For purposes of determining eligibility for modified adjusted gross income (MAGI)–based Washington apple health (WAH) (see WAC 182-509-0300
(1) The agency uses a point-in-time estimate to determine a person's countable income.
(2) Point-in-time means that the income is received, or is likely to be received, in the month in which the person submits an application or renewal for WAH, or the month in which the agency completes a redetermination of coverage, with the following provisions:
(a) When a person is paid less frequently than on a monthly basis, (for example, they are self-employed), the agency uses an average to calculate the monthly amount. The average is calculated by:
(i) Adding the total income for representative period of time;
(ii) Dividing by the number of months in the time frame; and
(iii) Using the result as a monthly average.
(b) When a person is paid more frequently than on a monthly basis, the agency uses the following budgeting method to calculate a monthly amount:
(i) If the person is paid weekly, the agency multiplies weekly expected income by 4.3;
(ii) If the person is paid every other week, the agency multiplies expected income by 2.15.
(c) If the person's current income does not represent his or her projected income as evidenced by clear indications of future changes in income, the agency permits the person to estimate a monthly amount by averaging income over a representative period of time.
(3) If the person normally gets the income:
(a) On a specific day, the agency counts it as available on that date.
(b) Monthly or twice monthly and pay dates change due to a reason beyond the person's control, such as a weekend or holiday, it is counted in the month it would normally be received.
(c) Weekly or every other week and pay dates change due to a reason beyond the person's control, it is counted in the month it would normally be received.
(4) For information about how income is verified, see WAC 182-503-0050
(5) If the person reports a change in income as required under WAC 182-504-0105
and the change is expected to last for two months or longer, the agency updates the estimate of income based on this change, unless the person receives categorically needy WAH coverage as a pregnant woman or child.
[Statutory Authority: RCW 41.05.021
, Patient Protection and Affordable Care Act (P.L. 111-148), 42 C.F.R. §§ 431, 435, 457, and 45 C.F.R. § 155. WSR 14-01-021, § 182-509-0310, filed 12/9/13, effective 1/9/14.]