Wash. Admin. Code § 182-507-0125 – State-funded long-term care services

(1) Caseload limits.
1. (a) The state-funded long-term care services program is subject to caseload limits determined by legislative funding.
2. (b) The home and community living administration (HCLA) must preauthorize state-funded long-term care service before payments begin.
3. (c) HCLA cannot authorize a service, under chapter 388-106 WAC or under chapter 388-825 WAC, if doing so would exceed statutory caseload limits.
(2) Location of services. State-funded long-term care services may be provided in:
1. (a) The person's own home, defined in WAC 388-106-0010;
2. (b) An adult family home, defined in WAC 182-513-1100;
3. (c) An assisted living facility, defined in WAC 182-513-1100;
4. (d) An enhanced adult residential care facility, defined in WAC 182-513-1100;
5. (e) An adult residential care facility, defined in WAC 182-513-1100;
6. (f) A nursing facility, defined in WAC 182-500-0050, but only if nursing facility care is necessary to sustain life; or
7. (g) A residential habilitation center, defined in WAC 388-835-0010, that is an intermediate care facility for individuals with intellectual disabilities (ICF/IID), defined in WAC 182-500-0050.
(3) Client eligibility. To be eligible for the state-funded long-term care services program, a person must meet all of the following conditions:
1. (a) General eligibility requirements for medical programs under WAC 182-503-0505, except (c) and (d) of this subsection;
2. (b) Reside in one of the locations under subsection (2) of this section;
3. (c) Attain institutional status under WAC 182-513-1320;
4. (d) Meet the functional eligibility requirements under WAC 388-106-0355 for nursing facility level of care or under WAC 388-845-0030 for ICF/IID level of care;
5. (e) Meet the financial eligibility requirements under WAC 182-513-1315;
6. (f) Not have a penalty period due to a transfer of assets under WAC 182-513-1363;
7. (g) Not have equity interest in a primary residence more than the amount under WAC 182-513-1350; and
8. (h) Meet the requirements under chapter 182-516 WAC for annuities owned by the person or the person's spouse.
(4) General limitations.
1. (a) If a person entered Washington only to obtain medical care, the person is ineligible for state-funded long-term care services.
2. (b) Disability requirements under WAC 182-512-0050 do not apply to state-funded long-term care services.
3. (c) The certification period for state-funded long-term care services may not exceed 12 months.
4. (d) People who qualify for state-funded long-term care services receive categorically needy (CN) medical coverage under WAC 182-501-0060.
5. (e) A person who is not eligible for the state-funded long-term care services program under CN rules may qualify under medically needy (MN) rules under WAC 182-513-1395.
6. (f) The agency determines how much a person is required to pay toward the cost of care, using:
  1. (i) WAC 182-513-1380, if the person resides in a nursing facility or residential habilitation center.
  2. (ii) WAC 182-515-1505 or 182-515-1510, if the person resides in one of the locations listed in subsection (2)(a) through (e) of this section.
(5) Current resource, income, PNA, and room and board 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.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 25-19-051, s 182-507-0125, filed 9/10/25, effective 10/11/25; WSR 24-16-023, § 182-507-0125, filed 7/26/24, effective 8/26/24; WSR 23-04-034, § 182-507-0125, filed 1/25/23, effective 2/25/23. Statutory Authority: RCW 41.05.021, 41.05.160, P.L. 111-148, 42 C.F.R. §§ 431, 435, and 457, and 45 C.F.R § 155. WSR 17-03-116, § 182-507-0125, filed 1/17/17, effective 2/17/17. WSR 12-13-056, recodified as § 182-507-0125, filed 6/15/12, effective 7/1/12. Statutory Authority: 2011 c 5, RCW 74.04.057, 74.08.090, and 74.09.510. WSR 11-19-070, § 388-438-0125, filed 9/15/11, effective 10/16/11. Statutory Authority: RCW 74.04.050, 74.08.090, and 2009 c 564 §§ 1109, 201, 209. WSR 10-19-085, § 388-438-0125, filed 9/17/10, effective 10/18/10.]