1. (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. (2) To determine income eligibility for an SSI-related long-term care (LTC) HCB waiver, the agency or its designee:

   1. (a) Determines income available under WAC 182-513-1325 and 182-513-1330;
   2. (b) Excludes income under WAC 182-513-1340;

   3. (c) Compares remaining gross nonexcluded income to:

      1. (i) The special income level (SIL) defined under WAC 182-513-1100; or
      2. (ii) For HCB service programs authorized by the home and community living administration (HCLA), 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. (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. (4) To be resource eligible under the HCB waiver program, the person must:

   1. (a) Meet the resource eligibility requirements and standards under WAC 182-513-1350;
   2. (b) Not be in a period of ineligibility due to a transfer of asset penalty under WAC 182-513-1363;
   3. (c) 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. (5) The agency or its designee determines a person's responsibility to pay toward the cost of care for LTC services as follows:

   1. (a) For people receiving HCS HCB waiver services, see WAC 182-515-1509;
   2. (b) For people receiving DDCS HCB waiver services, see WAC 182-515-1514.
6. (6) To be eligible for the CN hospice program, see WAC 182-513-1240.
7. (7) To be eligible for the MN hospice program in a medical institution, see WAC 182-513-1245.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 25-22-083, s 182-513-1318, filed 11/4/25, effective 12/5/25. 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, § 182-513-1318, filed 1/17/17, effective 2/17/17.]