WAC 182-513-1363 Evaluating an asset transfer for clients applying for or receiving long-term care (LTC) services.

Effective August 1, 2020

1. When determining a client's eligibility for long-term care (LTC) services, the medicaid agency or the agency's designee evaluates the effect of an asset transfer made within the sixty-month period before the month that the client:
   1. Attained institutional status, or would have attained institutional status but for a period of ineligibility; and
   2. Applied for LTC services.
2. The agency or the agency's designee evaluates all transfers for recipients of LTC services made during or after the month the recipient attained institutional status.
3. The agency or the agency's designee establishes a period of ineligibility during which the client is not eligible for LTC services if the client, the client's spouse, or someone acting on behalf of either:
   1. Transfers an asset within the time period under subsection (1) or (2) of this section; and
   2. There is uncompensated value because:
      1. Adequate consideration was not received for the asset, unless the transfer meets one of the conditions in subsection (4) of this section;
      2. The transfer was compensated, but fails a requirement under subsection (4) (d) (iv) or (f) of this section, or
      3. The transfer was determined to be an uncompensated asset transfer under chapter 182-516 WAC.
4. The agency or the agency's designee does not apply a period of ineligibility for uncompensated value if:
   1. The total of all asset transfers in a month does not exceed the statewide average daily private cost for nursing facilities at the time of application or the date of transfer, whichever is later;
   2. The transferred asset was an excluded resource under WAC 182-513-1350 except a home, unless the transfer of the home meets the conditions under (d) of this subsection;
   3. The asset was transferred for less than fair market value (FMV), and the client can establish one of the following:
      1. An intent to transfer the asset at FMV. This intent is established by providing convincing evidence to the agency's designee;
      2. The asset was transferred exclusively for a purpose other than to qualify for medicaid, continue to qualify for medicaid, or avoid estate recovery.
         1. An asset transfer is presumed to be for the purpose of establishing or continuing medicaid eligibility, avoiding estate recovery, or both;
         2. A client can rebut this presumption by providing convincing evidence that the transfer of an asset was exclusively for a purpose
            other than to qualify for medicaid, continue to qualify for medicaid, or avoid estate recovery.
      3. All assets transferred for less than FMV have been returned to the client or the client's spouse; or
      4. Denial of eligibility results in an undue hardship under WAC 182-513-1367.
   4. The transferred asset was a home, if the home was transferred to the person's:
      1. Spouse;
      2. Child who meets the disability criteria under WAC 182-512-0050 (1)(b) or (c);
      3. Child who was under age twenty-one; or
      4. Child who lived in the home and provided care, but only if:
         1. The child lived in the person's home for at least two years;
         2. The child provided verifiable care to that person during the time period in (d)(iv)(A) of this subsection for at least two years;
         3. The period of care under (d)(iv)(B) of this subsection was immediately before the person's current period of institutional status;
         4. The care was not paid for by medicaid;
         5. The care enabled the person to remain at home; and
         6. The physician's documentation verifies that the in-home care was necessary to prevent the person's current period of institutional status; or
      5. Sibling, who has lived in and has had an equity interest in the home for at least one year immediately before the date the person attained institutional status.
   5. The asset was transferred to the client's spouse; or to the client's or their spouse's child, if the child meets the disability criteria under WAC 182-512-0050 (1)(b) or (c);
   6. The transfer was to a family member before the current period of institutional status, and all the following conditions are met. If all the following conditions are not met, the transfer is an uncompensated transfer, regardless of consideration received:
      1. The transfer is in exchange for care services the family member provided to the client or their spouse;
      2. The client or their spouse had a documented need for the care services provided by the family member;
      3. The care services provided by the family member are allowed under the medicaid state plan or the department's home and community-based waiver services;
      4. The care services provided by the family member do not duplicate those that another party is being paid to provide;
      5. The FMV of the asset transferred is comparable to the FMV of the care services provided;
      6. The time for which care services are claimed is reasonable based on the kind of services provided; and
      7. The assets were transferred as the care services were performed, with no more time delay than one calendar month between the provision of the service and the transfer.
   7. The transfer meets the conditions under subsection (5) of this section, and the asset is transferred:
      1. To another party for the sole benefit of the client's spouse;
      2. From the client's spouse to another party for the sole benefit of the client's spouse;
      3. To a trust established for the sole benefit of the client's or their spouses child who meets the disability criteria under WAC 182-512-0050 (1)(b) or (c); or
      4. To a trust established for the sole benefit of a person who is under age sixty-five who meets the disability criteria under WAC 182-512-0050 (1)(b) or (c).
5. An asset transfer or establishment of a trust is for the sole benefit of a person under subsection (4)(g) of this section if the document transferring the asset:
   1. Was made in writing;
   2. Is irrevocable;
   3. States that the client's spouse, their blind or disabled child, or another disabled person can benefit from the transferred assets; and
   4. States that all assets involved must be spent for the sole benefit of the person over an actuarially sound period, based on the life expectancy of that person or the term of the document, whichever is less, unless the document is a trust that meets the conditions of a trust established under Section 42 U.S.C. 1396p(d)(4)(A) or Section 42 U.S.C. 1396(d)(4)(C) as described under chapter 182-516 WAC.
6. To calculate the period of ineligibility under subsection (3) of this section:
   1. Add together the total uncompensated value of all transfers under subsection (3) of this section; and
   2. Divide the total in (a) of this subsection by the statewide average daily private cost for nursing facilities at the time of application or the date of transfer, whichever is later. The result is the length, in days rounded down to the nearest whole day, of the period of ineligibility;
7. The period of ineligibility under subsection (6) of this section begins:
   1. For an LTC services applicant: The date the client would be otherwise eligible for LTC services, but for the transfer, based on an approved application for LTC services or the first day after any previous period of ineligibility has ended; or
   2. For an LTC services recipient: The first of the month following ten-day advance notice of the period of ineligibility, but no later than the first day of the month that follows three full calendar months from the date of the report or discovery of the transfer; or the first day after any previous period of ineligibility has ended.
8. The period of ineligibility ends after the number of whole days, calculated in subsection (6) of this section, pass from the date the period of ineligibility began in subsection (7) of this section.
9. If the transfer was to the client's spouse, from the client's spouse to the client, and it included the right to receive an income stream, the agency or the agency's designee determines availability of the income stream under WAC 182-513-1330.
10. If the transferred asset, for which adequate consideration was not received, included the right to receive a stream of income not generated by a transferred asset, the length of the period of ineligibility is calculated and applied in the following way:
    1. The amount of reasonably anticipated future monthly income, after the transfer, is multiplied by the actuarial life expectancy in months of the previous owner of the income. The actuarial life expectancy is based on age of the previous owner in the month the transfer occurs. If the client and their spouse co-owned the asset, the longer actuarial life expectancy is used. This product is the FMV of the asset;
    2. Any consideration received in return for the FMV of the asset under (a) of this subsection is subtracted to calculate the uncompensated value;
    3. The uncompensated value in (b) of this subsection is divided by the statewide average daily private cost for nursing facilities at the time of application or the date of
       transfer, whichever is later. The result is the length, in days rounded down to the nearest whole day, of the period of ineligibility; and
    4. The period of ineligibility begins under subsection (7) of this section and ends under subsection (8) of this section.
11. A period of ineligibility for the transfer of an asset that is applied to one spouse is not applied to the other spouse, unless both spouses have attained institutional status. When both spouses are institutionalized, the agency or the agency's designee divides the penalty equally between the two spouses. If one spouse is no longer subject to a period of ineligibility, the remaining period of ineligibility that applied to both spouses will be applied to the other spouse.
12. Throughout this section, the date of an asset transfer is:
    1. For real property:
       1. The day the deed is signed by the grantor if the deed is recorded; or
       2. The day the signed deed is delivered to the grantee;
    2. For all other assets, the day the intentional act or the failure to act resulted in the change of ownership or title.
13. If a client or their spouse disagrees with the determination or application of a period of ineligibility, a hearing may be requested under chapter 182-526 WAC.
14. Additional statutes that apply to transfer of asset penalties, real property transfer for inadequate consideration, disposal of realty penalties, and transfers to qualify for assistance can be found at:
    1. RCW 74.08.331 Unlawful practices—Obtaining assistance—Disposal of realty—Penalties;
    2. RCW 74.08.338 Real property transfers for inadequate consideration;
    3. RCW 74.08.335 Transfers of property to qualify for assistance; and
    4. RCW 74.39A.160 Transfer of assets—Penalties.

WAC 182-513-1355 Allocating resources to a community spouse when determining resource eligibility for SSI-related long-term care services

Effective February 25, 2023

1. The agency or its designee uses this section to calculate the resource allocation from the institutionalized spouse to the community spouse for the determination of the institutionalized spouse's resource eligibility under WAC 182-513-1350 (2)(a)(ii).
2. If the institutionalized spouse's most recent continuous period of institutionalization (MRCPI) began:
   1. Before October 1, 1989, the agency adds together one-half the total amount of countable resources, as determined under WAC 182-513-1350(4), held in the name of:
      1. The institutionalized spouse; and
      2. Both spouses.
   2. On or after October 1, 1989, the agency or its designee adds together the total amount of countable resources, as determined under WAC 182-513-1350(4), held in the name of:
      1. Either spouse; and
      2. Both spouses.
3. If subsection (2)(b) of this section applies, the agency or its designee determines the amount of resources allocated to the community spouse, before determining the amount of countable resources used to establish eligibility for the institutionalized spouse under WAC 182-513-1350:
   1. If the institutionalized spouse's MRCPI began on or after October 1, 1989, and before August 1, 2003, the agency or its designee allocates the federal spousal resource maximum;
   2. If the institutionalized spouse's MRCPI began on or after August 1, 2003, the agency or its designee allocates the greater of:
      1. A spousal share equal to one-half of the couple's combined countable resources, up to the federal spousal resource maximum; or
      2. The state spousal resource standard.
4. Countable resources under subsection (3)(b) of this section determined as of the first day of the month in which MRCPI began.
5. The agency or its designee uses a community spouse evaluation to determine the amount of the spousal share under subsection (3)(b)(i) of this section.
6. The agency or its designee completes a community spouse resource evaluation:
   1. Upon request by the institutionalized spouse, or the institutionalized spouse's community spouse;
   2. At any time between the date that the MRCPI began and the date that eligibility for long-term care (LTC) is determined; and
   3. Upon receipt of any verification required to establish the amount of the couple's resources in the month of MRCPI.
7. The community spouse resource evaluation can be completed prior to an application for LTC or as part of the LTC application if:
   1. The beginning of the MRCPI was prior to the month of application; and
   2. The spousal share exceeds the state spousal resource standard.
8. The amount of allocated resources under subsection (3) of this section can be increased, but only if:
   1. A court has entered an order against the institutionalized spouse for the support of the community spouse or a dependent of either spouse; or
   2. A final order is entered under chapter 182-526 WAC, ruling that the institutionalized spouse or community spouse established that the income generated by the resources allocated under subsection (3) of this section is insufficient to raise the community spouse's income to the monthly maintenance needs allowance (MMNA) determined under WAC 182-513-1385, but only after the application of the income-first rule under 42 U.S.C. 1396r–5(d)(6).
9. If a final order establishes that the conditions identified in subsection (8)(b) of this section have been met, then an amount of allocated resources under subsection (3) of this section will be substituted by an amount adequate to provide such an MMNA.
10. The institutionalized spouse has until the end of the month of the first regularly scheduled eligibility review to transfer countable resources in excess of $2000 to the community spouse.
11. Standards in this section are found at www.hca.wa.gov/free-or-low-cost-health-care/program-administration/program-standard-income-and-resources.

WAC 182-513-1350 Defining the resource standard and determining resource eligibility for SSI-related long-term care (LTC) services.

Effective February 25, 2023

1. General information.
   1. This section describes how the agency or the agency's designee defines the resource standard and countable or excluded resources when determining a person's eligibility for SSI-related long-term care (LTC) services.
   2. "Resource standard" means the maximum amount of resources a person can have and still be resource eligible for program benefits.
   3. For a person not SSI-related, the agency applies program specific resource rules to determine eligibility.
2. Resource standards.
   1. The resource standard for the following people is $2000:
      1. A single person; or
      2. An institutionalized spouse.
   2. The resource standard for a legally married couple is $3000, unless subsection (3)(b)(ii) of this section applies.
   3. The resource standard for a person with a qualified long-term care partnership policy under WAC 182-513-1400 may be higher based on the dollar amount paid out by a partnership policy.
   4. Determining the amount of resources that can be allocated to the community spouse when determining resource eligibility is under WAC 182-513-1355.
3. Availability of resources.
   1. General. The agency or the agency's designee applies the following rules when determining available resources for LTC services:
      1. WAC 182-512-0300 SSI-related medical—Resources eligibility;
      2. WAC 182-512-0250 SSI-related medical—Ownership and availability of resources; and
      3. WAC 182-512-0260 SSI-related medical—How to count a sponsor's resources.
   2. Married couples.
      1. When both spouses apply for LTC services, the resources of both spouses are available to each other through the month in which the spouses stopped living together.
      2. When both spouses are institutionalized, the agency or the agency's designee determines the eligibility of each spouse as a single person the month following the month of separation.
      3. If the agency or the agency's designee has already established eligibility and authorized services for one spouse, and the community spouse needs LTC services in the same month, but after eligibility has been established and services authorized for the institutionalized spouse, then the agency applies the standard under subsection (2)(a) of this section to each spouse. If doing this would make one of the spouses ineligible, then the agency applies subsection (2)(b) of this section for the couple.
      4. The resources of the community spouse are unavailable to the institutionalized spouse the month after eligibility for LTC services is established, unless (v) or (vi) of this subsection applies.
      5. When a single institutionalized individual marries, the agency or the agency's designee redetermines eligibility applying the resource and income rules for a legally married couple.
      6. A redetermination of the couple's resources under this section is required if:
         1. The institutionalized spouse has a break of at least 30 consecutive days in a period of institutional status;
         2. The institutionalized spouse's countable resources exceed the standard under subsection (2)(a) of this section, and WAC 182-513-1355 (2)(b) applies; or
         3. The institutionalized spouse does not transfer the amount, under WAC 182-513-1355 (3) or (5), to the community spouse by either:
            1. The end of the month of the first regularly scheduled eligibility review; or
            2. A reasonable amount of time necessary to obtain a court order for the support of the community spouse.
4. Countable resources.
   1. The agency or the agency's designee determines countable resources using the following sections:
      1. WAC 182-512-0200 SSI-related medical—Definition of resources.
      2. WAC 182-512-0250 SSI-related medical—Ownership and availability of resources.
      3. WAC 182-512-0260 SSI-related medical—How to count a sponsor's resources.
      4. WAC 182-512-0300 SSI-related medical—Resources eligibility.
      5. WAC 182-512-0350 SSI-related medical—Property and contracts excluded as resources;
      6. WAC 182-512-0400 SSI-related medical—Vehicles excluded as resources;
      7. WAC 182-512-0450 SSI-related medical—Life insurance excluded as a resource; and
      8. WAC 182-512-0500 SSI-related medical—Burial funds, contracts and spaces excluded as resources.
      9. Chapter 182-516 WAC, Trusts, annuities, life estates, and promissory notes—Effect on medical programs.
   2. The agency or the agency's designee determines excluded resources based on federal law and WAC 182-512-0550, except:
      1. For institutional and HCB waiver programs, pension funds owned by a nonapplying spouse are counted toward the resource standard.
      2. For long-term services and supports (LTSS), based on the need for either nursing facility level of care or intermediate care facility for the intellectually disabled level of care, one home is excluded only if it meets the home equity limits of subsection (8) of this section. See WAC 182-512-0350 (1)(b).
   3. The agency or the agency's designee adds together the countable resources of both spouses if subsections (3)(b)(i) and (iv) apply, but not if subsection (3)(b)(ii) or (iii) apply. For a person with a community spouse, see WAC 182-513-1355.
5. Excess resources.
   1. For LTC programs, a person may reduce excess resources by deducting incurred medical expenses under subsection (6) of this section;
   2. The amount of excess resources is limited to the following amounts:
      1. For LTC services provided under the categorically needy (CN) program:
         1. In a medical institution, excess resources and available income must be under the state medicaid rate based on the number of days the person spent in the medical institution in the month.
         2. For HCB waiver eligibility, incurred medical expenses must reduce resources within allowable resource standards. The cost of care for the HCB waiver services cannot be allowed as a projected expense.
      2. For LTC services provided under the medically needy (MN) program, see:
         1. WAC 182-513-1395 for LTC programs; and
         2. WAC 182-513-1245 for hospice.
   3. Excess resources not otherwise applied to medical expenses will be applied to the projected cost of care for services in a medical institution under WAC 182-513-1380.
6. Allowable medical expenses.
   1. The following incurred medical expenses may be used to reduce excess resources:
      1. Premiums, deductibles, coinsurance, or copayment charges for health insurance and medicare;
      2. Medically necessary care defined under WAC 182-500-0070, but not covered under the state's medicaid plan. Information regarding covered services is under chapter 182-501 WAC;
      3. Medically necessary care defined under WAC 182-500-0070 incurred prior to medicaid eligibility. Expenses for nursing facility care are reduced at the state rate for the specific facility that provided the services.
   2. To be allowed, the medical expense must:
      1. Have been incurred no more than three months before the month of the medicaid application;
      2. Not be subject to third-party payment or reimbursement;
      3. Not have been used to satisfy a previous spenddown liability;
      4. Not have been previously used to reduce excess resources;
      5. Not have been used to reduce participation;
      6. Not have been incurred during a transfer of asset penalty under WAC 182-513-1363; and
      7. Be an amount for which the person remains liable.
7. ​Nonallowable expenses. The following expenses are not allowed to reduce excess resources:
   1. Unpaid adult family home (AFH) or assisted living facility expenses incurred prior to medicaid eligibility;
   2. Personal care cost in excess of approved hours determined by the CARE assessment under chapter 388-106 WAC; and
   3. Expenses excluded by federal law.
8. Excess home equity.
   1. A person with an equity interest in a primary residence in excess of the home equity limit is ineligible for long-term services and supports (LTSS) that are based on the need for either nursing facility level of care or intermediate care facility for the intellectually disabled level of care, unless one of the following persons lawfully resides in the home:
      1. That person's spouse; or
      2. That person's dependent child under age 21, blind child, or disabled child.
   2. The home equity provision applies to all applications for LTSS received on or after May 1, 2006.
   3. The excess home equity limit is the federal maximum allowed. On January 1st of each year, this standard may change by the percentage in the consumer price index for all consumers (CPI-U). The current maximum home equity limit is posted by the Centers for Medicare and Medicaid Services. (See subsection (9) of this section for institutional resource standards.)
   4. A person who is denied or terminated LTC services due to excess home equity may apply for an undue hardship waiver under WAC 182-513-1367.
9. Institutional resource 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.

WAC 182-513-1345 Determining disregarded income for institutional or hospice services under the medically needy (MN) program.

Effective February 20, 2017

This section describes income the agency or its designee disregards when determining a person's eligibility for institutional or hospice services under the medically needy (MN) program. Disregarded income is available when determining a person's participation in the cost of care.

1. The agency or its designee disregards the following income amounts in the following order:
   1. Income that is not reasonably anticipated, or is received infrequently or irregularly, when such income does not exceed:
      1. Twenty dollars per month if unearned; or
      2. Ten dollars per month if earned.
   2. The first $20 per month of earned or unearned income, unless the sole source of income paid to a person is:
      1. Based on need; and
      2. Totally or partially funded by the federal government or a nongovernmental agency.
2. For a person who is related to the supplemental security income (SSI) program under WAC 182-512-0050(1), the first $65 per month of earned income not excluded under WAC 182-513-1340, plus one-half of the remainder.
3. Department of Veterans Affairs benefits designated for:
   1. The veteran's dependent when determining LTC eligibility for the veteran. The VA dependent allowance is considered countable income to the dependent unless it is paid due to unusual medical expenses (UME);
   2. Unusual medical expenses, aid and attendance allowance, special monthly compensation (SMC) and housebound allowance, with the exception under subsection (4) of this section.
4. Benefits under subsection (3)(b) of this section for a person who receives long-term care services are excluded when determining eligibility, but are considered available as a third-party resource (TPR) defined under WAC 182-513-1100 when determining the amount the person contributes in the cost of care.

WAC 182-513-1340 Determining excluded income for long-term care (LTC) services.

Effective June 10, 2019

This section describes income the agency or its designee excludes when determining a client's eligibility and participation in the cost of care for long-term care (LTC) services.

1. When determining a client's eligibility and participation in the cost of care for LTC services, the agency excludes:
   1. Crime victim's compensation;
   2. Earned income tax credit (EITC) for twelve months after the month of receipt;
   3. American Indian/Alaskan native benefits excluded by federal statute (refer to WAC 182-512-0770);
   4. Tax rebates or special payments excluded by other statutes;
   5. Any public agency's refund of taxes paid on real property and/or on food;
   6. Supplemental security income (SSI) and certain state public assistance based on financial need;
   7. The amount a representative payee charges to provide services when the services are a requirement for the client to receive the income;
   8. The amount of expenses necessary for a client to receive compensation, e.g., legal fees necessary to obtain settlement funds;
   9. Education benefits under WAC 182-512-0760;
   10. Self-employment income allowed as a deduction by the Internal Revenue Service (IRS);
   11. Payments to prevent fuel cut-offs and to promote energy efficiency that are excluded by federal statute;
   12. Assistance (other than wages or salary) received under the Older Americans Act;
   13. Assistance (other than wages or salary) received under the foster grandparent program;
   14. Certain cash payments a client receives from a governmental or nongovernmental medical or social service agency to pay for medical or social services;
   15. Interest earned on excluded burial funds and any appreciation in the value of an excluded burial arrangement that are left to accumulate and become part of the separately identified burial funds set aside;
   16. Tax exempt payments received by Alaska natives under the Alaska Native Settlement Act established by P.L. 100-241;
   17. Compensation provided to volunteers in ACTION programs under the Domestic Volunteer Service Act of 1973 established by P.L. 93-113;
   18. Payments made from the Agent Orange Settlement Fund or any other funds to settle Agent Orange liability claims established by P.L. 101-201;
   19. Payments made under section six of the Radiation Exposure Compensation Act established by P.L. 101-426;
   20. Payments made under the Energy Employees Occupational Illness Compensation Program Act of 2000, (EEOICPA) Pub. L. 106-398;
   21. Restitution payment, and interest earned on such payment to a civilian of Japanese or Aleut ancestry established by P.L. 100-383;
   22. Payments made under sections 500 through 506 of the Austrian General Social Insurance Act;
   23. Payments made from Susan Walker v. Bayer Corporation, et, al., 95-C-5024 (N.D. Ill.) (May 8, 1997) settlement funds;
   24. Payments made from the Ricky Ray Hemophilia Relief Fund Act of 1998 established by P.L. 105-369;
   25. Payments made under the Disaster Relief and Emergency Assistance Act established by P.L. 100-387;
   26. Payments made under the Netherlands' Act on Benefits for Victims of Persecution (WUV);
   27. Payments made to certain survivors of the Holocaust under the Federal Republic of Germany's Law for Compensation of National Socialist Persecution or German Restitution Act.
   28. Interest or dividends received by the institutionalized individual is excluded as income. Interest or dividends received by the community spouse of an institutional individual is counted as income of the community spouse. Dividends and interest are returns on capital investments such as stocks, bonds, or savings accounts. Institutional status is defined in WAC 182-513-1320.
   29. Income received by an ineligible or nonapplying spouse from a governmental agency for services provided to an eligible person, e.g., chore services.
2. The agency or its designee treats Department of Veterans Affairs (VA) benefits as follows:
   1. Any VA dependent allowance is countable income to the dependent unless it is paid due to unusual medical expenses (UME);
   2. UME, aid and attendance allowance, special monthly compensation (SMC) and housebound allowance are third-party resources;
   3. Benefits in subsection (2)(b) of this section for a client who receives long-term care services are excluded when determining eligibility, but are available as a third-party resource (TPR) as defined under WAC 182-513-1100 when determining the amount the institutionalized client contributes in the cost of care.
3. Any other income excluded by federal law is excluded.

WAC 182-513-1330 Determining available income for legally married couples for long-term care (LTC) services.

Effective August 26, 2018

This section describes income the agency or its designee determines available when evaluating a legally married person's eligibility for long-term care (LTC) services.

1. The agency or the agency's designee applies the following rules when determining income eligibility for LTC services:
   1. WAC 182-512-0600 SSI-related medical—Definition of income;
   2. WAC 182-512-0650 SSI-related medical—Available income;
   3. WAC 182-512-0700 SSI-related medical—Income eligibility;
   4. WAC 182-512-0750 SSI-related medical—Countable unearned income;
   5. WAC 182-512-0840(3), self-employment income-allowance expenses;
   6. WAC 182-512-0960 SSI-related medical —Allocating income—Determining eligibility for a spouse when the other spouse receives long-term services and supports (LTSS);
   7. WAC 182-512-0785, 182-512-0790, and 182-512-0795 for sponsored immigrants and how to determine if the sponsors' income counts in determining benefits.
2. In initial categorically needy income eligibility for LTC, the agency does not allow any deductions listed in 1612(b) of the Social Security Act, for example:
   1. Twenty dollars per month income exclusion under WAC 182-512-0800;
   2. The first $65 and the remaining one-half earned income work incentive under WAC 182-512-0840; and
   3. Impairment related work expense or blind work expense under WAC 182-512-0840.
3. The following income is available to an institutionalized spouse, unless subsections (5) and (6) apply:
   1. Income received in the institutionalized spouse's name;
   2. Income paid to a representative on the institutionalized spouse's behalf; and
   3. One-half of the income received in the names of both spouses.
4. The following income is unavailable to an institutionalized spouse:
   1. Separate income received in the name of the community spouse; and
   2. Income established as unavailable through a court order.
5. For the determination of eligibility only, if available income under subsection (3)(a) through (c) of this section, minus income exclusions under WAC 182-513-1340, exceeds the special income level (SIL), defined under WAC 182-513-1100, the agency or its designee:
   1. Follows Washington state community property law when determining ownership of income;
   2. Presumes all income received after the marriage by either spouse to be community income;
   3. Considers one-half of all community income available to the institutionalized spouse.
6. If the total of subsection (5)(c) of this section plus the institutionalized spouse's separate income is over the SIL, determine available income using subsection (3) of this section.
7. A stream of income, not generated by a transferred resource, is available to the institutionalized spouse, even if the institutionalized spouse transfers or assigns the rights to the stream of income to one of the following:
   1. The community spouse; or
   2. A trust for the benefit of the community spouse.

WAC 182-513-1325 Determining available income for an SSI-related single client for long-term care (LTC) services.

Effective February 20, 2017

This section describes income the agency or its designee determines available when evaluating an SSI-related single client's eligibility for long-term care (LTC) services.

1. See WAC 182-513-1330 for rules related to available income for legally married couples.
2. The agency or its designee applies the following rules when determining income eligibility for SSI-related LTC services:
   1. WAC 182-512-0600 SSI-related medical—Definition of income;
   2. WAC 182-512-0650 SSI-related medical—Available income;
   3. WAC 182-512-0700 SSI-related medical—Income eligibility;
   4. WAC 182-512-0750 SSI-related medical—Countable unearned income;
   5. WAC 182-512-0840 (3) self-employment income-allowable expenses
   6. WAC 182-512-0785, 182-512-0790, and 182-512-0795 for sponsored immigrants and how to determine if sponsors' income counts in determining benefits.
3. In initial categorically needy income eligibility for LTC, the agency does not allow any deductions listed in 1612(b) of the Social Security Act, for example:
   1. Twenty dollars per month income exclusion under WAC 182-512-0800;
   2. The first $65 and the remaining one-half earned income work incentive under WAC 182-512-0840; and
   3. Impairment related work expense or blind work expense under WAC 182-512-0840.

WAC 182-513-1320 Determining institutional status for long-term care (LTC) services.

Effective February 17, 2017

1. To attain institutional status outside a medical institution, a person must be approved for and receive:
   1. Home and community based (HCB) waiver services under chapter 182-515 WAC;
   2. Roads to community living (RCL) services under WAC 182-513-1235;
   3. Program of all-inclusive care for the elderly (PACE) under WAC 182-513-1230;
   4. Hospice services under WAC 182-513-1240(3); or
   5. State-funded long-term care service under WAC 182-507-0125.
2. To attain institutional status in a medical institution, a person must reside in a medical institution thirty consecutive days or more, or based on a department assessment, be likely to reside in a medical institution thirty consecutive days or more.
3. Once a person meets institutional status, the person's status is not affected if the person:
   1. Transfers between medical facilities; or
   2. Changes between any of the following programs: HCB waiver, RCL, PACE, hospice or services in a medical institution.
4. A person loses institutional status if the person is absent from a medical institution, or does not receive HCB waiver, RCL, PACE, or hospice services, for more than twenty-nine consecutive days.

WAC 182-513-1318 Income and resource criteria for home and community based (HCB) waiver programs and hospice.

Effective February 20, 2017

1. This section provides an overview of the income and resource eligibility rules for a person to be eligible for a categorically needy (CN) home and community based (HCB) waiver program under chapter 182-515 WAC or the hospice program under WAC 182-513-1240 and 182-513-1245.
2. To determine income eligibility for an SSI-related long-term care (LTC) HCB waiver, the agency or its designee:
   1. Determines income available under WAC 182-513-1325 and 182-513-1330;
   2. Excludes income under WAC 182-513-1340;
   3. Compares remaining gross nonexcluded income to:
      1. The special income level (SIL) defined under WAC 182-513-1100; or
      2. For HCB service programs authorized by the aging and long-term supports administration (ALTSA), a higher standard is determined following the rules under WAC 182-515-1508 if a client's income is above the SIL but net income is below the medically needy income level (MNIL).
3. A person who receives MAGI-based coverage is not eligible for HCB waiver services unless found eligible based on program rules in chapter 182-515 WAC.
4. To be resource eligible under the HCB waiver program, the person must:
   1. Meet the resource eligibility requirements and standards under WAC 182-513-1350;
   2. Not be in a period of ineligibility due to a transfer of asset penalty under WAC 182-513-1363;
   3. Disclose to the state any interest the person or that person's spouse has in an annuity and meet the annuity requirements under chapter 182-516 WAC.
5. The agency or its designee determines a person's responsibility to pay toward the cost of care for LTC services as follows:
   1. For people receiving HCS HCB waiver services, see WAC 182-515-1509;
   2. For people receiving DDA HCB waiver services, see WAC 182-515-1514.
6. To be eligible for the CN hospice program, see WAC 182-513-1240.
7. To be eligible for the MN hospice program in a medical institution, see WAC 182-513-1245.

WAC 182-513-1317 Income and resource criteria for an institutionalized person.

Effective February 20, 2017

1. This section provides an overview of the income and resource eligibility rules for a person who lives in an institutional setting.
2. To determine income eligibility for an SSI-related long-term care (LTC) applicant under the categorically needy (CN) program, the agency or its designee:
   1. Determines available income under WAC 182-513-1325 and 182-513-1330;
   2. Excludes income under WAC 182-513-1340; and
   3. Compares remaining available income to the special income level (SIL) defined under WAC 182-513-1100. A person's available income must be equal to or less than the SIL to be eligible for CN coverage.
3. To determine income eligibility for an SSI-related LTC client under the medically needy (MN) program, the agency or its designee follows the income standards and eligibility rules under WAC 182-513-1395.
4. To be resource eligible under the SSI-related LTC CN or MN program, the person must:
   1. Meet the resource eligibility requirements under WAC 182-513-1350;
   2. Not have a penalty period of ineligibility due to a transfer of assets under WAC 182-513-1363;
   3. Disclose to the state any interest the person or the person's spouse has in an annuity, which must meet the annuity requirements under chapter 182-516 WAC.
5. A resident of eastern or western state hospital is eligible for medicaid if the person:
   1. Has attained institutional status under WAC 182-513-1320; and
   2. Is under age twenty-one; or
   3. Applies for or receives inpatient psychiatric treatment in the month of the person's twenty-first birthday that will likely continue through the person's twenty-first birthday, and can receive coverage until:
      1. The facility discharges the person; or
      2. The end of the month in which the person turns age twenty-two, whichever occurs first; or(d) Is at least age sixty-five.
6. To determine long-term care CN or MN income eligibility for a person eligible under a MAGI-based program, the agency or its designee follows the rules under chapter 182-514 WAC.
7. There is no asset test for MAGI-based LTC programs under WAC 182-514-0245.
8. The agency or its designee determines a person's total responsibility to pay toward the cost of care for LTC services as follows:
   1. For an SSI-related person residing in a medical institution, see WAC 182-513-1380;
   2. For an SSI-related person on a home and community based waiver, see chapter 182-515 WAC.