirements for RCA and RMA if the individual was previously in one of the statuses described in subsection (1) of this section.

WAC 182-503-0110 Washington apple health -- Limited-English proficient (LEP) services.

Effective March 31, 2014.

1. We provide interpreter and translation services (limited-English proficient or LEP services) free of charge to you if you have limited ability to read, write, and/or speak English. Interpreter services are those used for oral communication between two parties who do not speak the same language. Translation services are those used for written communication.
2. We provide LEP services in your primary language.
   1. A primary language is the language you tell us that you wish to use when communicating with us. You may designate at least one primary language for oral communications and at least one primary language for written communications, and you may designate a different primary language for oral and for written communications.
   2. We note your primary languages in a record available to the agency, its designee, and health benefit exchange employees.
3. We can provide LEP services through bilingual workers and/or contracted interpreters and translators who are expected to be competent. We consider a bilingual worker or a contracted interpreter or translator to be competent if he or she is:
   1. Certified for interpreting and/or translating in the language by the language testing and certification program of the department of social and health services;
   2. Certified or otherwise determined to be competent for interpreting and/or translating in the language by an association or organization with a regional or national reputation for certifying or determining the competence of interpreters and/or translators; or
   3. Determined competent for interpreting and/or translating in the language by us, taking into account his or her:
      1. Demonstrated proficiency in both English and the other language;
      2. Orientation and training that includes the skills and ethics of interpreting;
      3. Fundamental knowledge in both languages of any specialized terms or concepts peculiar to Washington apple health;
      4. Sensitivity to cultural differences; and
      5. Demonstrated ability to convey information accurately in both languages.
4. We provide notice of the availability of LEP services on printed applications and notices, in the Washington healthplanfinder web site, and during contact with persons who appear to need LEP services.
5. LEP services include:
   1. Spoken language interpreter (oral) services in person, over the telephone, or through other simultaneous audio or visual transmission (if available); and
   2. Translation of our forms, letters, and other text-based materials, whether printed in hard-copy or stored and presented by computer. These include, but are not limited to:
      1. Our pamphlets, brochures, and other informational material that describe our services and your health care rights and responsibilities;
      2. Our applications and other forms you need to complete and/or sign; and
      3. Notices of our actions affecting your eligibility for health care coverage.
   3. Direct provision of services by our bilingual employees.
6. We provide interpreter services and translated documents in a prompt manner that allows the timely processing of your eligibility for health care coverage within time frames defined in WAC 182-503-0060, 182-503-0035, and 182-504-0125.
7. If you believe that we have discriminated against you on the basis of race, color, national origin, birthplace, or another protected status, you may file a complaint with the U.S. Department of Health and Human Services or Regional Manager, Office of Civil Rights, U.S. Department of Health and Human Services, 2201 Sixth Ave. – M/S: RX-11, Seattle, WA 98121-1831 (voice phone 800-368-1019, fax 206-615-2297, TDD 800-537-7697).

WAC 182-513-1400 Long-term care (LTC) partnership program (index).

Effective February 20, 2017

Under the long-term care (LTC) partnership program, people who purchase qualified long-term care partnership insurance policies can apply for long-term care medicaid under special rules for determining financial eligibility. These special rules generally allow the person to protect assets up to the insurance benefits received from a partnership policy so that such assets will not be taken into account in determining financial eligibility for long-term care medicaid and will not subsequently be subject to estate recovery for medicaid and long-term care services paid. The Washington long term care partnership program is effective on December 1, 2011.

The following rules govern long-term care eligibility under the long-term care partnership program:

1. WAC 182-513-1405 Definitions
2. WAC 182-513-1410 LTC Partnership policy qualifications.
3. WAC 182-513-1415 Assets that can't be protected under the LTC partnership provisions.
4. WAC 182-513-1420 Eligibility for asset protection under a partnership policy.
5. WAC 182-513-1425 Not qualifying for LTC medicaid if an LTC partnership policy is in pay status.
6. WAC 182-513-1430 Change of circumstances that must be reported when there is an LTC partnership policy paying a portion of my care.
7. WAC 182-513-1435 When Washington recognizes an LTC partnership policy purchased in another state.
8. WAC 182-513-1440 Determining how many assets can be protected.
9. WAC 182-513-1445 Designating a protected asset and required proof.
10. WAC 182-513-1450 How the transfer of assets affects LTC partnership and medicaid eligibility.
11. WAC 182-513-1455 Protected assets under an LTC partnership policy after death.

WAC 182-503-0535 Washington apple health -- Citizenship and immigration status.

Effective February 7, 2025

1. Definitions.
   1. Nonqualified alien means someone who is lawfully present in the United States (U.S.) but who is not a qualified alien, a U.S. citizen, a U.S. national, or a qualifying American Indian born abroad.
   2. Qualified alien means someone who is lawfully present in the United States and who is one or more of the following:
      1. A person lawfully admitted for permanent residence (LPR).
      2. An abused spouse or child, a parent of an abused child, or a child of an abused spouse who no longer resides with the person who committed the abuse, and who has one of the following:
         1. A pending or approved I-130 petition or application to immigrate as an immediate relative of a U.S. citizen or as the spouse of an unmarried LPR younger than 21 years of age.
         2. Proof of a pending application for suspension of deportation or cancellation of removal under the Violence Against Women Act (VAWA).
         3. A notice of prima facie approval of a pending self-petition under VAWA. An abused spouse's petition covers his or her child if the child is younger than 21 years of age. In that case, the child retains qualified alien status even after he or she turns 21 years of age.
      3. A person who has been granted parole into the U.S. for one year or more, under the Immigration and Nationality Act (INA) Section 212 (d)(5), including public interest parolees.
      4. A member of a Hmong or Highland Laotian tribe that rendered military assistance to the U.S. between August 5, 1964, and May 7, 1975, including the spouse, unremarried widow or widower, and unmarried dependent child of the tribal member.
      5. A person who was admitted into the U.S. as a conditional entrant under INA Section 203 (a)(7) before April 1, 1980.
      6. A person admitted to the U.S. as a refugee under INA Section 207.
      7. A person who has been granted asylum under INA Section 208.
      8. A person granted withholding of deportation or removal under INA Section 243(h) or 241 (b)(3).
      9. A Cuban or Haitian national who was paroled into the U.S. or given other special status.
      10. An Amerasian child of a U.S. citizen under 8 C.F.R. Section 204.4(a).
      11. A person from Iraq or Afghanistan who has been granted one of the following:
          1. Special immigrant status under INA Section 101 (a) (27);
          2. Special immigrant conditional permanent resident; or
          3. Parole under Section 602 (b) (1) of the Afghan Allies Protection Act of 2009 or Section 1059(a) of the National Defense Authorization Act of 2006.
      12. An Afghan granted humanitarian parole between July 31, 2021, and September 30, 2023, their spouse or child, or a parent or guardian of an unaccompanied minor who is granted parole after September 30, 2022, under Section 2502 of the Extending Government Funding and Delivering Emergency Assistance Act of 2021.
      13. A citizen or national of Ukraine (or a person who last habitually resided in Ukraine) who, under section 401 of the Additional Ukrainian Supplemental Appropriations Act, 2022 (AUSAA) and the Ukraine Security Supplemental Appropriations Act, 2024 (USSAA), is evaluated as a qualified alien until the end of their parole term when:
          1. Granted parole into the United States between February 24, 2022, and September 30, 2024; or
          2. Granted parole into the United States after September 30, 2024, and is:
             1. The spouse or child of a person described in (b)(xiii)(A) of this subsection; or
             2. The parent or guardian of a person described in (b)(xiii)(A) of this subsection who is an unaccompanied minor.
      14. A person who has been certified or approved as a victim of trafficking by the federal office of refugee resettlement, or who is:
          1. The spouse or child of a trafficking victim of any age; or
          2. The parent or minor sibling of a trafficking victim who is younger than 21 years of age. 
      15. A person from the Federated States of Micronesia, the Republic of Palau, or the Republic of the Marshall Islands living in the United States in accordance with the Compacts of Free Association. 
   3. U.S. citizen means someone who is a United States citizen under federal law.
   4. U.S. national means someone who is a United States national under federal law.
   5. Undocumented person means someone who is not lawfully present in the U.S.
   6. Qualifying American Indian born abroad means someone who:
      1. Was born in Canada and has at least 50 percent American Indian blood, regardless of tribal membership; or
      2. Was born outside of the United States and is a member of a federally recognized tribe or an Alaska Native enrolled by the Secretary of the Interior under the Alaska Native Claims Settlement Act.
2. Eligibility.
   1. A U.S. citizen, U.S. national or qualifying American Indian born abroad may be eligible for:
      1. Apple health for adults;
      2. Apple health for kids;
      3. Apple health for pregnant women; or
      4. Classic medicaid.
   2. A qualified alien who meets or is exempt from the five-year bar may be eligible for:
      1. Apple health for adults;
      2. Apple health for kids;
      3. Apple health for pregnant women; or
      4. Classic medicaid.
   3. A qualified alien who neither meets nor is exempt from the five-year bar may be eligible for:
      1. Alien medical programs;
      2. Apple health for kids;
      3. Apple health for pregnant women; or
      4. Medical care services.
   4. A nonqualified alien may be eligible for:
      1. Alien medical programs;
      2. Apple health for kids;
      3. Apple health for pregnant women; or
      4. Medical care services.
   5. An undocumented person may be eligible for:
      1. Alien medical programs;
      2. State-only funded apple health for kids; 
      3. State-only funded apple health for pregnant women; or
      4. State-only funded apple health expansion.
3. The five-year bar.
   1. A qualified alien meets the five-year bar if he or she:
      1. Continuously resided in the U.S. for five years or more from the date he or she became a qualified alien; or
      2. Entered the U.S. before August 22, 1996, and:
         1. Became a qualified alien before August 22, 1996; or
         2. Became a qualified alien on or after August 22, 1996, and has continuously resided in the U.S. between the date of entry into the U.S. and the date he or she became a qualified alien.
   2. A qualified alien is exempt from the five-year bar if he or she is:
      1. A qualified alien as defined in subsections (1)(b)(vi) through (xv) of this section;
      2. An LPR, parolee, or abused person, who is also an armed services member or veteran, or a family member of an armed services member or veteran, as described below:
         1. An active-duty member of the U.S. military, other than active-duty for training;
         2. An honorably discharged U.S. veteran;
         3. A veteran of the military forces of the Philippines who served before July 1, 1946, as described in Title 38 U.S.C. Section 107; or
         4. The spouse, unremarried widow or widower, or unmarried dependent child of an honorably discharged U.S. veteran or active-duty member of the U.S. military.

WAC 182-503-0050 Verification of eligibility factors.

Effective November 3, 2019

1. General rules.
   1. We may verify the information we use to determine, redetermine, or terminate your apple health eligibility.
   2. We verify the eligibility factors listed in WAC 182-503-0505(3).
   3. Before we ask you to provide records to verify an eligibility factor, we use information available from state databases, including data from the department of social and health services and the department of employment security, federal databases, or commercially available databases to verify the eligibility factor.
   4. We may require information from third parties, such as employers, landlords, and insurance companies, to verify an eligibility factor if the information we received:
      1. Cannot be verified through available data sources;
      2. Did not verify an eligibility factor; or
      3. Is contradictory, confusing, or outdated.
   5. We do not require you to submit a record unless it is necessary to determine or redetermine your eligibility.
   6. If you can obtain verification within three business days and we determine the verification is sufficient to confirm an eligibility factor, we base our initial eligibility decision upon that record.
   7. If we are unable to verify eligibility as described in (f) of this subsection, then we may consider third-party sources.
   8. If a fee is required to obtain a necessary record, we pay the fee directly to the holder of the record.
   9. We do not deny or delay your application if you failed to provide information to verify an eligibility factor in a particular type or form.
   10. Except for eligibility factors listed in WAC 182-503-0505 (3)(c) and (d), we accept alternative forms of verification. If you give us a reasonable explanation that confirms your eligibility, we may not require additional documentation.
   11. Once we verify an eligibility factor that will not change, we may not require additional verification. Examples include:
       1. U.S. citizenship;
       2. Family relationships by birth;
       3. Social Security numbers; and
       4. Dates of birth, death, marriage, dissolution of marriage, or legal separation.
   12. If we cannot verify your immigration status and you are otherwise eligible for Washington apple health, we approve coverage and give additional time as needed to verify your immigration status.
2. Submission timelines.
   1. We allow at least ten calendar days for you to submit requested information.
   2. If you request more time to provide information, we allow the time requested.
   3. If the tenth day falls on a weekend or a legal holiday as described in RCW 1.16.050, the due date is the next business day.
   4. We do not deny or terminate your eligibility when we give you more time to provide information.
   5. If we do not receive your information by the due date, we make a determination based on all the information available.
3. Notice requirements.
   1. When we need more information from you to determine your eligibility for apple health coverage, we send all notices according to the requirements of WAC 182-518-0015.
   2. If we cannot determine you are eligible, we send you a denial or termination notice including information on when we reconsider a denied application under WAC 182-503-0080.
4. Equal access and limited-English proficiency services. If you are eligible for equal access services under WAC 182-503-0120 or limited-English proficiency services under WAC 182-503-0110, we provide legally sufficient support services.
5. Eligibility factors for nonmodified adjusted gross income (MAGI)-based programs. If you apply for a non-MAGI program under WAC 182-503-0510(3), we verify the factors in WAC 182-503-0505(3). In addition, we verify:
   1. Household composition, if spousal or dependent deeming under chapter 182-512 WAC or spousal or dependent allowance under chapters 182-513 and 182-515 WAC applies;
   2. Income and income deductions;
   3. Resources, including:
      1. Trusts, annuities, life estates and promissory notes under chapter 182-516 WAC;
      2. Real property transactions; and
      3. Financial records, as defined in WAC 182-503-0055, held by financial institutions.
   4. Medical expenses required to meet any spenddown liability under WAC 182-519-0110;
   5. All post-eligibility deductions used to determine cost of care for clients eligible for long-term services and supports under chapters 182-513 and 182-515 WAC;
   6. Transfers of assets under chapter 182-513 WAC and WAC 182-503-0055 when the program is subject to transfer of assets limitations;
   7. Shelter costs for long-term care cases where spousal and dependent allowances apply;
   8. Blindness or disability, if you claim either; and
   9. Social Security number for a community spouse if needed when you apply for long-term care.
6. Verification for MAGI-based programs.
   1. After we approve your coverage based on your self-attestation, we may conduct a post-eligibility review to verify your self-attested information.
   2. When conducting a post-eligibility review, we attempt to verify eligibility factors using your self-attested information available to us through state, federal, and commercially available data sources, or other third parties, before requiring you to provide information.
   3. You may be required to provide additional information if:
      1. We cannot verify an eligibility factor through other data sources listed in subsection (b) of this section; or
      2. The information received from the data source is not reasonably compatible with your self-attestation.
7. Reapplication following post-eligibility review. If your eligibility for MAGI-based apple health terminates because of a post-eligibility review and you reapply, we may request verification of eligibility factors prior to determining eligibility.

WAC 182-513-1400 Long-term care (LTC) partnership program (index).

Effective February 20, 2017

Under the long-term care (LTC) partnership program, people who purchase qualified long-term care partnership insurance policies can apply for long-term care medicaid under special rules for determining financial eligibility. These special rules generally allow the person to protect assets up to the insurance benefits received from a partnership policy so that such assets will not be taken into account in determining financial eligibility for long-term care medicaid and will not subsequently be subject to estate recovery for medicaid and long-term care services paid. The Washington long term care partnership program is effective on December 1, 2011.

The following rules govern long-term care eligibility under the long-term care partnership program:

1. WAC 182-513-1405 Definitions
2. WAC 182-513-1410 LTC Partnership policy qualifications.
3. WAC 182-513-1415 Assets that can't be protected under the LTC partnership provisions.
4. WAC 182-513-1420 Eligibility for asset protection under a partnership policy.
5. WAC 182-513-1425 Not qualifying for LTC medicaid if an LTC partnership policy is in pay status.
6. WAC 182-513-1430 Change of circumstances that must be reported when there is an LTC partnership policy paying a portion of my care.
7. WAC 182-513-1435 When Washington recognizes an LTC partnership policy purchased in another state.
8. WAC 182-513-1440 Determining how many assets can be protected.
9. WAC 182-513-1445 Designating a protected asset and required proof.
10. WAC 182-513-1450 How the transfer of assets affects LTC partnership and medicaid eligibility.
11. WAC 182-513-1455 Protected assets under an LTC partnership policy after death.

WAC 182-513-1405 Definitions.

Effective February 20, 2017

For purposes of WAC 182-513-1400 through 182-513-1455, the following terms have the meanings stated. See chapter 182-500 WAC and WAC 182-513-1100 for additional definitions.

"Issuer" means any entity that delivers, issues for delivery, or provides coverage to, a resident of Washington, any policy that claims to provide asset protection under the Washington long-term care partnership act, chapter 48.85 RCW. As used in this chapter, issuer specifically includes insurance companies, fraternal benefit societies, health care service contractors, and health maintenance organizations.

"Long-term care (LTC) insurance" means a policy under chapter 284-83 WAC.

"Protected assets" means assets that are designated as excluded or not taken into account upon determination of long-term care medicaid eligibility under WAC 182-513-1315. The protected or excluded amount is up to the dollar amount of benefits that have been paid for long-term care services by the qualifying long-term care partnership policy on the medicaid applicant's or client's behalf. The assets are also protected or excluded for the purposes of estate recovery under chapter 182-527 WAC, up to the amount of benefits paid by the qualifying policy for medical and long-term care services.

"Qualified long-term care insurance partnership" means an agreement between the Centers for Medicare and Medicaid Services (CMS), and the health care authority (HCA) which allows for the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of a person who is a beneficiary under a long-term care insurance policy that has been determined by the Washington state insurance commission to meet the requirements of section 1917 (b)(1)(c)(iii) of the act. These policies are described in chapter 284-83 WAC.

"Reciprocity Agreement" means an agreement between states approved under section 6021(b) of the Deficit Reduction Act of 2005, Public Law 109-171 (DRA) under which the states agree to provide the same asset protections for qualified partnership policies purchased by a person while residing in another state and that state has a reciprocity agreement with the state of Washington.

WAC 182-513-1410 LTC partnership policy qualifications.

Effective February 20, 2017

A LTC partnership policy is a LTC policy that has been approved by the office of insurance commissioner as a LTC partnership policy described in chapter 284-83 WAC.

WAC 182-513-1415 Assets that can't be protected under the LTC partnership provisions.

Effective February 20, 2017

The following assets cannot be protected under a LTC partnership policy.

1. Resources in a trust under WAC 182-516-0100 (6) and (7).
2. Annuity interests in which Washington must be named as a preferred remainder beneficiary as under WAC 182-516-0201.
3. Home equity in excess of the standard under WAC 182-513-1350. Individuals who have excess home equity interest are not eligible for long-term care medicaid services.
4. Any portion of the value of an asset that exceeds the dollar amount paid out by the LTC partnership policy.
5. The unprotected value of any partially protected asset is subject to estate recovery described in chapter 182-527 WAC.

WAC 182-513-1420 Eligibility for asset protection under a partnership policy.

Effective February 20, 2017

1. The LTC partnership policy must meet all the requirements in chapter 284-83 WAC. For existing LTC policies which are converted to a LTC partnership policy via an exchange or through the addition of a policy rider or endorsement, the conversion must take place on or after December 1, 2011 unless the policy is paying out benefits at the time the policy is exchanged.
2. You meet all applicable eligible requirements for LTC medicaid and:
   1. Your LTC partnership policy benefits have been exhausted and you are in need of LTC services.
   2. Your LTC partnership policy is not exhausted and is:
      1. Covering all costs in a medical institution and you are still in need for medicaid; or
      2. Covering a portion of the LTC costs under your LTC partnership policy but does not meet all of your LTC needs.
   3. At the time of your LTC partnership policy has paid out more benefits than you have designated as protected. In this situation your estate can designate additional assets to be excluded from the estate recovery process up to the dollar amount the LTC partnership policy has paid out.

WAC 182-513-1425 Not qualifying for LTC medicaid if an LTC partnership policy is in pay status.

Effective February 20, 2017

You are not eligible for long-term care (LTC) medicaid when the following applies:

1. The income you have available to pay toward your cost of care under WAC 182-513-1380, combined with the amount paid under the qualifying LTC partnership policy, exceeds the monthly private rate at the institution.
2. The income you have available to pay toward your cost of care on a home and community based (HCB) waiver under chapter 182-515 WAC, combined with the amount paid under the qualifying LTC partnership policy, exceeds the monthly private rate in a home or residential setting.
3. You fail to meet another applicable eligibility requirement for LTC medicaid.

WAC 182-513-1430 Change of circumstances that must be reported when there is an LTC partnership policy paying a portion of care.

Effective February 20, 2017

You must report changes described in WAC 182-504-0105 plus the following:

1. You must report and verify the value of the benefits that your issuer has paid on your behalf under the long-term care (LTC) partnership policy upon request by the agency, and at each annual eligibility review.
2. You must provide proof when you have exhausted the benefits under your LTC partnership policy.
3. You must provide proof if you have given away or transferred assets that you have previously designated as protected. Although, there is no penalty for the transfer of protected assets once you have been approved for LTC medicaid, the value of transferred assets reduces the total dollar amount that is designated as protected and must be verified.
4. You must provide proof if you have sold an asset or converted a protected asset into cash or another type of asset. You will need to make changes in the asset designation and verify the type of transaction and new value of the asset.

WAC 182-513-1435 When Washington recognizes an LTC partnership policy purchased in another state.

Effective February 20, 2017

The Washington long term care partnership program provides reciprocity with respect to qualifying long-term care insurance policies covered under other state long-term care insurance partnerships. This allows you to purchase a partnership policy in one state and move to Washington without losing your asset protection. If your LTC policy is in pay status at the time you move to Washington and you are otherwise eligible for LTC medicaid, Washington will recognize the amount of protection you accumulated in the other state.

WAC 182-513-1440 Determining how many of my assets can be protected.

Effective February 20, 2017

You can protect assets based on the amount paid by your LTC partnership policy. Assets are protected in both LTC eligibility and estate recovery. If the partnership for long-term care program is discontinued, an individual who purchased an approved plan before the date the program is discontinued remains eligible to receive dollar-for-dollar asset disregard and asset protection under the long-term care (LTC) medicaid program.

WAC 182-513-1445 Designating a protected asset and required proof.

Effective February 20, 2017

1. Complete a department of social and health services (DSHS) 10-438 long-term care partnership (LTCP) asset designation form listing assets and the full fair market value that are earmarked as protected at the time of initial application for long-term services and supports under medicaid.
   1. The full fair market value (FMV) of real property or interests in real property will be based on the current assessed value for property tax purposes for real property. A professional appraisal by a licensed appraiser can establish the current value if the assessed value is disputed.
   2. The value of a life estate in real property is determined using the life estate tables found at https://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/determining-value-life-estates.
   3. If you own an asset with others, you can designate the value of your pro rata equity share.
   4. If the dollar amount of the benefits paid under a LTCP policy is greater than the fair market value of all assets protected at the time of the application for long-term care medicaid, you may designate additional assets for protection under this section. The DSHS LTCP asset designation form must be submitted with the updated assets indicated along with proof of the current value of designated assets.
   5. The value of your assets protected for you under your LTC partnership policy do not carry over to your spouse should the spouse need medicaid LTC services during or after your lifetime. If your surviving spouse has an LTC partnership policy the spouse may designate assets based on the dollar amount paid under the spouse's own policy.
   6. Assets designated as protected under this subsection will not be subject to transfer penalties under WAC 182-513-1363.
2. Proof of the current fair market value of all protected assets is required at the initial application and each annual review.
3. Submit current verification from the issuer of the LTCP policy of the current dollar value paid toward LTC benefits. This verification is required at application and each annual eligibility review.
4. Any person or the personal representative of the person's estate who asserts that an asset is protected has the initial burden of:
   1. Documenting and proving by convincing evidence that the asset or source of funds for the asset in question was designated as protected;
   2. Demonstrating the value of the asset and the proceeds of the asset beginning from the time period the LTC partnership has paid out benefits to the present; and
   3. Documenting that the asset or proceeds of the asset remained protected at all times.

WAC 182-513-1450 How the transfer of assets affect LTC partnership and medicaid eligibility?

Effective February 20, 2017

1. If you transfer an asset within the sixty months prior to the medicaid application or after medicaid eligibility has been established, the agency will evaluate the transfer based on WAC 182-513-1363 and determine if a penalty period applies unless:
   1. You have already been receiving institutional services;
   2. Your LTC partnership policy has paid toward institutional services for you; and
   3. The value of the transferred assets has been protected under the LTC partnership policy.
2. The value of the transferred assets that exceed your LTC partnership protection will be evaluated for a transfer penalty.
3. If you transfer assets ((whose)) with values that are protected, you lose that value as future protection unless all the transferred assets are returned.
4. The value of your protected assets less the value of transferred assets equals the adjusted value of the assets you are able to protect.

WAC 182-513-1455 What happens to protected assets under a LTC partnership policy after death.

Effective February 20, 2017

Assets designated as protected prior to death are not subject to estate recovery for medical or long-term care (LTC) services paid on your behalf under chapter 182-527 WAC as long as the following requirements are met:

1. A personal representative who asserts an asset is protected under this section has the initial burden of providing proof under chapter 182-527 WAC.
2. A personal representative must provide verification from the LTC insurance company of the dollar amount paid out by the LTC partnership policy.
3. If the LTC partnership policy paid out more than was previously designated, the personal representative has the right to assert that additional assets should be protected based on the increased protection. The personal representative must use the DSHS LTCP asset designation form and send it to the office of financial recovery.
4. The amount of protection available to you at death through the estate recovery process is decreased by the FMV of any protected assets that were transferred prior to death.