WAC 182-513-1395. Determining eligibility for institutional services for people living in a medical institution under the SSI-related medically needy program

(1) For the purposes of this section only, "remaining income" means all gross nonexcluded income remaining after the post-eligibility calculation under WAC 182-513-1380 . (2) General information. To be eligible for institutional services when living in a medical institution under the SSI-related medically needy (MN) program, a person must: (a) Meet program requirements under WAC 182-513-1315 ; (b) Have gross nonexcluded income in excess of the special income level (SIL) defined under WAC 182-513-1100 ; and (c) Meet the financial requirements of subsection (3) or (4) of this section. (3) Financial eligibility. (a) The agency or its designee determines a person's resource eligibility, excess resources, and medical expense deductions using WAC 182-513-1350 . (b) The agency or its designee determines a person's countable income by: (i) Excluding income under WAC 182-513-1340 ; (ii) Determining available income under WAC 182-513-1325 or 182-513-1330 ; (iii) Disregarding income under WAC 182-513-1345 ; and (iv) Deducting medical expenses that were not used to reduce excess resources under WAC 182-513-1350 . (4) Eligibility for agency payment to the facility for institutional services and the MN program. (a) If a person's remaining income plus excess resources is less than, or equal to, the state-contracted daily rate times the number of days the person has resided in the facility, the person: (i) Is eligible for agency payment to the facility for institutional services and the MN program; and (ii) Is approved for a twelve-month certification period. (b) The person must pay income and excess resources towards the cost of care under WAC 182-513-1380 . (5) Eligibility for agency payment to the facility for institutional services and MN spenddown. If a person's remaining income is more than the state-contracted daily rate times the number of days the person has resided in the facility, but less than the private nursing facility rate for the same period, the person: (a) Is eligible to receive institutional services at the state-contracted rate; and (i) Is approved for a three-month or six-month base period; (ii) Pays income and excess resources towards the state-contracted cost of care under WAC 182-513-1380 ; and (b) Is eligible for the MN program for the same three-month or six-month base period when the total of additional medical expenses incurred during the base period exceeds: (i) The total remaining income for all months of the base period; (ii) Minus the total state-contracted rate for all months of the base period. (6) If a person has excess resources and the person's remaining income is more than the state-contracted daily rate times the number of days the person has resided in the facility, the person is not eligible to receive institutional services and the MN program.