What is the process for nursing facility care?

For ABD, SSI-related Apple Health programs:

Department-designated social service staff:

Assess the client's functional eligibility for institutional care.

Screen all clients to determine potential for HCB services.

Determine if the client is likely to attain institutional status and be likely to reside at the nursing facility for 30 days or longer WAC 182-513-1320, or notifies the facility when the client doesn't appear to meet the need for nursing facility care.

Determine if a housing maintenance allowance (HMA) is appropriate (current rule states HMA is the amount of the Federal Poverty Level).

Provide PBS staff with the following information: Date of NF admission, Whether the client meets nursing facility level of care (NFLOC), For Medicaid recipients, the first date DSHS was notified of the admission by the nursing facility, If the client is likely to attain institutional status, Whether there is a housing maintenance allowance and the start date, if appropriate.

Public benefit specialist (PBS) staff:

Refer the client to social services for a care assessment if the client contacts the PBS first and document the date the client first requested NF care.

Determine the client's financial eligibility for LTSS and noninstitutional medical assistance including three months retroactive medical coverage if financially eligible.

Authorize payment for NF care if the client is both functionally and financially eligible. For Medicaid applicants, institutional services are approved based on the date the client is eligible up to 3 months prior to the date of application. For Medicaid recipients, institutional services are approved based on the first date the admission is known to DSHS as long as the client meets all other eligibility factors. If the NF admission is on a weekend or holiday, the NF has until the first business day to report the admission.

Issue the NF award letter to the applicant/recipient and the nursing facility.