SSI-Related Medical - Resources
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SSI-Related Medical - Resources


Revised May 2, 2014



Purpose: This section describes how the department determines the resource standards/limits and availability of resources used to determine a client's eligibility for SSI-related medical programs, either categorically needy (CN) or medically needy (MN).

WAC 182-512-0200SSI related medical -- Definition of resources.
WAC 182-512-0250SSI-related medical -- Ownership and availability of resources.
WAC 182-512-0300SSI related medical -- Resources eligibility.
WAC 182-512-0350SSI-related medical -- Property and contracts excluded as resources.
WAC 182-512-0400SSI-related medical -- Vehicles excluded as resources.
WAC 182-512-0450SSI-related medical -- Life insurance excluded as a resource.
WAC 182-512-0500SSI-related medical -- Burial funds, contracts and spaces excluded as resources.
WAC 182-512-0550SSI-related medical -- All other excluded resources.

WAC 182-512-0200

WAC 182-512-0200

Effective December 1, 2011

WAC 182-512-0200 SSI related medical -- Definition of resources.

  1. A resource is any cash, other personal property, or real property that an applicant, recipient or other financially responsible person: 
    1. Owns;
    2. Has the right, authority, or power to convert to cash (if not already cash); and
    3. Has the legal right to use for his/her support and maintenance.
  2. The value of a resource may change. However, the property (personal or real) still remains a resource.
  3. Some assets are not resources. Any asset that does not meet the criteria in subsection (1) above is not a resource.
  4. When an SSI related client owns a bank account or time deposit jointly with others who are also SSI related clients, we consider the funds as being available to the SSI related individuals in equal shares, unless sufficient evidence to the contrary is provided.
  5. When an SSI related client owns a bank account or time deposit jointly with others who are not SSI related, we consider all funds in the joint account as available to the client unless sufficient evidence to the contrary is provided.
  6. When an SSI related client jointly owns either real or personal property other than bank accounts or time deposits, the department considers that the client owns and has available only his or her fractional interest in the property unless sufficient evidence to the contrary is provided.
  7. A resource is countable toward the resource limit only if it is available and is not excluded.

 

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

  1. The following assets are not considered resources, so are neither “excluded” nor “counted”:

    1. Home Energy Assistance/Support and Maintenance assistance;

    2. Certain cash to purchase medical or social services;

    3. Retroactive In-Home Supportive Services payments to ineligible spouses and parents;

    4. Certain death benefits for last illness and burial expenses, until the second calendar month after receipt when the benefits are for the expenses not yet paid e) Gifts of domestic travel tickets.

  2. A resource remains a resource regardless of value.


EXAMPLE

John has 100 shares of XYZ common stock for which he paid $5,000 last year. The stock is currently valued at $0.001 per share. While it currently has almost no value, the shares of stock remain a resource. The value should be checked at each review, because the value of the resource may change.


  1. A piece of property in which a person has an ownership interest is not a resource if that person can not legally transfer their ownership interest to another person. For an asset to be a resource, WAC 182-512-0200(1) must apply.

  2. A person can supply evidence showing that a time deposit or bank account they own jointly with others is not available or does not belong to the person. This evidence may be supplied at the time of application or after the department has made a decision with which the person disagrees. If evidence is presented, the department will consider it in making its determination. Each case is considered on its own merits.


WAC 182-512-0250

WAC 182-512-0250

Effective October 1, 2013

WAC 182-512-0250 SSI-related medical -- Ownership and availability of resources.



(1) The agency considers personal or real property to be available to a Washington apple health (WAH) applicant or recipient, their spouse or other financially responsible person if the applicant or recipient:

(a) Owns the property;

(b) Has the authority to convert the property into cash;

(c) Can expect to convert the property to cash within twenty working days; and

(d) May legally use the property for his/her support.

(2) The agency counts the resources of financially responsible persons (as defined in WAC 182-506-0010) who live in the home even if those persons do not receive WAH coverage.

(3) Cash or resources owned by a WAH applicant or recipient or their spouse but held or directed by another, such as, but not limited to, an authorized representative, guardian, or power of attorney, are considered an available resource to the applicant or recipient.

(4) For long-term care services, cash or resources transferred by a WAH applicant or recipient or their spouse to another person, persons, or entity for purposes of paying for the WAH applicant or recipient's long-term care services, whether on a current or a prepaid basis, is considered an available resource to the applicant or recipient.

(5) A resource is considered available on the first day of the month following the month of receipt unless a rule about a specific type of resource provides for a different time period.

(6) A resource, which ordinarily cannot be converted to cash within twenty working days, is considered unavailable as long as a reasonable effort is being made to convert the resource to cash.

(7) A person may provide evidence showing that a resource is unavailable. A resource is not counted if the person shows sufficient evidence that the resource is unavailable.

(8) We do not count the resources of victims of family violence, as defined in WAC 388-452-0010, when:

(a) The resource is owned jointly with members of the former household;

(b) Availability of the resource depends on an agreement of the joint owner; or

(c) Making the resource available would place the person at risk of harm.

(9) The value of a resource is its fair market value minus encumbrances.

(10) Refer to WAC 182-512-0260 to consider additional resources when an alien has a sponsor.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

  1. Community property is an available resource unless the client can provide proof to the contrary.

  2. Real or personal property is considered to be community property when it is in the name of either the husband or wife or both and can be disposed of by either of them.

  3. A person can show evidence that a resource is unavailable to them, and if the department agrees that it is unavailable it will not be counted until it becomes available.


EXAMPLE

A separated couple may own a piece of property, which the non-applying spouse refuses to sell, making the resource unavailable to the applying spouse.


EXAMPLE

A wife applies for SSI-related medical. She fled from an abusive marriage after her husband said he would kill her the next time he saw her, and she is living in a domestic violence shelter. The jointly owned motor home is at the family home and is an unavailable resource to her.


EXAMPLE

A client applies for SSI-related medical. He states he jointly owns property with his brother who recently passed away. The property is currently in probate. The property is not an available resource at this time since the client cannot access the property as long as it remains in probate.


  1. Clients may provide evidence that they are trying to convert a resource to cash.

EXAMPLE

A man applies for SSI-related medical. He owns a home locally and a vacation home on the Oregon coast that he is trying to sell. The vacation home can be considered an unavailable resource as long as the man continues making a reasonable effort to sell the property. The man produces evidence of a reasonable effort to convert the resource to cash (selling it), by producing an agreement to sell with a real estate agent, verification that the home is reasonably priced (the sales agreement with the realty shows the asking sales price and comparable homes/sales prices or tax assessment shows the value) and advertising showing the home for sale.


EXAMPLE

A woman receives SSI-related medical. She owns free and clear, a 5 acre plot that she has put up for sale at $20,000. She turned down an $18,000 offer as it was not the full asking price. The property is now considered available as she is no longer making a reasonable effort to sell. (A reasonable offer to buy is 2/3rd of the estimated current market value unless the client can provide evidence showing another amount constitutes a reasonable offer. In this case, a reasonable offer is $13,320 or more.) See EA-Z manual: Resources, for more information about this.


  1. To calculate the value of a resource, subtract the amount the client stills owes on it from the fair market value (how much the client could reasonably sell the resource for). The amount that remains is the value of the resource at the current time.

WAC 182-512-0300

WAC 182-512-0300

Effective December 1, 2011

WAC 182-512-0300 SSI related medical -- Resources eligibility.

  1. At 12:00 a.m. on the first day of the month a client's countable resources must be at or below the resource standard to be eligible for noninstitutional medical benefits for that month.  If the total of the client's countable resources is above the resource standard at 12:00 a.m. on the first day of the month, the client is ineligible for noninstitutional medical benefits for that entire month regardless of resource status at the time of application during that month. For resource eligibility relating to long term care eligibility see chapter 388-513 WAC. 

  2. An excluded resource converted to another excluded resource remains excluded.

  3. Cash received from the sale of an excluded resource becomes a countable resource the first of the month following conversion unless the cash is;

    1. Used to replace the excluded resource; or

    2. Invested in another excluded resource in the same month or within the longer time allowed for home sales under WAC 388-475-0350; or

    3. Spent.

  4. The unspent portion of a nonrecurring lump sum payment is counted as a resource on the first of the month following its receipt with the following exception: the unspent portion of any Title II (SSA) or Title XVI (SSI) retroactive payment is excluded as a resource for nine months following the month of receipt. These exclusions apply to lump sums received by the client, client's spouse or any other person who is financially responsible for the client.

  5. Clients applying for SSI related medical coverage for long term care (LTC) services must meet different resource rules. See chapter 388-513 WAC for LTC rules.

  6. The transfer of a resource without adequate consideration does not affect medical program eligibility except for LTC services described in chapters 388-513 and 388-515 WAC. In those programs, the transfer may make a client ineligible for medical benefits for a period of time. See WAC 388-513-1363  through WAC 388-513-1366  for LTC rules.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-512-0350

WAC 182-512-0350

Effective October 1, 2013

WAC 182-512-0350 SSI-related medical -- Property and contracts excluded as resources.

 

(1) The agency does not count the following resources when determining eligibility for SSI-related medical assistance:

(a) A person's household goods and personal effects;

(b) One home (which can be any shelter), including the land on which the dwelling is located and all contiguous property and related out-buildings in which the person has ownership interest (for WAH long-term care programs, see WAC 182-513-1350 for home equity limits), when:

(i) The person uses the home as his or her primary residence; or

(ii) The person's spouse lives in the home; or

(iii) The person does not currently live in the home but the person or his/her representative has stated he or she intends to return to the home; or

(iv) A relative, who is financially or medically dependent on the person, lives in the home and the person, or his or her authorized representative or dependent relative has provided a written statement to that effect.

(c) The value of ownership interest in jointly owned real property is an excluded resource for as long as sale of the property would cause undue hardship to a co-owner due to loss of housing. Undue hardship would result if the co-owner:

(i) Uses the property as his or her principal place of residence;

(ii) Would have to move if the property were sold; and

(iii) Has no other readily available housing.

(2) Cash proceeds from the sale of the home described in subsection (1)(b) of this section are not considered if the person uses them to purchase another home by the end of the third month after receiving the proceeds from the sale.

(3) An installment contract from the sale of the home described in subsection (1)(b) above is not a resource as long as the person plans to use the entire down payment and the entire principal portion of a given installment payment to buy another excluded home, and does so within three full calendar months after the month of receiving such down payment or installment payment.

(4) The value of sales contracts is excluded when the:

(a) Current market value of the contract is zero,

(b) Contract cannot be sold, or

(c) Current market value of the sales contract combined with other resources does not exceed the resource limits.

(5) Sales contracts executed before December 1, 1993, are exempt resources as long as they are not transferred to someone other than a spouse.

(6) A sales contract for the sale of the person's principal place of residence executed between December 1, 1993 and May 31, 2004 is considered an exempt resource unless it has been transferred to someone other than a spouse and it:

(a) Provides interest income within the prevailing interest rate at the time of the sale;

(b) Requires the repayment of a principal amount equal to the fair market value of the property; and

(c) The term of the contract does not exceed thirty years.

(7) A sales contract executed on or after June 1, 2004 on a home that was the principal place of residence for the person at the time of institutionalization is considered exempt as long as it is not transferred to someone other than a spouse and it:

(a) Provides interest income within the prevailing interest rate at the time of the sale;

(b) Requires the repayment of a principal amount equal to the fair market value of the property within the anticipated life expectancy of the person; and

(c) The term of the contract does not exceed thirty years.

(8) Payments received on sales contracts of the home described in subsection (1)(b) of this section are treated as follows:

(a) The interest portion of the payment is treated as unearned income in the month of receipt of the payment;

(b) The principal portion of the payment is treated as an excluded resource if reinvested in the purchase of a new home within three months after the month of receipt;

(c) If the principal portion of the payment is not reinvested in the purchase of a new home within three months after the month of receipt, that portion of the payment is considered a liquid resource as of the date of receipt.

(9) Payments received on sales contracts described in subsection (4) of this section are treated as follows:

(a) The principal portion of the payment on the contract is treated as a resource and counted toward the resource limit to the extent retained at the first moment of the month following the month of receipt of the payment; and

(b) The interest portion is treated as unearned income the month of receipt of the payment.

(10) For sales contracts that meet the criteria in subsections (5), (6), or (7) of this section but do not meet the criteria in subsections (3) or (4) of this section, both the principal and interest portions of the payment are treated as unearned income in the month of receipt.

(11) Property essential to self-support is not considered a resource within certain limits. The agency places property essential to self-support in several categories:

(a) Real and personal property used in a trade or business (income-producing property), such as:

(i) Land;

(ii) Buildings;

(iii) Equipment;

(iv) Supplies;

(v) Motor vehicles; and

(vi) Tools.

(b) Nonbusiness income-producing property, such as:

(i) Houses or apartments for rent; and

(ii) Land, other than home property.

(c) Property used to produce goods or services essential to a person's daily activities, such as land used to produce vegetables or livestock, which is only used for personal consumption in the person's household. This includes personal property necessary to perform daily functions including vehicles such as boats for subsistence fishing and garden tractors for subsistence farming, but does not include other vehicles such as those that qualify as automobiles (cars, trucks).

(12) The agency excludes a person's equity in real and personal property used in a trade or business (income producing property listed in subsection (11)(a) of this section) regardless of value as long as it is currently in use in the trade or business and remains used in the trade or business.

(13) The agency excludes up to six thousand dollars of a person's equity in nonbusiness income producing property listed in subsection (11)(b) of this section, if it produces a net annual income to the person of at least six percent of the excluded equity.

(a) If a person's equity in the property is over six thousand dollars, only the amount over six thousand dollars is counted toward the resource limit, as long as the net annual income requirement of six percent is met on the excluded equity.

(b) If the six percent requirement is not met due to circumstances beyond the person's control, and there is a reasonable expectation that the activities will again meet the six percent rule, the same exclusions as in subsection (13)(a) of this section apply.

(c) If a person has more than one piece of property in this category, each is looked at to see if it meets the six percent return and the total equities of all those properties are added to see if the total is over six thousand dollars. If the total is over the six thousand dollars limit, the amount exceeding the limit is counted toward the resource limit.

(d) The equity in each property that does not meet the six percent annual net income limit is counted toward the resource limit, with the exception of property that represents the authority granted by a governmental agency to engage in an income-producing activity if it is:

(i) Used in a trade or business or nonbusiness income-producing activity; or

(ii) Not used due to circumstances beyond the person's control, e.g., illness, and there is a reasonable expectation that the use will resume.

(14) Property used to produce goods or services essential to a person's daily activities is excluded if the person's equity in the property does not exceed six thousand dollars.

(15) Personal property used by a person for work is not counted, regardless of value, while in current use, or if the required use for work is reasonably expected to resume.

(16) Interests in trust or in restricted Indian land owned by a person who is of Indian descent from a federally recognized Indian tribe or held by the spouse or widow/er of that person, is not counted if permission of the other persons, the tribe, or an agency of the federal government must be received in order to dispose of the land.

(17) Receipt of money by a member of a federally recognized tribe from exercising federally protected rights or extraction of exempt resources, such as fishing, shell-fishing, or selling timber from protected land, is considered conversion of an exempt resource during the month of receipt. Any amount remaining from the conversion of this exempt resource on the first of the month after the month of receipt will remain exempt if it is used to purchase another exempt resource. Any amount remaining in the form of a countable resource (such as in a checking or savings account) on the first of the month after receipt, will be added to other countable resources for eligibility determinations.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

  1. If a client continues making a reasonable effort to convert a resource to cash, the resource is not counted.   The worker should verify that the client continues to make efforts to convert/sell the resource periodically, and at again at time of recertification. 

  2. Loan proceeds are not considered a gain to the individual and are not considered income.   Proceeds from a reverse mortgage on a client’s home are considered loan proceeds.   However, the loan proceeds are considered a resource if held into the month after they are paid to the client (the first of the month following the month of receipt).  Any interest earned on the proceeds is considered unearned income. 

  3. Proceeds from the sale of the one excluded home are counted as a resource back to the receipt of the proceeds if the client does not use the funds on purchase of another home by the end of the third month after receipt of the funds.  The funds affect eligibility only if they cause countable resources to exceed allowed levels as of the first of the month after the month of receipt. 

  4. The home exemption is used once for each married couple.  A determination must be made on whether a 2nd home is an available resource.  For a married couple, if the client lives in one home and the client’s spouse lives in a second home jointly owned by the couple, the client’s interest in the second home is not excluded.  Evaluate whether the client’s interest in the 2nd home is an available resource.  If the second home is sold, the remaining proceeds belonging to the client count as a resource the first of the month following the receipt of the proceeds. 

  5. An example of an individual’s equity in non-business income-producing property producing net annual income of less than 6 percent of the excluded equity through no fault of the individual (such as that described in (10)(b) of the WAC above) is crop failure due to weather conditions or illness. 

  6. If the client transfers property to the community spouse when receiving LTC benefits, it is no longer the client’s resource; it is the community spouse’s resource.  Refer to Chapter 388-513 WAC for LTC rules. 

  7. Trucks and other equipment are not counted if used to produce income or if used in pursuit of employment to produce income. 

  8. Boats and fishing equipment are not counted as resources if used to produce income or if used in Indian Treaty fishing. 


WAC 182-512-0400

WAC 182-512-0400

Effective October 1, 2013

WAC 182-512-0400 SSI-related medical -- Vehicles excluded as resources.



(1) For SSI-related medical programs, a vehicle is defined as anything used for transportation. In addition to cars and trucks, a vehicle can include boats, snowmobiles, and animal-drawn vehicles.

(2) One vehicle is excluded regardless of its value, if it is used to provide transportation for the disabled person or a member of the person's household.

(3) For a person receiving SSI-related institutional coverage who has a community spouse, one vehicle is excluded regardless of its value or its use. See WAC 182-513-1350 (7)(b).

(4) A vehicle used as the person's primary residence is excluded as the home, and does not count as the one excluded vehicle under subsection (2) or (3) of this section.

(5) All other vehicles, except those excluded under WAC 182-512-0350 (11) through (14), are treated as nonliquid resources and the equity value is counted toward the resource limit.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

  1. A leased vehicle is not counted as a resource, because the client does not own the vehicle and is not purchasing it. 
  2. Determination of the value of a vehicle is found in the Resource Chapter of the E A-Z Manual, Section H, How Vehicles Count - Worker Responsibility.  The WAC reference is WAC 388-470-0070

WORKER RESPONSIBILITIES

To determine the fair market value of a vehicle, check the current value as listed in the Kelley Blue Book @ http://www.kbb.com/ or N. A. D. A. guides @  http://www.nadaguides.com/.  The amount owed on the vehicle is subtracted from the value to determine the amount of equity the person has in the vehicle.  The amount of the resource is the equity value. 


WAC 182-512-0450

WAC 182-512-0450

Effective October 1, 2013

WAC 182-512-0450 SSI-related medical -- Life insurance excluded as a resource.



(1) The agency excludes life insurance policies that do not have or cannot accrue a cash surrender value (CSV) in determining whether owned policies exceed the life insurance exclusion limits for resources and in determining burial fund exclusion limits.

(2) Policies owned by each spouse are evaluated and counted separately.

(3) If the total face value of all policies with a CSV potential that a person owns on the same insured is equal to or less than fifteen hundred dollars, the resource is excluded.

(4) If the total face value of all policies with a CSV potential that a person owns on the same insured is more than fifteen hundred dollars, the total CSV of the policies is counted toward the resource limit, unless the person designates such policies as burial funds. If they are designated as burial funds, they must be evaluated under the burial fund exclusion described in WAC 182-512-0500.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

  1. The Cash Surrender Value (CSV) of life insurance is counted as a resource when the face value of the policy exceeds $1500.  If the face value is under $1500, the CSV is excluded. 

  2. Consider the life insurance policies owned by each spouse separately. 

  3. The face value of life insurance policies that have no possible CSV (such as term insurance) are not counted in determining whether the total value of all policies is below the allowable $1,500 resource limit because they can not be cashed out.  These policies are not resources. 

  4. Clients can shift money from life insurance policies to an irrevocable burial fund or add to an existing irrevocable burial fund (the fund must be in a reasonable amount as defined by the department after considering individual and cultural circumstances) to reduce their resources below the resource limit. 

  5. Each spouse is allowed the $1,500 exclusion on the face value of policies they own. 


EXAMPLE

Archie and Edith are a married couple.  When they married, they each bought a $1,000 face value (FV) whole life insurance policy on their own life and another $1,000 FV policy on the life of their spouse.  There are no other policies.  The $1,000 FV Archie owns on his own life is less than the $1,500 exclusion, so it is excluded.  The $1,000 policy Archie owns on his wife’s life is also under $1,500, so it is also excluded.  The same applies to Edith’s policies. 


EXAMPLE

Tarzan and Jane are a married couple, both disabled and applying for Medicaid.  Tarzan owns a $50,000 term life insurance policy and a $500 FV whole life insurance policy on himself.  Jane owns 2 whole life policies on Tarzan, each with an FV of $500.  The term life policy does not count as a resource because it has no CSV potential.  The FV of Tarzan’s whole life policy is less than the $1,500 exclusion limit, so it is excluded.  The FV of the 2 policies Jane owns are also less than the $1,500 exclusion so they are excluded, too.  This couple has no countable resources from life insurance policies. 


WAC 182-512-0500

WAC 182-512-0500

Effective October 1, 2013

WAC 182-512-0500 SSI-related medical -- Burial funds, contracts and spaces excluded as resources.



(1) For the purposes of this section, burial funds are funds set aside and clearly designated solely for burial and related expenses and kept separate from all other resources not intended for burial. These include:

(a) Revocable burial contracts;

(b) Revocable burial trusts;

(c) Installment contracts for purchase of a burial space on which payments are still owing;

(d) Other revocable burial arrangements. The designation is effective the first day of the month in which the person intended the funds to be set aside for burial.

(2) The following burial funds are excluded as resources for the person and his or her spouse up to fifteen hundred dollars each when set aside solely for the expenses of burial or cremation and expenses related to the burial or cremation, and the funds are either:

(a) An installment contract for purchase of a burial space that is not yet paid in full; or

(b) In a revocable burial contract, burial trust, cash accounts, or other financial instrument with a definite cash value.

(3) Interest earned in burial funds and appreciation in the value of excluded burial arrangements in subsection (2)(a) and (b) of this section are excluded from resources and are not counted as income if left to accumulate and become part of the separate burial fund.

(4) The fifteen hundred dollar exclusion for burial funds described in subsection (2) of this section is reduced by:

(a) The face value of life insurance with CSV excluded in WAC 182-512-0450; and

(b) Amounts in an irrevocable burial trust, or other irrevocable arrangement available to meet burial expenses, or burial space purchase agreement installment contracts on which money is still owing. If these reductions bring the balance of the available exclusion to zero, no additional funds can be excluded as burial funds.

(5) An irrevocable burial account, burial trust, or other irrevocable burial arrangement, set aside solely for burial and related expenses is not considered a resource. The amount set aside must be reasonably related to the anticipated death-related expenses in order to be excluded.

(6) A person's burial funds are no longer excluded when they are mixed with other resources that are not related to burial.

(7) When excluded burial funds are spent for other purposes, the spent amount is added to other countable resources and any amount exceeding the resource limit is considered available income on the first of the month it is used. The amount remaining in the burial fund remains excluded.

(8) Burial space and accessories for the person and any member of the person's immediate family described in subsection (9) of this section are excluded. Burial space and accessories include:

(a) Conventional gravesites;

(b) Crypts, niches, and mausoleums;

(c) Urns, caskets and other repositories customarily used for the remains of deceased persons;

(d) Necessary and reasonable improvements to the burial space including, but not limited to:

(i) Vaults and burial containers;

(ii) Headstones, markers and plaques;

(iii) Arrangements for the opening and closing of the gravesite; and

(iv) Contracts for care and maintenance of the gravesite.

(e) A burial space purchase agreement that is currently paid for and owned by the person is also defined as a burial space. The entire value of the purchase agreement is excluded; as well as any interest accrued, which is left to accumulate as part of the value of the agreement. The value of this agreement does not reduce the amount of burial fund exclusion available to the person.

(9) Immediate family, for the purposes of subsection (8) of this section includes the person's:

(a) Spouse;

(b) Parents and adoptive parents;

(c) Minor and adult children, including adoptive and stepchildren;

(d) Siblings (brothers and sisters), including adoptive and stepsiblings;

(e) Spouses of any of the above.

None of the family members listed above, need to be dependent on or living with the person, to be considered immediate family members.

 

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

  1. Irrevocable burial funds may be in any reasonable amount designated solely for burial and related expenses.  Reasonableness must be evaluated on an individual, case by case basis, and should include cultural considerations and special burial arrangements.  The purpose is to insure that only amounts expected to be used for death-related expenses are placed in irrevocable burial accounts. 

  2. Irrevocable burial funds may not include a contingent, or residual, beneficiary.  All funds must be used solely for the client’s burial and related expenses. 

  3. Burial funds must be separately identifiable.  They can be commingled with other counted funds if the other counted funds are also burial-related.  A total of $1,500 is excluded for an individual as burial funds. 


EXAMPLE

Mary has a savings account with $2,000 in it.  She states it is for household maintenance.  She adds $500, designating this $500 for burial.  Mary does not want to separate the money she has set aside for burial in this account.  Explain to Mary that the burial funds must be separated from other funds to remain excluded.  If Mary refuses to separate the burial funds from other funds in the account, the total $2,500 is countable toward the resource limit.  For us to consider $500 for her burial fund exclusion, it must be in a separate, burial-related account. 

Mary may designate more than $1,500 of the savings account as burial funds, but we can only exclude up to the $1,500 maximum.  The rest of the account must be added toward her resource limit. 


EXAMPLE

Jerry has a $100 savings account designated as burial-related funds.  He adds $500 to the account, stating the additional funds are also designated for burial-related expenses.  This whole account is eligible for burial funds exclusions (up to the $1,500 maximum allowed for one person). 


  1. If a client has resources above the standard, the client may establish a burial fund that meets the criteria of WAC 182-512-0500 in order to reduce their countable resources. 

  2. Consider the burial funds owned by each spouse separately. 

  3. The face value of term burial policies is not counted in determining whether or not the total value of all policies is below the allowable $1,500 resource limit, because term policies have no possible CSV. 

  4. The $1,500 limit on excludable burial funds is reduced by both the face value of life insurance policies if the CSV was excluded and by the amount of any irrevocable burial funds. 

  5. Clients can shift money from revocable burial funds to an irrevocable burial fund or add to an existing irrevocable burial fund in any reasonable amount. 


WORKER RESPONSIBILITIES

  1. The client needs to complete the DSHS 14-251(X); Burial Fund Provision, to declare the amount of funds set aside for burial. 

  2. Allow up to two months from the end of the application month to cash in or physically separate funds. 

  3. The client’s statement is acceptable as verification for the planned use of the funds for burial when commingled with other counted funds. 


EXAMPLE

Laurie owns a life insurance policy on her husband with a face value of $1,500 and a cash surrender value (CSV) of $1,000.  The CSV is excluded.  The burial funds exclusion is reduced by the face value of this life insurance policy, so Laurie cannot set aside additional excluded funds toward his burial.  Any other funds she sets aside for his burial will count against the resource limit. 


EXAMPLE

Jack is applying for medical assistance.  He bought a life insurance policy on his own life with a face value of $10,000 and a CSV of $1,600.  He did not want to designate the policy as burial funds.  Since the CSV exceeds the $1,500 life insurance face value (FV) limit and is not designated as burial funds, the $1,600 is applied to the resource limit.  Jack also has set aside a bank account of $1,200 for his burial.  The $1,200 is excluded for his burial since the cash surrender value of the life insurance policy was not designated as burial funds. 


EXAMPLE

Jack (from Example Two), has the same life insurance policy and burial funds ($10,000 FV, $1,600 CSV, burial funds of $1,200).  However, he states he wants to designate the life insurance policy as burial funds.  He now can exclude $300 of the CSV from the life insurance policy as burial funds, but the other $1,300 is a countable resource.  The $1,200 from his other burial funds were excluded previously and remain excluded.  Jack has now reached his entire allowable $1,500 burial funds exclusion.  He has $1,300 in countable resources and $1,500 in burial funds exclusions, if he has no other resources. 


EXAMPLE

Jack (from the previous 2 examples) owns the policies already mentioned and his wife owns a life insurance policy on his life with a face value of $100,000 and a CSV of $1,000.  Jack’s wife is not applying for any benefits from Medicaid, but because her assets count, we must look at all resources of the couple.  She may designate this life insurance policy for a burial funds set-aside, and the entire CSV is excluded.  She may also have an additional $500 face value life insurance policy to be used for either life insurance or burial funds exclusion. 


EXAMPLE

Jill has a life insurance policy with a face value of $10,000 and a CSV of $500.  She has $1,500 in a savings account set aside for her burial.  She also has an irrevocable burial trust valued at $6,000.  The irrevocable burial trust does not count as a resource in itself, but it reduces her remaining burial funds exclusion to zero, since it exceeds $1,500.  This means the $500 in CSV from the life insurance policy counts toward the resource limit.  The $1,500 in the savings account burial fund can not be excluded as a resource because the $1,500 burial set-aside exclusion was used by the irrevocable burial trust.  Jill has $2,000 in countable resources, assuming these accounts are the total resources she owns: $500 from CSV and $1,500 from her burial funds savings account. 


EXAMPLE

Derek recently bought two $50,000 whole life insurance policies on his wife, with a total current CSV of $500.  He also owns a term insurance policy on himself, his wife and on each of his three children.  The term insurance policies do not count toward the resource limits, since there is no possibility of accruing CSV.  If the burial funds set-aside has not been used, Derek could designate the $500 CSV from the whole life policies toward that exclusion. 


EXAMPLE

John has a $2,000 CD.  He states that $1,500 is set aside as burial funds and he also plans to use the remaining $500 for burial related expenses.  The CD does not have to be cashed or physically separated, because all of the CD is designated for burial related expenses.  Five hundred dollars of the CD are countable resources.  If any of the funds from the CD were designated or used for anything other than burial related expenses, the entire CD would be countable as a resource and none of it could be excluded under the burial funds exclusion. 


WAC 182-512-0550

WAC 182-512-0550

Effective October 1, 2013

WAC 182-512-0550 SSI-related medical -- All other excluded resources.

 

All resources described in this section are excluded resources for SSI-related medical programs. Unless otherwise stated, interest earned on the resource amount is counted as unearned income.

(1) Resources necessary for a person who is blind or disabled to fulfill a self-sufficiency plan approved by the agency.

(2) Retroactive payments from SSI or RSDI, including benefits a person receives under the interim assistance reimbursement agreement with the Social Security Administration, are excluded for nine months following the month of receipt. This exclusion applies to:

(a) Payments received by the person, the person's spouse, or any other person financially responsible for the person;

(b) SSI payments for benefits due for the month(s) before the month of continuing payment;

(c) RSDI payments for benefits due for a month that is two or more months before the month of continuing payment; and

(d) Proceeds from these payments as long as they are held as cash, or in a checking or savings account. The funds may be commingled with other funds, but must remain identifiable from the other funds for this exclusion to apply. This exclusion does not apply once the payments have been converted to any other type of resource.

(3) All resources specifically excluded by federal law, such as those described in subsections (4) through (11) of this section as long as such funds are identifiable.

(4) Payments made under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.

(5) Payments made to American Indians/Alaska Natives as listed in 20 C.F.R. 416.1182, Appendix to subpart K, section IV, paragraphs (b) and (c), and in 20 C.F.R. 416.1236.

(6) The following American Indian/Alaska Native funds are excluded resources:

(a) Resources received from a native corporation under the Alaska Native Claims Settlement Act, including:

(i) Shares of stock held in a regional or village corporation;

(ii) Cash or dividends on stock received from the native corporation up to two thousand dollars per person per year;

(iii) Stock issued by a native corporation as a dividend or distribution on stock;

(iv) A partnership interest;

(v) Land or an interest in land; and

(vi) An interest in a settlement trust.

(b) All funds contained in a restricted individual Indian money (IIM) account.

(7) Exercise of federally protected rights, including extraction of exempt resources by a member of a federally recognized tribe during the month of receipt. Any funds from the conversion of the exempt resource which are retained on the first of the month after the month of receipt will be considered exempt if they are in the form of an exempt resource, and will be countable if retained in the form of a countable resource.

(8) Restitution payment and any interest earned from this payment to persons of Japanese or Aleut ancestry who were relocated and interned during war time under the Civil Liberties Act of 1988 and the Aleutian and Pribilof Islands Restitution Act.

(9) Funds received from the Agent Orange Settlement Fund or any other funds established to settle Agent Orange liability claims.

(10) Payments or interest accrued on payments received under the Radiation Exposure Compensation Act received by the injured person, the surviving spouse, children, grandchildren, or grandparents.

(11) Payments or interest accrued on payments received under the Energy Employees Occupational Illness Compensation Act of 2000 (EEOICA) received by the injured person, the surviving spouse, children, grandchildren, or grandparents.

(12) Payments from:

(a) The Dutch government under the Netherlands' Act on Benefits for Victims of Persecution (WUV).

(b) The Victims of Nazi Persecution Act of 1994 to survivors of the Holocaust.

(c) Susan Walker vs. Bayer Corporation, et al., 96-C-5024 (N.D. Ill.) (May 8, 1997) settlement funds.

(d) Ricky Ray Hemophilia Relief Fund Act of 1998 P.L. 105-369.

(13) The unspent social insurance payments received due to wage credits granted under sections 500 through 506 of the Austrian General Social Insurance Act.

(14) Tax refunds and earned income tax credit refunds and payments are excluded as resources for twelve months after the month of receipt.

(15) Payments from a state administered victim's compensation program for a period of nine calendar months after the month of receipt.

(16) Cash or in-kind items received as a settlement for the purpose of repairing or replacing a specific excluded resource are excluded:

(a) For nine months. This includes relocation assistance provided by state or local government.

(b) Up to a maximum of thirty months, when:

(i) The person intends to repair or replace the excluded resource; and

(ii) Circumstances beyond the control of the settlement recipient prevented the repair or replacement of the excluded resource within the first or second nine months of receipt of the settlement.

(c) For an indefinite period, if the settlement is from federal relocation assistance.

(d) Permanently, if the settlement is assistance received under the Disaster Relief and Emergency Assistance Act or other assistance provided under a federal statute because of a catastrophe which is declared to be a major disaster by the President of the United States, or is comparable assistance received from a state or local government or from a disaster assistance organization. Interest earned on this assistance is also excluded from resources. Any cash or in-kind items received as a settlement and excluded under this subsection are considered as available resources when not used within the allowable time periods.

(17) Insurance proceeds or other assets recovered by a Holocaust survivor.

(18) Pension funds owned by an ineligible spouse. Pension funds are defined as funds held in a(n):

(a) Individual retirement account (IRA) as described by the IRS code; or

(b) Work-related pension plan (including plans for self-employed persons, known as Keogh plans).

(19) Cash payments received from a medical or social service agency to pay for medical or social services are excluded for one calendar month following the month of receipt.

(20) SSA- or DVR-approved plans for achieving self-support (PASS) accounts, allowing blind or disabled persons to set aside resources necessary for the achievement of the plan's goals, are excluded.

(21) Food and nutrition programs with federal involvement. This includes Washington Basic Food, school reduced and free meals and milk programs and WIC.

(22) Gifts to, or for the benefit of, a person under eighteen years old who has a life-threatening condition, from an organization described in section 501 (c)(3) of the Internal Revenue Code of 1986 which is exempt from taxation under section 501(a) of that code, as follows:

(a) In-kind gifts that are not converted to cash; or

(b) Cash gifts up to a total of two thousand dollars in a calendar year.

(23) Veteran's payments made to, or on behalf of, natural children of Vietnam veterans regardless of their age or marital status, for any disability resulting from spina bifida suffered by these children.

(24) The following are among assets that are not considered resources and as such are neither excluded nor counted:

(a) Home energy assistance/support and maintenance assistance;

(b) Retroactive in-home supportive services payments to ineligible spouses and parents; and

(c) Gifts of domestic travel tickets. For a more complete list please see POMS @ http://policy.ssa.gov/poms.nsf/lnx/0501130050.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

  1. An approved Plan for Achieving Self-Support (PASS) for a blind or disabled client needs to be signed by SSA or DVR staff in order for the resources to be excluded. Resources and income included in the PASS are not counted for eligibility or post-eligibility determinations while the PASS is in place, according to 20 CFR 416.1180 (income) and 20 CFR 416.1225 (resources).

  2. Funds that are excludable by federal law must be identifiable in order to be excluded. This does not mean they must be in a physically separate account, but workers must be able to see that excluded funds have not been used for anything other than the intention of the exclusion.

  3. When excluded funds are commingled with non-excluded funds and there is a withdrawal from that commingled account, assume that the non-excluded funds are removed prior to any excluded funds being removed.

  4. Excluded funds contained in a restricted Individual Indian Money (IIM) account includes both money that is held in an IIM account pursuant to a tribal credit hold (withheld with BIA consent to repay a loan) and accounts to minors or incapacitated adults that are supervised on a regular basis by the BIA.

  5. Good sources of information for resource exclusion under Federal law include the:

    1. Social Security Program Operation Manual System (POMS) @ https://secure.ssa.gov/apps10/poms.nsf/lnx/0501130050  SI 01130.050 (a chart showing exclusions with references to specific rules), and

    2. Code of Federal Regulations (CFR) at 20 CFR 416.1182 subpart K appendix. The internet site for the CFR is http://www.access.gpo.gov/nara/cfr/cfr-table-search.html.

Modification Date: May 2, 2014