Standards - Medical Assistance Programs
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Standards - Medical Assistance Programs


Revised April 22, 2013



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 182-505-0100Medical programs-- Monthly income standards based on the federal poverty level (FPL).
WAC 182-505-0245Income and resource standards for family medical programs.
WAC 182-512-0010Supplemental Security Income (SSI) standards; SSI-related categorically needy income level (CNIL); and countable resource standards.
WAC 182-517-0100Medicare savings programs--Monthly income standards.
WAC 182-519-0050Monthly income and countable resource standards for medically needy (MN).

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

WAC 182-505-0245

WAC 182-505-0245

Effective October 1, 2013

WAC 182-505-0245 REPEALED -- Income and resource standards for family medical programs.



REPEALED ON OCTOBER 1, 2013.

  1. The categorically needy income level (CNIL) standards for family medical are:

    a. For assistance units with obligations to pay shelter costs:

 Assistance Unit Size

 Payment Standard

 1

$359

 2

453 

 3

562 

 4

661 

 5

762 

 6

866 

 7

1,000 

 8

1,107 

 9

1,215 

 10 or more

1,321 

 

b. For assistance units with shelter provided at no cost:

 

 Assistance Unit Size

Payment Standard

 1

 $218

 2

 276

 3

 341

 4

 402

 5

 464

 6

 526

 7

 608

 8

 673

 9

 739

 10 or more

 803

 

2.   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

3.   Each unborn child is counted as a household member when determining household size for:

a.  Family medical;

b.  Pregnancy medical; and

c.   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

  1. To see the complete list of Medical Assistance Standards, please go to Medical Income and Resource Standards Chart (pdf)The resource standard for an applying family is $1000. There is no resource limit for continuing recipient families.


WAC 182-519-0050

WAC 182-519-0050

Effective October 20, 2012

WAC 182-519-0050 Monthly income and countable resource standards for medically needy (MN).

  1. Changes to the Medically Needy Income Level (MNIL) occur on January 1st of each calendar year when the Social Security Administration (SSA) issues a cost-of-living adjustment for that year.
  2. Medically Needy (MN) standards for persons who meet institutional status requirements are in WAC 388-513-1395.  The standard for a client who lives in an alternate living facility can be found in WAC 388-513-1305.
  3. The resource standards for institutional programs are found in WAC 388-513-1350.  The institutional standard chart can be found at http://www.dshs.wa.gov/manuals/eaz/sections/LongTermCare/LTCstandardspna.shtml

  4. Countable resource standards for the noninstitutional MN program are:

    1. One person $2,000.

    2. Two persons $3,000.

    3. For each additional family member add $50.

  5. For individuals who do not meet institutional status requirements, the income standard used to determine eligibility for the medically needy program is the "effective" MNIL.  The "effective" MNIL is the one-person federal benefit rate (FBR) established by SSA each year, or the MNIL listed below, whichever amount is higher.  The FBR is the supplemental security income (SSI) payment standard.  For example, in 2012 the FBR is six hundred ninety-eight dollars.

 

1

2

3

4

5

6

7

8

9

10

467

592

667

742

858

975

1125

1242

1358

1483

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. 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.

  2. Under the MN program, a person whose income is more than the MNIL can use medical expenses to reduce income. See SPENDDOWN.

  3. Income and resource standards for long term care services are found in LONG TERM CARE.


WAC 182-505-0100

WAC 182-505-0100

Effective October 1, 2013

WAC 182-505-0100 Washington apple health -- Monthly income standards based on the federal poverty level (FPL).



(1) 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 Washington apple health (WAH) programs change on the first day of April every year based on the new FPL:

(a) WAH for parents and caretaker relatives up to fifty-four percent of FPL (see WAC 182-505-0240). Parents and caretaker relatives whose earned income exceeds this limit are the only persons who may be eligible for the WAH transitional medical program as described in WAC 182-523-0100;

(b) Modified adjusted gross income (MAGI)-based WAH for adults up to one hundred thirty-three percent of FPL;

(c) WAH for pregnant women up to one hundred ninety-three percent of FPL;

(d) WAH for children up to two hundred ten percent of FPL; and

(e) Premium-based coverage under WAH for children over two hundred ten percent of FPL, but not over three hundred twelve percent of FPL.

(2) The agency uses the FPL income standards to determine the premium amount, if any, for a child.

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 medical income standards for programs based on the FPL can be found at:  Medical Income and Resource Standards Chart (pdf). An unborn or confirmed multiple unborns are counted as family members when determining family (Assistance Unit) size.

  2. There are no resource limits for the pregnant women's and children's (CN) or HWD programs when using the FPL income standards.

  3. If the income of an Assistance Unit exceeds the FPL standards, consider eligibility for the MN program using the MNIL income standards in WAC 182-519-0050.

  4. 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.


WAC 182-512-0010

WAC 182-512-0010

Effective November 21, 2011

WAC 182-512-0010 Supplemental Security Income (SSI) standards; SSI-related categorically needy income level (CNIL); and countable resource standards.

1.  SSI payment standards, also known as the federal benefit rate (FBR), change each January 1.

 

2.  See WAC 388-478-0055 for the amount of the state supplemental payments (SSP) for SSI recipients.

 

3.  See WAC 388-513-1305  for standards of clients living in an alternate living facility.  

 

4.  The SSI-related CNIL [Categorically Needy Income Level] standards are the same as the SSI payment standards for single persons and couples.  Those paying out shelter costs have a higher standard than people who have supplied shelter.

 

5.  The countable resource standards for SSI and SSI-related CN medical programs are:

a. One person $2,000.

b. 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

  1. To see the complete list of Medical Assistance Standards, please go to Medical Income and Resource Standards Chart (pdf)If income exceeds the CNIL standard, consider the MN program. See: SPENDDOWN


WAC 182-517-0100

WAC 182-517-0100

Effective November 21, 2011

WAC 182-517-0100 Medicare savings programs--Monthly income standards.

  1. 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).

  2. 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.

  3. 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.  

  1. 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

  1. To see the complete list of Medical Assistance Standards, please go to Medical Income and Resource Standards Chart (pdf).

Modification Date: April 22, 2013