1. (1) This section provides an overview of the income and resource eligibility rules for a person who lives in an institutional setting.

2. (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. (a) Determines available income under WAC 182-513-1325 and 182-513-1330;
   2. (b) Excludes income under WAC 182-513-1340; and
   3. (c) 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. (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. (4) To be resource eligible under the SSI-related LTC CN or MN program, the person must:

   1. (a) Meet the resource eligibility requirements under WAC 182-513-1350;
   2. (b) Not have a penalty period of ineligibility due to a transfer of assets under WAC 182-513-1363;
   3. (c) 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. (5) A resident of eastern or western state hospital is eligible for medicaid if the person:

   1. (a) Has attained institutional status under WAC 182-513-1320; and
   2. (b) Is under age twenty-one; or

   3. (c) 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. (i) The facility discharges the person; or
      2. (ii) The end of the month in which the person turns age twenty-two, whichever occurs first; or
   4. (d) Is at least age sixty-five.
6. (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. (7) There is no asset test for MAGI-based LTC programs under WAC 182-514-0245.

8. (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. (a) For an SSI-related person residing in a medical institution, see WAC 182-513-1380;
   2. (b) For an SSI-related person on a home and community based waiver, see chapter 182-515 WAC.

[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, § 182-513-1317, filed 1/17/17, effective 2/17/17.]