WAC 182-514-0260 Institutional program for children under age nineteen.

Effective July 1, 2017

1. To qualify for the modified adjusted gross income (MAGI)-based long-term care (LTC) program under this section, you (a child under age nineteen) must meet:
   1. The general eligibility requirements in WAC 182-514-0240; and
   2. Program requirements under WAC 182-505-0210 or 182-505-0117.
2. If you are eligible for the premium-based children's program under WAC 182-505-0215, we redetermine your eligibility under this section so that your family is not required to pay the premium.
3. The categorically needy (CN) income level for LTC coverage under this section is two hundred ten percent of the federal poverty level after the standard five percentage point income disregard.
4. To determine countable income for CN coverage under this section, we apply the MAGI methodology under chapter 182-509 WAC.
5. We approve CN coverage under this section for twelve calendar months (certification period). If you are discharged from the facility before the end of the certification period, the child remains continuously eligible for CN coverage through the certification period, unless you age out of the program, move out-of-state, or die.
6. If you are not eligible for CN coverage under this section, we determine your eligibility for coverage under the institutional medically needy program described in WAC 182-514-0263.
7. The institution where you reside may submit an application on your behalf and may act as your authorized representative if you are:
   1. In a court-ordered, out-of-home placement under chapter 13.34 RCW; or
   2. Involuntarily committed to an inpatient treatment program by a court order under chapter 71.34 RCW.

WAC 182-514-0245 Resource eligibility.

Effective February 29, 2016.

Applicants for and recipients of the modified adjusted gross income (MAGI)-based long-term care program are exempt from the transfer-of-asset evaluation under WAC 182-513-1363, and there is no resource test. 

WAC 182-514-0240 General eligibility.

Effective February 29, 2016.

1. To be eligible for modified adjusted gross income (MAGI) - based long-term care (LTC) coverage under this section, a person must:
   1. Meet institutional status under WAC 182-513-1320;
   2. Meet the general eligibility requirements under WAC 182-503-0505, unless the applicant is a noncitizen, in which case WAC 182-503-0505 (3) (c) and (d) do not apply;
   3. Have countable income below the applicable standard described in WAC 182-514-0250 (2) or 182-514-0260 (3), unless the applicant is eligible as medically needy;
   4. Satisfy the program requirements in WAC 182-514-0250 and 182-514-0260; and
   5. Meet the nursing facility level of care under WAC 388-106-0355 if admitted to a nursing facility for nonhospice care. Hospice patients are exempt from this requirement.
2. A person age nineteen or older who does not meet the citizenship or immigration requirements under WAC 182-503-0535 to qualify for medicaid must meet the criteria in subsection (1) of this section and:
   1. Have a qualifying emergency condition and meet the requirements under WAC 182-507-0115 and 182-507-0120; or
   2. Meet the requirements under WAC 182-507-0125 if the person needs LTC coverage in a nursing facility.
3. If a person meets institutional status, the medicaid agency counts only income received by the person or on behalf of the person when determining eligibility.
4. A person who meets the federal aged, blind, or disabled criteria may qualify for coverage under chapter 182-513 WAC.
5. A person who receives supplemental security income (SSI) is not eligible for the MAGI-based LTC program.
6. If a person does not meet institutional status, the agency determines the person's eligibility for a noninstitutional medical program.
7. A person eligible for categorically needy or medically needy coverage under a noninstitutional program who is admitted to a nursing facility for fewer than thirty days is only approved for coverage for the nursing facility room and board costs if the person meets the nursing facility level of care as described under WAC 388-106-0355.
8. A MAGI-based LTC recipient is not required to pay toward the cost of care.

WAC 182-514-0230 Purpose.

Effective February 25, 2023.

1. This chapter describes eligibility requirements for the Washington apple health (WAH) modified adjusted gross income (MAGI)-based long-term care program (LTC) for children and adults who have been admitted to an institution as defined in WAC 182-500-0050 for at least 30 days. The rules are stated in the following sections:
   1. WAC 182-514-0240 General eligibility;
   2. WAC 182-514-0245 Resource eligibility;
   3. WAC 182-514-0250 Program for adults age 19 and older;
   4. WAC 182-514-0260 Program for children under age nineteen;
   5. WAC 182-514-0263 Non-SSI-related institutional medically needy coverage for pregnant women and people age 20 and younger.
   6. WAC 182-514-0270 Involuntary commitment to Eastern or Western State Hospital.
2. A noninstitutional WAH program recipient does not need to submit a new application for LTC coverage if admitted to an institution under this section. Admission to an institution constitutes a change of circumstances. Eligibility is based on institutional status under WAC 182-513-1320.
3. In this chapter, "medicaid agency" or "agency" means the Washington state health care authority and includes the agency's designee. See chapter 182-500 WAC for additional definitions.
4. Income standards used in this chapter are listed at www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.

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.

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 182-513-1445 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 182-513-1435 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 182-513-1430 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 182-513-1425 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.