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Long Term Care Medical Standards-Personal Needs Allowance (PNA) Charts |
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Revised June 16, 2008 |
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Purpose: The long-term care medical chart includes standards for income and resource eligibility The personal needs allowance chart defines the amount of money a client is allowed to keep for their personal use |
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Long Term Care Medical Standards Resource standards WAC 388-513-1350 Defining the resource standard and determining resource eligibility for long-term care (LTC) services
Income standards Used to determine income eligibility and financial participation in long-term care
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PERSONAL NEEDS ALLOWANCE (PNA) and ADSA room and board standard | |||||||||||||||||||||||||||||||||||||||||||||||||||
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Nursing facility private rate standard. Used to determine period of ineligibility due to asset transfer Reference WAC 388-513-1363, 388-513-1364, 388-513-1365 Transfer of an asset. This rate increases annually on October 1. It is calculated using the reported date from Medicaid cost reports and determined by ADSA. It is used to determine a period of ineligibility due to a resource transfer. Current rate effective 10/1/2007
Rates Prior to 10/1/2007
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Other Medical Assistance Standards Standards-Medical Assistance Programs Medical Income and Resource Standards (Health & Recovery Services Administration (HRSA), 2nd bullet includes charts for 2006 through current standard chart ) Key Medicaid Standards as of April 2008 (From Northwest Justice Website) | |||||||||||||||||||||||||||||||||||||||||||||||||||
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Links to Federal Medicaid Standards 2007 Health & Human Services Poverty Guidelines U.S. Department of Labor Consumer Price Index Federal Spousal Impoverishment (Long term care eligibility with a community spouse) Centers for Medicare & Medicaid Services Income and Resource standards (includes past standards) | |||||||||||||||||||||||||||||||||||||||||||||||||||
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CLARIFYING INFORMATION
a. The department compares a client’s non-excluded income to the SIL to determine whether a client is eligible for LTC services under the institutional CN program. b. The SIL is equal to 300% of the annually adjusted SSI Federal Benefit Rate (FBR). c. The department does not allow income disregards when determining eligibility for CN services. It reduces a client’s gross income only by the exclusions allowed by federal statute as described in WAC 388-513-1340. d. Income disregards not allowed before doing the SIL comparison are the $20 disregard and 65 ½ earned income deduction. e. The SIL is the maximum amount allowed by law as the CN income standard. 2. Disabled Adult Children (DAC), Pickle/COLA, Widowers, SSI clients and SSI clients because of 1619B status. How does the SIL affect their eligibility for HCBS Waiver programs. Gross income can be over the SIL if eligible for a S01 or S02 Medicaid program (CN SSI related medical). Clients who are on SSI and are considered eligible for SSI by Social Security Administration (1619B) or Deemed eligible for SSI (Protected DAC, Widowers, Pickle/COLA ) who have countable income under the SSI Standard. These clients may have gross income above the SIL. Clients who are eligible to receive non-institutional CN-P Medicaid based on countable income below the SSI standard do not need to meet the SIL criteria for institutional Waiver Medicaid. These clients are already eligible for CN-P Medicaid because their countable income is under the SSI standard. They are receiving SSI or considered a SSI client due to 1619B status with Social Security Administration. It is possible that a 1619B status client can have gross income over the SIL because of their earnings. A 1619B client is treated just like a SSI client. Their eligibility is maintained by the Social Security Administration and they do not need to submit eligibility reviews to DSHS for Medicaid eligibility. The SDX gives information on clients having 1619B status and to continue the CN-P Medicaid eligibility. Client’s deemed “SSI eligible” such as the disabled adult child (DAC), Pickle/COLA and Widowers group because their countable income after the allowable exclusion is under the SSI standard can have gross income over the SIL, but as long as this group is eligible for CN-P under the S02 program, they are financial eligible for the HCS or DDD Waiver and do not participate toward their personal care. Not all clients receiving DAC are considered deemed SSI clients if their non DAC countable income is over the SSI standard. Clients receiving DAC benefits who have other countable income (after the DAC and other SSI related exclusions) UNDER the SSI standard are called “protected DAC” clients. These clients are eligible for non institutional CN-P medicaid (S02 in ACES). Clients receiving DAC benefits who have countable income after SSI related exclusions OVER the SSI standard are not considered protected DAC, they are not automatically eligible for a CN-P program and their countable income is considered in determining Medicaid eligibility. These clients do need to meet specific eligibility criteria for long-term care services. Transfer of asset penalties and excess home equity (WAC 388-513-1350 (7)) apply to Waiver and institutional long-term care services. Transfer of asset penalties and excess home equity criteria does not apply to MPC services. For more information on SSI related exclusions including DAC, Pickle/COLA and Widowers: | |||||||||||||||||||||||||||||||||||||||||||||||||||
