EAZ	Search All DSHS manuals ACES EAZ Social Services WCCC Work First   for:
Acronyms  Revisions  WAC Number Index  Site Map  WCCC  DSHS Home

Standards - Medical Assistance Programs

Revised July 3, 2008

Purpose: The following medical assistance countable income and resource standards are used to determine eligibility when cash assistance is not involved. See the following categories for eligibility and computation factors:

WAC 388-478-0065 Income and resource standards for family medical programs. WAC 388-478-0070 Monthly income and countable resource standards for medically needy (MN). WAC 388-478-0075 Medical programs --Monthly income standards based on the federal poverty level (FPL). WAC 388-478-0080 Supplemental Security Income (SSI) standards; SSI-related categorically needy income level (CNIL); and countable resource standards. WAC 388-478-0085 Medicare savings programs--Monthly income standards.

ADULT MEDICAL PROGRAMS, FAMILY MEDICAL PROGRAMS, PREGNANCY, INCOME, RESOURCES, and SPENDDOWN.

WAC 388-478-0065 Effective August 14, 2005 WAC 388-478-0065 Income and resource standards for family medical programs. The categorically needy income level (CNIL) standard for family medical is the same as the grant payment standards for the TANF cash program as stated in WAC 388-478-0020. The countable resource standards for family medical are the same as those of the TANF/SFA cash program as stated in WAC 388-470-0005.  Each unborn child is counted as a household member when determining household size for: Family medical Pregnancy medical; and Children's medical. 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 The current income and resource standards for family medical programs are as follows. Assistance Unit Size Payment Standard Assistance Unit Size Payment Standard 1 $359 6 $866 2 453 7 1000 3 562 8 1,107 4 661 9 1,215 5 762 10 or more 1,321 The income standards for family medical assistance units with shelter provided at no cost are: Assistance Unit Size Payment Standard Assistance Unit Size Payment Standard 1 $218 6 $526 2 276 7 608 3 341 8 673 4 402 9 739 5 464 10 or more 803 The resource standard for an applying family is $1000. There is no resource limit for continuing recipient families. To see the complete list of Medical Assistance Standards, please go to Medical Income and Resource Standards Chart (pdf)

WAC 388-478-0070 Effective May 20, 2008 WAC 388-478-0070 Monthly income and countable resource standards for medically needy (MN).   Changes to the Medically Needy Income Level (MNIL) occur on January 1st of each calendar year.  Current income standards can be found at http:www1.dshs.wa.gov/pdf/esa/manual/Standards_C_MedAsst_Chart/pdf. Medically Needy (MN) standards for persons who meet institutional status requirements are in WAC 388-513-1395.  The standard for a client who lives inan alternate living facility can be found in WAC 388-513-1305. Find the resource standards for institutional programs in WAC 388-513-1350.  The institutional standard chart can be found at http://www1.dshs.wa.gov/manuals/eaz/sections/lLongTermCare/LTCstandardspna.shtml. Countable resource standards for the MN program are: One person $2,000. Two persons $3,000. For each additional family member add $50. 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 To see the complete list of Medical Assistance Standards, please go to Medical Income and Resource Standards Chart (pdf) Eligibility for MN is limited to children, pregnant women, or adults who are aged, blind, or disabled. See FAMILY MEDICAL PROGRAMS and ADULT MEDICAL PROGRAMS. Under the MN program, a person whose income is more than the MNIL can use medical expenses to reduce income. See SPENDDOWN. Income and resource standards for long term care services are found in LONG TERM CARE.

WAC 388-478-0075 Effective March 14, 2008 WAC 388-478-0075 Medical programs --Monthly income standards based on the federal poverty level (FPL). Each year, the federal government publishes new federal poverty level (FPL) income standards in the Federal Register found at http://aspe.hhs.gov/poverty/index.shtml. The income standards for the following medical programs change on the first of April every year based on the new FPL: Pregnant women's program up to one hundred eighty-five percent of FPL. Children's healthcare programs up to two hundred percent of FPL. Healthcare for workers with disabilities (HWD) up to two hundred twenty percent of FPL. Premium-based coverage under the children's healthcare programs over two hundred percent of FPL but not over two hundred fifty percent of FPL. The department uses the FPL income standards to determine: The mandatory or optional Medicaid status of an individual. Premium amount, if any, for a child. There are no resource limits for the programs under this section. 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 The medical income standards for programs based on the FPL are as follows (See Appendix II for Medicare Savings Program Standards): Assistance Unit Size 100% FPL 133% FPL 150% FPL 185% FPL 1 $867 $1153 $1300 $1604 2 1167 1552 1750 2159 3 1467 1951 2200 2714 4 1767 2350 2650 3269 5 2067 2749 3100 3824 6 2367 3148 3550 4379 7 2667 3547 4000 4934 8 2967 3946 4450 5489 9 3267 4345 4900 6044 10 3567 4744 5350 6599 Per person over 10 300 399 450 555   Assistance Unit Size 200% FPL 220% FPL 250% FPL 1 $1,734 $1,908 $2,167 2 2,334 2,568 2,917 3 2,934 3,228 3,667 4 3,534 3,888 4,417 5 4,134 4,548 5,167 6 4,734 5,208 5,917 7 5,334 5,868 6,667 8 5,934 6,528 7,417 9 6,534 7,188 8,167 10 7,134 7,848 8,917 Per person over 10 600 660 750 To see the complete list of Medical Assistance Standards, please go to Medical Income and Resource Standards Chart (pdf) An unborn or confirmed multiple unborns are counted as family members when determining family (Assistance Unit) size. There are no resource limits for the pregnant women's and children's (CN) or HWD programs when using the FPL income standards. If the income of an Assistance Unit exceeds the FPL standards, consider eligibility for the MN program using the MNIL income standards in WAC 388-478-0070. When using the MNIL standards, the MN countable resource standards apply to the pregnant women's program, but no resource standards apply to the children's MN or children's health programs. See Appendix I for the FPL income standards for medical programs.

WAC 388-478-0080 Effective January 1, 2006 WAC 388-478-0080 Supplemental Security Income (SSI) standards; SSI-related categorically needy income level (CNIL); and countable resource standards. Emergency effective 1/1/07 Emergency The SSI payment standards, also known as the federal benefit rate (FBR), beginning January 1, 2007 are: Living alone (in own home or alternate care, does not include nursing homes or medical situations) Individual $637 Individual with an ineligible spouse $637 Couple $956 Shared living (in the home of another) Individual $424.67 Individual with an ineligible spouse $424.67  Couple $667.34 Living in an institution Individual $ 30   See WAC 388-478-0055 for the amount of the state supplemental payments (SSP) for SSI recipients. The SSI-related CNIL standards are: Single person $637 A married couple - both eligible $956 Supplied shelter - single person $424.67 Supplied shelter couple - both eligible $637 The countable resource standards for SSI and SSI-related CN medical programs are: One person $2,000 A legally married couple $3,000 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 The medical income SSI/CNIL standards are as follows: SSI/CNIL Standards Single Eligible Person Couple Both Eligible CNIL Income $637 $956 FBR (SSI Standard) 667 956 1/2 FBR 318.50 NA Shared Living FBR 424.67 637.34 SSI Resources 2000 3000 If income exceeds the CNIL standard, consider the MN program. See: SPENDDOWN To see the complete list of Medical Assistance Standards, please go toMedical Income and Resource Standards Chart (pdf)

WAC 388-478-0085 Effective August 4, 2006 WAC 388-478-0085 Medicare savings programs--Monthly income standards. The income standards for Medicare Savings Programs change each year based on the federal poverty level (FPL) published yearly by the federal government in the Federal Register at http://aspe.hhs.gov/poverty/index.shtml. The qualified Medicare beneficiary (QMB) program income standard is up to one hundred percent of the federal poverty level (FPL). The specified low-income Medicare beneficiary (SLMB) program income standard is over one hundred percent of FPL, but not more than one hundred twenty percent of FPL. The qualified individual (QI-1) program income standard is over one hundred percent of FPL, but not more than one hundred thirty-five percent of FPL.   The qualified disabled working individual (QDWI) program income standard is two hundred percent of FPL . 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.

Footnote1: These standards are based on the poverty level for the 48 contiguous states. It excludes Alaska and Hawaii because of a higher cost of living. CLARIFYING INFORMATION See Appendix II for the Medicare Saving Programs income standards and resources. To see the complete list of Medical Assistance Standards, please go to Medical Income and Resource Standards Chart (pdf)

---

Modification Date: July 3, 2008

Have comments on the manual? Please e-mail us. You can also use this link to report broken links or content problems.