WAC 182-510-0001

Effective October 1, 2013

WAC 182-510-0001 Washington apple health -- Supplemental security income (SSI) and associated categorically needy (CN).


(1) Supplemental security income (SSI) is a federal cash benefit administered by the Social Security Administration (SSA) under Title XVI of the Social Security Act. The SSI program replaces state programs for the aged, blind and disabled individuals beginning January 1974. An individual who received state assistance in December 1973 who became eligible for SSI in January 1974 is considered a grandfathered client by the medicaid agency, and a mandatory income level (MIL) client by SSI. The individual must continue to meet the definition of blind or disabled that was in effect under the state plan in December 1973. These definitions can be found in the SSA program operations manual system (POMS), see https://secure.ssa.gov/apps10/poms.nsf/aboutpoms. Other definitions related to SSI eligibility are described in WAC 182-500-0100.

(2) An essential person is an individual who is needed in the home to care for an SSI recipient. An essential person is eligible for categorically needy (CN) Washington apple health (WAH) as long as he or she has lived continuously with the eligible person since January 1974.

(3) An ineligible spouse is not eligible for SSI-related CN WAH. An ineligible spouse must have his or her eligibility for WAH determined separately in accordance with SSI-related medically needy (MN) rules in WAC 182-519-0100.

(4) When an individual receives SSI, the agency accepts SSA's determination of medicaid entitlement. The individual is eligible for CN WAH without submitting an additional application as long as he or she:

(a) Remains entitled to an SSI cash payment;

(b) Is no longer entitled to an SSI cash payment, but SSA is in the process of determining eligibility under Section 1619(b) of the Social Security Act; or

(c) Currently has 1619(b) status as described in WAC 182-512-0880(3).

(5) An SSI recipient may be terminated from CN WAH when he or she:

(a) Does not provide the agency with information necessary for the agency to determine if he or she has other medical insurance; or

(b) Does not assign the right to recover insurance funds to the agency as required in WAC 182-503-0540.

(6) When SSA stops an individual's SSI cash payment for one of the reasons listed in (a), (b), or (c) of this subsection, CN WAH eligibility continues.

(a) The individual's countable income exceeds the SSI income standard due solely to the annual cost-of-living adjustment (COLA) as described in WAC 182-512-0880(1);

(b) The individual is a "deemed" eligible SSI recipient on the basis of eligibility for a special income disregard described in WAC 182-512-0880; or

(c) The individual has an appeal of an SSA termination pending which has not yet resulted in a final determination.

(7) If an individual's SSI cash payment stops due to an SSA determination that the individual is no longer disabled, and any appeal of this determination has resulted in a final decision, the agency:

(a) Redetermines eligibility for all other WAH programs that are not based on receipt of SSI; and

(b) Continues CN WAH until the agency completes the redetermination process described in WAC 182-504-0125.

(8) If an individual's SSI cash payment stops for a reason not addressed elsewhere in this section, the agency considers the individual to meet disability requirements through the SSA's original disability review date. The agency:

(a) Redetermines eligibility for other WAH programs, which may or may not be based on disability; and

(b) Continues CN WAH until the agency completes the redetermination process described in WAC 182-504-0125.

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.