Washington’s functional routes to nursing-facility care
A person can qualify if daily registered-nurse or licensed-practical-nurse care is required. The rule also provides routes based on unmet or partially met needs in specified activities of daily living, including a three-ADL route, a two-ADL route with the rule’s listed categories, and a cognitive-impairment-plus-one-ADL route (WAC 388-106-0355).
The rule counts a need for assistance that did not occur because the person was unable to perform the activity or because no provider was available. A diagnosis alone does not state the test; the CARE assessment and the detailed functional criteria control (WAC 388-106-0355).
Personal-needs allowance and participation
Washington sets aside a personal-needs allowance before determining an institutional client’s contribution to cost of care. The PNA regulation points to HCA’s current standards chart for the amount and provides that the general medical-institution and ALF PNA is annually adjusted by the Social Security COLA beginning in 2024 (WAC 182-513-1105).
The HCA chart located in this research lists the most recent verifiable public chart as 2025 and shows $105.78 for “All other PNA Medical Institutions.” Because the rule calls for annual adjustment, confirm the live chart for the application month instead of assuming that 2025 dollar amount remains current (Washington Apple Health income and resource standards chart; WAC 182-513-1105).
Different PNA amounts can apply to ABD/TANF cash recipients and certain state-veterans-home residents. For example, the rule states $41.62 for the specified ABD/TANF medical-institution cash payment and $160 for a state-veterans-home client who does not receive a needs-based veteran’s pension (WAC 182-513-1105).
Who pays after skilled days end
Washington’s managed-care guidance says the MCO pays qualifying rehabilitative and skilled nursing-facility days, while ALTSA pays custodial long-term nursing-facility services fee-for-service after MCO coverage days end (HCA managed-care and long-term-care guidance).
Before admission or an application, identify the current facility, care setting, Medicare/managed-care status, expected duration, and whether the applicant can safely return home. Those details affect the program and cost-of-care calculation.
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