Some of you may have recently seen the attached rulemaking notice from the Department of Social and Health Resources regarding guardian fees. Here is a brief explanation of the process that DSHS has provided for WAPG members:


“The Health Care Authority (HCA) and the Department of Social and Health Services (DSHS) are proposing to amend the rules regarding the long-term care participation deduction allowed for persons subject to a guardianship. In general, these are the rules that allow a Medicaid client, who would otherwise contribute their income towards their cost of care, to contribute their income towards the provision of guardianship services provided to the client. The process of amending these rules follows the steps outlined in the Administrative Procedure Act (APA), which can take up to nine months or more to complete.


Under the APA, HCA and DSHS, 1) announces the intent to amend the rule, and invites the public to participate in the rule-making process; 2) works together with the public in a variety of ways to amend the rule, proposes the rule language, and holds a public hearing; and 3) responds to comments (or testimony) provided regarding the rule, and finally adopts the rule as final.


HCA and DSHS seek to include stakeholders of the community in this process, which is comprised of (but not limited to):

•         Medicaid clients;

•         Medicaid clients’ attorneys;

•         Medicaid clients’ guardians;

•         The guardians’ attorneys; and

•         Other state agencies.


The purpose of the intent to amend the rule is two-fold:

•         First, the rules have not been updated since 2003, and the fee and cost amounts have remained at the same level from even before 2003. HCA and DSHS recognize the current fee and cost amounts may be unsustainable without an amendment.

•         Second, HCA and DSHS recognize several deficiencies in the current rule that impairs the ability to administer the Medicaid program in accordance with state and federal law. HCA and DSHS wish to amend the rule to ensure compliance with state and federal law, and to lower the costs that the Medicaid program and clients (and their guardians) incur complying with the rule”.


If you are interested in being informed about opportunities to participate in the rulemaking process or to receive information about the process, contact