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Washington Administrative Code (Last Updated: November 23, 2016) |
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Title 182. Health Care Authority |
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Chapter 182-514. Long-term care for families and children. |
Section 182-514-0263. Non-SSI-related institutional medically needy coverage for pregnant women and people age twenty and younger.
Latest version.
- (1) Medically needy (MN) coverage under this section is only available for people age twenty and younger or pregnant women. The medicaid agency determines a person who meets SSI-related criteria under WAC 182-512-0050 eligible for institutional MN coverage under WAC 182-513-1395. If a person meets requirements in both this section and WAC 182-513-1395, the person may choose which program to enroll in for coverage.(2) A person whose income exceeds the categorically needy (CN) standards under WAC 182-514-0250 and 182-514-0260 is:(a) Eligible for MN coverage with no spenddown if the person's countable income (CI) is equal to or less than the department-contracted daily rate times the number of days in the institution;(b) Eligible for MN coverage after a spenddown under WAC 182-519-0110 is met if the person's CI is above the department-contracted daily rate times the number of days in the institution but less than the institution's private rate;(c) Not eligible for payment of long-term care services provided by the institution if the person's CI exceeds the institution's private rate;(d) Responsible for paying up to the monthly state rate for the facility as participation in the cost of care; and(e) Allowed to keep a monthly personal needs allowance (PNA) of at least $57.28. Current PNA and long-term care standards can be found at http://www.hca.wa.gov/medicaid/eligibility/pages/standards.aspx.(3) If a person's CI exceeds the institution's private rate, the agency determines eligibility for medical coverage under chapter 182-519 WAC.
Rules
182-512-0050,182-513-1395,182-513-1395,182-514-0250,182-514-0260,182-519-0110,182-519,