WAC 388-450-0162 How does the department count my income to determine if my assistance unit is eligible and calculate the amount of my cash and Basic Food benefits?
1.Countable income is all income your assistance unit (AU) has after we subtract the following:
2.Countable income includes all income that we must deem or allocate from financially responsible persons who are not members of your AU under WAC 388-450-0095 through 388-450-0160.
b.You are not eligible for benefits when your AU's countable income is equal to or greater than the payment standard plus any authorized additional requirements.
c.Your benefit level is the payment standard and authorized additional requirements minus your AU's countable income.
4.For Basic Food, if you meet all other eligibility requirements for the program under WAC 388-400-0040, we determine if you meet the income requirements for benefits and calculate your AU's monthly benefits as specified under Title 7 Part 273 of code of federal regulations for the supplemental nutrition assistance program (SNAP). The process is described in brief below:
a.How we determine if your AU is income eligible for Basic Food:
i.We compare your AU's total monthly income to the gross monthly income standard under WAC 388-478-0060. We don't use income that isn't counted under WAC 388-450-0015 as a part of your gross monthly income.
ii.We then compare your AU's countable monthly income to the net income standard under WAC 388-478-0060.
A.If your AU is categorically eligible for Basic Food under WAC 388-414-0001, your AU can have income over the gross or net income standard and still be eligible for benefits.
B.If your AU includes a person who is sixty years of age or older or has a disability, your AU can have income over the gross income standard, but must have income under the net income standard to be eligible for benefits.
C.All other AUsmust have income at or below the gross and net income standards as required under WAC 388-478-0060 to be eligible for Basic Food.
b.How we calculate your AU's monthly Basic Food benefits:
i.We start with the maximum allotment for your AU under WAC 388-478-0060.
ii.We then subtract thirty percent of your AU's countable income from the maximum allotment and round the benefit down to the next whole dollar to determine your monthly benefit.
iii.If your AU is eligible for benefits and has one or two persons, your AU will receive at least the minimum allotment as described under WAC 388-412-0015, even if the monthly benefit we calculate is lower than the minimum allotment.
We reduce the cash or Basic Food benefit amount by any sanction penalties or overpayment deductions before issuing a benefit.
We allow child support payments as a deduction when the payment is for a period of time that the child was out of the home. This means that we can allow a deduction for a child support payment made for when the child was living in another home even if the child currently lives with the parent paying the support.
EXAMPLE
Father and son live together and receive Basic Food. The father pays $100 monthly child support to cover a period of time when his son lived with his son’s mother. We allow the $100 monthly child support payment as a deduction for Basic Food because it covers a period of time his son wasn’t in the AU.
For information on how the cash benefit amount is calculated for the first month of eligibility, see WAC 388-450-0225.
For cash assistance, when an AU contains eight or more people we calculate the benefit level by subtracting the countable income from the appropriate payment standard. The grant payment cannot exceed the maximum payment for a family of eight. See WAC 388-478-0020 for cash assistance payment standards.
Staff must understand how to calculate Basic Food benefits in order to explain how a client's income and circumstances affect their benefits. Use the following procedures to determine an AU's Basic Food benefits.
Gross income:
Determine total countable gross income for all AUs as follows:
Include all dollar and cent amounts when calculating;
Add all non-excluded earned income from all sources;
Add all non-excluded unearned income from all sources; and
Add all deemed and allocated income.
Compare total countable gross income to the gross income standard.
Deny the application or terminate benefits for AUs with income above the gross income standard under WAC 388-478-0060unless the AU:
4. Determine net income for AUs that meet the gross income standard and for AUs containing
an elderly or disabled member.
Net income:
Start with all dollar and cent amounts for income that is not excluded for Basic Food and all allowable expenses.
Subtract the following from the AU’s gross income:
The appropriate standard deduction based on AU size;
The earned income deduction, if appropriate, which is 20% of gross earned income;
Out-of-pocket dependent care expenses;
Allowable non-reimbursable medical expenses over $35 for persons in the AU who are elderly or disabled.
Legally obligated child support payments made by an AU member to or for a person who is not a member of the AU.
Calculate the shelter cost income deduction:
Start with the AU’s allowable monthly shelter costs including the utility deduction;
Subtract ½ of the result from step 1. above.
§If the AU includes a person who is elderly or has a disability, we use the result from step b above as the shelter cost income deduction.
§If the AU does not include an elderly or disabled person, we use the lesser amount of the result from step b or the maximum shelter deduction for these households under WAC 388-450-0190.
Take the result from step 1. Subtract the result from step 2 to calculate the AU’s net income. Round this value to the nearest whole dollar (Round up from $.50 and down from $.49.)
Compare net income from step 3 to the net income standard.
Eligibility:
Deny or terminate benefits if they are not CE under 388-414-0001 and they have net income over the net income limit under WAC 388-478-0060.
Benefit level:
For eligible AUs, determine their monthly benefit level by using the allotment formula or basis of issuance tables:
Allotment formula:
Multiply the AU's net income by 30%;
Round this amount up to the next whole dollar; and
Subtract the result from the Maximum Allotment for the number of eligible AU members.
How to calculateBenefits for an AU eligible for both state-funded and federally- funded Basic Food benefits
For AUs where all persons are immigrants eligible to receive state-funded Basic Food, we calculate the benefits the same way we do for federally funded benefits. The AU receives the same type of Basic Food benefits and gets the same notices. The state funds 100% of benefits issued under state-funded Basic Food.
ACES uses the following process to determine benefits in an AU that has both citizen and legal immigrant members:
Step 1
ACES calculates benefits as if all members were eligible for the federal program (following all federal rules regarding income, resources, and AU composition).
Step 2
ACES does a second benefit calculation for just the members eligible for the federal food stamps (legal immigrants not eligible for federal benefits are treated as ineligible AU members following federal rules).
Step 3
If Step 1 is greater than Step 2, the difference is the state-funded benefit.
If Step 2 is greater than Step 1, we issue the amount in Step 2.
Prorating Income and Deductions
For AUs with both federal and state-funded Basic Food, we budget deductions for Basic Food the same way as we budget the income. If we prorate the income among the AU members, we prorate the deductions as well. If we do not prorate the income, we do not prorate the deductions either.
WORKER RESPONSIBILITIES
In an emergency situation when ACES is not available, calculate benefits for an AU eligible for both state and federally funded Basic Food benefits by using Steps 1 - 3 above.
ACES is programmed to determine benefits for federal food AUs, state-funded AUs and for mixed AUs eligible for both state and federally funded basic food benefits. Ensure that you code the immigrant’s (ALAS) screen in ACES correctly and update an immigrant’s information at recertification.
WAC 388-450-0165
WAC 388-450-0165
Effective March 8, 2004
WAC 388-450-0165 Gross earned income limit for TANF / SFA.
When applying the gross earned income limit as required under WAC 388-478-0035:
"Family" means:
All adults and children who would otherwise be included in the assistance unit under WAC 388-408-0015, but who do not meet TANF / SFA eligibility requirements;
The unborn child of a woman in her third trimester of pregnancy; and
The husband of a woman in her third trimester of pregnancy, when residing together.
"Gross earned income" does not include excluded income, as provided in WAC 388-450-0015.
The following amounts are disregarded when determining a family's gross earned income:
Court or administratively ordered current or back support paid to meet the needs of legal dependents, up to:
The amount actually paid; or
A one-person need standard for each legal dependent.
Authorized ongoing additional requirement payment as defined in chapter 388-473 WAC .
To find the gross earned income limit for TANF/SFA, see WAC 388-478-0035, Maximum earned income limits for TANF and SFA.
WAC 388-450-0170
WAC 388-450-0170
Effective February 15, 2004
WAC 388-450-0170 TANF / SFA earned income incentive and deduction.
This section applies to TANF / SFA, RCA, and medical programs for children, pregnant women and families except as specified under WAC 388-450-0210.
If a client works, the department only counts some of the income to determine eligibility and benefit level.
We only count fifty percent of your monthly gross earned income. We do this to encourage you to work.
If you pay for dependent care before we approve your benefits, we subtract the amount you pay for those dependent children or incapacitated adults who get cash assistance with you.
The amount we subtract is:
Prorated according to the date you are eligible for benefits;
Cannot be more than your gross monthly income; and
Cannot exceed the following for each depending child or incapacitated adult:
Dependent Care Maximum Deductions
Hours Worked Per Month
Child Two Years of Age & Under
Child Over Two Years of Age or Incapacitated Adult
0 - 40
$ 50.00
$ 43.75
41 - 80
$ 100.00
$ 87.50
81 - 120
$ 150.00
$131.25
121 or More
$ 200.00
$175.00
The amount we subtract is:
The person providing the care must be someone other than the parent or stepparent of the child or incapacitated adult; and
You must verify the expense.
b. In order to get this deduction:
i. The person providing the care must be someone other than the parent or stepparent of the child or incapacitated adult; and
If a client does not report income timely and we later discover this income, we recalculate the client's benefits as if they had reported timely and determine if there is a benefit error. Clients still receive the 50% earned income incentive.
GA and ADATSA clients receive an earned income incentive and as described in WAC 388-450-0175, GA earned income incentive and deduction.
When we determine the dependent care maximum deduction, we use a child's age on the first day of the month as the child's age for that month (e.g., If a child turns two on August 15, we consider the child as under two for August and two years of age in September).
WAC 388-450-0175
WAC 388-450-0175
Effective October 1, 2009
WAC 388-450-0175 Does the department offer an income deduction for the general assistance program as an incentive for clients to work?
The department gives a deduction to people who receive income from work while receiving general assistance. The deduction appliesto general assistance cash benefits only. We allow the following income deduction when we determine the amount of your benefits:
We only count fifty percent of your monthly gross earned income. We do this to encourage you to work.
Someone who is self-employed as described under WAC 388-450-0080 gets either the $100 standard self-employment expense deduction or verified actual costs of self-employment as described under WAC 388-450-0085.
We apply the earned income incentive deduction to the remaining income from self-employment after applying the $100 standard deduction or verified actual expenses in excess of $100.
WAC 388-450-0185
WAC 388-450-0185
Effective November 15, 2009
WAC 388-450-0185 What income deductions does the department allow when determining if I am eligible for food benefits and the amount of my monthly benefits?
We determine if your assistance unit (AU) is eligible for Basic Food and calculate your monthly benefits according to requirements of the Food and Nutrition Act of 2008 and federal regulations related to the supplemental nutrition assistance program (SNAP).
These federal laws allow us to subtract only the following amounts from your AU's total monthly income to determine your countable monthly income under WAC 388-450-0162:
A standard deduction based on the number of people in your AU under WAC 388-408-0035:
Eligible and ineligible AU members
Standard deduction
1
$141
2
$141
3
$141
4
$153
5
$179
6 or more
$205
Twenty percent of your AU's gross earned income (earned income deduction);
Your AU's expected monthly dependent care expense needed for an AU member to:
Keep work, look for work, or accept work;
Attend training or education to prepare for employment; or
The Federal government sets the standard deduction each October by comparing 8.31% of the current federal poverty rate for the number of AU members to $144. The standard deduction is the larger of the two figures.
For the standard deduction, we count eligible and ineligible AU members, but we do not count non-members such as ineligible students or someone who lives in the residence but is not an AU member under WAC 388-408-0035.
We exempt court-ordered child support payments from gross income prior to administering the gross income test.
We exempt the lesser of the amount paid or the amount legally obligated. We do not exempt an amount that is voluntarily paid over the legal obligation.
NOTE:
We allow an amount over the monthly support order if it is to repay back child support the client is legally obligated to pay.
We do not exempt payments that are not legally obligated. Examples of payments that do not qualify for this exemption are voluntary payments and contributions for a child's needs not specified in the court order.
Clients do not have to report changes in the amount of child support they pay. We do not consider failure to pay child support as a change of circumstance. We are required to act on a change if clients report an increase or decrease in child support.
In addition to support paid for children outside the home, we allow the exemption when clients pay support for children now in the AU when the support is:
Legally obligated; and
For a period of time the child was outside the support payer's home.
If someone outside the AU consistently pays the child support obligation, we allow the child support exemption only if the AU member must repay the amount under a bona fide loan agreement.
If a child support order requires the client to make an in-kind child support payment instead of, or in addition to a cash payment, we allow the amount the client pays for this expense as a child support exemption. Examples of these in-kind orders include requirements for the non-custodial parent to pay a portion of child care or medical costs.
EXAMPLE
For information on the shelter deductions, see WAC 388-450-0190.
The Federal government sets the standard deduction each October by comparing 8.31% of the current federal poverty rate for the number of AU members to $144. The standard deduction is the larger of the two figures.
For the standard deduction, we count eligible and ineligible AU members, but we do not count non-members such as ineligible students or someone who lives in the residence but is not an AU member under WAC 388-408-0035.
We exempt court-ordered child support payments from gross income prior to administering the gross income test.
We exempt the lesser of the amount paid or the amount legally obligated. We do not exempt an amount that is voluntarily paid over the legal obligation.
We allow all of the out-of-pocket cost for dependent care for the dependent care deduction. This deduction is no longer limited based on the age of the person receiving care.
When a portion of the client's dependent care expenses are paid by Working Connections Child Care (WCCC) or any other source, the client gets the dependent care deduction for the portion not paid by someone else.
Some clients have both subsidized and private-pay child care expenses. Clients can receive the deduction for both, as long as the requirements of WAC 388-450-0185 are met.
Child care expenses for educational purposes:
If we disregard a client's educational benefits under WAC 388-450-0035, we can only allow a deduction for the anticipated child care expense above the amount "earmarked" for dependent care expenses.
We prorate earmarked funds over the period that the clients are intended to use the educational benefits.
EXAMPLE
Client receives $1200.00 Educational Benefits through the Perkins Act for January-March. $400.00 is identified as being for childcare expenses. Client pays $195.00 monthly for the care of her five-year old daughter.
$195.00
Monthly cost of childcare
-133.33
$400 Earmarked expense ÷ 3 months
$61.67
Allowable dependent care deduction
NOTE:
There is no federal definition for "training or education to prepare for employment." This could be a short-term course or a four-year college, as long as it would be reasonable to expect that it would help the client become employed.
5. Dependent care deduction when the person with income is an ineligible AU member:
If the ineligible member has income and dependent care expense billed to or paid by the ineligible member(s), we determine the deduction by:
1.Dividing the expenses evenly among all the AU's eligible and ineligible members; and
2.Assigning the prorated share of such expenses to the eligible members.
6.WCCC co-payment waived by the provider:
We allow the dependent care deduction for a client's WCCC co-pay even if the provider waives the fee on a regular basis.
7. Drug and Alcohol Treatment Facilities:
We allow the following deductions for clients who are paying a part of the cost of their own care:
a.Standard deduction;
b.The amount the client pays as a medical cost if treatment is prescribed by a physician; and
c.The amount the client pays that we do not use as a deduction in (ii) above as a shelter expense up to the shelter maximum.
Clients that do not pay a part of the cost of their own care receive the standard deduction only.
NOTE:
The deductions described above for D&A treatment facilities applies only when a client has been in the facility for more than 30 days.
8.Group livingarrangements:
For clients who live in group-homes, we follow normal eligibility procedures other than shelter costs. We determine the shelter costs for clients that pay room and board by deducting the maximum allotment for one person from the amount paid to the home.
WAC 388-450-0190 How does the department figure my shelter cost income deduction for Basic Food?
The department calculates your shelter cost income deduction as follows:
First, we add up the amounts your assistance unit (AU) must pay each month for shelter. We do not count any overdue amounts, late fees, penalties or mortgage you make ahead of time as an allowable cost. We count the following expenses as an allowable shelter cost in the month the expense is due:
Monthly rent, lease, and mortgage payments;
Property taxes;
Homeowner's association or condo fees;
Homeowner's insurance for the building only;
Utility allowance your AU is eligible for under WAC 388-450-0195;
Out-of-pocket repairs for the home if it was substantially damaged or destroyed due to a natural disaster such as a fire or flood;
Expense of a temporarily unoccupied home because of employment, training away from the home, illness, or abandonment caused by a natural disaster or casualty loss if your:
AU intends to return to the home;
AU has current occupants who are not claiming the shelter costs for Basic Food purposes; and
AU's home is not being leased or rented during your AU's absence.
Second, we subtract all deductions your AU is eligible for under WAC 388-450-0185 (1) through (5) from your AU's gross income. The result is your AU's net income.
Finally, we subtract one-half of your AU's net income from your AU's total shelter costs. The result is your excess shelter costs. Your AU's shelter cost deduction is the excess shelter costs:
Up to a maximum of four hundred fifty-nine dollars if no one in your AU is elderly or disabled; or
The entire amount if an eligible person in your AU is elderly or disabled, even if the amount is over four hundred fifty-nine dollars.
We allow the following ongoing and current shelter costs when calculating the shelter deductions for an assistance unit (AU):
We allow monthly rent cost including mandatory lease agreement fees for extra non-food expenses (e.g., cable, furniture, garage, and storage).
We count non-food expenses only when the lease or contract requires the client to pay the fees. For example, if a client's rent includes cable and the cable expense is not optional, then the expense is considered mandatory and is allowable;
We do not count a mandatory fee for daily meals or toiletries as a shelter cost.
We use the cost a client must pay if the rent is paid on time as the rent cost. We do not change the allowable shelter costs due to discounts for early payment or fees for late payment.
For AUs receiving HUD, FHA, or other rental subsidies, we allow only the out-of-pocket rent expense for the AU.
We allow money paid by one AU to another AU living in the same residence for a share of the total rent.
We allow rent paid in advance as an expense for the month the rent is due.
NOTE:
Even though we use ineligible members to determine the SUA for the AU, an ineligible member cannot receive Basic Food benefits. Make sure to enter any ineligible members on the AU's STAT screen for this to work correctly.
Shelter costs should be entered on the SHEL screen of any ineligible AU member that has income to ensure correct proration of shelter costs.
EXAMPLE
Larry receives a severance package of $1,500 from a former employer. Because Larry knows that hours where he works vary by season, he decides to pay his $250.00 rent for September through February in July.
We don't allow the $1,500 at the time Larry prepaid the rent, because the rent is not yet due. We allow the $250 monthly rent expense when each month's rent is due from September through February.
2.For group home residents who pay a flat fee for room and board, we calculate allowable shelter costs by subtracting the one-person maximum allotment for Basic Food from the amount paid to the home.
3.AU members that own or are buying a home can use the following home-ownership expenses as a shelter cost:
·Payments on first and / or second mortgages (including home equity loans & home equity lines of credit);
·Real estate contract payments, loan payments including interest, leading to ownership of the house or mobile home;
·Property taxes. When an AU has their property taxes deferred to a later date, we allow only the deductions for the taxes at the point the tax would be due without a deferral. We do not allow taxes as a shelter cost if the taxes have been waived;
·State and local assessments;
·The entire amount of condo fees;
·Mandatory homeowner's association fees;
·Structural insurance only. We allow the total cost of structural and furnishings insurance only when the structural insurance cannot be separated from coverage for furniture and belongings;
·Cost of home repairs resulting from a natural disaster such as fire or flood. We do not allow costs covered by insurance or other public or private sources; and
·Costs for more than one residence in a single month when an AU moves mid-month.
Non-allowable shelter costs:
We do not allow the following costs as a part of the shelter deduction:
·The unpaid value of shelter a client receives free or at a reduced cost in exchange for work;
·In-kind or non-cash payments instead of paying rent (e.g., client purchases $300 worth of household supplies instead of paying $300 to a roommate or landlord.)
·Payments on a mortgage in excess of monthly minimum payment (pre-paying mortgage);
·Down payments on a mortgage;
·Balloon payments on a mortgage;
·A payment toward the purchase of a home that is made after the last contract payment for the home;
·A payment on a foreclosed home if the client is no longer legally obligated to pay the mortgage;
·An HUD add-on to contract rental charges to recover previously undercharged rent.
·Security or rental deposits;
·Pre-payment of future rent in the month rent is prepaid (the expense is allowed in the month the payment is due);
·Payments made directly to landlord or mortgage company by non-AU members;
·Mandatory fees for meals specified in lease agreements.
·Late fees;
·Payments on mortgage or rental costs for a previous time period;
·Costs for an unoccupied home unless it is allowed in WAC 388-450-0190.
·Shelter expenses that are consistently paid by someone outside the AU. If a parent, friend, or agency pays the client's shelter costs only on occasion, the AU is still eligible for the full shelter expense deduction. HUD or FHA or other subsidies are not allowed as shelter costs.
·Shelter deductions above the maximum shelter cost for an AU without an elderly or disabled person or where the only elderly or disabled AU member is an ineligible AU member.
NOTE:
A landlord statement or receipt may not reflect any add-on expenses to recover previously undercharged rent.
4.Shared living / roomers:
AU owns or is buying home -
When an AU owns or is buying a residence and shares the residence with another AU, we consider the AU that owns the home to have a roomer.
c.The owner receives the shelter deduction for the standard utility allowance (SUA) and either:
i.The portion of shelter costs not used as a self-employment expense based on number of bedrooms in the residence and the number of bedrooms rented out; or
ii.All expenses the landlord must pay for the housing costs.
EXAMPLE
Landlord rents out one of the three bedrooms. Total cost of mortgage, taxes, and insurance is $900.00 monthly. The owner can use either of the two options below for her expenses.
When clients rent out an area of their home other than a bedroom, we count this area as another bedroom and determine self-employment expenses as described in ‘AU owns or is buying home '. (above)
AU rents residence -
AUs that rent a residence are considered to have roomers when:
a.They rent out a portion of the residence to someone outside of the AU; and
b.The rent they receive is more that the total rent obligation for the AU as shown on the rental agreement or lease.
c.The AU receives the shelter deduction for the standard utility allowance (SUA) and either:
i.The portion of shelter costs not used as a self-employment expense based on number of rooms in the residence and the number of rooms rented out; or
ii.All costs the AU must pay for the housing. See Clarifying Information of WAC 388-450-0195 for information on utilities.
d.Clients that share a residence are not considered to have roomers if they:
i.Do not own the residence;
ii.Are not buying the residence; and
iii.Do not charge their roommates an amount above the total rent as shown on the lease.
WAC 388-450-0195
WAC 388-450-0195
Effective October 1, 2008
WAC 388-450-0195 Utility allowances for Basic Food Programs.
For Basic Food, "utilities" include the following:
Heating or cooling fuel;
Electricity or gas;
Water or sewer;
Well or septic tank installation/maintenance;
Garbage/trash collection; and
Telephone service.
The Department uses the amounts below if you have utility costs separate from your rent or mortgage payment. We add your utility allowance to your rent or mortgage payment to determine your total shelter costs. We use total shelter costs to determine your Basic Food benefits.
If you have heating or cooling costs, you get a standard utility allowance (SUA) that depends on your assistance unit's size.
Assistance Unit (AU) Size
Utility Allowance
1
$352
2
$362
3
$373
4
$384
5
$394
6 or more
$405
If your AU does not qualify for the SUA and you have any two utility costs listed above, you get a limited utility allowance (LUA) of two hundred seventy-six dollars.
If your AU has only telephone costs and no other utility costs, you get a telephone utility allowance (TUA) of forty-two dollars.
The department provides all Basic Food Households an annual LIHEAP benefit of at least $1.
This means that all Basic Food and WASHCAP households are eligible for the SUA regardless of their out-of-pocket utility expenses or obligation.
CLARIFYING INFORMATION
1. How can an AU qualify for SUA?
An AU qualifies for SUA if the AU:
a.Receives a Low Income Home Energy Assistance Program (LIHEAP) payment;
b.Is obligated to pay out-of-pocket heating or cooling costs separate from rent or mortgage costs; or
c.Lives in public housing, uses a shared utility meter, and is billed only for excess utility expenses.
How ineligible AU members affect the SUA:
a.We use everyone who is in the AU under WAC 388-408-0035 to determine the SUA for the AU. This includes ineligible members such as ineligible aliens, clients who refuse to provide a social security number, etc. (See Income WAC 388-450-0140 for how we count the income and expenses of an ineligible AU member.)
b.We don't use people who are not members of the AU to determine the AU's SUA. This includes ineligible students or someone who doesn't have to be in the AU because they buy and fix food separately.
c.After determining the correct SUA based on the number of members in the AU, the SUA may be prorated as a part of the AU’s shelter expenses as described under WAC 388-450-0140.
(See Income WAC 388-450-0140 for how we count the income and expenses of an ineligible AU member.)
NOTE:
Even though we use ineligible members to determine the SUA for the AU, an ineligible member cannot receive Basic Food benefits. Make sure to enter any ineligible members on the AU's STAT screen for this to work correctly.
Shelter costs should be entered on the SHEL screen of any ineligible AU member that has income to ensure correct proration of shelter costs.
WAC 388-450-0200
WAC 388-450-0200
Effective April 1, 2006
WAC 388-450-0200 Will the medical expenses of elderly persons or individuals with disabilities in my assistance unit be used as an income deduction for Basic Food?
If your Basic Food Assistance Unit (AU) includes an elderly person or individual with a disability as defined in WAC 388-400-0040, your AU may be eligible for an income deduction for that person's out-of-pocket medical expenses. We allow the deduction for medical expenses over $35 each month.
You can use an out-of-pocket medical expense toward this deduction if the expense covers services, supplies, medication, or other medically needed items prescribed by a state-licensed practitioner or other state-certified, qualified, health professional. Examples of expenses you can use for this deduction include those for:
Medical, psychiatric, naturopathic physician, dental, or chiropractic care;
Prescribed alternative therapy such as massage or acupuncture;
Prescription drugs;
Over the counter drugs;
Eye glasses;
Medical supplies other than special diets;
Medical equipment or medically needed changes to your home;
Shipping and handling charges for an allowable medical item. This includes shipping and handling charges for items purchased through mail order or the Internet;
Long distance calls to a medical provider;
Hospital and outpatient treatment including:
Nursing care; or
Nursing home care including payments made for a person who was an assistance unit member at the time of placement.
Health insurance premiums paid by the person including:
Medicare premiums; and
Insurance deductibles and co-payments.
Out-of-pocket expenses used to meet a Spenddown as defined in WAC 388-519-0110. We do not allow your entire Spenddown obligation as a deduction. We allow the expense as a deduction as it is estimated to occur or as the expense becomes due.
Dentures, hearing aids, and prosthetics.
Cost to obtain and care for a seeing eye, hearing, or other specially trained service animal. This includes the cost of food and veterinarian bills. We do not allow the expense of food for a service animal as a deduction if you receive Ongoing Additional Requirements under WAC 388-473-0040 to pay for this need.
Reasonable costs of transportation and lodging to obtain medical treatment or services.
Attendant care necessary due to age, infirmity, or illness. If your AU provides most of the attendant's meals, we allow an additional deduction equal to a one-person allotment.
There are two types of deductions for out-of-pocket expenses:
One-time expenses are expenses that cannot be estimated to occur on a regular basis. You can choose to have us:
Allow the one-time expense as a deduction when it is billed or due;
Average the expense through the remainder of your certification period; or
If your AU has a 24-month certification period, you can choose to use the expense as a one-time deduction, average the expense for the first twelve months of your certification period, or average it for the remainder of your certification period.
Recurring expenses are expenses that happen on a regular basis. We estimate your monthly expenses for the certification period.
We do not allow a medical expense as an income deduction if:
The expense was paid before you applied for benefits or in a previous certification period;
The expense was paid or will be paid by someone else;
The expense was paid or will be paid by the department or another agency;
The expense is covered by medical insurance;
We previously allowed the expense, and you did not pay it. We do not allow the expense again even if it is part of a repayment agreement.
You included the expense in a repayment agreement after failing to meet a previous agreement for the same expense; or
You claim the expense after you have been denied for presumptive SSI; and you are not considered disabled by any other criteria.
To be eligible for the medical deduction, people must report and verify all incurred and anticipated medical expenses at application and recertification.
We do not have to re-verify ongoing medical expenses during the certification period if they are not likely to change.
People do not have to report any changes in medical expenses during the certification period.
Anticipated expenses:
Persons eligible for a medical deduction may estimate medical expenses they expect to incur during the certification period.
The estimate must be based upon current, verified medical expenses that the AU member incurred, as well as other available information about the member's medical condition and insurance coverage.
If an AU reports an anticipated medical expense at the time of application or recertification but can't provide the verification at that time, we allow the expense when the verification is provided during the certification period.
If an AU voluntarily reports a change in a recurring medical expense, we treat the change as a CHANGE OF CIRCUMSTANCES.
Incurred expenses
We allow verified, out-of-pocket medical expenses that the eligible AU member incurs when the person:
Has an unpaid bill that has not been allowed previously,
Has a paid bill incurred during the certification period not reported previously; or
Arranges a payment plan for an expense and verifies when the installments are due.
One-time medical expense deduction:
Customers who report a one-time, non-recurring medical expense can elect to have the entire expense budgeted in a single month for a one-time deduction. This would be a likely choice for bills that when averaged using one of the options in WAC 388-450-0200(3)(a) would not result in an increase in benefits.
EXAMPLE
Joan reports on May 20th that she paid for a doctor visit on May 15th in the amount of $200. She has 10 months remaining in her certification period. Averaging the expense would only allow a $20 monthly expense and would not impact her ongoing Basic Food allotment since she has no other expenses. The customer could choose to budget the $200 in one month and either have her May benefits supplemented or have her June benefits increased.
Medicare Part D:
Eligible customers can begin enrollment in Medicare Part D beginning November 15, 2005, with the change effective January 1, 2006. Clients who are enrolled in Part D are entitled to verified out-of-pocket expenses. There are no special Basic Food deductions associated with Medicare Part D.
Medicare Prescription Drug Cards:
The Medicare-approved discount prescription drug card will expire on May 15th, 2006. The expenses we allow depend upon when cardholders apply or recertify, and whether changes are reported.
If a person tells us they have an active Medicare Prescription Drug Card and are certified or recertified prior to June 2006, we can allow:
Monthly standard expenses, including the $50 average of their subsidy for the appropriate duration and the $23 discount standard for the entire certification period, plus any verified out-of-pocket expenses.
People may instead choose to provide verification that the medical expenses they regularly paid prior to using the discount drug card were higher. We allow:
Only the amount of the pre-card expenses for the entire certification period. People choosing this option do not receive the $23 or $50 deductions.
If verification is available as to how many regular prescriptions a person previously paid, but verification is not available as to the actual specific pre-card prescription costs, we may use the Centers for Medicare and Medicaid Services (CMS) average of $48.17 per drug to budget pre-card expenses.
We do not make any change to the medical expenses during the certification period unless the client voluntarily reports a change.
If a cardholder voluntarily reports as a change:
Medicare Part D enrollment for January 2006 and ongoing; or
Discount drug card expiration for June 2006 and ongoing; we:
Remove the $23 discount deduction, allowing for adverse action;
Continue to allow the $50 averaged subsidy for the appropriate remaining months, if any; and
Update any verified out-of-pocket expenses.
Certifications beginning June 2006 and ongoing will consider only out-of-pocket medical expenses, unless there is an average subsidy remainder as described below.
$50 Monthly Subsidy Average Expense:
If the person had Basic Food and received the drug card in 2004, we continue to allow the $50 for the 24 consecutive months originally set, regardless of subsequent changes in other medical expenses.
Persons who had Basic Food and received the Medicare drug card after January 2005 received a subsidy prorated by $150 per quarter. A Basic Food recipient in this situation continues to receive the $50 average subsidy deduction for the number of months originally set based on the total 2005 subsidy.
This deduction is only for out-of pocket costs for the elderly person or an individual with a disability's medical needs. We can’t allow a deduction for medical expenses of an AU member who is not an elderly person or does not have a disability under WAC 388-400-0040 even if the individual in the AU who does meet these criteria pays the medical expense.
Medical equipment:
We can allow the cost of equipment as a medical deduction if it is needed due to the person's medical condition. Examples of allowable medical equipment are:
Specialized telephone devices or TTY for hearing impaired people; and
Items needed for people with limited mobility such as:
Wheelchairs;
Walkers; and
Modifications to the person's home such as:
Grab bars;
Wheelchair ramps; and
Lowered countertops
NOTE:
If a person has improvements related to their medical condition completed along with improvements not related to their condition, we can't allow the expense as a medical deduction because they aren't separately identified and billed.
If the improvements were paid for by a second mortgage, we allow the entire amount as a shelter expense instead of a medical expense.
Health insurance premiums:
We do not allow the cost of third party health and accident insurance when the insurance benefit:
Is payable in a lump sum payment upon death or dismemberment;
Covers mortgage or loan payments upon death or disability; or
Will be reimbursed.
We allow the cost of Medicare premiums as a deduction:
When the person is responsible to pay the premium; and
For the period of time between approval of Medicare Savings benefits and the start of the buy-in. For information on buy-in, see Medicare Savings Program.
NOTE:
It takes 1 - 2 months from when Medicare Savings benefits are approved for the state to start paying the premium. We can't make recipient persons tell when the buy-in starts, but we must end the deduction when we start to pay the premium.
Reasonable medical transportation costs:
We must determine transportation costs on a case-by-case basis. It is essential that the case documentation clearly show why an expense was allowed or denied. If the cost is reasonable according to the situation, we can allow the costs. Examples of allowable expenses are:
Bus fare to get to medical appointments;
The standard mileage rate for a privately owned vehicle as determined by the Internal Revenue Service. Information on the current rate may be found in section 10.90.20 of The Office of Financial Management’s State Administrative and Accounting Manual: http://www.ofm.wa.gov/policy/10.90a.pdf.
A rental car or taxi in an area or circumstance where bus service or a private vehicle is not available; and
Long-distance phone calls to the person's medical practitioner instead of travel.
Postage or shipping cost for mail-order prescriptions:
Some people who use mail-order pharmacies must pay a shipping or postage fee in addition to the cost of their medicines. We allow the out-of-pocket costs of medications for certain AU members as an expense for the excess medical expense deduction. This includes postage or shipping fees if they are not included in the cost of the medications.
Spenddown:
We do not allow the total spenddown obligation as a medical expense. We allow the out-of-pocket expenses as they are incurred or anticipated.
Attendant care:
We allow attendant care that is necessary due to age, infirmity, or illness. Allowable attendant care includes, but is not limited to:
Homemaker;
Home health aide; or
Housekeeper.
NOTE:
If the AU provides the majority of the attendant's meals, we allow an additional deduction equal to a one-person allotment. If allotments are increased during the certification period, we update the deduction at the next recertification.
If attendant care can be claimed as either a dependent care or medical expense, we allow the deduction as a medical expense.
Expenses from non-standard providers:
We allow medical expenses prescribed by a state-licensed practitioner or other state-certified health professional. If the person's health professional prescribes the treatment, we allow the medical deduction. Expenses we allow when prescribed by a licensed or certified health professional include treatment by:
Christian Science practitioners or theological healers.
Installment agreements:
We can allow expenses when they are anticipated to become due in an installment agreement. If the person misses some payments, we do not allow the expense again when it is actually paid, as it has already been allowed based on when it was originally due.
WORKER RESPONSIBILITIES
Determining Allowable Medical Expenses
Review the application for a statement that the client has a medical expense.
Ask all AUs with an elderly person or an individual with a disability if those members have:
Any medical/dental bills or expect to have these expenses; and/or
An active Medicare prescription drug discount card prior to June 2006.
Verify the portion of the expense that will not be reimbursed or paid by another source by obtaining:
Proof of the amount of covered and uncovered expenses from all insurance carriers including Medicare; or
A billing from the provider showing the amount due after insurance coverage.
Certify the AU's benefits without the claimed deduction if the expense is not verified. Allow the appropriate standard deductions for Medicare drug cardholders if they cannot verify their out-of-pocket expenses.
Review medical expense deductions and Medicare prescription drug card status at each certification.
NOTE:
Do not require the person to verify their medical expenses if they have changed by $25 or less unless the information provided is incomplete, outdated, or inconsistent with other information you know about the case.
8. When Medicare Savings benefits have been approved but the buy-in has not started, allow the deduction. Set an alert to remove this deduction when the state starts to pay the premium.
WAC 388-450-0210
WAC 388-450-0210
Effective March 14, 2008
WAC 388-450-0210 Countable income for medical programs.
For purposes of medical program eligibility, a client's countable income is income which remains when:
The income cannot be specifically excluded; and
All appropriate deductions and disregards allowed by a specific program, have been applied.
Unless modified by subsection (4) or (6) of this section, the TANF / SFA income rules, as described in this chapter, are used to determine a client's countable income for the following programs:
Children's healthcare programs as described in WAC 388-505-0210; and
Psychiatric indigent inpatient (PII) program as described in WAC 388-865-0217.
Exceptions to the TANF / SFA cash assistance methodology apply as follows:
The financial responsibility of relatives when a client is applying for medical for families, children, pregnant women or for the psychiatric indigent inpatient program is specified in WAC 388-408-0055;
Actual work-related child and dependent care expenses, which are the client's responsibility, are income deductions (the limits on this deduction in WAC 388-450-0170(3) and (4) do not apply);
Court or administratively-ordered current or back support paid to meet the needs of legal dependents, are income deductions;
Only income actually contributed to an alien client from the alien's sponsor is countable unless the sponsor signs the affidavit of support I-864 or I-864A. See subsection (5) of this section;
TANF / SFA gross earned income limits as described in WAC 388-450-0165 do not apply;
The fifty percent earned income deduction is not used to calculate countable income for CN scope of care programs with income levels based upon the Federal Poverty Level (FPL). These programs are listed in subsection (3) (c) and (d). The only work related income deductions for these programs are:
Ninety dollars; and
Actual work-related child and dependent care expenses, as described in subsection (b) of this subsection; and
Child support as described in (c) of this subsection.
When determining medically needy (MN) or MN scope of care coverage for children or pregnant women for the program described in subsection (3)(c) and (d), the exception described in subsection (4)(f) is not used as the MN income standards are not based on the FPL.
For TANF-related medical, as income in the month the client receives payment, and a resource if the client retains the payment after the month of receipt; or
Effective April 1, 2002, the department will disregard an increase in earned income when:
A family is receiving benefits under the family medical program; and
The increase occurs during the second or third month of eligibility. The disregard stops the last day of the third month of eligibility for a family medical program.
COLA increases are not counted as income until April 1 of each year for the QMB, SLMB, ESLMB, QDWI, and QI programs.
The medical programs described in subsection (3) of the above WAC use the TANF / SFA income rules to determine countable income. After determining countable income, treatment of income for medical programs may be different. For example, see the Assistance Units for more information on family financial responsibility and when separate medical assistance units must be established.
For children's and pregnant women's programs with monthly income standards based on the FPL, the earned income deduction is limited to $90 for each working adult. When the family income exceeds the CNIL, the case trickles to F99 / P99. The medically needy monthly income standards are not based on the FPL. The earned income deduction changes to the 50% deduction.
The income exclusion described in subsection (4)(i) is designed to assist families to meet the "three out of last six months" federal requirement. See the Medical Extensions for further information.
