Medical care services (MCS)--Income - Ownership and Availability
Purpose: This section includes rules, clarifying information and worker responsibilities in determining and maintaining medical care services eligibility.
WAC 182-509-0005 MCS income--Ownership and availability.
This section applies to medical care services (MCS) program.
1. The agency or the agency's designee counts all available income owned or held by persons in the assistance unit under WAC 182-506-0020 to decide if the individual is eligible for benefits when:
a. The individual gets or expects to get income in the month.
b. The agency or the agency's designee must count the income based on rules under this chapter.
c. The individual owns the income. The agency or the agency's designee uses state and federal laws about who owns property to decide if the individual actually owns the income. If the individual is married, the agency or the agency's designee decides if the income is separate or community income according to chapter 26.16 RCW.
d. The individual has control over the income, which means the income is actually available to the individual. If the individual has a representative payee, protective payee, or other person who manages the individual's income, the agency or the agency's designee considers this as the individual having control over this income.
e. The individual can use the income to meet their current needs. The agency or the agency's designee counts the gross amount of available income in the month the individual's assistance unit gets it. If the individual normally gets the income:
i. On a specific day, the agency or the agency's designee counts it as available on that date.
ii. Monthly or twice monthly and the pay date changes due to a reason beyond the individual's control, such as a weekend or holiday, the agency or the agency's designee counts it in the month the individual would normally get it.
iii. Weekly or every other week and the pay date changes due to a reason beyond the individual's control, the agency or the agency's designee counts it in the month the individual would normally get it.
2. If income is legally the individual's designee, the agency or the agency's designee considers the income as available to the individual even if it is paid to someone else for the individual.
3. The agency or the agency's designee:
a. May count the income of certain people who live in the individual's home, even if they are not getting or applying for benefits. Their income counts as part of the individual's income.
b. Counts the income of ineligible, disqualified, or financially responsible people as defined in WAC 182-509-0100.
4. If the individual has a joint bank account with someone who is not in the individual's assistance unit (AU), the agency or the agency's designee counts any money deposited into that account as the individual's income unless:
a. The individual can show that all or part of the funds belong only to the other account holder and are held or used only for the benefit of that holder; or
b. Social Security Administration (SSA) used that money to determine the other account holder's eligibility for SSI benefits.
5. Potential income is income the individual may be able to get that can be used to lower their need for assistance. If the agency or the agency's designee determines that the individual has a potential source of income, the individual must make a reasonable effort to make the income available in order to get MCS. The agency or the agency's designee does not count that income until the individual actually gets it.
6. If the individual's AU includes a sponsored immigrant, the agency or the agency's designee considers the income of the immigrant's sponsor as available to the immigrant under the rules of this chapter. The agency or the agency's designee uses this income when deciding if the individual's AU is eligible for benefits and to calculate the individual's monthly benefits.
7. The individual may give the agency or the agency's designee proof about a type of income at anytime, including when the agency or the agency's designee asks for it or if the individual disagrees with a decision the agency or the agency's designee made, about:
Determine if clients have any potential income available.
1. Making a source of income available:
a. If someone meets all other eligibility factors, do not delay eligibility if they try to make a potential source of income available but aren't able to.
b. If a person can't make a source of income available for reasons beyond their control, consider the income as unavailable to the client.
c. Clients must give proof of how a source of income can be available and when the income will be available. Request verification. Ask for proof that the client has tried to make potential income available. Examples of proof include:
i. Financial statements;
ii. Collateral statements; and
iii. Letter from the person or company that has control of the income.
See VERIFICATION for information on how to ask for proof from clients.
See WAC 388-406-0030 to decide how much time to allow clients to provide the proof.
d. Clients must take all needed steps to get any income such as annuities, pensions, and retirement benefits they can receive.
i. Clients do not have to take steps to get the income if they can show a good reason for not doing so.
ii. Examples of benefits the client must try to make available include:
A. Veteran's compensation and pensions;
B. OASDI benefits;
C. Railroad retirement benefits; and
D. Unemployment compensation.
e. Refer clients to the correct agency to apply for potential income and/or help clients get potential income if they ask for assistance.
2. When the date income is available changes:
a. Budget the income for the date you expect the client to receive the income.
b. Set an alert in ACES for the date we expect the client to receive the income to check if the income is available.
3. Community income:
a. When a husband and wife live together, count the following as community income:
i. Income in the name of the husband, wife, or both spouses;
ii. Income that the husband, wife, or both spouses have access to;
iii. Income the husband, wife, or both spouses received; and
iv. Earnings of the husband, wife, or both spouses.
b. Always count community income as available for MCS. It doesn't matter if one or both spouses are applying for or receiving benefits.
4. Separate income:
a. We count income as separate income when the income:
i. Was received by either spouse before marriage;
ii. Was received as a result of a gift or inheritance;
iii. Was received from separate property; or
iv. Are the earnings of the husband, wife, or both spouses when the spouses live separate and apart.
b. Separate income becomes community income when someone puts the income in an account with community income.
5. If a client refuses to make income available: Deny or terminate assistance.
6. Jointly owned bank accounts:
a. When a client has a joint bank account or is holding funds for someone else, determine if the client and the other person have a written or verbal agreement about the amount of the funds available to the client.
b. If the client and the other person have an agreement, decide if the client uses more than this amount to meet their current needs. Count the excess as available unearned income and budget it for the assistance unit.
c. If the client and the other person do not have an agreement, decide if the funds are available to meet the client's needs:
i. Get a detailed record of the dates and amounts of money deposited into the account or given to the client to hold for the other person.
ii. Get a detailed record of the types and amounts of payments for the other party.
iii. Consider any amount over the itemized payments for the other party as income available to the client. Budget it as unearned income for the assistance unit.
d. Review the client's circumstances at each eligibility review, reapplication, or when they report a change in the joint bank account or the source of funds.
WAC 182-509-0015
WAC 182-509-0015
Effective October 14, 2012
WAC 182-509-0015 MCS income--Excluded income types.
There are some types of income that do not count when determining if an individual is eligible for medical care services (MCS) coverage. Examples of income that do not count are:
Bona fide loans as defined in WAC 182-509-0205, except certain student loans as specified under WAC 182-509-0035;
Federal earned income tax refunds and earned income tax credit (EITC) payments for up to twelve months from the date of receipt;
Federal economic stimulus payments that are excluded for federal and federally assisted state programs;
Federal twenty-five dollar supplemental weekly unemployment compensation payment authorized by the American Recovery and Reinvestment Act of 2009;
Title IV-E and state foster care maintenance payments if the individual chooses not to include the foster child in the assistance unit;
Energy assistance payments;
Educational assistance that is not counted under WAC 182-509-0035;
Native American benefits and payments that are not counted under WAC 388-450-0040;
Income from employment and training programs that is not counted under WAC 182-509-0045;
Money withheld from a benefit to repay an overpayment from the same income source;
One-time payments issued under the Department of State or Department of Justice Reception and Replacement Programs, such as voluntary agency (VOLAG) payments;
Payments we are directly told to exclude as income under state or federal law; and
Payments made to someone outside of the household for the benefits of the assistance unit using funds that are not owed to the household.
This section applies to medical care services (MCS).
Earned income money received from working. This includes:
Wages;
Tips;
Commissions;
Profits from self-employment activities as described in WAC 182-509-0080; and
One-time payments for work performed over a period of time.
Income received for work performed for something other than money, such as rent, is considered earned income. The amount that is counted when determining the individual's eligibility for MCS is the amount received before any taxes are taken out (gross income).
1. Annuity: Payments and interest received from an annuity is counted as unearned income.
2. Bona fide loans:
Exclude bona fide loans from MCS. If a loan is not bona fide, count the money someone receives as unearned income for the month they receive it. Determine if a loan is bona fide by getting proof of the details of the loan. Examples of proof that a loan is bona fide include:
a. When the loan is through a bank, credit union, or other institution that loans money as a part of their business:
i. A copy of the formal loan agreement; or
ii..A written agreement to repay the money within a certain timeframe; and
iii. Proof that the money came from a person or business that loans money.
b. If the money is from a person or business who does not normally loan money, proof to show:
i. That the borrower understands they must repay the loan either with or without interest;
ii. The borrower's intent to repay by promising real property, personal property, or anticipated income; or
iii. A timetable and plan for repayment with details of the plan to repay the loan when the person receives the anticipated income.
c. If there isn't a formal written loan agreement, accept a written statement from the borrower and the lender about the terms of the loan. Request additional verification if the proof they give you is questionable.
NOTE:
For information on how to request additional proof and how much time someone has to give proof, see VERIFICATION
3. Court-ordered payments:
Count payments, other than child support, made to someone by order of the court as follows:
a. If someone receives the money as a one-time payment, count this as a lump-sum payment.
b. If they will receive more than one payment, count the payments as unearned income.
NOTE:
See LUMP SUM PAYMENTS to decide how a lump sum payment affects someone's benefits.
4. In-kind income:
When someone works for something of value other than cash, count the value of the item they receive as earned income. People receive earned income in kind when they work in exchange for things like:
i. Rent;
ii. Furniture;
iii. A car; or
iv. Any other item of value.
v. If a person does not have full ownership of the item from the work they do in a single month, count the amount they earn toward ownership as income for the month.
EXAMPLE
Charlie works for his cousin Ray in exchange for Ray's used car. Charlie and Ray agree that the car is worth the Kelly Blue Book stated value of $1000.
Charlie works six hours each week. Charlie and Ray agree the hours worked amount to $200 toward the car each month.
Count $200 as earned income in kind for each month until Charlie has worked off the debt. After he has worked off the debt for the car, count the car as a resource.
5. Joint bank accounts:
a. When someone has a joint bank account or holds funds for someone else, decide how much of the money belongs to them. See Worker Responsibilities of MCS INCOME - Ownership and Availability to decide how much of the money belongs to them.
b. If the person uses more than their share of the money in the account, count the money the person uses above their share as unearned income to the AU.
6. Military pay:
a. Count the following allowances as earned income:
i. Basic allowance for housing (BAH); and
ii. Basic allowance for subsistence (BAS).
b. Exclude the following allowances or in-kind benefits:
i. Clothing maintenance allowance (CMA);
ii. Basic housing or barracks;
iii. Meals; and
iv. Reimbursement or an allowance for transportation or moving costs.
c. Advance pay:
i. Count advance pay as earned income for the month someone receives the income, unless they requested for travel.
ii. If someone has asked for advance pay for travel, exclude the amount that is to reimburse actual travel expenses. Count any excess as earned income for the month they will receive it.
d. Count enlistment and re-enlistment bonuses as earned income for the month the person will receive it.
7. Military Income - Special and incentive pay received while serving in a combat zone:
Military personnel in a combat zone are not members of the assistance unit, but may give income to people in the AU. If an AU receives income from an armed service member serving in a combat zone, decide how much income to budget as described below:
a. First, determine the amount of money the service member made available to the AU before being deployed to a designated combat zone;
b. Second, determine the amount of money the service member now makes available to the AU after being deployed to a designated combat zone; and
c. Last, determine how much of the service person's military pay we must count as income to the AU:
i. Before deployment to a combat zone: If the amount of military pay the service person makes available to the AU after deployment is equal to or less than before they were deployed to a combat zone, count the income currently made available to the AU as income for cash and food benefits.
ii. After deployment to a combat zone: If the military pay the service person makes available to their family is greater since being deployed to a combat zone, exclude the additional income.
8. Money received for an absent or non-household member:
a. Exclude income the AU receives for the care and maintenance of an absent or non-household member as long as the AU doesn't keep the income. Examples of income for absent or non-household members include:
i. Child support for an ineligible child;
ii. SSI benefits for a couple when one of the spouses is in a nursing home; and
iii. SSDI paid to a relative as the protective payee.
b. If the AU keeps a portion of the income, count the portion the AU keeps as unearned income for the month they receive the income and as a resource in the next month.
9. Money withheld for repayment:
If people have money withheld from their benefits to recover an overpayment from the same income source, exclude the amount withheld from their gross benefit. Count the net benefit amount as income to the AU.
SSA does not determine intent of an overpayment. Assume that the overpayment of SSI or SSA benefits was unintentional unless there is something to clearly show otherwise. Therefore, we always exclude these overpayments when they are from the same source.
10. Real estate / mortgage sales and contracts:
a. When someone sells real estate that they owe money on under a mortgage or contract, and they carry the contract for the new buyer, count the proceeds from the sale as unearned income for all programs after you subtract any amount paid for:
i. Insurance;
ii. Property taxes; and
iii. Interest on the prior purchase.
b. Look at the value of the contract to decide if the AU is eligible for benefits:
i. If the value of the contract puts the AU over resource limit, the AU is ineligible for benefits.
ii. If the total resources are below the resource limit, the AU is resource eligible for benefits. Count payments from the contract as unearned income.
11. Reimbursements for out-of-pocket expenses:
Exclude money to reimburse a person's past or future out-of-pocket expenses. These payments are not a gain to the household. Examples of some reimbursements we exclude as income are:
a. Work or training expenses;
b. Title XX services (such as CHORE services); and
a. We exclude third-party payments as income when a payment is specifically directed to be paid to a third party, does not pass through the assistance unit's control at any point, and is not otherwise payable to them.
We also exclude support payments made directly to a third party for a household expense when:
There is no court order for support; such as a separated parent paying the house payment of the parent still in the home when there is no court order; or
The payment is more than the court-ordered amount. For example, an ex-spouse pays $50 over the court-ordered support to the landlord.
EXAMPLE
A court awards someone support payments in the amount of $400 a month and in addition orders the parent to pay $200 directly to a bank to repay a loan.
We count the $400 support payment as income. We exclude the $200 loan payment as income because it is not otherwise payable to them.
EXAMPLE
A friend or relative uses his or her own money to pay the household's rent directly to the landlord; or someone's employer pays the household's rent directly to the landlord in addition to their regular wages.
NOTE:
This is not the same as diverted payments from income that is otherwise payable to someone.
b. We count money that is legally obligated and payable to the household but has been diverted to a third-party as income to the AU. Count the diverted payment as:
i. Earned income if the household diverted employment or self-employment income;
ii. Unearned income if the money was not earned by employment or self-employment.
This section applies to medical care services (MCS).
Educational benefits that do not count are:
Educational assistance in the form of grants, loans or work study, issued from Title IV of the Higher Education Amendments (Title IV - HEA) and Bureau of Indian Affairs (BIA) education assistance programs. Examples of Title IV - HEA and BIA educational assistance include but are not limited to:
College work study (federal and state);
Pell grants; and
BIA higher education grants.
Educational assistance in the form of grants, loans or work-study made available under any program administered by the Department of Education (DOE) to an undergraduate student. Examples of programs administered by DOE include, but are not limited to:
Christa McAuliffe Fellowship Program;
Jacob K. Javits Fellowship Program; and
Library Career Training Program.
For assistance in the form of grants, loans or work-study under the Carl D. Perkins Vocational and Applied Technology Education Act, P.L. 101-391:
If the individual is attending school half-time or more, the following expenses are subtracted:
Tuition;
Fees;
Costs for purchase or rental of equipment, materials, or supplies required of all students in the same course of study;
Books;
Supplies;
Transportation;
Dependent care; and
Miscellaneous personal expenses.
If the individual is attending school less than half-time, we subtract the following expenses:
Tuition;
Fees; and
Costs for purchase or rental of equipment, materials, or supplies required of all students in the same course of study.
The MCS eligibility standard based on one person is also subtracted.
Any remaining income is unearned income and budgeted using the appropriate budgeting method for the assistance unit.
If the individual is participating in a work study program that is not excluded in subsection (1), of this section, that work study income is counted as earned income under the following conditions:
The individual is allowed the earned income work incentive deduction described in WAC 282-509-0175; and
The remaining income is budgeted using the appropriate budgeting method for the assistance unit.
If the individual receives Veteran's Administration Educational Assistance:
All applicable attendance costs are subtracted; and
The remaining unearned income is budgeted using the appropriate budgeting method for the assistance unit.
Title IV education assistance that is excluded regardless of how the money is used or a client's graduate or undergraduate status:
College Work-Study (CWS) Program, both federal and state programs
Direct Loan Demonstration Program
Family Education Loan Program (FELP)
HEP/CAMP Programs, special programs for students whose families are engaged in migrant and seasonal farm work
National Early Intervention Scholarship and Partnership Program
Pell Grant Program
Perkins Loan Program
Presidential Access Scholarships
PLUS Loan Program
Robert C. Byrd Honors Scholarship Program
Special Child care Services for Disadvantaged College Students
Stafford Loan Program
State Need Grant (SNG) Program
State Student Incentive Grant (SSIG) Program
Supplemental Education Opportunity Grant (SEOG) Program
Supplemental Loans for Students (SLS) Program
TRIO Programs, special programs for students from disadvantaged backgrounds
2. Educational assistance benefits where we exclude just the funds used for attendance costs:
Carl D Perkins vocational and Applied Technology Education Act, P.L. 101-391
Bilingual Education - Fellowship Program
Christa McAuliffe Fellowship Program
Dwight D. Eisenhower Mathematics and Science Education Program
Jacob K. Javits Fellowship Program
Library Career Training Program
National Science Scholars Program
Patricia Roberts Harris Fellowship Program
Ronald E. McNair Post-Baccalaureate Achievement Program
Other educational assistance, not listed above, in the form of grants, work study, scholarships, or fellowships.
3. Bureau of Indian Affairs (BIA) education assistance benefits that are excluded regardless of use:
BIA Higher Education Grants
Indian Education - Fellowship for Indian Students
4. Employment or training funds:
For information on employment or training funds, see WAC 182-509-0045.
WORKER RESPONSIBILITIES
1. Averaging education assistance over the period of use:
Average educational assistance income meant to cover more than one month over the months the school expects the client to use the money.
2. Changing from one school term to another:
a. When one school term ends and a new term begins in the same month, count the first day of the next full month as the start of the term.
b. Do not use costs from one school term to offset the educational assistance a client earns or gets in another term.
3. Student Loans:
Consider student loans that clients must repay as bona fide loans under WAC 182-509-0015. Do not count student loans as income regardless of whether the student is part-time, full time, a graduate student, or an undergraduate.
4. Work study:
Count work-study income that is not specifically excluded in WAC 182-509-0035 as earned income using the following steps:
a. For MCS assistance:
i. Exclude the amount earmarked for educational expenses;
ii. Subtract the AUs eligibility standard from the remaining income of (i) above; and
iii. Budget the remaining income as earned income to the AU. Average this income over the period of time the client's award letter states the assistance is for.
a. Look at the student's financial aid award letter to identify the amount and type of educational assistance.
b. Use the Student Grant and Expense Verification, DSHS 14-173, to verify the gross amount of the educational assistance and the student's attendance costs.
c. Disregard and exclude educational assistance as allowed under WAC 182-509-0035.
d. Subtract the AU's eligibility standard from the remaining income of (c) above. See STANDARDS - Medical Care Services to find the eligibility standards for the AU.
e. Budget the remaining income as unearned income to the AU. Average this income over the period of time the client's award letter states the assistance is for.
6. Carl D. Perkins (Perkins Loan Program) educational assistance for MCS:
a. Decide if the student is a full-time or half-time student. The school defines a full-time schedule. A half-time schedule is at least 1/2 the full-time schedule.
b. Subtract attendance costs allowed in subsections (2)(a) and (b) of WAC 182-509-0035 from the student's educational expenses based on the student's full - or half-time status.
c. subtract the AU's eligibility standard from the remaining income of (b) above. See STANDARDS - Medical Care Services to find the eligibility standards for the AU.
d. Budget the remaining income as unearned income to the AU. Average this income over the period of time the client's award letter states the assistance is for.
7. Veteran's Administration educational assistance for MCS:
a. Subtract all attendance costs allowed in sub-sections (2)(a) and (b) of WAC 182-509-0035 from the student's educational assistance. Budget the amount left as unearned income to the AU. Average this income over the period of time the VA states the assistance is for.
b. DO NOT deduct the AU's eligibility standard.
EXAMPLE
MCS client began school in September and has attendance costs of $600 for the semester of September through December. The client gets VA educational assistance of $400 a month.
$1600 VA educational assistance Sept. - Dec. ($400 x 4)
This section applies to medical care services (MCS).
Educational benefits that do not count are:
Educational assistance in the form of grants, loans or work study, issued from Title IV of the Higher Education Amendments (Title IV - HEA) and Bureau of Indian Affairs (BIA) education assistance programs. Examples of Title IV - HEA and BIA educational assistance include but are not limited to:
College work study (federal and state);
Pell grants; and
BIA higher education grants.
Educational assistance in the form of grants, loans or work-study made available under any program administered by the Department of Education (DOE) to an undergraduate student. Examples of programs administered by DOE include, but are not limited to:
Christa McAuliffe Fellowship Program;
Jacob K. Javits Fellowship Program; and
Library Career Training Program.
For assistance in the form of grants, loans or work-study under the Carl D. Perkins Vocational and Applied Technology Education Act, P.L. 101-391:
If the individual is attending school half-time or more, the following expenses are subtracted:
Tuition;
Fees;
Costs for purchase or rental of equipment, materials, or supplies required of all students in the same course of study;
Books;
Supplies;
Transportation;
Dependent care; and
Miscellaneous personal expenses.
If the individual is attending school less than half-time, we subtract the following expenses:
Tuition;
Fees; and
Costs for purchase or rental of equipment, materials, or supplies required of all students in the same course of study.
The MCS eligibility standard based on one person is also subtracted.
Any remaining income is unearned income and budgeted using the appropriate budgeting method for the assistance unit.
If the individual is participating in a work study program that is not excluded in subsection (1), of this section, that work study income is counted as earned income under the following conditions:
The individual is allowed the earned income work incentive deduction described in WAC 282-509-0175; and
The remaining income is budgeted using the appropriate budgeting method for the assistance unit.
If the individual receives Veteran's Administration Educational Assistance:
All applicable attendance costs are subtracted; and
The remaining unearned income is budgeted using the appropriate budgeting method for the assistance unit.
JTPA ended and was replaced by the Workforce Investment Act (WIA)
2. Job Corps
Job corps is funded through Title 1-C of WIA and is treated as described in WAC 182-509-0045 (1).
3. WIA Paid Work Experience
Paid work experience that is funded by Title 1 of WIA is treated as described in WAC 182-509-0045 (1).
4. AmeriCorps Income
The AmeriCorps program is issued under the National and Community Service Trust Act of 1993. We exclude all payments issued under AmeriCorps. Although it sounds similar, the AmeriCorps and AmeriCorps VISTA programs are two different programs and how we treat the income varies between the two programs.
5. VISTA / AmeriCorps VISTA Income
The Volunteers In Service To America (VISTA) program, commonly known as AmeriCorps VISTA, is issued under title II of the Domestic Volunteer Act of 1973.
We exclude VISTA income for MCS.
6. How to identify AmeriCorps or AmeriCorps VISTA and know which stipends to count as income:
AmeriCorps
AmeriCorps VISTA
AmeriCorps participants (typically referred to as members) generally begin their term of service in late summer or fall. (August - October), but on occasion may start at other times throughout the year.
Full-time AmeriCorps members serve for a period of no less than 9 months and not more than 12 months per term of service.
An individual is eligible to serve up to two terms of service in AmeriCorps.
Receive funds under the National and Community Services Trust Act of 1993.
VISTA participants (typically referred to as volunteers) attend a Pre-Service Orientation (PSO) prior to beginning their term of service. Enrollment windows are established by the Corporation for National Service. Enrollment occurs at various times throughout the year.
VISTA volunteers serve for 12 months.
An individual is eligible to serve up to three terms of service in VISTA.
Receive funds under Title I of the Domestic Volunteer Act of 1973.
How to treat AmeriCorps income:
Exclude AmeriCorps income for MCS.
How to treat AmeriCorps VISTA income:
Exclude VISTA income for MCS.
If someone is not sure whether they are volunteering in a program under AmeriCorps or AmeriCorps VISTA, ask the person for a copy of their letter of introduction. The letter will identify the program and should include one of the logos shown in the above table.
WAC 182-509-0055
WAC 182-509-0055
Effective October 14, 2012
WAC 182-509-0055 MCS income--Needs-based assistance from other agencies or organizations.
Needs-based assistance given to the individual by other agencies or organizations is not counted if the assistance is given for reasons other than ongoing living expenses which do not duplicate the purpose of DSHS cash assistance programs. Ongoing living expenses include the following items:
a. Clothing;
b. Food;
c. Household supplies;
d. Medical supplies (nonprescription);
e. Personal care Items;
f. Shelter;
g. Transportation; and
h. Utilities (e.g., lights, cooking fuel, the cost of heating or heating fuel).
2. “Needs-based” means eligibility is based on an asset test of income and resources relative to the Federal Poverty Level (FPL). This definition excludes such incomes as retirement benefits or unemployment compensation which are not needs-based.
3. If the needs-based assistance is countable, it is treated as unearned income under WAC 182-509-0025.
1. Assistance from other agencies and organizations:
a. Includes cash and in-kind income; and
b. Can come from public or private agencies or organizations.
2. For MCS, we can exclude money given by public or for-profit companies as long as the money is not intended for ongoing living expenses.
WORKER RESPONSIBILITIES
1. Verify the following information:
a. How much assistance the client receives;
b. How often the client receives the assistance;
c. Why the client receives the assistance;
d. What conditions the client had to meet to receive the assistance;and
e. What the client must do to continue to receive the assistance.
2. Subtract the following from the gross assistance:
a. Any amount that is not intended to cover ongoing living expenses; and
b. Any amount provided under conditions which prevent it from being used for the client's current living expenses (e.g., a damage deposit provided by the Salvation Army for the AU to relocate after a fire); and
c. The eligibility standard for the AU.
3. Budget any remaining assistance as unearned income for the month.
EXAMPLE
In the month of application, a MCS applicant received $1,000 in assistance from a local community agency after their apartment complex was condemned. Of the $1,000, $600 is intended for a damage deposit at the new apartment the agency found for the AU. The other funds are for household items.
Total Assistance $1,000 Eligibility Standard $339
Less Damage Deposit -600
Amount Duplicating Need $400
Eligibility Standard -339
Available Income $61
Budget $61.00 as unearned income in the initial month of application.
WAC 182-509-0065
WAC 182-509-0065
Effective October 14, 2012
WAC 182-509-0065 MCS income--Gifts--Cash and noncash.
This section applies to medical care services. A gift is an item furnished to an individual without work or cost on the individual's part.
A cash gift is a gift that is furnished as money, cash, checks or any other readily negotiable form. Cash gifts totaling no more than thirty dollars per calendar quarter for each assistance unit member are disregarded as income.
A noncash gift is treated as a resource.
a. If the gift is a countable resource, its value is added to the value of the individual's existing countable resources and a determination is made on the impact to continue the individual's eligibility for MCS, per WAC 182-509-0005.
b. If the gift is an excluded or noncountable resource, it does not affect the individual's eligibility or benefit level.
A gift is an item voluntarily given to someone without expecting something in return. Some common examples when someone may receive a gift include birthdays, Christmas, wedding and graduations.
a. A cash gift is a gift that is in the form of cash, checks or a sellable security such as stocks or bonds.
b. A non-cash gift is any gift that is not considered a cash gift. Examples of non-cash gifts include:
i. Real or personal property (e.g., a home, television, furniture, jewelry or new furnace); and
ii. Goods or services provided at no charge to the client (e.g., free phone service provided by the telephone company).
WORKER RESPONSIBILITIES
1. Cash gifts for MCS:
a. If more than one person share a cash gift, find out the client's share in the gift by dividing the value of the gift by the number of persons receiving it. If the person giving the gift states that the gift must be divided a specific way, use the method stated by the gift giver.
b. Disregard the first $30 each person gets in cash gifts for each calendar quarter.
c. Budget any amount above the $30 disregard as unearned income to the AU.
2. Non-cash gifts for MCS:
a. Disregard non-cash gifts when:
i. The gift is a voucher or vendor payment (a payment made for a client by another person to a vendor of goods and services);
ii. The donor states in writing that the gift must be used for a specific purpose;
iii. The gift is within the resource limits for the program the client receives; or
iv. The gift is excluded.
b. For information on non-cash gifts as resources, see the specific resource type in MCS RESOURCES.
This section applies to medical care services (MCS).
Self-employment income is income that is earned by an individual from running a business, performing a service, selling items that are made by the individual, or re-selling items to make a profit.
An individual is self-employed if the individual earns income without having an employer/employee relationship with the person who pays for the goods or services. This includes, but is not limited to, when:
(a) The individual has primary control of the way they do their work; or
(b)Income is reported by the individual using IRS Schedule C, Schedule C-EZ, Schedule K-1 or Schedule SE.
3. An individual usually is considered to have an employer/employee relationship when:
(a) The person the individual provides services for has primary control of how the individual does their work; or
(b) The individual gets an IRS Form W-2 to report their income.
4. Self-employment does not have to be a licensed business for the individual's business or activity to qualify as self-employment. Some examples of self-employment include:
(a) Childcare that requires a license under chapter 74.15 RCW;
(b) Driving a taxi cab;
(c) Farming/fishing;
(d) Odd jobs such as mowing lawns, house painting, gutter cleaning, or car care;
(e) Running a lodging for roomers and/or boarders. Roomer income includes money paid
to the individual for shelter costs by someone not in your assistance unit who lives with
you when:
(i) The individual owns or is buying their own residence; or
(ii) The individual rents all or a part of their residence and the total rent charges to all others living in the home is more than the individual's total rent.
(f) Running an adult family home;
(g) Providing services such as a massage therapist or a professional escort;
(h) Retainer fees to reserve a bed for a foster child;
(i) Selling items that are home-made or items that are supplied to the individual;
(j) Selling or donating biological products such as providing blood or
reproductive material for profit;
(k) Working as an independent contractor; and
(l) Running a business or trade either as a sole proprietorship or in a partnership.
5. If the individual is an employee of a company or person who does the activities listed in subsection (2) of this section as a part of their job, the agency or the agency's designee does not count the work that is performed by the individual as self-employment.
6. Self-employment income is counted as earned income as described in WAC 182-509-0030 except as described in subsection (7) of this section.
7. There are special rules about renting or leasing out property or real estate that is owned by the individual. If the individual does not spend at least twenty hours per week managing the property, the income is counted as unearned income.
To determine whether a job is self-employment, we:
a. Accept the customer's statement that their work is self-employment unless it is questionable.
b. Accept the company's statement that the customer is self-employed unless there is evidence to the contrary.
c. Review the specific circumstances of the work only when the customer statement is questionable and there is no company to verify the business relationship.
NOTE:
Document whether the job is self-employment once this has been determined.
EXAMPLE
Jorge is a newspaper carrier. He is not certain if he is an employee or an independent contractor (self-employed). We contact the people at the newspaper, and they state that Jorge is an independent contractor. We treat Jorge's newspaper income as self-employment earnings.
EXAMPLE
Lydia works constructing patios for people. She declares that she is an independent contractor (self-employed). There is no reason to question her statement, and we treat her earnings as self-employment.
2. Self-Employed versus Employee:
a. When we do have to review the specific circumstances of a case to determine whether someone is self-employed/independent contractor or an employee, we consider the relationship of the worker to the person or business, and whether or not this forms an employer/employee relationship.
b. Often tax documents will sufficiently address the relationship of a person to either their employer or business.
c. When tax information is unavailable or unclear, we must review the specific circumstances to decide if a person's work is self-employment. In general:
i. Self-employed persons will have ultimate control of the way the work is done - when, where and how. Self-employed persons will generally use their own tools and offer their services to the public to seek business.
ii. Employees will be under more direct control as to how their work is done and will usually have set hours and wages by the employer.
Click Here for a chart that gives more guidance on determining self-employment status.
EXAMPLE
The Aging and Disability Services Administration (ADSA) individual providers work at the direction and control of the person to whom they provide care as well as the state. Their hours and wages are set by the customer and the state. Also, they receive benefits and have representation. WAC 388-71-0505 requires COPES customers to establish an employer-employee relationship. COPES and other ADSA individual providers are employees.
EXAMPLE
Yvonne cleans houses for several people. She uses some of her own tools, but mostly the cleaning products of the homeowners. She bases when she does the work upon the schedules of the different homeowners, but has ultimate control of when she schedules her different jobs or whether she accepts more houses to clean. Yvonne calls her service "Yvonne's Housecleaning" and posts fliers at local businesses to attract more customers. Yvonne is self-employed.
3. Child Care:
a. People who are child care providers that are subject to the licensing requirements under chapter 74.15 RCW are considered self-employed, even if they do not have a current license. Child day-care center operators and family home day-care providers are self-employed.
b. People who are not required to be licensed under state law to provide care are considered to have an employer/employee relationship with the parent of the child for whom they provide care. These unlicensed individual providers are considered employees.
EXAMPLE
Beth is an individual provider paid by Ms. Lee to provide care in the child's home. Beth is Ms. Lee's employee.
EXAMPLE
Lance cares for ten neighborhood children in his home while their parents are at work on a regularly scheduled basis. He has not yet applied for a license to operate this family home, as is required by state law for people regularly caring for children outside of their own homes. Lance is self-employed.
4. Independent contractors:
Independent contractors are self-employed. The guidelines above apply to determining a self-employed contractor from an employee. Subcontractors are independent contractors who contract with another firm versus directly with the customer, and are also self-employed.
EXAMPLE
Robert works as a freelance gardener for several private households. He also subcontracts his services with a local landscaping firm for additional business. Robert is self-employed.
5. Corporations:
People who run their business out of a corporation are not considered self-employed. This is true even if the person is the sole investor in the business. Corporations are separate entities from their investors and employees. The person is considered an employee of a corporation, and may also have income from dividends related to any investment in the corporation. See Treatment of Income for information on budgeting income from dividends and regular earnings.
Corporations include S Corporations and can include Limited Liability Companies (LLC) if they are set up as corporate structures. Partnerships are not incorporated, and are considered self-employment enterprises. For more information on various business structures, visit the IRS website.
6. Selling self-produced items:
Examples of selling self-produced items include someone running a lemonade stand or selling vegetables from their garden at the local farmer's market.
7. Re-sale income:
Examples of re-sale income include selling items for profit at garage sales, or on an online auction site such as e-bay.
NOTE:
This does not include when someone sells their personal belongings at a garage sale or even on an auction site for at or under the amount they originally paid. A person selling their belongings who does not make a profit is selling a resource and is not self-employed.
WAC 182-509-0085
WAC 182-509-0085
Effective October 14, 2012
WAC 182-509-0085 MCS income--Self-employment income--Calculation of countable income.
This section applies to medical care services (MCS). The agency or the agency's designee decides how much of an individual's self-employment income to count by:
Counting actual income in the month of application. This is done by:
a. Adding together the individual's gross self-employment income and any profit the individual made from selling their business property or equipment;
b. Subtracting the individual's business expenses as described in subsection (2) of this section; and
c. Dividing the remaining amount of self-employment income by the number of months over which the income will be averaged.
2. Subtracting one hundred dollars as a business expense even if the individual's costs are less than this. If the individual's costs of more than one hundred dollars, the agency or the agency's designee may subtract the individual's actual costs if the individual provides proof of their expenses. The following expenses are never allowed:
a. Federal, state, and local income taxes;
b. Money set aside for retirement purposes;
c. Personal work-related expenses (such as travel to and from work);
d. Net losses from previous periods;
e. Depreciation; or
f. Any amount that is more than the payment the individual gets from a boarder for lodging and meals.
3. If the individual has worked at their business for less than a year, figuring the individual's gross self-employment income by averaging:
a. The income over the period of time the business has been in operation; and
b. The monthly amount is estimated to be the amount the individual will get for the coming year.
4. If the individual's self-employment expenses are more than their self-employment income, not using this "loss" to reduce income from other self-employment businesses or other sources of income to the assistance unit.
1. We always allow the $100 standard deduction if the client doesn't choose to claim actual costs for non-boarder self-employment income.
This includes when the client:
a. Claims no self-employment expenses;
b. Has self-employment expenses under $100.00;
c. Has gross self-employment income under $100.00.
2. Some examples of allowable expenses are:
a. Rent or lease of business equipment or property;
b. Utilities;
c. Postage;
d. Telephone;
e. Office supplies;
f. Advertising;
g. Business related insurance, taxes, licenses, and permits;
h. Insurance premiums for a medical plan established under the business;
i. Legal, accounting, and other professional fees;
j. Repairs to business equipment and property;
k. Gross wages and salaries paid to employees;
l. Business loans (interest and principle) used to buy income-producing property or equipment;
and
m. The cost of a home office or place of business in the home if the area is used exclusively and regularly for business purposes. We cannot allow the cost for any area used for both personal and business use.
n. Transportation costs such as gas, oil, replacing worn items, registration and licensing fees, and auto loans. The client may claim the actual transportation costs or use the State standard cost-per-mile. The Office of Financial Management publishes the standard cost for a privately owned vehicle in section 10.90.20 of the State Administrative and Accounting Manual: http://www.ofm.wa.gov/policy/10.90a.pdf.
NOTE:
The rate as of October 1, 2011 was $.51 / mile.
3. If someone chooses to use their actual expenses instead of the standard deduction, they must list out and give us proof of the expenses before we can use them.
WORKER RESPONSIBILITIES
1. Determine gross self-employment income:
To determine gross self-employment income, count:
The sales from items the business sold;
Gross income from providing services;
Profit from selling business property or equipment.
2. Net self-employment income:
A person's net self-employment income is Gross self-employment income minus:
Their allowable self-employment expenses; or
The $100 self-employment expenses deduction.
3. Budget self-employment income:
When someone earns self-employment income, average the income over the period the income covers. If they choose to claim actual self-employment expenses, average their allowable expenses over the same period.
a. If the person gets their annual income as self-employment income, and they get this income over a period of less than a year, average the self-employment over the year.
b. If a person's income is from self-employment for only part of the year, average the income over the period of time the income covers.
c. If the averaged income doesn't reflect what the person will get because of a significant increase or decrease in business:
i. Anticipate the person's self-employment income for each month; and
ii. Average any capital gains they will get over the year.
d. If someone chooses to use their actual expenses instead of the standard deduction, average or anticipate the expenses for the same period of time you use for the income.
4. Calculate each self-employment business separately:
Each self-employment business is separate. Calculate the net self-employment income for each self-employment enterprise separately. Do not use the losses on one business to offset the profit of another business.
5. Roomer income:
Use the steps described below to determine what deductions to allow when someone has roomer income.
a. Use either the standard self-employment deduction as a self-employment expense or:
i. Verified non-board costs, such as laundry expenses; and
ii. For people buying their home, a prorated share of the mortgage, taxes, and insurance if they don't use the entire shelter costs toward the shelter deduction. Base the pro-ration on the number of total bedrooms in the house.
b. Give the person the choice of using the entire shelter cost toward their shelter deduction or using a portion of it as a business expense.
c. Households that rent and have a roomer cannot use their rent as a business expense. Count the amount of rent from the roomer that is more than their rent obligation as income to the household.
NOTE:
People in the same Assistance Unit who share household costs are not roomers. We do not count these shared household costs as roomer income.
EXAMPLE
Stan is buying his 3 bedroom home and rents out a room for $400. His mortgage payment of $750 includes taxes and insurance. Stan chooses to use actual expenses, rather than the standard $100 self-employment deduction. The pro-rated portion of his mortgage, taxes, and insurance is $250 ($750/ 3 bedrooms). We allow the pro-rated portion of his mortgage, taxes and insurance, as an allowable business expense.
Stan has $150 in net self-employment income. His shelter deduction would be the $500 mortgage (the portion of his housing costs that wasn't taken as a business expense) and the utility allowance he is eligible for under WAC 388-450-0195.
Enter $400 as roomer income and enter the mortgage payment and number of bedrooms in Stan's home for ACES to calculate his expenses correctly.
6. Rental Property:
a. Rental property that is subject to the criteria in WAC 182-509-0080 (7) is property that someone owns, but is not their residence.
b. We count any managerial duties toward the 20-hour weekly requirement for us to count rental property as self-employment earned income under WAC 182-509-0080. Count time people spend bookkeeping, showing the property to possible tenants, doing yard work, repairs, etc. as time spent managing the property.
c. Budget the gross earned or unearned income from renting the property after subtracting the standard self-employment deduction or the following verified expenses:
i. Property tax or a prorated share of the tax if their home and rental property are taxed as a single unit;
ii. Maintenance costs for the property;
iii. The mortgage or sales contract payment for the rental property or a prorated share if their property and the rental property are in the same loan or contract; and
iv. The insurance premium or a prorated share if they insure their home and rental property as a unit.
This section applies to medical care services (MCS).
Allocation is the process of determining how much of a financially responsible person's income is considered available to meet the needs of legal dependents within or outside of an assistance unit (AU).
"In-bound allocation" means income possessed by a financially responsible person outside the AU which is considered available to meet the needs of legal dependents in the AU.
"Out-bound allocation" means income possessed by a financially responsible AU member which is set aside to meet the needs of a legal dependent outside the AU.
Unmarried persons are not legally or financially responsible for each other.
A parent’s income is not allocated to children living in the home.
WORKER RESPONSIBILITIES
Determine if there is income possessed by someone outside the assistance unit that must be allocated to meet the needs of the assistance unit.
Determine if there is income possessed by someone included in the assistance unit that must be allocated to meet the needs of someone outside the assistance unit.
Refer to the appropriate sections under Income – Allocation and Deeming for specific allocation rules and worker responsibilities.
The following definitions apply to the allocation rules for medical care services (MCS):
1. "Dependent" means a person who:
a. Is or could be claimed for federal income tax purposes by the financially responsible person; or
b. The financially responsible person is legally obligated to support.
2. "Financially responsible person" means a parent, stepparent, adoptive parent, spouse or caretaker relative.
3. "Ineligible assistance unit member" means a person who is:
a. Ineligible for MCS due to the citizenship/alien status requirements in WAC 182-503-0532;
b. Ineligible to receive MCS under WAC 182-503-0560 for fleeing to avoid prosecution or custody or confinement after conviction for a crime or attempt to commit a crime; or
c. Ineligible to receive MCS under WAC 182-503-0560 for violating a condition of probation or parole which was imposed under federal or state law as determined by an administrative body or court of competent jurisdiction.
Do not allocate income of an AU member to legal dependents living in the home unless it’s to the non-applying spouse.
Allocate the one-person eligibility standard as specified under WAC 182-508-0230 to the non-applying spouse living in the home.
Children cannot be included in the AU.
A financially responsible person can only have income allocated to the following individuals:
a. A spouse living in the home; and
b. Legal dependents living outside the home when there is an ordered amount for court or administratively ordered current or back support.
WAC 182-509-0110
WAC 182-509-0110
Effective October 14, 2012
WAC 182-509-0110 MCS income--Allocating income to legal dependents.
This section applies to medical care services (MCS).
The income of an individual is reduced by the following:
The MCS earned income work incentive deduction, as specified in WAC 182-509-0175; and
An amount not to exceed the ordered amount paid for court or administratively ordered current or back support for legal dependents living outside the home.
When an individual resides in a medical institution, alcohol or drug treatment center, boarding home, or adult family home and has income, the individual retains an amount equal to:
The eligibility standard amount for the nonapplying spouse living in the home; and
The eligibility standard of personal needs allowance the individual is eligible for based upon their living arrangement.
An individual with countable income remaining after the allocation in subsection (2) ( a) and (b) of this section is not eligible for medical care services (MCS).
For treatment of income of a non-applying spouse, see WAC 182-509-0135.
WORKER RESPONSIBILITIES
MCS client living at home
To determine a MCS client's net countable earned income, apply rules in WAC 182-509-0175.
Combine the countable earned income with the countable unearned income.
Income is allocated to the following individuals:
a. A spouse living in the home in an amount not to exceed the one-person MCS eligibility standard under WAC 182-508-0230; and
b. Legal dependents living outside the home when there is an ordered amount paid for court or administratively ordered current or back support.
MCS client living in a nursing home, alternate living facility, or adult family home
When a MCS client does not live in the home with their spouse (and/or dependents), the client is allowed a deduction for the support of their spouse living in the home and for legal dependents living outside the home for whom they pay court ordered child support.
Determine a MCS client's net countable earned income under WAC 182-509-0175. Combine the countable earned income with any countable unearned income.
Deduct an amount up to the one person MCS eligibility standard (minus the spouse's income) for the support of the spouse from the income of the MCS applicant.
Deduct court ordered child support payments for a child living outside the home if paid by the MCS client or their spouse.
Compare the remainder to the following standards:
a. For a client living in a nursing home, compare the remainder to the Personal Needs Allowance (PNA) described in WAC 388-478-0040 (currently $41.62). If the client's countable income exceeds the PNA, the client is not eligible for MCS medical.
b. For a client living in an alternate living facility, compare the remainder to the Personal Needs Allowance (PNA) described in WAC 388-478-0045 (currently $38.84). If the client's net countable income exceeds the PNA, the client is not eligible for MCS medical.
c. For a client living in an adult family home, compare the remainder to the one-person MCS eligibility standard described in WAC 182-508-0230. If net income is below this standard, the client keeps a Personal Needs Allowance of $38.84 and pays the remainder of their income to the adult family home for room and board.
WAC 182-509-0135
WAC 182-509-0135
Effective October 14, 2012
WAC 182-509-0135 MCS--Allocating income of an ineligible spouse to a medical care services (MCS) client.
This section applies to medical care services (MCS). When an individual is married and lives with the nonapplying spouse, the following income is available to the individual:
1. The remainder of the individual's wages, retirement benefits or separate property after reducing the income by:
a. The MCS earned income work incentive deduction, as specified in WAC 182-509-0175; and
b. An amount not to exceed the ordered amount paid for court or administratively ordered current or back support for legal dependents living outside the home.
2. The remainder of the nonapplying spouse's wages, retirement benefits and separate property after reducing the income by:
a. An amount not to exceed the ordered amount paid for court or administratively ordered current or back support for legal dependents living outside the home; and
b. The one-person eligibility standard amount as specified under WAC 182-508-0230 which includes ineligible assistance unit members.
3. One-half of all other community income, as provided in WAC 182-509-0005.
A non-applying spouse doesn't receive the earned income incentive deduction.
WAC 182-509-0155
WAC 182-509-0155
Effective October 14, 2012
WAC 182-509-0155 MCS income--Exemption from sponsor deeming for medical care services (MCS).
This section applies to medical care services (MCS).
1. An individual who meets any of the following conditions is permanently exempt from deeming and none of a sponsor's income or resources are counted when determining eligibility for MCS:
a. The Immigration and Nationality Act (INA) does not require the individual to have a sponsor. Immigrants who are not required to have a sponsor include those with the following status with United States Citizenship and Immigration Services (USCIS):
i. Refugee;
ii. Parolee;
iii. Asylee;
iv. Cuban/Haitian entrant; or
v. Special immigrant from Iraq or Afghanistan.
b. The sponsor is an organization or group as opposed to an individual;
c. The individual does not meet the alien status requirements to be eligible for benefits under WAC182-503-0532;
d. The individual has worked or can get credit for forty qualifying quarters of work under Title II of the Social Security Act. If the individual worked during a quarter in which they received TANF, Basic Food, SSI, CHIP, or nonemergency medicaid benefits, a quarter of work is not counted towards the forty quarters.. A quarter of work by the following people is also counted toward the forty qualifying quarters:
i. The individual;
ii. The individual's parents for the time they worked before the individual turned eighteen years old (including the time they worked before you were born); and
iii. The individual's spouse if still married or if the spouse is deceased.
e. The individual becomes a United States (U.S.) Citizen;
f. The individual's sponsor is dead; or
g. If USCIS or a court decides that the individual, their child, or their parent was a victim of domestic violence from the sponsor and:
i. The individual no longer lives with the sponsor; and
ii. Leaving the sponsor caused the need for benefits.
2. While the individual is in the same assistance unit (AU) as their sponsor, they are exempt from the deeming process. An individual is also exempt from the deeming process if:
a. The sponsor signed the affidavit of support more than five years ago;
b. The sponsor becomes permanently incapacitated; or
i. Is on active duty with the U.S. armed forces or the individual is the spouse or unmarried dependent child of someone on active duty;
ii. Is an honorably-discharged veteran of the U.S. armed forces or the individual is the spouse or unmarried dependent child of a honorably-discharged veteran;
iii. Was employed by an agency of the U.S. government or served in the armed forces of an allied country during a military conflict between the U.S. and a military opponent; or
iv. Is a victim of domestic violence and the individual has petitioned for legal status under the Violence Against Women Act.
3. If the individual, their child, or their parent was a victim of domestic violence, the individual is exempt from the deeming process for twelve months if:
a. The individual no longer lives with the person who committed the violence; and
b. Leaving this person caused the need for benefits.
4. If the AU has income at or below one hundred thirty percent of the Federal Poverty Level (FPL), the individual is exempt from the deeming process for twelve months. This is called the "indigence exemption". For this rule, the following in counted as income to the AU:
a. Earned and unearned income the AU receives from any source; and
b. Any noncash items of value such as free rent, commodities, goods, or services that are received from an individual or organization.
5. If the individual chooses to use the indigence exemption, and is eligible for a state program, this information is not reported to the United States attorney general.
6. If the individual chooses not to use the indigence exemption:
a. The individual could be found ineligible for benefits for not verifying the income and resources of the sponsor; or
b. The individual will be subject to regular deeming rules under this section.
SSA qualifying work quarters: SSA decides how much income someone must earn in order to earn a qualifying quarter of work. See WAC 388-424-0008 for information on how to decide if someone has 40 qualifying quarters of work.
If an immigrant has 40 qualifying quarters of work using the spouse's work quarters, the immigrant keeps the exemption even if the immigrant divorces the spouse at a later date.
Deeming is time-limited for state-funded benefits: For state funded benefits, including MCS, we only deem a sponsor's income to the immigrant for five years from the date the sponsor signed the affidavit of support.
Using in-kind income: We do not deem in-kind income to the client. We add the sponsored immigrant's in-kind and other income outside of ACES and compare against 130% of the FPL to decide if the client is exempt from the deeming process. The United Stated Department of Health and Human Services (HHS) publishes the federal poverty level on the Internet at: http://www.poverty.us/Poverty-Guidelines.html
Value of in-kind income: We use the amount someone would normally pay for items or services (the market rate) as the value of free rent, commodities, goods, or services when we look at a client's in-kind income to decide if they are exempt from the deeming process.
Alien Emergency Medical: If a non-citizen isn't eligible for other medical benefits, that person may be eligible for AEM. We don't deem a sponsor's income or resources for AEM. See WAC 182-507-0110.
Special Immigrants: Immigrants from Iraq or Afghanistan who were granted Special Immigrant status under section 101 (a)(27) of the INA are not required to have a sponsor, and therefore, are not subject to deeming rules.
Renewing Indigence Exemptions: While indigence exemptions expire at the end of 12 months, they may be renewed for additional 12-month periods if the eligibility criteria are met.
Reporting Indigence Exemptions: The requirement to report indigence exemptions to the U.S. Attorney General described in WAC 388-450-0156 (7) applies only to recipients of federal benefits and is only done after giving them the opportunity to opt out and decline the exemption. Sponsored immigrants must be told the consequences of opting out of the deeming exemption to avoid indigence reporting. Although recipients of state benefits are also eligible for the exemption, they will not be reported. See Worker Responsibilities #5 for instructions.
WORKER RESPONSIBILITIES
When a sponsor abandons an immigrant:
If the sponsor abandoned the client, look to see if the client meets the exemption for having income at or below 130% of the FPL and explain to the client about the requirement to notify the U.S. Attorney General if they decide to use the indigence exemption.
If the client meets this exemption, the department must notify the U.S. Attorney General only after giving the client the opportunity to opt out and decline the exemption. See Notifying U.S. Attorney General.
Deciding if a sponsor is permanently incapacitated:
Unless it is questionable, accept the client's statement that the sponsor is permanently incapacitated. If you think the sponsor may not be incapacitated, request a note from the sponsor's doctor.
When a sponsored immigrant gets long-term care services: See WAC 388-513-1325, WAC 388-513-1340, and WAC 388-513-1350 for information on how to treat income and resources for a client who gets long-term care services.
Deciding if the AU has more than 130% of FPL:
Start with the AU's earned and unearned income;
Add any cash or in-kind benefits the client receives from any source.
The result is the client's total cash and in-kind income.
Multiply the current FPL based on the client's AU size by 1.3.
Compare the total cash and in-kind income to 130% of FPL.
If the client's total income is at or below 130% of FPL, exempt the client from deeming for 12 months.
EXAMPLE
A sponsored immigrant applies for benefits. He gets $250 a month from their sponsor and he stays in an apartment furnished by the sponsor's church. The apartment has been rented for $600 a month.
250
Monthly income from sponsor
+600
In-kind income (free-rent) from church
$850
Total cash and in-kind income
1128
2010 Monthly FPL for one person
X 1.3
130%
$1466
130% of FPL to decide on exemption
In this example, the client's cash and in-kind income of $850 is less than $1466. The client is exempt from the deeming process for twelve months. This exemption can be renewed if the client's income remains at or under 130% of the monthly FPL.
EXAMPLE
A sponsored-immigrant married couple applies for benefits. The sponsor does not give them money, but they give the clients $2000 worth of food and household items each month. The couple has no other income.
2000
In-kind income from sponsor
$ 2000
Total cash and in-kind income
$1428
2010 Monthly FPL for two people
x 1.3
130%
$1856
130% of FPL to decide on exemption
In this example, the client's in-kind income of $2000 is more than $1856. The client is not exempt from the deeming process. Calculate how much of the sponsor's income to deem under WAC 388-450-0160.
NOTE:
A client is not automatically eligible for benefits by being exempt from deeming.
NOTE:
Don't refer a client if they are exempt for any reason other than having income under 130% of FPL (e.g., the client was sponsored by an organization.) Don't refer a client who is receiving only state benefits.
WAC 182-509-0165
WAC 182-509-0165
Effective October 14, 2012
WAC 182-509-0165 MCS income--Income calculation.
This section applies to medical care services (MCS).
1. Countable income is all income that is available to the assistance unit (AU) after the following is subtracted:
a. Excluded or disregarded income under WAC 182-509-0015;
b. The earned income work incentive deduction under WAC 182-509-0175;
c. Income that is allocated to someone outside of the AU under WAC 182-509-0110 through 182-509-0135.
2. Countable income includes all income that must be counted because it is deemed or allocated from financially responsible persons who are not members of the AU under WAC 182-509-0110 through 182-509-0165.
3. Countable income is compared to the eligibility standards under WAC 182-508-0230.
4. If countable income available to the AU is equal to or greater than the eligibility standard, the individual is not eligible for medical care services (MCS).
ACES is programmed to determine eligibility for AUs appropriately based on the circumstances of the household including citizenship and alien status.
For households with non-citizens members, ensure that you code the (ALAS) screen in ACES correctly and update an immigrant’s information at recertification.
WAC 182-509-0175
WAC 182-509-0175
Effective October 14, 2012
WAC 182-509-0175 MCS--Earned income work incentive deduction.
This section applies to medical care services (MCS).
1. When determining eligibility for MCS, the agency or the agency's designee allows an earned income work incentive deduction of fifty percent of an individual's gross earned income.
2. This deduction is used to reduce countable income before comparing the income to the eligibility standard for the program.
Someone who is self-employed as described underWAC 182-509-0080gets either the $100 standard self-employment expense deduction or verified actual costs of self-employment as described underWAC 182-509-0085.
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.
