WAC 388-513-1305   Determining eligibility for noninstitutional medical assistance in an alternate living facility (ALF).  This section describes how the department defines the monthly income standard and uses it to determine eligibility for noninstitutional medical assistance for a client who lives in a department-contracted ALF. Refer to WAC 388-478-0045 for the personal needs allowance (PNA) amount that applies in this rule.

     (1) Alternate living facilities include the following:

     (a) An adult family home (AFH);

     (b) An adult residential care facility (ARC);

     (c) An adult residential rehabilitation center (ARRC);

     (d) An adult residential treatment facility (ARTF);

     (e) An assisted living facility (AL);

     (f) A division of developmental disabilities (DDD) group home (GH); and

     (g) An enhanced adult residential care facility (EARC).

     (2) The monthly income standard for noninstitutional medical assistance under the categorically needy (CN) program that cannot exceed the special income level (SIL) equals the following amounts. For a client who lives in:

     (a) An ARC, an ARRC, an ARTF, an AL, a DDD GH, or an EARC, the department-contracted rate based on a thirty-one day month plus the PNA; or

     (b) An AFH, the department-contracted rate based on a thirty-one day month plus the PNA plus the cost of any add-on hours authorized by the department.

     (3) The monthly income standard for noninstitutional medical assistance under the medically needy (MN) program equals the private facility rate based on a thirty-one-day month plus the PNA.

     (4) The monthly income standard for noninstitutional medical assistance under the general assistance (GA) program equals the GA grant standard described in WAC 388-478-0045.

     (5) The department determines a client's nonexcluded resources for noninstitutional medical assistance under the:

     (a) General assistance (GA) and Temporary Assistance for Needy Families (TANF) programs as described in chapter 388-470 WAC; and

     (b) SSI-related medical program as described in chapter 388-475 WAC.

     (6) The department determines a client's nonexcluded income for noninstitutional medical assistance as described in:

     (a) Chapter 388-450 WAC for GA and TANF programs; and

     (b) Chapter 388-475 WAC and WAC 388-506-0620 for SSI-related medical programs.

     (7) The department approves CN noninstitutional medical assistance for a period of up to twelve months for a client who receives supplemental security income (SSI) or who is SSI-related as described in WAC 388-475-0050, if:

     (a) The client's nonexcluded resources described in subsection (5) do not exceed the standard described in WAC 388-513-1350(1); and

     (b) The client's nonexcluded income described in subsection (6) does not exceed the CN standard described in subsection (2).

     (8) The department approves MN noninstitutional medical assistance for a period of months described in chapter 388-416 WAC for an SSI-related client, if:

     (a) The client's nonexcluded resources described in subsection (5) do not exceed the standard described in WAC 388-513-1350(1); and

     (b) The client satisfies any spenddown liability as described in chapter 388-519 WAC.

     (9) The department approves GA and TANF noninstitutional medical assistance for a period of months described in chapter 388-416 WAC.

     (10) The client described in subsections (7) and (9) keeps the PNA amount and pays remaining income to the facility for board and room.



[Statutory Authority: RCW 74.08.090. 06-07-077, § 388-513-1305, filed 3/13/06, effective 4/13/06. Statutory Authority: RCW 11.92.180, 43.20B.460, 48.85.020, 74.04.050, 74.04.057, 74.08.090, 74.09.500, 74.09.530, 74.[09.]575,74.09.585 ; 20 C.F.R. 416.1110-1112, 1123 and 1160; 42 C.F.R. 435.403 (j)(2) and 1005; and Sections 17, 1915(c), and 1924 (42 U.S.C. 1396) of the Social Security Act. 00-01-051, § 388-513-1305, filed 12/8/99, effective 1/8/00. Statutory Authority: RCW 74.08.090 and 74.09.500. 99-06-045, § 388-513-1305, filed 2/26/99, effective 3/29/99. Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), § 388-513-1305, filed 5/3/94, effective 6/3/94. Formerly parts of WAC 388-83-036 and 388-99-036.]