SSI-Related Medical - Income
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SSI-Related Medical - Income


Revised April 22, 2013



Purpose: To describe how various types and amounts of income affect a client’s eligibility and benefit level for either Categorically Needy (CN) or Medically Needy (MN) medical coverage.

WAC 182-512-0600SSI related medical -- Definition of income.
WAC 182-512-0650SSI related medical -- Available income.
WAC 182-512-0700SSI related medical -- Income eligibility.
WAC 182-512-0750SSI related medical -- Countable unearned income.
WAC 182-512-0800SSI-related medical -- General Income Exclusions
WAC 182-512-0820SSI-related medical --Child-related income exclusions and allocations.
WAC 182-512-0840SSI-related medical -- Work- and agency-related income exclusions.
WAC 182-512-0860SSI-related medical -- Income exclusions under federal statute or other state laws.
WAC 182-512-0880Special Income disregards for SSI-related medical programs
WAC 182-512-0900SSI-related medical -- Deeming and allocating of income.
WAC 182-512-0920SSI-related medical -- Deeming/allocation of income from nonapplying spouse.
WAC 182-512-0940SSI-related medical -- Deeming income from an ineligible parent(s) to a child applying for SSI-related medical.
WAC 182-512-0960SSI-related medical - Allocating income - How the department considers income and resources when determining eligibility for an individual applying for noninstitutional medicaid when another household member is receiving institutional medicaid.

  • Income Eligibility

  • Availability of Income

  • Income Exclusions

  • Special Income Types

  • Income Allocation

See also Chapter 388-450 WAC (Income) and Chapter 388-517 WAC (Medicare Savings Programs).

There are Federal laws requiring the department to exclude some receipts for varying amounts of time. One example of these exclusions is Earned Income Tax Credit (EITC). We do not count the receipt of EITC or Advanced EITC as either a resource or earned income in the month of receipt or the next month. However, any retained amount from the EITC is considered a resource in the SECOND month after the month of receipt (20 CFR 416.1235)


WAC 182-512-0600

WAC 182-512-0600

Effective October 1, 2013

WAC 182-512-0600 SSI-related medical -- Definition of income.



(1) Income is anything a person receives in cash or in-kind that can be used to meet his/her needs for food, or shelter. Income can be earned or unearned.

(2) Some receipts are not income because they do not meet the definition of income above, including:

(a) Cash or in-kind assistance from federal, state, or local government programs whose purpose is to provide medical care or services;

(b) Some in-kind payments that are not food, clothing or shelter coming from nongovernmental programs whose purposes are to provide medical care or medical services;

(c) Payments for repair or replacement of an exempt resource;

(d) Refunds or rebates for money already paid;

(e) Receipts from sale of a resource;

(f) Replacement of income already received (see 20 C.F.R. 416.1103 for a more complete list of receipts that are not income); and

(g) Receipts from extraction of exempt resources for a member of a federally recognized tribe.

(3) Earned income includes the following types of payments:

(a) Gross wages and salaries, including garnished amounts;

(b) Commissions and bonuses;

(c) Severance pay;

(d) Other special payments received because of employment;

(e) Net earnings from self-employment (WAC 182-512-0840 describes earnings exclusions);

(f) Self-employment income of tribal members unless the income is specifically exempted by treaty;

(g) Payments for services performed in a sheltered workshop or work activities center;

(h) Royalties earned by a person in connection with any publication of his/her work and any honoraria received for services rendered; and

(i) In-kind payments made in lieu of cash wages, including the value of food, clothing or shelter.

(4) Unearned income is all income that is not earned income. Some types of unearned income are:

(a) Annuities, pensions, and other periodic payments;

(b) Alimony and support payments;

(c) Dividends and interest;

(d) Royalties (except for royalties earned by a person in connection with any publication of his/her work and any honoraria received for services rendered which would be earned income);

(e) Capital gains;

(f) Rents;

(g) Benefits received as the result of another's death to the extent that the total amount exceeds the expenses of the deceased person's last illness and burial paid by the recipient;

(h) Gifts;

(i) Inheritances;

(j) Prizes and awards; and

(k) Amounts received by tribal members from gaming revenues.

(5) Some items which may be withheld from income, but which the agency considers as received income are:

(a) Federal, state, or local income taxes;

(b) Health or life insurance premiums;

(c) SMI premiums;

(d) Union dues;

(e) Penalty deductions for failure to report changes;

(f) Loan payments;

(g) Garnishments;

(h) Child support payments, court ordered or voluntary (WAC 182-512-0900 has an exception for deemors);

(i) Service fees charged on interest-bearing checking accounts;

(j) Inheritance taxes; and

(k) Guardianship fees if presence of a guardian is not a requirement for receiving the income.

(6) Countable income, for the purposes of this chapter, means all income that is available to the person:

(a) If it cannot be excluded; and

(b) After deducting all allowable disregards and deductions.

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

Items an individual may receive that are not considered income include:

  • Food and shelter received during a medical confinement;

  • Weatherization assistance;

  • Receipt of non-cash items that will be an excluded resource in the following month;

  • Proceeds from a loan the individual takes out; or

  • Bills paid by someone else directly.


NOTE:

Proceeds from timber sales are considered a resource, not income, in the month received. This was a court decision – conversion of a resource: Cootes v. Sullivan, No. 91 36073 (9th Cir. 1992).


EXAMPLE

Riley just bought his first home. He paid the closing costs that were on the papers, and a month later was sent $300 because the actual closing costs were less than estimated. The $300 is not income; it is a refund of money he already paid.


EXAMPLE

Debbie just sold her 1989 Toyota because she decided to use public transportation instead of spending money on car repairs. The money she gets for selling the car is not income. She exchanged one resource (the car) for another (cash).


WAC 182-512-0650

WAC 182-512-0650

Effective October 1, 2013

WAC 182-512-0650 SSI-related medical -- Available income.



(1) Income is considered available to a person at the earliest of when it is:

(a) Received; or

(b) Credited to a person's account; or

(c) Set aside for his or her use; or

(d) Can be used to meet the person's needs for food or shelter.

(2) Anticipated nonrecurring lump sum payments are treated as income in the month received, with the exception of those listed in WAC 182-512-0700(5), and any remainder is considered a resource in the following month.

(3) Reoccurring income is considered available in the month of normal receipt, even if the financial institution posts it before or after the month of normal receipt.

(4) In-kind income received from anyone other than a legally responsible relative is considered available income only if it is earned income.

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. When recurring income is received in advance or electronically deposited in the client’s account, the income is considered available for the month it would normally be received. For example: if the Social Security check normally received in February is electronically deposited on January 31st because February 1st is on a weekend, the income is still counted for February.

  2. Unanticipated non-recurring lump sums cannot be counted as income in the month received because medical programs must budget prospectively and can only count income that can be anticipated. However, any amounts remaining the first of the month after the month of receipt are considered a resource.

  3. Income that has been anticipated in a different amount than was actually received is not an overpayment if the anticipated amount was reasonable. If the anticipated amount was based on false information or information known at the time to be incomplete, or if the department made an error in calculation, there may be an overpayment.


WAC 182-512-0700

WAC 182-512-0700

Effective October 1, 2013

WAC 182-512-0700 SSI-related medical -- Income eligibility.



(1) In order to be eligible, a person is required to do everything necessary to obtain any income to which he or she is entitled including (but not limited to):

(a) Annuities;

(b) Pensions;

(c) Unemployment compensation;

(d) Retirement; and

(e) Disability benefits; even if their receipt makes the person ineligible for agency services, unless the person can provide evidence showing good reason for not obtaining the benefits.

(2) The agency does not count this income until the person begins to receive it. Income is budgeted prospectively for all Washington apple health (WAH) health care programs.

(3) Anticipated nonrecurring lump sum payments other than retroactive SSI/SSDI payments are considered income in the month received, subject to reporting requirements in WAC 182-504-0110. Any unspent portion is considered a resource the first of the following month.

(4) The agency follows income and resource methodologies of the supplemental security income (SSI) program defined in federal law when determining eligibility for WAH SSI-related medical or medicare savings programs unless the agency adopts rules that are less restrictive than those of the SSI program.

(5) Exceptions to the SSI income methodology:

(a) Lump sum payments from a retroactive SSDI benefit, when reduced by the amount of SSI received during the period covered by the payment, are not counted as income;

(b) Unspent retroactive lump sum money from SSI or SSDI is excluded as a resource for nine months following receipt of the lump sum; and

(c) Both the principal and interest portions of payments from a sales contract, that meet the definition in WAC 182-512-0350(10), are unearned income.

(6) To be eligible for WAH categorically needy (CN) SSI-related health care coverage, a person's countable income cannot exceed the WAH CN program standard described in:

(a) WAC 182-512-0010 for noninstitutional WAH coverage unless living in an alternate living facility; or

(b) WAC 182-513-1305(2) for noninstitutional WAH CN coverage while living in an alternate living facility; or

(c) WAC 182-513-1315 for institutional and waiver services coverage.

(7) To be eligible for SSI-related health care coverage provided under the WAH medically needy (MN) program, a person must:

(a) Have countable income at or below the effective WAH MN program standard as described in WAC 182-519-0050;

(b) Satisfy spenddown requirements described in WAC 182-519-0110;

(c) Meet the requirements for noninstitutional WAH MN coverage while living in an alternate living facility (ALF). See WAC 182-513-1305(3); or

(d) Meet eligibility for institutional WAH MN coverage described in WAC 182-513-1315.

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

Anticipated non-recurring lump sum payments are those such as a structured settlement with a defined date of receipt. For example, a client reports on April 10 that she will receive a settlement on a lawsuit that specifies a payment of $5,000 on 7/1. We can anticipate the $5,000 receipt in July and count that as income for July. If the client has $100 of that money left on 8/1, that $100 would be counted as a resource effective 8/1.


WAC 182-512-0750

WAC 182-512-0750

Effective October 1, 2013

WAC 182-512-0750 SSI-related medical -- Countable unearned income.



The agency counts unearned income for Washington apple health (WAH) SSI-related medical programs as follows:

(1) The total amount of income benefits to which a person is entitled is treated as available unearned income even when the benefits are:

(a) Reduced through the withholding of a portion of the benefit amount to repay a legal obligation;

(b) Garnished to repay a debt, other legal obligation, or make any other payment such as payment of medicare premiums.

(2) Payments received on a loan:

(a) Interest paid on the loan amount is considered unearned income; and

(b) Payments on the loan principal are not considered income. However, any amounts retained on the first of the following month are considered a resource.

(3) Money borrowed by a person, which must be repaid, is not considered income. It is considered a loan. If the money received does not need to be repaid, it is considered a gift.

(4) Rental income received for the use of real or personal property, such as land, housing or machinery is considered unearned income. The countable portion of rental income received is the amount left after deducting necessary expenses of managing and maintaining the property paid in that month or carried over from a previous month. Necessary expenses are those such as:

(a) Advertising for tenants;

(b) Property taxes;

(c) Property insurance;

(d) Repairs and maintenance on the property; and

(e) Interest and escrow portions of a mortgage.

NOTE: When a person is in the business of renting properties and actively works the business (over twenty hours per week), the income is counted as earned income.

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.

NOTE: When a client is in the business of renting properties and actively works the business (over twenty hrs per week), the income is counted as earned income.

CLARIFYING INFORMATION

  1. Self-employment income is based on the net earnings reported on the federal income tax return. See Worker Responsibility.

  2. Income and resources of spouses are considered available to each other through the end of the month in which the spouses stop living together. See Long Term Care for exceptions.

  3. Child support paid by the client is not an allowable income exclusion for SSI-related medical eligibility (20 CFR 416.1123(b)(2), POMS 00830.115)  Child support paid by the non-applying spouse of an SSI-related applicant is an allowable deduction for the spouse.

  4. Income payments received from annuities, pension funds and/or retirement funds are considered unearned income when the fund itself is not available as a resource.

  5. Goods and services received “in-kind” from an employer are considered differently depending on the classification of the employee. For example: an apartment manager’s housing, provided by an employer, is earned income, while a migrant farm worker’s housing, provided by the employer, is not considered as income for SSI-related medical purposes.

  6. Income (such as fishing income) of tribal members is counted as self-employment income unless the income is specifically excluded due to exercise of treaty rights. A tribal member working for a specific business (such as a retail store or restaurant) is considered an employee of that business, unless that tribal member owns the business. If the business is owned by the tribe, the tribal member is still considered an employee.

  7. For an in-kind payment to be considered income it must be food, clothing, shelter or something that can be used to get food, clothing or shelter.

  8. When it is necessary to place a value on them, in-kind payments are valued at current market value.

  9. In-kind income in the form of food or shelter that is provided by an employer is countable earned income unless:

    1. It is provided on the employer’s premises;

    2. It is provided for the employer’s convenience; and, if it is shelter,

    3. Its acceptance by the employee is a condition of employment. In these cases, the income is considered unearned.

  10. Rent payments received from roomers and/or boarders are considered unearned income.

  11. Money paid by a person who is “sharing” the cost of food and/or housing (rent, utilities, etc.) is not considered income. Housing costs are adjusted according to how they are “shared”. For example, if the apartment rent is $750 per month and a husband, wife and child are sharing the costs with an unrelated person, only the costs that each AU pays is allowed for that shelter expense. If the family pays $500 and the other person, $250, then the shelter cost for the family is $500. If that family only pays ½ of the rent for the apartment ($375), then $375 is considered their shelter cost.

  12. The interest portion of payments on sales and/or real estate contracts owned by a client who is resource eligible is counted as unearned income when the combined value of all resources is at or below the resource standard. Count only the portion of the payment that goes toward interest as unearned income.

  13. Puyallup Tribe Settlement Income: Budget interest income from the annuity fund payment or the initial investments as newly acquired income.

  14. Receipt of gaming money by tribal members is considered unearned income in the month received. Gaming money set aside in trust funds by the tribe is not considered available until it may be accessed by the tribal member for whom it is set aside.


EXAMPLE

A tribe pays $5,000 per month gaming money to each tribal member. For tribal members under age 18, $4,000 per month is set-aside in a trust fund which can be used by the child on or after the 18th birthday. The $1,000 received each month is considered income in the month received. The $4,000 per month set-aside is not considered until the child reaches 18. The month after the child turns 18, any money remaining from the trust fund is considered an available resource and that month’s $5,000 is considered income.


  1. Life insurance policy benefits, which an SSI-related client receives as a beneficiary, are counted as unearned income, except for any of the money spent on the insured’s (deceased person’s) last illness and burial expenses.

  2. Funds that do not represent an appreciable gain are not counted as income, including:

    1. Receipts from the sale or exchange of a resource;

    2. Money borrowed or receipt of repayment on a loan;

    3. Payments made replacing income that has been lost, stolen or destroyed;

    4. Interest left to accumulate on funds set aside for burial.

  3. In-kind support or payments made by friends or families providing items not covered by Medicaid, (e.g. payment for rent, telephone or cable services), or payments of bills incurred by the client that are paid directly to the persons owed, are not counted as income.

  4. Cash provided by any non-governmental medical services program or under a health insurance policy (except cash to cover food, clothing or shelter) is not counted when it is:

    1. Repayment of medical care, prescriptions or medical services the client has already paid for, or

    2. A payment restricted to the future purchase of such services.

  5. Interest earned on excluded income and resources is considered unearned income and appropriate disregards may apply.

  6. Unearned income that is used to pay personal income taxes is not excluded.

  7. Home equity conversion plans: a security interest in the home is given in exchange for a lump sum, a periodic cash payment, or a line of credit. The most common home equity conversion plan is a reverse mortgage that allows the homeowner to borrow from the equity in the home with no repayment as long as they live in the home. The funds received under a home equity conversion plan are a loan, and thus do not count as income; however:

    1. Interest earned on any money received under the home conversion plan is considered unearned income, and

    2. Money retained into the following month is considered a resource as of the first of the month following the month of receipt.


WORKER RESPONSIBILITIES

  1. Self-employment income – How to determine:

    1. Use the most recent tax return whenever it is available:

      1. If unavailable, use the business records that show profit and loss to verify the most recent tax year’s income.

      2. Current business records can also be used if the client’s circumstances have changed so much that the use of the tax return would be inaccurate.

    2. Assume that any deductions taken on the tax return or business records as allowable by the IRS, absent evidence to the contrary.

    3. Divide the net earnings by the number of months the business existed to obtain a monthly total.

    4. Verified net loss can reduce other income. Divide the total net loss by the number of months the business existed before subtracting it from the net average monthly profit in #3 above.

    5. Apply income disregards to the net earnings from self-employment.

    6. Explain and document any significant decrease in net income from the last tax year to the current one.

    7. Obtain updated verification of self-employed income annually.

  2. Rental income from rental property (excluding renting a room within the home) – How to determine:

    1. Deduct the usual and necessary expenses paid in a month (not just incurred in that month) from the gross rental income received in that month, including:

      1. Interest and escrow portions of a mortgage payment including taxes and insurance;

      2. Real estate insurance and relevant taxes if paid separately from the mortgage payment;

      3. Utilities that are paid from the rental amount;

      4. Repairs and maintenance to the rental property;

      5. Yard maintenance such as lawn mowing and snow removal;

      6. Cost of advertising for tenants;

      7. Other necessary expenses as allowed by the IRS, except depreciation.

If the expenses paid in one month are more than the gross rental income received in that month, carry the excess expenses over into the next month and subtract from the gross rental income received in that month.

  1. Income from sales and real estate contracts: only the amount of the underlying mortgage is deducted from payments received from the contract. See the Resource section, WAC 182-512-0350 for treatment of payments made under sales and real estate contracts.

  2. Expenses related to hospital, medical, funeral and interment expenses can be excluded from the life insurance payment by a beneficiary.


EXAMPLE

An SSI-related client receives $2,000 from her uncle’s life insurance policy. She spends $900 on his last illness and burial expenses. Count $1,100 as unearned income in the month it is received


WAC 182-512-0800

WAC 182-512-0800

Effective October 1, 2013

WAC 182-512-0800 SSI-related medical -- General Income Exclusions



The agency excludes, or does not consider, the following when determining a person's eligibility for Washington apple health (WAH) SSI-related medical programs:

(1) The first twenty dollars per month of unearned income. If there is less than twenty dollars of unearned income in a month, the remainder is excluded from earned income in that month.

(a) The twenty-dollar limit is the same, whether applying it for a couple or for a single person.

(b) The disregard does not apply to income paid totally or partially by the federal government or a nongovernmental agency on the basis of an eligible person's needs.

(c) The twenty dollars disregard is applied after all exclusions have been taken from income.

(2) Income that is not reasonably anticipated or is received infrequently or irregularly, whether for a single person or each person in a couple when it is:

(a) Earned and does not exceed a total of thirty dollars per calendar quarter; or

(b) Unearned and does not exceed a total of sixty dollars per calendar quarter;

(c) An increase in a person's burial funds that were established on or after November 1, 1982, if the increase is the result of:

(i) Interest earned on excluded burial funds; or

(ii) Appreciation in the value of an excluded burial arrangement that was left to accumulate and become part of separately identified burial funds.

(3) Essential expenses necessary for a person to receive compensation (e.g., necessary legal fees in order to get a settlement).

(4) Receipts, which are not considered income, when they are for:

(a) Replacement or repair of an exempt resource;

(b) Prepayment or repayment of medical care paid by a health insurance policy or medical service program; or

(c) Payments made under a credit life or credit disability policy.

(5) The fee a guardian or representative payee charges as reimbursement for providing services, when such services are a requirement for the person to receive payment of the income.

(6) Funds representing shared household costs.

(7) Crime victim's compensation.

(8) The value of a common transportation ticket, given as a gift, that is used for transportation and not converted to cash.

(9) Gifts that are not for food, clothing or shelter, and gifts of home produce used for personal consumption.

(10) The agency does not consider in-kind income received from someone other than a person legally responsible for the person unless it is earned. Therefore, the following in-kind payments are not counted when determining eligibility for WAH SSI-related medical programs:

(a) In-kind payments for services paid by a person's employer if:

(i) The service is not provided in the course of an employer's trade or business; or

(ii) The service is in the form of food that is on the employer's business premises and for the employer's convenience; or

(iii) The service is in the form of shelter that is on the employer’s business premises, for the employer's convenience, and required to be accepted by the employee as a condition of employment.

(b) In-kind payments made to people in the following categories:

(i) Agricultural employees;

(ii) Domestic employees;

(iii) Members of the uniformed services; and

(iv) Persons who work from home to produce specific products for the employer from materials supplied by the employer.

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 example of what the department excludes from income is:

    1. A payment the client received from their health insurance provider to repay the client for an amount spent to get prescriptions that are covered by the insurance;

    2. A payment to repair damage to the home ; or

    3. Replacement of the contents of a home due to a fire or flood.

  2. Home produce used for personal consumption and gifts that are not used for food, clothing or shelter are not counted because they are not defined as income by the Social Security Act.


WAC 182-512-0820

WAC 182-512-0820

Effective October 1, 2013

WAC 182-512-0820 SSI-related medical -- Child-related income exclusions and allocations.



(1) For the purposes of Washington apple health (WAH) SSI-related medical eligibility determinations under chapter 182-512 WAC, a child is defined as a person who is:

(a) Unmarried;

(b) Living in the household of the SSI-related applicant;

(c) The natural, adopted or stepchild of the SSI-related applicant or the applicant's spouse;

(d) Not receiving a needs-based cash payment such as TANF or SSI; and

(e) Either:

(i) Age seventeen or younger; or

(ii) Age twenty-one or younger and meets the SSI-related definition of a student described in subsection (6) of this section.

(2) The agency allows an allocation for the support of a child when determining the countable income of an SSI-related applicant. The allocation is calculated as follows:

(a) For WAH categorically needy (CN) health care coverage, the allocation is deducted from the countable income of a nonapplying spouse before determining the amount of the nonapplying spouse's income to be deemed to the SSI-related applicant. Allocations to children are not deducted from the income of an unmarried SSI-related applicant.

(b) For WAH medically needy (MN) medical coverage, the allocation is first deducted from the income of the nonapplying spouse as described in subsection (2)(a) of this section when the SSI-related applicant is married, and from the income of the applicant when the applicant is not married.

(3) The child's countable income, if any, is subtracted from the maximum child's allowance before determining the amount of allocation.

(4) Foster care payments received for a child who is not SSI-eligible and who is living in the household, placed there by a licensed, nonprofit or public child placement or childcare agency are excluded from income regardless of whether the person requesting or receiving SSI-related medical is the adult foster parent or the child who was placed.

(5) Adoption support payments, received by an adult for a child in the household that are designated for the child's needs, are excluded as income. Adoption support payments that are not specifically designated for the child's needs are not excluded and are considered unearned income to the adult.

(6) The agency excludes the earned income of a person age twenty-one or younger if that person is a student. In order to allow the student earned income exclusion, a student must:

(a) Attend a school, college, or university a minimum of eight hours a week; or

(b) Pursue a vocational or technical training program designed to prepare the student for gainful employment a minimum of twelve hours per week; or

(c) Attend school or be home schooled in grades seven through twelve at least twelve hours per week.

(7) Any portion of a grant, scholarship, fellowship, or gift used for tuition, fees and/or other necessary educational expenses at any educational institution is excluded from income and not counted as a resource for nine months after the month of receipt.

(8) One-third of child support payments received for a child who is an applicant for WAH SSI-related medical is excluded from the child's income. Child support payments that are subject to the one third deduction may be voluntary or court-ordered payments for current support or arrears.

(9) The one-third deduction described in subsection (8) of this section does not apply to child support payments received from an absent parent for a child living in the home when the parent(s) or their spouse is the applicant for SSI-related medical. Voluntary or court ordered payments for current support or arrears are always considered the income of the child for whom they are intended and not income to the parent(s).

(10) The following 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, are excluded:

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

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

(11) 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 are excluded from income. Any portion of a veteran's payment that is designed as the dependent's income is countable income to the dependent and not the applicant (assuming the applicant is not the dependent).

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 POMS SI 0820.510 lists the amount of a a child’s earned income exemption (See #7 in WAC 182-512-0820 for the student earned income exclusion).


WAC 182-512-0840

WAC 182-512-0840

Effective October 1, 2013

WAC 182-512-0840 SSI-related medical -- Work- and agency-related income exclusions.



The agency excludes the following when determining eligibility for Washington apple health (WAH) SSI-related medical programs:

(1) Work related expenses:

(a) That enable an SSI-related person to work; or

(b) That allows a blind or disabled person to work and that are directly related to the person's impairment.

(2) First sixty-five dollars plus one-half of the remainder of earned income. This is considered a work allowance/incentive. This deduction does not apply to income already excluded.

(3) Any portion of self-employment income normally allowed as an income deduction by the Internal Revenue Service (IRS).

(4) Earned income of a person age twenty-one or younger if that person meets the definition of a student as defined in WAC 182-512-0820.

(5) Veteran's aid and attendance, housebound allowance, unusual/unreimbursed medical expenses (UME) paid by the VA to some disabled veterans, their spouses, widows or parents. For people receiving WAH long-term care services, see chapter 182-513 WAC.

(6) Department of veterans affairs benefits designated for the veteran's dependent as long as the SSI-related applicant is not the dependent receiving the income. If an SSI-related applicant receives a dependent allowance based on the veteran's or veteran's survivor claim, the income is countable as long as it is not paid due to unusual medical expenses (UME).

(7) Payments provided in cash or in-kind, to an ineligible or nonapplying spouse, under any government program that provides social services provided to the person, such as chore services or attendant care.

(8) SSA refunds for medicare buy-in premiums paid by the person when the state also paid the premiums.

(9) Income that causes a person to lose SSI eligibility, due solely to reduction in the SSP.

(10) Tax rebates or special payments excluded under other statutes.

(11) Any public agency refund of taxes paid on real property or on food.

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

VETERANS BENEFITS

 

There are several different types of veteran’s benefits issued by the Veteran’s Administration (VA).  The benefit type, who the benefit is for, and what the benefit is intended for, determine how the department treats the income source for SSI-related medical purposes.  All VA income is considered countable unearned income for cash and food programs, but not all VA income is countable for SSI-related medicaid programs.

 

The VA publishes their current payment standards in the VA benefits chart which is available from the ADSA website.

 

Verification of VA income may be obtained by requesting a copy of the VA award letter or by using the information in the PARIS cross match.  The VA claim number must be coded in ACES to ensure the cross-match data is current and accurate.  Don't use bank statements or copies of checks to verify VA income as this doesn't verify the type of VA income, what benefits have been awarded to the veteran and who those benefits are intended for.

 

Listed below are the common types of VA income sources.  VA income may be needs-based which means other income affects the total VA payment or it may be compensation based on disability or death.

 

Service Connected Disability Compensation (VA code in ACES)

 

Service connected disability compensation is a benefit paid to a veteran because of injuries or diseases that happened while on active duty, or were made worse by active military service.  The benefits are issued tax-free and are based on the degree to which the VA determined the veteran was found disabled. These benefits are countable income for medicaid eligibility.  

Since these benefits aren't needs-based, other income of the veteran or their family is not taken into consideration when determining the amount of the payment, however the payment may include an amount for the veteran’s dependents (spouse and/or children).  Any portion of the VA payment designated as a dependent’s income must be split out of the total VA compensation amount and coded as that individual’s income.  It isn't considered the veteran’s income for medicaid purposes.


EXAMPLE

John receives VA compensation based on 40% disability.  He has two children under the age of 18.  The total payment John receives is $601 per month.  In reviewing the VA benefits Chart (page 2), the worker determined that the VA payment at 40% disability is $541 and that each child is awarded $30.  Code $541 as VA income on John's UNER screen and $30 as VA income on each of the children's UNER screens.


Dependency and Indemnity Compensation (DIC) (VW code in ACES)

 

DIC benefits are paid to eligible survivors (spouse or children) of deceased veterans.  DIC is not a needs-based program so other income received by the household isn't considered.  The amount that a survivor receives depends upon the veteran's date of death. The VA payment was based on a different formula for veterans who died prior to January 1, 1993.  After January 1993, the VA switched to a basic rate with add-on amounts for dependent children or aid and attendance expenses.  As with service-connected disability, any amount designated for a dependent child needs to identified and coded on that dependent’s screen in ACES.  Both the widow’s and the child’s income are countable income for Medicaid eligibility purposes, although any amount designated as aid and attendance would not be.

 


EXAMPLE

Betty is the surviving spouse of a veteran who was killed on active duty in 2009.  She has one child who is still in school, under the age of 21.  Betty receives a total VA payment of $1440.  This is made up of the $1154 basic rate payment which is coded on Betty's UNER screen and a dependent allowance of $286 which is coded as the child's income.  Use the VW code for ACES entry of DIC benefits on both individual's UNER screens.


If there is no surviving spouse, DIC benefits may be paid directly to children through the age of 18 or 21 if a student still in school.  DIC children’s benefits, when received directly by the child, are coded as VK in ACES.

 

Parent’s Dependency & Indemnity Compensation (VP code in ACES)

 

Parents’ DIC is a needs-based benefit for one or both parents of a veteran who died while on active duty, or from an illness or injury incurred while on active duty which led to the death of the veteran.  A parent includes a biological, adoptive or foster parent of the veteran.  Since this is a needs-based program, if the parent’s income exceeds the limit set by law, no benefit is payable. It is countable income for medicaid eligibility purposes.  All income received by the household is taken into consideration when determining the amount of the VA payment. 

 

The parent(s) may also be eligible to receive an additional amount to cover aid and attendance (A&A) expenses.  The VA benefits chart provides a breakdown of the payment amount and any A&A amount.   Amounts designated for A&A are not countable for Medicaid eligibility purposes and must be coded separately in ACES.  (More on Aid and Attendance later in this section).

 

 


EXAMPLE

Dawn and Jim's son, Brian, was killed on active duty in 2008.  Dawn is not working and Jim recently lost his job and is drawing unemployment benefits of $100 per week.  They receive a monthly VA payment of $374.  (This is based on the maximum VA benefit amount of $387 for each parent (see the bottom of page 1 of the VA benefit chart), less $400 in unemployment benefits).  The $374 VA benefit is coded in ACES as VP and split between both spouse's UNER screens.


Needs-based pensions

 

Disability pensions are benefits paid to wartime veterans with limited income who are no longer able to work.  Pensions are available to veterans, surviving spouses, and children if the veteran has qualifying service, there is financial need, and the veteran has a qualifying disability.  In addition to the veteran’s pension amount, the VA may increase the payment by a dependent allocation, an aid and attendance or housebound allowance, or monies to reimburse veterans for unusual medical expenses (UME). Any portion of the payment determined to be the pension is countable income to the veteran.  Any portion of the payment determined to be the dependent’s income is countable income to that dependent.  A&A, housebound allowance and UME are not countable income for the purposes of SSI-related medicaid and must be separated out of the total payment amount and coded separately in ACES.

 

Currently, the only pension program that the VA accepts applications for is the Improved Pension.  However veterans who applied for a pension prior to 01/01/1979 may be receiving one of the following pension types:

  • Old Law Disability or Death Pension
  • Section 306 Disability or Death Pension; or
  • Improved Pension if the veteran elected that plan at that time. 

 

Old Law and Section 306 Pensions (approved prior to 1979) (VA code in ACES)

 

These plans have an income cap.  Veterans may have household income up to the cap and still be eligible for the full benefit amount.  Veterans continue to be eligible for these pensions as long as they:

  • Remain disabled
  • Don't lose a dependent
  • Retain surviving spouse or child status (if not the veteran)
  • Don't have assets over the limit set by the VA
  • Don't exceed the annual income limit set by the VA.

 

Improved Pensions (VI code in ACES).

 

Improved pensions are directly affected by other household income.  The VA pays the difference between the household’s annual income from all sources (except SSI) and the VA’s annual income standard.  The improved pension amounts listed in Part 1 of the VA benefit chart show the maximum benefit the veteran would be eligible for based on the household having no other income. 

 


EXAMPLE

Joe receives $600 per month in Social Security Disability Benefits (SSDI) and $385 per month in veteran's pension benefits.  In reviewing the VA benefit chart, you see that the maximum VA pension benefit for a veteran with no dependents is $985 (Dec.08 amount).  The benefit Joe receives is $985 less the $600 SSDI for a total VA payment amount of $385.  Code the $385 as VI income in ACES.


EXAMPLE

Imagine Joe has a dependent child living at home.  Joe would now be entitled to receive a total VA payment of $691.  In reviewing the VA benefit chart, you see that the maximum VA pension benefit for a veteran with a single dependent is $1291.  Again the VA subtracts the $600 SSDI benefit from the maximum payment.  Line 2 on the chart shows you that the dependent's allowance is $306.  Code $385 VI income in Joe's UNER screen and $306 VI income on the child's UNER screen.


It is extremely important to separate out the dependent’s income in ACES so that the ACES system can correctly determine allocations and deeming to dependents for SSI-related purposes.   In some situations the VA may pay a dependent allocation for a child that does not live in the home.  In those situations, the income is countable income to the veteran if he keeps the money and non-countable if he gives the income to the dependent it's intended for. 

 

 Aid and Attendance/Housebound Allowances (VT code in ACES)

 

These are additional benefits paid to veterans, their spouses, surviving spouses, and parents.  This allowance is available within all compensation, DIC and pension programs.  Aid and Attendance (A&A) is paid based on the need for personal care services from another person or based on a specific disability.  The housebound allowance is paid based on certain specific disabilities and is a lesser amount than A&A.   Any amount designated as A&A or a housebound allowance is excluded income for SSI-related medical programs.


EXAMPLE

Use the same example above of Joe and his child, but Joe tells you he's now been approved for A&A.  Joe's total income is $1349 VA income plus the $600 SSDI income, for total income of $1949 per month.  Of this, $385 is his pension payment (code as VI in ACES), $306 is his child's income (code as VI on the child's screen in ACES) and $658 is A&A (code as VT in ACES), which is exempt income for SSI-related Medicaid.  Joe's total countable income is $985 per month.


Unusual Medical Expenses (UME) (VU code in ACES)

 

Some individuals or surviving spouses who receive the Improved Pension or Improved Death Pension benefits may be eligible to receive an offset of their other income due to increased medical costs.  This offset for unusual medical expenses may reduce the veteran’s other countable income, therefore allowing the veteran to receive a higher VA pension benefit.  It works similar to an income deduction.   Amounts designated for UME are not countable for SSI-related medicaid purposes and must be split out from the total VA payment amount.


EXAMPLE

Joe receives $600 SSDI benefits and a VA Improved Pension benefit of $985 for total monthly income of $1585.  Joe doesn't have a dependent in this example and is not getting A&A.  We know from the example above that the maximum pension benefit Joe could receive is $385 based on the other income of $600 SSDI, so he must be receiving an allowance for unusual medical expenses in the amount of $600.  (The VA 'offsets' his SSDI income by the amount he is expending on high medical expenses).  In ACES $385 is his VA pension (code as VI), $600 is UME (code as VU), and $600 is his SSDI income. 


The UME calculator.  (From this link, go down to the VA Income and TPL Training section).  In some cases, you can tell if a client is receiving an allowance for UME by checking the PARIS interface data.  However, for new applicants there may not be a recent cross-match available to review and the VA award letter does not give this information.  The UME calculator breaks down the amount of benefits that have been restored due to UME for veterans receiving the Improved Pension.   You need to know the following information to use the UME calculator:

  • Total VA payment amount,
  • The type of VA pension benefit,
  • Whether the payment includes an amount for A&A, housebound allowance, or a dependent allowance,
  • All other family income amounts.

UME restores benefits in a certain order – A&A/Housebound, then dependent allowance, then the basic pension.  The calculator is programmed with this logic and displays the correct amounts and codes to enter into ACES. (Note:  The calculator still uses the ACES code VA for the improved pension and not the VI code.  Please record this as VI income in ACES).


EXAMPLE

Maria is a disabled veteran who receives an improved pension and A&A.  Her total VA income is $1643 per month.  She also receives $800 in Social Security Disability Benefits (SSDI).  Since $1643 is the maximum amount the VA pays for someone with no other income, the VA must be offsetting her SSDI benefits of $800 with unusual medical expenses (UME).  If this information is entered to the UME calculator, you can determine that Maria receives $658 in A&A (code as VT in ACES), $800 in UME (code as VU in ACES) and $185 in improved pension benefits (code as VI in ACES).  The VA restores the A&A benefit before it restores the improved pension benefit.  Total countable income for Maria is $985. 


WAC 182-512-0860

WAC 182-512-0860

Effective October 1, 2013

WAC 182-512-0860 SSI-related medical -- Income exclusions under federal statute or other state laws.



The Social Security Act and other federal statutes or state laws list income that the agency excludes when determining eligibility for Washington apple health (WAH) SSI-related medical programs. These exclusions include, but are not limited to:

(1) Income tax refunds;

(2) Federal earned income tax credit (EITC) payments for twelve months after the month of receipt;

(3) Compensation provided to volunteers in the Corporation for National and Community Service (CNCS), formerly known as ACTION programs established by the Domestic Volunteer Service Act of 1973. P.L. 93-113;

(4) Assistance to a person (other than wages or salaries) under the Older Americans Act of 1965, as amended by section 102 (h)(1) of Pub. L. 95-478 (92 Stat. 1515, 42 U.S.C. 3020a);

(5) Federal, state and local government payments including assistance provided in cash or in-kind under any government program that provides medical or social services;

(6) Certain cash or in-kind payments a person receives from a governmental or nongovernmental medical or social service agency to pay for medical or social services;

(7) Value of food provided through a federal or nonprofit food program such as WIC, donated food program, school lunch program;

(8) Assistance based on need, including:

(a) Any federal SSI income or state supplement payment (SSP) based on financial need;

(b) Basic food;

(c) State-funded cash assistance;

(d) CEAP;

(e) TANF; and

(f) Bureau of Indian Affairs (BIA) general assistance.

(9) Housing assistance from a federal program such as HUD if paid under:

(a) United States Housing Act of 1937 (section 1437 et seq. of 42 U.S.C.);

(b) National Housing Act (section 1701 et seq. of 12 U.S.C.);

(c) Section 101 of the Housing and Urban Development Act of 1965 (section 1701s of 12 U.S.C., section 1451 of 42 U.S.C.);

(d) Title V of the Housing Act of 1949 (section 1471 et seq. of 42 U.S.C.);

(e) Section 202(h) of the Housing Act of 1959; or

(f) Weatherization provided to low-income homeowners by programs that consider income in the eligibility determinations.

(10) Energy assistance payments including:

(a) Those to prevent fuel cutoffs; and

(b) Those to promote energy efficiency.

(11) Income from employment and training programs as specified in WAC 182-512-0780.

(12) Foster grandparents program;

(13) Title IV-E and state foster care maintenance payments if the foster child is not included in the assistance unit;

(14) The value of any childcare provided or arranged (or any payment for such care or reimbursement for costs incurred for such care) under the Child Care and Development Block Grant Act, as amended by section 8(b) of P.L. 102-586 (106 Stat. 5035).

(15) Educational assistance as specified in WAC 182-512-0760.

(16) Up to two thousand dollars per year derived from a person's interest in Indian trust or restricted land.

(17) Native American benefits and payments as specified in WAC 182-512-0770 and other Native American payments excluded by federal statute.

(18) Payments from Susan Walker v. Bayer Corporation, et al., 96-c-5024 (N.D. Ill) (May 8, 1997) settlement funds;

(19) Payments from Ricky Ray Hemophilia Relief Fund Act of 1998, P.L. 105-369;

(20) Disaster assistance paid under Federal Disaster Relief P.L. 100-387 and Emergency Assistance Act, P.L. 93-288 amended by P.L. 100-707 and for farmers P.L. 100-387;

(21) Payments to certain survivors of the Holocaust as victims of Nazi persecution; payments excluded pursuant to section 1(a) of the Victims of Nazi Persecution Act of 1994, P.L. 103-286 (108 Stat. 1450);

(22) Payments made under section 500 through 506 of the Austrian General Social Insurance Act;

(23) Payments made under the Netherlands' Act on Benefits for Victims of Persecution (WUV);

(24) Restitution payments and interest earned to Japanese Americans or their survivors, and Aleuts interned during World War II, established by P.L. 100-383;

(25) Payments made from the Agent Orange Settlement Funds or any other funds to settle Agent Orange liability claims established by P.L. 101-201;

(26) Payments made under section six of the Radiation Exposure Compensation Act established by P.L. 101-426; and

(27) Any interest or dividend is excluded as income, except for the community spouse of an institutionalized person.

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 182-512-0880

WAC 182-512-0880

Effective October 1, 2013

WAC 182-512-0880 SSI-related medical -- Special income disregards.



Portions of a person's income the agency otherwise counts are disregarded when determining eligibility for Washington apple health SSI-related medical programs.

(1) The agency disregards cost of living adjustments to Social Security benefits and provides categorically needy (CN) SSI-related Medicaid benefits under the "Pickle Amendment" criteria of 42 C.F.R. 435.135(1)(a) to a person who:

(a) Is currently receiving Title II Social Security benefits;

(b) Was eligible for and received SSI or State Supplement payments (SSP) but became ineligible for those payments after April, 1977; and

(c) Would still be eligible for SSI or SSP payments if the amount of Social Security cost-of-living adjustment increases paid under section 215(i) of the Social Security Act were deducted from his or her current Title II Social Security benefits.

(d) To satisfy this provision, a person must have been eligible for and received SSI or SSP payments and in the same month was entitled to, but did not necessarily receive, a Title II Social Security benefit for at least one month since April 1977. This includes a person who receives a Title II Social Security benefit payment the month after the last SSI or SSP payment is made due to the fact that Social Security is paid the month after entitlement begins.

(e) For purposes of this section, the agency also disregards cost of living adjustments received by a person, his or her financially responsible spouse, and other financially responsible family members, such as a parent.

(2) In determining SSI-related CN WAH coverage, the agency disregards:

(a) Widow(er)'s benefits for a person who:

(i) Was entitled to SSA title II (widow/widower's) benefits in December 1983;

(ii) Was at least fifty years old, but not yet sixty at that time;

(iii) Received title II benefits and SSI in January 1984;

(iv) Would continue to be eligible for SSI/SSP payments if the title II benefits were disregarded; and

(v) Filed an application for medicaid with the state by July 1, 1988.

(b) Widow, Widower or Surviving Divorced Spouse (title II) benefits for a ((client)) person who:

(i) Received SSI/SSP benefits the month prior to receipt of title II benefits;

(ii) Would continue to be eligible for SSI/SSP benefits if the title II benefits or the COLA(s) to those benefits were disregarded; and

(iii) Is not eligible for medicare Part A. This person is considered an SSI recipient until becoming entitled to medicare Part A.

(3) A disabled adult child (DAC) who is ineligible for SSI/SSP solely due to receipt of either Social Security benefits as a disabled adult child of a person with a Social Security account or due to receipt of a COLA to the DAC benefits, may be income eligible for WAH categorically needy (CN) health care coverage if disregarding the SSA DAC benefits and COLA brings countable income below the CN standards, and the person:

(a) Is eighteen years of age or older;

(b) Remains related to the SSI program through disability or blindness;

(c) Lost SSI eligibility on or after July 1, 1988, due solely to the receipt of DAC benefits from SSA or a COLA to those benefits; and

(d) Meets the other WAH SSI-related CN medical requirements.

(4) A person is eligible for WAH CN coverage if:

(a) In August 1972, the person received:

(i) Old age assistance (OAA);

(ii) Aid to blind (AB);

(iii) Aid to families with dependent children (AFDC); or

(iv) Aid to the permanently and totally disabled (APTD).

(b) The person was entitled to or received retirement, survivors, and disability insurance (RSDI) benefits; or

(c) The person was ineligible for OAA, AB, AFDC, SSI, or APTD solely because of the twenty percent increase in Social Security benefits under P.L. 92-336.

(5) Persons who stop receiving an SSI cash payment due to earnings, but still meet all of the other SSI eligibility rules and have income below the higher limit established by the Social Security Act's Section 1619(b) are eligible for continued WAH CN medicaid.

(6) TANF income methodology is used to determine countable income for children and pregnant women applying for WAH medically needy (MN) coverage unless the SSI methodology would be more beneficial to the person. When using the TANF income methodologies, deduct:

(a) A fifty percent earned income disregard described in WAC 388-450-0170;

(b) Actual child care and dependent care expenses related to employment; and

(c) Child support actually paid.

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

Special Income Disregards

COLA

  1. Clients who became ineligible for SSI/SSP because of an SSA Cost of Living Adjustment (COLA) may be income eligible for CN through the disregard of the SSA COLA. The COLA disregard is allowed only for the CN medical program.

  2. This income disregard applies to persons living in their own home, an Alternate Care Facility, Assisted Living Facility, Adult Residential Rehabilitation Center (ARRC) or a Developmental Disability Division (DDD) group home. Clients in alternate living arrangements described above and receiving CN Medicaid are considered receiving a State Supplemental Payment (SSP).

  3. A client whose income is below the CNIL after the COLA disregard and other SSI-related income exclusions and disregards are deducted is eligible for CN. Eligibility for other medical programs is determined if the client’s income is above the CNIL.

Pickle

  1. An adult not meeting the CN income and resource standards is eligible for CN medical coverage if the person is a current beneficiary of Title II of the Social Security Act (SSA) benefits who:

    1. Simultaneously received both Social Security (SSA and/or OASDI) and SSI; in any month after April 1977;

    2. Is currently eligible for and receiving Social Security;

    3. Is ineligible for SSI benefits and/or SSP payments; and

    4. Would be eligible for SSI benefits if the COLA increases received since becoming ineligible for SSI are deducted from the client’s current Social Security benefit amount.

  2. Countable Social Security income under the Pickle calculation must be added to any other countable income the person may have. If the total income after the special disregard is under the SSI standard, the person is income eligible for CN Medicaid. Resource eligibility must also be met.

  3. The Pickle multiplier used to determine the Title II benefit amount is found in ACES parameters, table CMT 3.

Widow/Widower’s Benefits (DWB)

  1. The disregards for disabled widow/widowers age 50 through 59 became effective July 1, 1988.

  2. The current disregard for widow/widowers (other than those in #1 above) became effective January 1, 1991.

  3. Widow/er benefits and Surviving Divorced Spouse benefits recipients have an SS claim number other than their own SSN and have BIC codes as listed on the ACES help screen in UNER (source codes SW, SB). These clients’ most common BIC codes (the letters at the end of the SS claim number) begin with D, E or W.

  4. Ineligibility for SSI due to reasons such as excess resources, other income etc., does not qualify the client for this income protection. Widow/er benefit disregards are only for those meeting the requirements in WAC.

  5. SSA sends a letter to the client that tells them to contact the CSO when their SSI terminates.

Disabled Adult Children (DAC)

  1. The income disregard for DACs became effective July 1, 1988.

  2. To be eligible for DAC the client must be 18 years of age or older.

  3. The onset date of disability must be earlier than the client’s 22nd birthday.

  4. The DAC must meet all other SSI-related CN eligibility requirements, such as the resource standard.

  5. A client may receive DAC benefits but not meet the requirements listed in 1-4, which are necessary to disregard the income.

  6. Ineligibility for SSI for other reasons such as excess resources, or other income does not qualify the client for this disregard.

SSP Income Disregard

The 1995 State Legislature authorized using the Total Expenditure Method for computing the state-funded State Supplemental Payment (SSP). The SSP is the amount DSHS adds to the Federal SSI benefit rate. The Total Expenditure Method caps SSP payments at the calendar year 1994 expenditure level for 1995 and beyond. This reduction in SSP is not reflected in an SSI-related CNIL lower than the amount in effect on January 1, 2002.

Beginning July 2002, the Social Security Administration no longer sent State Supplemental Payments out to people with income over the SSI standards in effect at the time: Area 1 ($570.90 for a single person, $836.90 for a couple, both eligible) and Area 2 ($550.45 for a single person, $817.00 for a couple, both eligible). The department disregards income between the FBR in effect at that time ($545) and the SSI standard for CN Medicaid eligibility.  

At the point the SSI-related CNIL matched the SSI Federal benefit rate in 2005, the SSP disregard was no longer applicable.  


WORKER RESPONSIBILITIES

Income Disregards:

  1. Disregard the first $65 of the remaining monthly earned income after you apply income exclusions. Apply this disregard to earned income only. If income is less than $65, the remainder of the disregard cannot be carried forward to the next month.

  2. Disregard one-half of the remaining earned income after applying the $65 disregard. Allow this disregard on the earned income of a non-applying or non-relatable spouse only after the income is allocated to the SSI-related client.

  3. Refer to Treatment of Income section in the EA-Z Manual, Clarifying Information after WAC 388-450-0030, for a chart of how income is counted, excluded and disregarded income.

Special Income Disregard:

  1. 1. COLA – Determination of eligibility for COLA and CN. This is automatically done in ACES. The procedure to do it by hand is as follows:
    1. Determine the client’s total income.

    2. Determine the month and year the SSI benefits stopped. Use this date to select the Pickle multiplier found in ACES in the parameters.  To get to the parameters, go to ACES mainframe. From WMEN screen choose option “F” (parameters).  Then choose option “A” (eligibility parameters).  From that screen, choose option “O” (CA-MA Tables 3 Inquiry). Then choose the most recent benefit year you are interested in. Current eligibility uses the most recent multiplier.

    3. Multiply the current SSA benefit by the multiplier you selected to determine the COLA disregarded amount. Round to the nearest dollar.

    4. Subtract the COLA disregard and other income exemptions and disregards from the client’s total income.

    5. Add any income allocated from a spouse or parents.

    6. Compare the result to the SSI CNIL.

      1. If income is below the CNIL, authorize CN.

      2. Do not allow the COLA disregard for programs other than CN.


EXAMPLE

Laura received SSA and SSI beginning in 1988, but was terminated from SSI after the most recent COLA. In redetermining her medical program eligibility, the worker notes that her income is above the CNIL after the $20 disregard, but she is eligible for the Pickle (COLA) disregards. After checking the ACES parameters table, using the multiplier for the current year (which effectively disregards the yearly COLAs Laura received) her income is below the CNIL and she is eligible for a CN medical program (S02) instead of MN with spenddown (S99).


  1. A client eligible for the COLA disregard is listed in his or her own assistance unit. Do not count the client as a member of any other AU.

  2. Consider the COLA eligible client’s income, including the COLA amounts, minus a one person MNIL standard, as available income to the spouse when the spouse applies for SSI related medical;

  3. Use the COLA eligible client’s non-covered medical expenses to meet the spouse’s spenddown liability, if any.

  4. Review eligibility for the COLA income disregard when:

    1. Terminating any cash or other medical program;

    2. When a nursing facility client returns to a non -Institutional living arrangement;

    3. At application and reapplication for medical care;

    4. At each recertification.

  5. If the disregard makes the client eligible for CN and the client:

    1. Is receiving CN, continue the certification. Make a note to allow the disregard at the next certification.

    2. ii. Is receiving MN, change the balance of the certification period to CN. Do not recompute spenddown for the period before the change.

    3. iii. Is in pending spenddown (“M”) status, recompute eligibility for the period after the change using the disregard. The period before the change remains the same.

Widow/widowers Benefits (DWB)

  1. SSA sends a letter to these clients, which tells them to contact the CSO when their SSI terminates.

  2. These clients receive SSA benefits under the SSN of the deceased spouse, not their own.

  3. Use this SSA letter to verify SSA terminated the client’s SSI due to receipt of SSA. Use an SSA inquiry, SDX screen or the Bendex screen to verify the benefits as DWB and the amount. Clients who get Widow/er benefits or Surviving Divorced Spouse benefits are listed as source code SB or SW when looking at the UNER help screen in ACES. Find the source code SB and SW on the help screen and compare the BIC code for the client with all possible BICs for these source codes. IF the client’s BIC is the same as one of the SB or SW source codes, the client is eligible for this disregard.

  4. To determine if the client receiving DWB benefits would be CN income eligible except for the DWB benefits or COLA to these benefits, determine the client’s total countable income;

    1. Subtract other income exemptions and disregards from the client’s total income;

    2. Determine and subtract the COLA increase on SSA income other than DWB the client has received from the date of SSI termination (using the Pickle multiplier in ACES);

    3. Subtract the total DWB amount;

    4. Compare the results to the current SSI CNIL;

    5. If the resulting income is below the CNIL, authorize CN;

    6. If the resulting income is above the CNIL, the client is not eligible for the DWB disregard. Determine eligibility for other medical care programs. Do not allow the DWB disregard for programs other than CN.

    7. Continue the DWB disregard as long as the client is CN eligible with the disregard, and continues to meet the criteria described in this section.


EXAMPLE

A disabled widow, age 60 was terminated from SSI in January 1990. She became disabled in November 1989 and started getting both SSI and SSA benefits. Her husband died in December 1989 and she now gets DWB benefits. She currently receives $302 DWB and $221 SSA. Computation is done as follows:

Total income  $523.00
Less general disregard  - 20.00
Less DWB disregard - 302.00
Less COLA disregard (1993 Multiplier)  - 24.00
Total countable income $177.00

The client is CN eligible because $177 is below the CNIL.


Review eligibility for the DWB income disregard:

  1. At application and reapplication for medical care and at each MN certification.
  2. If the disregard makes the client eligible for CN and the client:
    1. Is receiving CN, continue CN. Make a note to allow the disregard at the next certification.
    2. Is receiving MN, change the certification to CN. Do not recompute spenddown for any period before the change in circumstance.
    3. Is not currently receiving medical care pending spenddown (“M” status), recompute eligibility for the period after the change using the disregard. The period before the change remains the same.

Disabled Adult Child (DAC)

  1. Client must have received SSI benefits that were terminated due solely to the receipt of the DAC benefits; or, if the client was already receiving SSI as well as DAC benefits, the termination of the SSI must be due solely to the receipt of a COLA to the DAC benefits.
  2. A client is not eligible for this disregard if they never received SSI.
  3. Ineligibility for SSI due to other reasons (such as excess resources or receipt of other income) does not qualify an individual for this disregard.
  4. Persons who are eligible for Medicare because of a disability are considered to have already met the disability criteria for SSI.
  5. DAC benefits are not countable income when determining eligibility for an SSI-related medical program.
  6. If the income disregard brings the client’s income below the CN income limit, open CN medical.
  7. If the client is receiving long term care services, the DAC disregard will affect post-eligibility income determinations such as participation.
  8. A client may lose their DAC benefits if they are no longer disabled.
  9. A DAC client who marries anyone other than another DAC or Title II recipient will lose their DAC designation and benefits.
  10. To verify receipt of DAC benefits use either;
    1. An SDX, which will show this Medicaid Eligibility code and message “ DISABLED ADULT CHILD: CONT SSI MED”; or
    2. An SSA inquiry, Bendex or award letter that shows the client has a BIC code (the 2 letter/number suffix to the Social Security claim number) beginning with a C; or
    3. Contact SSA by phone.
  11. To determine if the client receiving DAC benefits would be CN income eligible but for receiving DAC benefits or a COLA to those benefits;
    1. Determine the client’s total income;
    2. Subtract other income exclusions and disregards from the client’s total income;
    3. Determine and subtract the COLA increase on SSA income other than DAC;
    4. Subtract the total DAC amount;
    5. Compare the results to the SSI CNIL:
      1. If income is below the CNIL, authorize CN. Continue the DAC disregard so long as the client is CN eligible with the disregard and continues to meet the criteria described in this section.
      2. If the income is above the CNIL, the client is not eligible for the DAC disregard. Determine eligibility for other medical care programs.

EXAMPLE

A 33-year-old woman was terminated from SSI in September 1989 because she started receiving DAC benefits. She currently receives $820 in DAC benefits and $221 in unearned income. She is otherwise program and resource eligible.

Total income $1041.00
Less general disregard  - 20.00
Less DAC disregard  - 820.00
Less COLA to the DAC benefits disregard (1993 Multiplier)  - 24.00
Total countable income $201.00

The countable income ($201) is below the CNIL; the client is CN eligible.


  1. Review eligibility for the DAC income disregard:

    1. At application and reapplication for medical care;

    2. When you receive an SDX with a Medicaid Eligibility code “D – DISABLED ADULT CHILD: CONT SSI MED;”

    3. At each MN certification.

  2. If the disregard makes the client eligible for CN and the client:

    1. Is receiving CN, continue the certification. Make a note to allow the disregard at the next certification;

    2. Is receiving MN, change the balance of the certification period to CN. Do not recalculate spenddown for the period before the change;

    3. Is not currently receiving medical care pending spenddown, recalculate eligibility for the period after the change using the disregard. The period before the change remains the same.

State Supplemental Payment (SSP) C income disregard

Client lost SSI eligibility due solely to the reduction in the SSP:

  1. Disregard the income which caused the client to lose SSI eligibility, and Authorize SSI-related CN medical coverage.

  2. Continue this income disregard as long as the client is CN eligible with this disregard and continues to meet the criteria described in this section.

  3. Clients who are eligible for the SSP income disregard may also be eligible for the COLA income disregard. If the client is:

    1. Eligible for CN with the COLA income disregard, it is not necessary to allow the SSP disregard.

    2. Not eligible for CN with the COLA disregard, determine eligibility for the SSP income disregard and SSI-related CN.


ALLOCATING INCOME

 

Purpose: SSI-related medical rules and procedures for:

  • Allocating the income of ineligible or non-applying unit members to an assistance unit;

  • Allocating the income of assistance unit members to non-members, non-applying spouse, and non-applying children;

  • Allocating the income of alien sponsors to an assistance unit.


WAC 182-512-0900

WAC 182-512-0900

Effective October 1, 2013

WAC 182-512-0900 SSI-related medical -- Deeming and allocating of income.



The agency considers income of financially responsible persons to determine if a portion of that income must be regarded as available to other household members.

(1) Deeming is the process of determining how much of another person's income is counted when determining Washington apple health (WAH) eligibility of an SSI-related applicant. When income is deemed to the SSI-related applicant from other household members, that income is considered the applicant's income. Income is deemed only:

(a) From a nonapplying spouse who lives with the SSI-related applicant; or

(b) From a parent(s) residing with an SSI-related applicant child.

(2) An allocation is an amount deducted from income counted in the eligibility determination and considered to be set aside for the support of a person other than the SSI-related applicant. When income is allocated to other household members from the SSI-related applicant(s) or from the applicant's spouse, that income is not counted as income of the SSI-related applicant.

(3) An SSI-related person applying for WAH categorically needy (CN) health care coverage must have countable income at or below the SSI categorically needy income level (CNIL) described in WAC 182-512-0010 unless the person is working and meets all requirements for the health care for workers with disabilities (HWD) program described in WAC 182-511-1000 through 182-511-1250.

(4) For WAH institutional or home and community based waiver programs, use rules described in WAC 182-513-1315.

(5) The agency follows rules described in WAC 182-512-0600 through 182-512-0880 to determine the countable income of an SSI-related applicant or SSI-related couple.

(6) If countable income of the applicant exceeds the one-person SSI CNIL prior to considering the income of a nonapplying spouse or children, the applicant is not eligible for WAH CN health care coverage and the agency determines eligibility for the WAH medically needy (MN) program. If the countable income does not exceed the SSI CNIL, see WAC 182-512-0920 to determine if income is to be deemed to the applicant from the nonapplying spouse.

(7) If countable income (after allowable deductions) of an SSI related couple both applying for medical coverage exceeds the two-person SSI CNIL, the couple is not eligible for WAH CN health care coverage and the agency determines eligibility for the WAH medically needy (MN) program.

(8) For WAH CN health care coverage, allocations to children are deducted from the nonapplying spouse's unearned income, then from their earned income before income is deemed to the SSI-related applicant. See WAC 182-512-0820.

(9) For MN medical coverage, allocations to children are deducted from the income of the SSI-related applicant or SSI-related applicant couple. See subsection (10) of this section to determine the amount of the allocation.

(10) An SSI-related person or couple applying for WAH MN health care coverage is allowed an allocation to a nonapplying spouse, their SSI recipient spouse or their dependent child(ren) to reduce countable income before comparing income to the effective medically needy income level (MNIL) described in WAC 182-519-0050. The agency allocates income:

(a) Up to the effective one-person MNIL to a nonapplying spouse or SSI recipient spouse minus the spouse's countable income; and

(b) Up to one-half of the federal benefit rate (FBR) to each dependent minus each dependent's countable income. See WAC 182-512-0820 for child exclusions.

(11) A portion of a nonapplying spouse's income may be deemed to the SSI-related applicant:

(a) See WAC 182-512-0920(5) to determine how much income is deemed from a nonapplying spouse to the SSI-related applicant when determining WAH CN eligibility; and

(b) See WAC 182-512-0920(10) to determine how much income is deemed from a nonapplying spouse to the SSI-related applicant when determining WAH MN eligibility.

(12) A portion of the income of an ineligible parent or parents is allocated to the needs of an SSI-related applicant child. See WAC 182-512-0940 (4) through (7) to determine how much income is allocated from ineligible parent(s).

(13) When income must be deemed from the sponsor or sponsors of a noncitizen applicant or recipient, see WAC 182-512-0795 to determine the amount that must be counted as income of the noncitizen applicant or recipient.

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 terms used to describe the spouse of an SSI or SSI-related client are as follows:

    1. IS (Ineligible Spouse) – the husband or wife of an SSI recipient who lives with the client and:

      1. Is not relatable to SSI; or

      2. Has not applied for SSI; or

      3. Elects to be considered an ineligible spouse by SSI to make his/her spouse eligible for SSI.

    2. NAS (Non-Applying Spouse) – the husband or wife of an SSI-related client who lives with the client and who may (or may not) be SSI-related, but who is not applying for medical assistance.

  2. Do not allocate SSI income to the IS when that spouse applies for SSI-related medical.

  3. When determining which member of a couple owns income, refer to 182-512 WAC. See SSI-related medical section 3.

  4. When community income and separate income are commingled, the separate income is no longer separate, making all of those funds community income.

  5. When both spouses are SSI-related and both are applying for medical assistance, consider income and resources jointly.

  6. When one person has been authorized SSI-related medical and another member of that person’s family applies for SSI-related medical, redetermine eligibility for them together as a household.


EXAMPLE

Gina receives SSI-related medical. Her husband, Joe, and 14 year old daughter, Amy, are now also applying for SSI-related medical. We redetermine their eligibility together as a family using the 3 person MNIL standard.


  1. Child support paid out is allowed as a deduction from the NAS’s income but it is not an allowed deduction from the applicant’s income. If both husband and wife are applying, there is no allowance for child support paid out.

EXAMPLE

Troy receives SSI-related medical of $800.  He pays $200/month in child support.  His wife, Stacia, works and earns $1500 a month.  We cannot deduct the $200 child support form Troy's income since he's the SSI-related applicant.  Since his countable income is over the CNIL, he is not eligible for CN medical.  Consider his eligibility for MN medical.


        8.  SSA reduces the SSI client's benefit by income owned by or deemed available from the IS.

        9.  If one spouse is an SSI client, the other spouse cannot be CN eligible, but may be eligible  for MN (with or without spenddown).

       10.  An IS cannot receive CN Medicaid, even with income and resources below CN standards, unless he or she is in need of long-term care services.  Consider SSI-related MN.

       11.  If an IS is SSI-related, he or she must complete an application before eligibility for medical coverage can be determined.

             a.  An IS who is pregnant or has minor children in the home should be considered for the appropriate Family, Pregnancy, or SSI-related MN medical program, whichever program is more advantageous to the client.

             b.  SSA has already made a resource eligibility determination so no further action is needed to determine resource eligibility.

             c.  Do not include the income of the SSI recipient when determining the IS's income eligibility for medical coverage, but do an allocation to bring the IS up to the one-person MNIL.

See Deeming Scenarios for examples of how deeming works.


EXAMPLE

Shanice receives SSI of $197/month; she receives SSI medical (S01).  Her IS, Darnell, receives SSDI of $902/month so he is not eligible for CN medical.  Their rent is $371/month.

1.  Take Darnell's income of $902 and deduct $20 general disregard, to get $882.  This is David's net income.

2.  Take the difference between Shanice's income and the FBR to get the spousal allocation:  $698-$197 = $501.

3.  Deduct the spousal allocation from David's net income:  $882-$501 = $381.

David's income is below the MN Income Limit (MNIL), so he is eligible for MN medical without a spenddown (S95).  ACES does not currently support this computation, but policy does.


12.  If there is no allocated income from the NAS:

         a.  Use only the applicant's countable income and the one-person SSI CNIL to determine CN eligibility.

         b.  Allow income exclusions and disregards.

         c.  If the applicant's countable income is:

              i.  At or below the one-person SSI CNIL, the client is eligible for CN medical.

              ii.  Above the one-person SSI CNIL, the client is not eligible for CN, and MN income allocation procedures apply.

13.  The Federal Benefit Rate (FBR) is the maximum dollar amount that an SSI recipient can receive.  It is equal to the SSI amount for a single person ($698 for 2012).

14.  Same-sex marriages, including registered domestic partnerships, are not recognized by the Social Security Administration because they do not meet the gender-based definitions of "wife" and "husband" in the Social Security Act or the definition of "marriage" established by the Defense of Marriage Act.  Medicaid is bound by this decision.  Same-sex couples who apply would have two separate medical AUs with his or her spouse listed as a non-member unless they have children in common (see WAC 182-506-0010).


EXAMPLE

Melissa receives SSDI of $682 due to a mental disability.  Her wife, Debbie, works and earns $2000 per month gross and does not need medical for herself.  Since same-sex marriages are not recognized by Medicaid, we would determine Melissa's eligibility for medical benefits using only her income.  Her income of $682 is below the CNIL so she is eligible for CN medical.


WORKER RESPONSIBILITIES

- ACES Financial Responsibility Codes: http://www.dshs.wa.gov/manuals/aces/sections/fin_resp_codes.shtml

 - Social Security Beneficiary Codes (the one or two letters in a Social Security recipient's claim number):  http://www.dshs.wa.gov/manuals/aces/sections/benefic_Id.shtml

 - Federal Benefit Rate (FBR):  http://www.ssa.gov/OACT/COLA/SSI.html

 


WAC 182-512-0920

WAC 182-512-0920

Effective October 1, 2013

WAC 182-512-0920 SSI-related medical -- Deeming/allocation of income from nonapplying spouse.



The agency considers the income of financially responsible persons to determine if a portion of that income is available to other household members.

(1) A portion of the income of a nonapplying spouse is considered available to meet the needs of a Washington apple health (WAH) SSI-related applicant. A nonapplying spouse is defined as someone who is:

(a) Financially responsible for the SSI-related applicant as described in WAC 182-506-0010 and 182-512-0960. For WAH institutional and home and community based waiver programs, see WAC 182-513-1315;

(b) Living in the same household with the SSI-related applicant;

(c) Not receiving a needs based payment such as temporary assistance to needy families (TANF) or state-funded cash assistance (SFA); or

(d) Not related to SSI, or is not applying for WAH coverage including spouses receiving SSI.

(2) An ineligible spouse is the spouse of an SSI cash recipient and is either not eligible for SSI for themselves or who has elected to not receive SSI cash so that their spouse may be eligible. An SSI related applicant who is the ineligible spouse of an SSI cash recipient is not eligible for WAH categorically needy (CN) health care coverage and must be considered for health care coverage under the WAH medically needy (MN) program or for a modified adjusted gross income-based program if the person does not receive Medicare.

(3) When determining whether a nonapplying spouse's income is countable, the agency:

(a) Follows the income rules described in WAC 182-512-0600 through 182-512-0780;

(b) Excludes income described in WAC 182-512-0800 (2) through (10), and all income excluded under federal statute or state law as described in WAC 182-512-0860.

(c) Excludes work-related expenses described in WAC 182-512-0840, with the exception that the sixty-five dollars plus one half earned income deduction described in WAC 182-512-0840(2) does not apply;

(d) Deducts any court ordered child support which the nonapplying spouse pays for a child outside of the home (current support or arrears); and

(e) Deducts any applicable child-related income exclusions described in WAC 182-512-0820.

(4) The agency allocates income of the nonapplying spouse to nonapplying children who reside in the home as described in WAC 182-512-0820. Allocations to children are deducted first from the nonapplying spouse's unearned income, then from their earned income.

(a) For WAH CN medical determinations, allocations to children are not allowed out of the income of the SSI-related applicant, only from the income of the nonapplying spouse.

(b) For WAH MN medical determinations, allocations to children are allowed from the income of the SSI-related applicant if the applicant is unmarried.

(5) For WAH SSI-related CN medical determinations, a portion of the countable income of a nonapplying spouse remaining after the deductions and allocations described in subsections (3) and (4) of this section may be deemed to the SSI-related applicant. If the nonapplying spouse's countable income is:

(a) Less than or equal to one-half of the federal benefit rate (FBR), no income is deemed to the applicant. Compare the applicant's countable income to the one-person SSI categorically needy income level (CNIL) described in WAC 182-512-0010. For health care for workers with disabilities (HWD) applicants, compare to the one-person HWD standard described in WAC 182-505-0100 (1)(c).

(b) Greater than one-half of the FBR, then the entire nonapplying spouse's countable income is deemed to the applicant. Compare the applicant's income to the two-person SSI CNIL. For HWD applicants, compare to the two-person HWD standard described in WAC 182-505-0100 (1)(c).

(6) When income is not deemed to the SSI-related applicant from the nonapplying spouse per subsection (5)(a):

(a) Allow all allowable income deductions and exclusions as described in chapter 182-512 WAC to the SSI-related applicant's income; and

(b) Compare the net remaining income to the one-person SSI CNIL or the one-person HWD standard.

(7) When income is deemed to the SSI-related applicant from the nonapplying spouse per subsection (5)(b) of this section:

(a) Combine the applicant's unearned income with any unearned income deemed from the nonapplying spouse and allow one twenty dollar general income exclusion to the combined amount.

(b) Combine the applicant's earned income with any earned income deemed from the nonapplying spouse and allow the sixty-five dollar plus one half of the remainder earned income deduction (described in WAC 182-512-0840(2)) to the combined amount.

(c) Add together the net unearned and net earned income amounts and compare the total to the two-person SSI CNIL described in WAC 182-512-0010 or the two-person HWD standard described in WAC 182-505-0100 (1)(c). If the income is equal to or below the applicable two-person standard, the applicant is eligible for WAH CN health care coverage.

(8) An SSI-related applicant under the age of sixty-five who is working at or below the substantial gainful activity (SGA) level but who is not eligible for WAH CN coverage under the regular WAH SSI-related program, may be considered for eligibility under the WAH MN program or under the HWD program. The SGA level is determined annually by the Social Security Administration and is posted at: https://secure.ssa.gov/apps10/poms.nsf/lnx/0410501015.

(9) If the SSI-related applicant's countable income is above the applicable SSI CNIL standard, the agency or its authorized representative considers eligibility under the WAH MN program or under the HWD program if the person is under the age of sixty-five and working. An SSI-related applicant who meets the following criteria is not eligible for WAH MN coverage and eligibility must be determined under HWD:

(a) The applicant is blind or disabled and under the age of sixty-five;

(b) The applicant has earned income over the SGA level; and

(c) The applicant is not receiving a title II Social Security cash benefit based on blindness or disability.

(10) For SSI-related WAH MN medical determinations, a portion of the countable income of a nonapplying spouse remaining after the deductions and allocations described in subsections (3) and (4) of this section may be deemed to the SSI-related applicant. If the nonapplying spouse's countable income is:

(a) Less than or equal to the effective one-person MNIL described in WAC 182-519-0050, no income is deemed to the applicant and a portion of the applicant's countable income is allocated to the nonapplying spouse's income to raise it to the effective MNIL standard.

(b) Greater than the effective MNIL, then the amount in excess of the effective one-person MNIL is deemed to the applicant. Compare the applicant's income to the effective one-person MNIL.

(11) When income is not deemed to the SSI-related applicant from the nonapplying spouse per subsection (10)(a) of this section:

(a) Allocate income from the applicant to bring the income of the nonapplying spouse up to the effective one-person MNIL standard;

(b) Allow all allowable income deductions and exclusions as described in chapter 182-512 WAC to the SSI-related applicant's remaining income;

(c) Allow a deduction for medical insurance premium expenses (if applicable); and

(d) Compare the net countable income to the effective one-person MNIL.

(12) When income is deemed to the SSI-related applicant from the nonapplying spouse per subsection (10)(b) of this section:

(a) Combine the applicant's unearned income with any unearned income deemed from the nonapplying spouse and allow one twenty dollar general income exclusion to the combined amount;

(b) Combine the applicant's earned income with any earned income deemed from the nonapplying spouse and allow the sixty-five dollar plus one half of the remainder earned income deduction (described in WAC 182-512-0840(2)) to the combined amount;

(c) Add together the net unearned and net earned income amounts;

(d) Allow a deduction for medical insurance premium expenses (if applicable) per WAC 182-519-0100(5); and

(e) Compare the net countable income to the effective one-person MNIL described in WAC 182-519-0050. If the income is:

(i) Equal to or below the effective one-person MNIL, the applicant is eligible for WAH MN health care coverage with no spenddown.

(ii) Greater than the effective MNIL, the applicant is only eligible for WAH MN health care coverage after meeting a spenddown liability as described in WAC 182-519-0110.

(13) The ineligible spouse of an SSI-cash recipient applying for WAH MN coverage is eligible to receive the deductions and allocations described in subsection (10)(a) of 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

1.  If an SSI-related applicant is under sixty-five years of age and working, review his or her earned income.

a.  If the earned income is above the Substantial Gainful Activity (SGA) limit of $1,010 and SSA has stopped the Title 2 (SSDI, DAC, DWB) cash benefit because of earnings, then he or she is NOT eligible for CN or MN medical coverage without enrolling in HWD. See the HWD chapter in the manual.

b.  If the earned income is below the SGA, continue determining the applicant's eligibility for CN or MN medical.


EXAMPLE

Mohamed (45) has applied for SSI-related medical.  He is working and earning $1200/month gross.  He continues to receive SSDI of $652/month.  Since SSA has not completed a determination that he is working at SGA and stopped his SSDI, he continues to be eligible for CN or MN medical.  He must be referred to HWD.  HWD staff will provide him with information about his options to enroll in HWD for CN medical or to spend down countable income above the MNIL for MN medical.

Once SSA stops his SSDI after completing a determination of work at SGA, he must enroll in HWD for Medicaid coverage.  When screening for CN medical (S02), current ACES programming does not support this policy.  With countable income based on $1200/month gross and no unearned income, ACES will incorrectly open S02.  These cases must be referred to HWD to avoid errors when determining eligibility for the correct program.


WAC 182-512-0940

WAC 182-512-0940

Effective October 1, 2013

WAC 182-512-0940 SSI-related medical -- Deeming income from an ineligible parent(s) to a child applying for SSI-related medical.



The agency considers income of financially responsible persons to determine if a portion of that income must be regarded as available to other household members.

(1) A portion of the income of a parent(s) is considered available to the SSI-related applicant child when the child is age seventeen or younger and the parent(s) is:

(a) Financially responsible for the SSI-related child as described in WAC 182-506-0015;

(b) The natural, adoptive, or step-parent of the child;

(c) Living in the same household with the child;

(d) Not receiving a needs-based payment such as TANF, SFA or SSI; and

(e) Not related to SSI or not applying for medical assistance.

(2) If an SSI-related applicant between the ages of eighteen to twenty-one lives with their parents, only consider the parent's income available to the applicant if it is actually contributed to the applicant. If income is not contributed, count only the applicant's own separate income.

(3) Income that is deemed to the child is considered as that child's income.

(4) When determining whether a parent's income is countable, the agency:

(a) Follows the income rules described in WAC 182-512-0600 through 182-512-0780; and

(b) Excludes income described in WAC 182-512-0800 and 182-512-0840, and all income excluded under a federal statute or state law as described in WAC 182-512-0860.

(5) When determining the amount of income to be deemed from a parent(s) to an SSI-related minor child for Washington apple health (WAH) categorically needy (CN) and medically needy (MN) coverage, the agency reduces the parent(s) countable income in the following order:

(a) Court ordered child support paid out for a child not in the home;

(b) An amount equal to one half of the federal benefit rate (FBR) for each SSI-eligible sibling living in the household, minus any countable income of that child. See WAC 182-512-0010 for FBR amount;

(c) A twenty dollar general income exclusion;

(d) A deduction equal to sixty-five dollars plus one-half of the remainder from any remaining earned income of the parent(s);

(e) An amount equal to the one-person SSI CNIL for a single parent or the two-person SSI CNIL for a two parent household;

(f) Any income remaining after these deductions is considered countable income to the SSI-related child and is added to the child's own income. If there is more than one child applying for SSI-related health care coverage, the deemed parental income is divided equally between the applicant children; and

(g) The deductions described in this section are deducted first from unearned income then from earned income unless they are specific to earned income.

(6) The SSI-related applicant child is also allowed all applicable income exclusions and disregards described in chapter 182-512 WAC from their own income. After determining the child's nonexcluded income, the agency:

(a) Allows the twenty dollar general income exclusion from any unearned income;

(b) Deducts sixty-five dollars plus one half of the remainder from any earned income which has not already been excluded under the student earned income exclusion (see WAC 182-512-0820); and

(c) Adds the child's countable income to the amount deemed from their parent(s). If the combination of the child's countable income plus deemed parental income is equal to or less than the SSI CNIL, the child is eligible for SSI-related WAH CN health care coverage.

(7) If the combination of the child's countable income plus deemed parental income is greater than the SSI CNIL, the agency considers the child for SSI-related WAH medically needy (MN) coverage. Any amount exceeding the effective medically needy income level (MNIL) is used to calculate the amount of the child's spenddown liability as described in WAC 182-519-0110. See WAC 182-519-0050 for the current MNIL standards.

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 182-512-0960

WAC 182-512-0960

Effective October 1, 2013

WAC 182-512-0960 SSI-related medical -- Allocating income -- How the agency considers income and resources when determining eligibility for a person applying for noninstitutional medicaid when another household member is receiving institutional medicaid.



(1) The agency follows rules described in WAC 182-513-1315 for a person residing in a medical institution, approved for a home and community based waiver, or approved for the Washington apple health (WAH) institutional hospice program. The rules in this section describe how the agency considers household income and resources when the household contains both institutional and noninstitutionalized household members.

(2) An institutionalized person (adult or child) who is not SSI-related may be considered under the long-term care for families and children programs described in WAC 182-514-0230 through 182-514-0265.

(3) The agency considers the income and resources of spouses as available to each other through the end of the month in which the spouses stopped living together. See WAC 182-513-1330 and 182-513-1350 when a spouse is institutionalized.

(4) The agency considers income and resources separately as of the first day of the month following the month of separation when spouses stop living together because of placement into a boarding home (assisted living, enhanced adult residential center, adult residential center), adult family home (AFH), adult residential rehabilitation center/adult residential treatment facility (ARRC/ARTF), or division of developmental disabilities-group home (DDD-GH) facility when:

(a) Only one spouse enters the facility;

(b) Both spouses enter the same facility but have separate rooms; or

(c) Both spouses enter separate facilities.

(5) The agency considers income and resources jointly when both spouses are placed in a boarding home, AFH, ARRC/ARTF, or DDD-GH facility and share a room.

(6) When determining SSI-related WAH categorically needy (CN) or medically needy (MN) eligibility for a community spouse applying for health care coverage, the agency counts:

(a) The separate income of the community spouse; plus

(b) One half of any community income received by the community spouse and the institutionalized spouse; plus

(c) Any amount allocated to the community spouse from the institutionalized spouse. The terms "community spouse" and "institutional spouse" are defined in WAC 182-513-1301.

(7) For the purposes of determining the countable income of a community spouse applying for health care coverage as described in subsection (6) of this section, it does not matter whether the spouses reside together or not. Income that is allocated and actually available to a community spouse is considered that person's income.

(8) For the purposes of determining the countable income of a community spouse or children applying for health care coverage under modified adjusted gross income (MAGI)-based family, pregnancy or children's WAH programs, the agency uses the following rules to determine if the income of the institutionalized person is considered in the eligibility calculation:

(a) When the institutionalized spouse or parent lives in the same home with the community spouse and/or children, their income is counted in the determination of household income following the rules for the medical program that is being considered.

(b) When the institutionalized spouse or parent does not live in the same home as the spouse and/or children, only income that is allocated and available to the household is counted.

(9) When determining the countable income of a community spouse applying for health care coverage under the WAH MN program, the agency allocates income from the community spouse to the institutionalized spouse in an amount up to the one-person effective medically needy income level (MNIL) less the institutionalized spouse's income, when:

(a) The community spouse is living in the same household as the institutionalized spouse;

(b) The institutionalized spouse is receiving home and community based waiver or institutional hospice services described in WAC 182-515-1505; and

(c) The institutionalized spouse has gross income of less than the MNIL.

(10) See WAC 182-506-0015 for rules on how to determine medical assistance units for households that include SSI-related persons. A separate medical assistance unit is always established for persons who meet institutional status described in WAC 182-513-1320.

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.
Modification Date: April 22, 2013