WAC 388-505-0230 Family related institutional medical. (Emergency effective 5/08/08)

This section describes how the department determines eligibility for institutional medical benefits for temporary assistance for needy families (TANF)‑related clients and children under the age of twenty‑one who reside in a medical institution or a psychiatric or chemical dependency facility.

1. An individual over the age of twenty-one is eligible for categorically needy (CN) family‑related institutional medical assistance when the individual:
   
   1. Meets U.S. citizenship or immigrant status as described in WAC 388‑424‑0010 (1) or (2);
   2. Meets the state residency requirement as described in chapter 388‑468 WAC;
   3. Provides a valid social security number as described in chapter 388‑476 WAC;
   4. Meets TANF eligibility requirements as described in WAC 388‑400‑0005, except for the requirement to participate in the Workfirst program under chapter 388-310 WAC;
   5. Has countable income below the applicable TANF payment standard based upon household size to include the institutionalized individual;
   6. Meets institutional status as described in WAC 388-513-1320 and resides in a medical institution, intermediate care facility for mentally retarded (ICF/MR), hospice care center, state veteran’s facility, or
   7. Participates available income towards the cost of care as described in WAC 388‑513‑1380.
2. An individual over the age of twenty‑one is not eligible for family‑related institutional medical assistance when the individual resides in a psychiatric facility, unless the individual is:
   1. A Medicaid recipient or has submitted an application for medical benefits prior to the individual’s twenty‑first birthday; and
   2. Receiving active psychiatric treatment and the treatment extends beyond the twenty‑first birth date but the individual has not yet reached the age of twenty‑two. (Eligibility in this circumstance terminates when the individual discharges from the facility or on the individuals twenty-second birthday, whichever happens first.)
3. An individual over the age of twenty-one with income in excess of the TANF payment standard is not eligible for medically needy family-related institutional medical assistance.
4. An individual aged nineteen through twenty-one is eligible for CN medical assistance under the family-related insitutional medical program when the individual:
   1. Meets the requirements in subsection (1)(a), (b), and (c);
   2. Resides in a medical facility as described in subsection (1)(f), a psychiatric facility (IMD) or a checmical dependency facility;
   3. Has countable income below the one-person TANF standard; and
   4. Participates toward the cost of their care as described in WAC 388-513-1380
5. An individual aged eighteen through twenty-one with countable income below the payment standard described in WAC 388-478-0040 may be eligible for general assistance cash assistance for the individual's personal needs allowance.
6. An individual under the age of nineteen is eligible for CN medical assistance under the famikly-related institutional medical program when the individual:
   1. Meets the requirements in subsection (1)(a), (b), (c);
   2. Resides in a medical facility as described in subsection (1)(f), a psychiatric facility 9IMD) or a chemical dependency facility;
   3. Has countable income below the applicable standard described in WAC 388-505-0210; and
   4. Participates toward the cost of their care as described in WAC 388-513-1380.
7. When an individual under the age of twenty-one resides or is expected to reside thirty days or longer in a medical; institution, intermediate care facility for the mentally;retarded (ICF/MR), hospice care center or nursing facility, only parental income the parent chooses to contribute is considered available.
8. When an individual resides in a psychiatric facility or chemical dependency facility, parental income is considered as follows:
   1. It is available to an individual seventeen years of age or younger unless:
      1. The individual is expected to reside outside of home for ninety days or longer; or
      2. The individual is in court‑ordered, out‑of‑home accordance with chapter 13.34 RCW; or
      3. The department determines the parents are not exercising responsibility for the care and control of the individual.
   2. Parental income is considered available only as contributed to an individual over seventeen years of age but under nineteen who resides or is expected to reside in a psychiatric facility for thirty days or longer; and
   3. Parental income is not considered available to an individual between nineteen and twenty-one years of age who resides or is expected to reside in a psychiatric facility or chemical dependency facility f or thirty days or longer
9. An individual under the age of twenty-one is considered for medically needy (MN) family-related institutional medical when the individual's countable income exceeds the standards in WAC 388-505-0210.
10. A TANF-related individual who is not expected to reside in a medical facility for thrity days or longer is not eligible for family-related institutional medical. The individual's eligibility will be considered for a non-institutional medical program as described in WAC 388-505-0210, 0211, or